A standards-based information infrastructure is needed for long-term care PMRI systems, just as such an infrastructure is needed in other areas of health care. In particular, the presence of a uniform data system for expressing terminological data would enable quality reporting as a "by-product" of care. More importantly, such a terminology system is critical in order to build automated alerts and decision support systems that would enable enhancements to the care provided. The convergence of "best practices" with information systems requires a highly coordinated approach between terminology systems, documentation systems, and the standards of care suggested in the literature such as the ACOVE indicators that point to best practices. Electronic point of service documentation using a terminology system that is recognized by the all of the software applications that interface with that documentation would enable, for example, prompts to be issued as reminders to care providers around practice guidelines such as those published by ACOVE. Further, failure to use standardized terminologies in electronic health information systems will increase costs and slow the adoption of interoperable PMRI systems.
Moving forward towards the NHII model for long-term care requires that standards for encoding clinical data, sending messages, and document architecture be adopted.
Experts in the development of health information systems agree that achieving the vision of the NHII requires Federal and private partnerships around the development, maintenance and dissemination of clinical terminologies. Among the recommendations made by the NCVHS to the Secretary of HHS is federal involvement in the selection of standards for patient medical record information, early adoption of PMRI standards by the Federal government, conformance testing and licensure of clinically specific terminologies, and funding for demonstration projects and research on improved clinical data capture (http://ncvhs.hhs.gov/reptrecs). Long-term care is an area of health care where there would likely be immediate benefits from the development of electronic health information systems.
To facilitate the evolution of the NHII first requires commitment to and adoption of standards by system developers, vendors, and purchasers; reaching consensus on the role of the federal government as a facilitator; continuing standards development, and providing financial resources. Until recently, standards development was seen largely as an industry responsibility because no federal funding has been allocated for this purpose. After standards are fully developed, subsequent efforts will be required that emphasize collaborations and implementations.
Sufficient progress has been achieved in our understanding of functioning characteristics, achievable reporting goals, information systems standards, and formal logics to permit the formation and defense of the vision proposed. However, many gaps exist in our underlying patient record model, standards specifications, and terminology logics. Each of these gaps defines a body of cross-cutting research to close them. Harmonization of this research, to ensure the comparability and interoperability of the patient data elements, would afford obvious efficiencies.