Resource-Intensive Mapping Requirements, Curation and Maintenance
Identifying Challenges and Opportunities within Standard Nursing Terminologies 25
needed training and skills in terminology and mapping techniques are in short supply throughout the market. Further, expert terminologists may not always perform their mappings in exactly the same way, creating an issue with interoperability while imprecise mapping creates issues with the reliability and validity of data. Finally, mappings must be updated when new versions of an SNT are released, new content is created or new quality measurement specifications are determined.
In addition to mapping concerns, the curation and maintenance of terminology maps and nursing documentation continues to present a barrier to progress. The establishment of curation parameters, the maintenance of standardized maps and nursing documentation, and the governance of those processes are beyond the scope of this paper. However, arriving at a consensus on a terminology strategy will only support progress if the issues of curation, housing, dissemination and communication are also established.
Licensing fees are charged for some SNTs, which rely on these fees to support operations. In addition, most assessment scales are copyrighted and the copyright owners charge a licensing fee for use, potentially serving as a barrier for integration at many customer sites.
SNTs that do not employ a licensing fee represent a different set of challenges, as they often lack the resources to perform regular maintenance and updates to terminology. It is also difficult to monitor for, and take action to discourage, the misuse of the terminologies. The absence of licensing can also present a challenge in tracking the usage of terminology.
There are many reasons for the absence of nursing data in the EHR, including the lack of a widely adopted approach to standard terminologies, high patient workload, low integration of required documentation with nursing decision support, poor design and the absence of a motivating value proposition. On the topic of design and value, one chief nursing informatics officer performed an intensive analysis of the nursing admission assessment at her facility and discovered that nurses completed 153 required fields across 14 different screens but only 25 percent of the nursing data in the EHR was useful to them (Effken & Weaver, 2016). Frustration with documentation can be exacerbated by workflow and usability issues within the EHR, as well as the lack of inclusion of some nursing components and nursing-sensitive data to support quality measurement and outcome analysis. The documentation burden on nurses could potentially be alleviated through the redesign and streamlining of their existing documentation, much of which was patterned after historical (i.e., paper-based) processes and forms. The combination of efficient, value-based documentation and a standardized terminology strategy could be significant for nurses and patients.