A Problem of Display Codes

A Problem of Display Codes

During the course of an electronic medical record (EMR) implementation

project at a large medical center, the question arises how best to design

display screens for the system. In particular, the concern is what standard

codes should be used for the information on the user screens. In the following

e-mail, an information technology staff member involved in the EMR

project asks a member of the health informatics group for advice:

Hi Carol,

I need your help with something, and it’s a pretty big something. I wonder

if you or anyone on your staff would be interested in taking this on as a

project? As you know, I’m working on the new EMR implementation. One

of the things we’re stuck on right now is standard displays of information

in the EMR. Because the record is integrated (which is the good news and

the bad news), most of the tables and code sets are shared among multiple

disciplines. We need to define what we will use for our displays. For

example, the code set we’re working on right now is Units of Measure.

Now, you wouldn’t think it would be too hard to decide what the display

for something like “milligrams” would be—except that the choices are

MG, Mg, mg, etc. And that’s one of the easy ones. According to the medical

center’s standard abbreviations, all of the above are perfectly acceptable.

The problem is, to build the EMR, we have to decide on just one. So far,

since we began implementing the EMR, we’ve included a mishmash of

displays depending on what department we were working with. Lo and

behold, now we’re in a real pickle, and our database is a mess. In the truly

integrated EMR, only one abbreviation can be displayed for “milligrams.”

Again, this is just one example out of literally hundreds (if not thousands)

of pieces of information we need to standardize. Do you have some time to

help us figure out what standards are out there? We’d like to standardize

on something that is nationally, if not internationally, accepted. It needs to

include content for standards, definitions, and especially abbreviations for

pharmacy, medicine, nursing, and purchasing units. We’d like to present

some standards to the EMR Steering Committee and the Medical Records

Committee for consideration. Do you have any suggestions? I’d be happy

to meet with you and discuss further if you’d like. Thanks!

Michael

1. What is the problem that needs to be addressed?

2. What solution is being considered as viable?

3. How would you define (or not define) the problem differently, or

define a viable solution differently?

4. What do you think is the correct solution?