The LOINC RSNA radiology playbook - a unified terminology for radiology procedures.

Objective: This paper describes the unified LOINC/RSNA Radiology Playbook and the process by which it was produced. Methods: The Regenstrief Institute and the Radiological Society of North America (RSNA) developed a unification plan consisting of six objectives 1) develop a unified model for radiology procedure names that represents the attributes with an extensible set of values, 2) transform existing LOINC procedure codes into the unified model representation, 3) create a mapping between all the attribute values used in the unified model as coded in LOINC (ie, LOINC Parts) and their equivalent concepts in RadLex, 4) create a mapping between the existing procedure codes in the RadLex Core Playbook and the corresponding codes in LOINC, 5) develop a single integrated governance process for managing the unified terminology, and 6) publicly distribute the terminology artifacts. Results: We developed a unified model and instantiated it in a new LOINC release artifact that contains the LOINC codes and display name (ie LONG_COMMON_NAME) for each procedure, mappings between LOINC and the RSNA Playbook at the procedure code level, and connections between procedure terms and their attribute values that are expressed as LOINC Parts and RadLex IDs. We transformed all the existing LOINC content into the new model and publicly distributed it in standard releases. The organizations have also developed a joint governance process for ongoing maintenance of the terminology. Conclusions: The LOINC/RSNA Radiology Playbook provides a universal terminology standard for radiology orders and results.

Use of Radiology Procedure Codes in Health Care: The Need for Standardization and Structure.

Radiology procedure codes are a fundamental part of most radiology workflows, such as ordering, scheduling, billing, and image interpretation. Nonstandardized unstructured procedure codes have typically been used in radiology departments. Such codes may be sufficient for specific purposes, but they offer limited support for interoperability. As radiology workflows and the various forms of clinical data exchange have become more sophisticated, the need for more advanced interoperability with use of standardized structured codes has increased. For example, structured codes facilitate the automated identification of relevant prior imaging studies and the collection of data for radiation dose tracking. The authors review the role of imaging procedure codes in radiology departments and across the health care enterprise. Standards for radiology procedure coding are described, and the mechanisms of structured coding systems are reviewed. In particular, the structure of the RadLex™ Playbook coding system and examples of the use of this system are described. Harmonization of the RadLex Playbook system with the Logical Observation Identifiers Names and Codes standard, which is currently in progress, also is described. The benefits and challenges of adopting standardized codes-especially the difficulties in mapping local codes to standardized codes-are reviewed. Tools and strategies for mitigating these challenges, including the use of billing codes as an intermediate step in mapping, also are reviewed. In addition, the authors describe how to use the RadLex Playbook Web service application programming interface for partial automation of code mapping. © RSNA, 2017.

Long-term population demography of Trillium recurvatum on loess bluffs in western Tennessee, USA.

BACKGROUND AND AIMS: Understanding the demography of long-lived clonal herbs, with their extreme modularity, requires knowledge of both their short- and long-term survival and ramet growth patterns. The primary objective of this study was to understand the dynamics of a clonal forest herb, Trillium recurvatum, by examining temporal and small-scale demographic patterns. We hypothesized: (i) there would be more variability in the juvenile age class compared with non-flowering adult and flowering adult classes due to year-to-year fluctuations in recruitment; (ii) rates of population growth (λ) and increase (r) would be highest in non-flowering ramets due to a combination of transitions from the juvenile stage and reversions from flowering adults; and (iii) inter-ramet distances would be most variable between flowering and juvenile ramets due to a combination of clonal growth, seed dispersal by ants and ramet death over time. METHODOLOGY: Census data were collected on the total number of stems in the population from 1990 to 2007, and placed within one of three life stages (juvenile, three-leaf non-flowering and three-leaf flowering). Modified population viability equations were used to assess temporal population viability, and spatial structure was assessed using block krigging. Correlations were performed using current and prior season weather to current population demography. PRINCIPAL RESULTS: The first hypothesis was rejected. The second hypothesis was supported: population increase (r) and growth rate (λ) were highest in non-flowering ramets. Finally, the third hypothesis was rejected: there was no apparent density dependence within this population of Trillium and no apparent spatial structure among life stages. CONCLUSIONS: Overall population density fluctuated over time, possibly due to storms that move soil, and prior year's temperature and precipitation. However, density remained at some dynamic stable level. The juvenile age class had greater variability for the duration of this study and population growth rate was greatest for non-flowering ramets.

Creating an ICNP subset: children with HIV/AIDS in developing countries.

Since 1993, the International Classification of Nursing Practice has evolved as a unified language for global nursing diagnoses/outcomes and interventions. It contains 5148 terms. Population- or condition-specific subsets of terms facilitate easier and consistent use of the International Classification of Nursing Practice. One condition, care of children in developing countries with HIV/AIDS, is listed by the World Health Organization as a world health priority. In this study, the investigators identified nursing diagnoses/outcomes and intervention terms used by nurses for this population and mapped the terms to the International Classification of Nursing Practice. Terms represent healthcare at different phases along a continuum: health promotion, health maintenance, acute conditions, chronic conditions, and end-of-life care with the child as the focus surrounded by family, community, and culture. In the analysis, the investigators' process is compared with the one outlined in the Guidelines for International Classification of Nursing Practice Catalogue Development, and the match of each local and International Classification of Nursing Practice term is categorized as perfect fit, conceptual fit, partial fit, or unable to fit. A total of 53 nursing diagnosis/outcome terms and 85 intervention terms make up the subset. Eighty-two percent of local terms mapped at least partially to International Classification of Nursing Practice.

