Our work as consultants primarily involve implementing CRM systems to consolidate clinical and administrative data from EHRs and health plans for patient care coordination, medical tourism, transitional care, aftercare and case management. In the case of a hospital setting, they are using Mckesson Paragon EHR using ICD 10, CPT and LOINC to capture data associated to problem lists, medical history, procedures, medical orders, and test results. In the case of medications, they are using RxNorm. The system can handle SNOMED but they are only using ICD. In the case of the health plan, the data we gather is based on ICD, CPT, and NDC only. In another project, we are working to establish a centralized system to capture all test results of Puerto Rico for abnormalities identification, patient and provider notification. In addition, this data will be used to analyze health population the data we are receiving include terminology type, LOINC or CPT. Depending on the laboratory information system vendor we get the CPT or LOINC code.

1. Terminology Recommendations
MMI 405
Francisco E. Figueroa
Current Status of Standard Terminologies
Our work as consultants primarily involve implementing CRM systems to consolidate
clinical and administrative data from EHRs and health plans for patient care coordination,
medical tourism, transitional care, aftercare and case management. In the case of a hospital
setting, they are using Mckesson Paragon EHR using ICD 10, CPT and LOINC to capture data
associated to problem lists, medical history, procedures, medical orders, and test results. In the
case of medications, they are using RxNorm. The system can handle SNOMED but they are
only using ICD. In the case of the health plan, the data we gather is based on ICD, CPT, and
NDC only. In another project, we are working to establish a centralized system to capture all
test results of Puerto Rico for abnormalities identification, patient and provider notification. In
addition, this data will be used to analyze health population the data we are receiving include
terminology type, LOINC or CPT. Depending on the laboratory information system vendor we
get the CPT or LOINC code.
Medications Domain
For the medications domain, I propose ​RxNorm. According to the U.S National Library
of Medicine, RxNorm is a standardized nomenclature for clinical drugs produced by the National
Library of Medicine. RxNorm has standards name for clinical drugs. The Rxnorm is a more

2. comprehensive database than the NDC. (UMLS, 2012). RxNorm represents the drugs in a way1
that corresponds to the prescriber’s view, as an ingredient, strength and dose form. 2
Clinical and Laboratory Observations Domain
For clinical and laboratory observations, I propose the use of LOINC. According to
LOINC.org, LOINC is a common language (set of identifiers, names, and codes) for clinical and
laboratory observations. It is a catalog of measurements, including laboratory tests, clinical
measures like vital signs and anthropometric measures, standardized survey instruments, and
more. The benefit of LOINC is that enables the exchange and aggregation of clinical results.
This aggregation of results can be used for care delivery, outcomes management, care
coordination, transition care, health population management and research through the use of
universal codes and structured names to identify things you can measure or observe. 3
Classification and Billing
To classify, diseases, signs and symptoms, abnormal findings, complaints, social
circumstances and external causes of injury or diseases, as classified by the World Health
Organization (WHO), ICD 10 is a good system that can be integrated with a SNOMED mapping
to integrate both clinical and administrative purposes. According to Medicaid.gov, ICD-10 is an
updated version of the ICD-9 code sets. Several countries have taken the ICD-10 code set and
modified it for use in their medical systems. In the case of the United States, has developed the
ICD-10-CM (or Clinical Modification) version of the code set for use in the US. This code set
1
UMLS. RxNorm Technical Documentation. Version 2012-1. January 03, 2012. Retrieved from
https://www.nlm.nih.gov/research/umls/rxnorm/docs/2012/rxnorm_doco_full_2012-1.html
2
Halamka, J. The Benefits of RxNorm. Life as a Healthcare CIO. Retrieved from
http://geekdoctor.blogspot.com/2011/11/benefits-of-rxnorm.html
3
LOINC.org. About LOINC. Retrieved from ​https://loinc.org/background

3. was developed through the National Center for Health Statistics. The Centers for Medicare &
Medicaid Services (CMS) has created a new code set, ICD-10-PCS (or Procedure Coding
System), for use. 4
The other terminology standard to use in combination with the ICD-10 for medical
billing process in the Current Procedural Terminology (CPT). The CPT is a code system set to
be used to report medical, surgical and diagnostic procedures and other services to entities that
include physicians, accreditation organizations, and health plans. The American Medical5
Association is the trusted sources for official Current Procedural Terminology (CPT). 6
Clinical Domain
In the clinical domain, problem lists, allergies, personal medical history and family
medical history is a good practice to capture clinical information at the point of care using the
SNOMED-CT. According to Browman, “SNOMED-CT is a comprehensive, multilingual,
controlled clinical reference terminology, or common reference terminology, with
comprehensive coverage of diseases, clinical findings, etiologies, procedures, living organisms,
and outcomes used for recording clinical data. SNOMED-CT enables a consistent way of7
capturing, sharing, and aggregating data across specialties and sites of care. It is designed for
use in electronic environments.
4
Medicaid.gov. ICD-10 Overview. Retrieved from
https://www.medicaid.gov/medicaid-chip-program-information/by-topics/data-and-systems/icd-coding/icd.html
5
Rouse. M. SearchHealthIT. Current Procedural Terminology (CPT). Retrieved from
http://searchhealthit.techtarget.com/definition/Current-Procedural-Terminology-CPT
6
American Medical Association. About CPT. Retrieved from
http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/c
pt/about-cpt.page​?
7
Bowman, Sue. "Coordination of SNOMED-CT and ICD-10: Getting the Most out of Electronic Health Record
Systems." ​Perspectives in Health Information ManagementSpring 2005 (May 25, 2005)

4. The Expected Benefits
The expected benefits of terminologies needs to be analyzed from the payer, provider and
patient perspective. SNOMED-CT helps the providers to have a better way to document clinical
interventions about the patient’s current and relevant conditions in the electronic health record
(EHR). It provides clear and consistent documentation, support them in collaborative care,
longitudinal patient records, and accurate patient data analysis. From the patient perspective,8
withe personal health records, they will be able to access to their records in a way that can
understandable. RxNorm provide a clear way to r​epresents the drugs in a way that corresponds
to the prescriber’s view, as an ingredient, strength and dose form. This help both patients and
providers to understand the medication lists. LOINC from a data sharing perspective it aids data
interoperability, improves analysis and reporting of the test results and clinical observations, and
links clinical and billing data. The integration of ICD-10 and CPT is key for health insurance to
classify and work medical billings accurately, fewers rejected claims, fewers fraudulent claims,
and better understanding of new procedures and better disease management.9
8
Health Language Blog. How SNOMED CT Compliance Will Benefit Your Patients. January 28, 2015.
Retrieved from ​http://blog.healthlanguage.com/how-snomed-ct-compliance-will-benefit-your-patients
9
AHIMA. What is the ICD-10-CM and ICD-10-PCS. Retrieved from ​http://www.ahima.org/topics/icd10/faqs