A NANDA representative attends the Nursing Terminology Summit held each summer at Vanderbilt University, Nashville, TN. This conference promotes the development and use of data standards. Given the advances being made in healthcare informatics and infrastructure development, such work is fundamental to nursing terminology implementation. I attended the July 2003 conference. Participants requested the Steering Committee to write a statement that summarizes the work of the Summit for the nursing profession and provides a brief overview of the role and function of the major standards organizations that impact nursing. The following represents their report.

Health Care Data Standards

As electronic communications and data storage become increasingly the norm in health care, as in other aspects of life, national and international efforts around the world are seeking to establish a robust infrastructure for Healthcare information. A key component of this infrastructure is healthcare data standards. These standards, with proper security to protect private information, will make it possible for healthcare providers to share information for the patient’s benefit, even when the information is in a different site or a different computer system. Use of such standards will increase patient safety, promote quality improvement, and facilitate clinical research based on patient care records. Standards for data and other aspects of information systems will also make it easier to track information for public health purposes - for early detection of disease outbreaks, for example, or for assessing effectiveness of a health promotion initiative.

The standards will affect all aspects of health care - medicine, nursing, dentistry, veterinary practice, ancillary services, administration, payment, and public health. Healthcare data standards are developed and recognized through independent, voluntary organizations. Some prominent ones include:

* The International Standards Organization (ISO), which uses democratic processes to establish worldwide standards for everything from photographic film to health care terminology. Technical Committee 215 of ISO is responsible for health care data standards.

* Technical Committee 251 of the European Standards Committee (Comitee Europeen de Normalisation [CEN]), which sets standards for health information in the European Union.

* Health Level 7 (HL7), which sets standards for electronic messages about all types of health information.

* The Systematic Nomenclature of Medicine Clinical Terms (SNOMED CT), a division of the College of American Pathologists, which represents health care concepts and the relationships among them.

* Logical Observation Identifier Names and Codes (LOINC), which sets standards for identifying laboratory tests and other clinical observations.

Reference Terminology: An Essential Standard

Among the many kinds of standards for healthcare data, an important one is “reference terminology.” Usually when nurses refer to standardized language, they mean the verbal expressions used in documents or computer systems to communicate among themselves and with other healthcare providers about nursing care. Reference terminology, by contrast, refers to the concepts and relationships necessary to define something (such as a nursing diagnosis or action), presented according to some formal set of rules about how to depict the concepts and relationships in models. In much the same way as a sentence diagram depicts the roles and relationships of the words in an English sentence, a reference terminology model shows how the defining components of a nursing diagnosis or action relate to one another. In both cases, the diagram or model removes ambiguity that may be present in the more usual vernacular expression.

Just as no one would want to read a paragraph composed of diagrammed sentences, no human would want to read a health record composed entirely of modeled reference terminology. Computers, however, can be programmed to be quite good at reading reference terminology. In fact, they can process reference terminology more accurately and “understand” its meaning better than they can everyday language. For this reason, many sets of terms that are used widely in health care-including, among others, ICD codes, CPT codes used in the United States to record medical procedures, and nursing languages recognized by the American Nurses Association - have been “modeled” within SNOMED Clinical Terms. In computer systems used to process health information for the National Health Service in the United Kingdom, and increasingly in the United States, humans will use familiar language on the screens to record and communicate, while SNOMED CT will operate behind the scenes to be sure that computer systems understand and process the information correctly.

Promoting Reference Terminology for Nursing: The Summit Conferences

To get the standards right, each professional discipline must set the standards for the information its practitioners collect and record in providing or managing patient care or public health services. A series of Nursing Terminology Summit Conferences held annually since 1999 at Vanderbilt University in. Nashville, TN, USA, has promoted and contributed to standards for nursing information not only in the United States but internationally.