Reactions of nurses to the use of electronic health record alert features in an inpatient setting.

While studies have been conducted to assess nurse perception of electronic health records, once electronic health record systems are up and running, there is little to guide the use of features within the electronic health record for nursing practice. Alerts are a promising tool for implementing best practice for patient care in inpatient settings. Yet the use of alerts for inpatient nursing is understudied. This study examined nurse attitudes and reactions to alerts in the inpatient setting. Focus groups were conducted at three hospitals with 50 nurses. Nurses were asked about five different alert features. For each alert, participants were asked about their feelings and reactions to the alert, how alerts help or hinder work, and suggestions for improvements. Findings include clear preferences for alert types and content. Nurses preferred a dashboard style alert with functions included to accomplish tasks directly in the alert. While nurses reported positive reactions to certain alert pages, they also reported low use of those features and occasional distrust of the data included in alerts. Findings provide guidance for future use of alerts and design of new alerts. Findings also identify the important challenge of designing and implementing alerts for integration with nursing workflow.

Bridge building: linking nursing practice to the ICNP catalogue developing an ICNP catalogue for children with HIV/AIDS in developing countries.

Over the past few decades much work has been done to develop nursing nomenclatures. One of these terminologies, the International Classification of Nursing Practice (R) (ICNP) is an international language to represent nursing problems, interventions, and outcomes. To facilitate use of the ICNP in practice, catalogue development is needed. The process and results of the catalogue development for children with HIV/AIDS in developing countries is described in this poster.

Attaching context sensitive infobuttons to an EHR options and issues.

Allina Hospitals & Clinics has implemented a fully integrated EHR. In the optimization of the EHR, they examined options for sharing the evidence base behind the content and presenting context sensitive answers to questions. After defining the evaluation criteria and options, they compared the options to the criteria. Allina has chosen to implement a database of clinician posed questions with concise answers coded to a patient and clinician context managed by an infobutton engine.

Native grasses as a management alternative on vegetated closure caps.

Capped waste sites often are vegetated with commercial turf grasses to increase evapotranspiration and prevent erosion and possible exposure of the barrier. Fertilizer, frequent watering, and mowing may be required to establish the turf grass and prevent invasion by trees and shrubs. Oldfield vegetation of grasses and forbs is a possible sustainable alternative to turf grass communities. To determine if oldfield vegetation can establish on caps, we (1) compared establishment of a dominant oldfield grass and a commercial turf grass under different combinations of new closure cap management: spring or summer planting and presence or absence of amendments to alleviate drought (watering, mulch) or increase soil fertility (fertilizer, lime, a nitrogen-fixing legume); (2) surveyed existing caps to determine if oldfield species establish naturally; and (3) performed a greenhouse experiment to compare growth of two native grasses under low and amended (added water, soil nutrients) conditions. Both the commercial grass and oldfield species established under new cap conditions; fertilizer, water, and mulch improved vegetation establishment in spring or summer, but legumes decreased grass cover. In the greenhouse, both native grasses grew best with amendments; however, substantial stem and root length were obtained with no fertilizer and only once-weekly watering. Existing vegetated caps supported planted grasses and naturally established oldfield species. Overall, the results indicate native grasses can establish on new caps and oldfields can serve as a management model; further work is needed to determine the management strategy to maintain herbaceous vegetation and slow woody species invasion.

Early experiences in using computerized patient record data for monitoring charting compliance, supporting quality initiatives and assisting with accurate charging at Allina Hospitals & Clinics.

Allina Hospitals & Clinics has been an early adopter of electronic medical records in both their hospitals and clinics. This article describes some of the ways their hospitals monitor the quality of the data and adherence to documentation policies, as well as how they use the data from the computerized patient records for healthcare quality initiatives, medical research and support of accurate charging. A key feature of their work is real-time, on-demand reporting from any workstation.

Elemental composition of native wetland plants in constructed mesocosm treatment wetlands.

Plants that accumulate a small percentage of metals in constructed treatment wetlands can contribute to remediation of acidic, metal contaminated runoff waters from coal mines or processing areas. We examined root and shoot concentrations of elements in four perennial wetland species over two seasons in mesocosm wetland systems designed to remediate water from a coal pile runoff basin. Deep wetlands in each system contained Myriophyllum aquaticum and Nymphaea odorata; shallow wetlands contained Juncus effusus and Pontederia cordata. Shoot elemental concentrations differed between plants of deep and shallow wetlands, with higher Zn, Al, and Fe concentrations in plants in shallow wetlands and higher Na, Mn, and P concentrations in plants in deep wetlands. Root and shoot concentrations of most elements differed between species in each wetland type. Over two seasons, these four common wetland plants did help remediate acidic, metal-contaminated runoff from a coal storage pile.

Using electronic medical record data for clinical workflow and analysis: a single center experience.

This paper focuses on the use of data from an electronic medical record (EMR) within a multi-facility health care organization. It describes how health provider workflow is enhanced by extracting data from multiple sources in a near real-time fashion and presenting it to the user in ways that are unavailable in the electronic medical record applications.