Societies standardize cardiology definitions, EHR data elements

The American College of Cardiology (ACC) Foundation and the American Heart Association have released a document containing definitions and data elements for symptoms and conditions relevant to the management of patients with acute coronary syndrome (ACS) and coronary artery disease (CAD). “Despite centuries of advances in medicine and science, the clinical community does not use a single vocabulary to communicate,” James E. Tcheng, MD, chair of the ACC's informatics committee told Cardiovascular Business. “We are espousing and advancing the development of a unified vocabulary in cardiovascular medicine.”

Noting that most EHR systems do not define terms, he explained that certain clinical terms may have one meaning in one context and another meaning in a different context. “This really impairs the ability of computers to move the information around to be sure that the meaning is maintained from one context to the next,” said Tcheng, who is also a professor of medicine at Duke University School of Medicine in Durham, N.C.

“The document tries to be a broad consensus for good definitions that will be useful, helpful for trials and registries and pave the way for standardizing electronic health record data and make the data more useful down the line,” writing committee chair Christopher P. Cannon, MD, of the cardiovascular division at Brigham and Women’s Hospital in Boston, told Cardiovascular Business.

The new standard definitions, which were published online on the ACC and AHA websites Jan. 28, update a 2001 document establishing definitions for ACS that formed the basis for many elements in the ACTION Registry-Get With the Guidelines and Get With the Guidelines CAD. Noting that ACS and CAD overlap in these registries and others, the current document adds definitions for CAD.  

Thirteen societies contributed to the document, and the authors drew definitions and data elements from evidence-based guidelines and other standardized definitions such as the FDA’s standardized definitions of outcomes for clinical trials. The definitions and data sets comprised seven categories of information:

  • Demographic and admission information;
  • History and risk factors;
  • Clinical presentation;
  • Diagnostic procedure;
  • Invasive therapeutic intervention;
  • Medication; and
  • Outcomes.

According to the document, the effort to standardize the definitions has several purposes: to allow better comparison of clinical results and outcomes between different trials and registries, to spur the collection of useful data at the individual hospital and national levels through new registries, to promote quality improvement, to facilitate standardized charting and to allow for more precise collection of data regarding confounding factors.

Tcheng pointed out that publication of the standards is the first step in the process. Now that the writing committee has agreed on the definitions, there is an educational process that must take place to ensure that the information is adopted consistently. Technically, optimum use of the definitions will require semantic interoperability and management of the constructs of the data itself that represent the clinical terminology, to allow the information to move back and forth, he explained.

“At the end of the day, somebody has to own this,” Tcheng said. “The ACC really has stepped up and said, ‘We should own the cardiovascular vocabulary.’” He noted also that the federal government and international standards development agencies have agreed to maintain the data systems that will serve as a reference point for researchers and clinicians.  

Tcheng pointed out that adoption into EHRs is slow, and acknowledged that the current focus of most EHR vendors is to address the requirements of the Meaningful Use program, but “in sidebar discussions with EHR vendors, they are in agreement about the importance of the controlled vocabulary,” he said. “It’s a marathon, not a sprint.”