Clinical terminology in a time of uncertainty

In the midst of the novel coronavirus pandemic, updates to COVID-19 coding guidelines, terms, and names are important for patient care, but challenging to manage. IMO’s clinical, product, and coding experts break down how COVID-19 terms have been developed and explain how IMO can help providers by taking terminology concerns off of their plates.
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Clinical Terminology COVID-19

The ability to easily document possible exposure to, infection with, or any other clinical symptoms of COVID-19 is crucial to mitigating the impact of the pandemic. However, the lack of standardized coding to capture this information at the start of the outbreak, coupled with the rapid evolution of scientific understanding of the novel virus, has made this an inherently difficult task.

Intelligent Medical Objects’ March 2020 updates to our IMO Core terminology provided 154 terms related to the COVID-19 pandemic. These terms give the hundreds of thousands of healthcare providers who use IMO the ability to document exposure to, as well as suspected cases and confirmed diagnoses of, infection with SARS-CoV-2, along with various manifestations of the disease. Additionally and free of charge, IMO is providing all customers with IMO Precision COVID-19 Sets – value sets designed to help healthcare organizations manage population health needs for cohorts of suspected and confirmed cases.

What’s in a name?

At the start of the outbreak, the World Health Organization (WHO) used a placeholder name, 2019-nCoV, to describe the disease – 2019 for the year the virus first appeared and nCov for novel coronavirus. Next, the International Committee on Taxonomy of Viruses announced the official name for the virus, severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2, given its close genetic relationship to the virus that caused the SARS outbreak in 2003, named SARS-CoV. On the same day, the WHO announced coronavirus disease 2019, abbreviated COVID-19, was the official name of the infectious disease caused by the SARS-CoV-2 virus.

In January, IMO recognized the imminent impact of SARS-CoV-2 and immediately released an initial batch of 15 terms to help clinicians document patient conditions during the first weeks of the outbreak. Since then, the spread of COVID-19 became a pandemic, and a myriad of code sets updated their guidelines for addressing the disease.

With new codes, a new need for terms

As the organization that creates and maintains the diagnostic codes within the International Classification of Diseases, Tenth Revision (ICD-10), the WHO released an emergency code for diagnoses of 2019-nCoV acute respiratory disease, U07.1, shortly after the new naming conventions were announced. Following the WHO’s lead, the Centers for Disease Control and Prevention (CDC) released their own interim coding guidelines using the existing, less specific code of B97.29, standing for other coronavirus as the cause of disease classified elsewhere, for patients with COVID-19. The National Health Service in the United Kingdom also released an emergency edition of SNOMED-UK, containing new COVID-19 terms and codes. In March, SNOMED International followed suit, including COVID-19 terms in their own emergency release. As the crisis was declared a pandemic, the CDC revised an earlier decision and implemented the ICD-10-CM code for COVID-19, U07.1, on April 1, 2020, as opposed to October 1, 2020, the initially announced date.

There is great potential for the rapid pace and complexity of these updates to create confusion as healthcare providers aim to accurately document diagnoses of the patients under their care. Furthermore, it is difficult to keep up with the latest coding guidelines to ensure accurate reporting, and more importantly, accurate epidemiologic analysis so that the pandemic can be tracked globally.

Doing our part to help those on the front lines

In this time of crisis, IMO is proud to be able to help address these challenges. Our expert staff of clinical terminologists continually review the clinical and microbiological scientific literature and consult with front-line clinical and public health leaders. This allows us to interpret complex information related to coding and clinical terminology updates about the virus, the disease, and the clinical descriptors providers need. Using a rigorous editorial process, our team identifies scientific and common colloquial naming practices to rapidly identify the terms that the healthcare system needs, curate them in a consistent manner, and map them to standardized global code sets according to the most current guidance. IMO will continue to update maps as code sets evolve to ensure that healthcare organizations have the most accurate and up to date codes associated with each IMO term.

We recognize that fluidity is needed around evolving conditions. For example, when this outbreak was initially reported, naming conventions for the virus only included 2019 novel coronavirus, 2019 n-CoV, and Wuhan coronavirus1. IMO ensured that the terms released in January accounted for all three of these variations so that any providers searching for a naming convention most familiar to them found the result they needed. Since SARS-CoV-2 and COVID-19 virus are now the scientific and common naming conventions, respectively, these have been added as searchable synonyms to all IMO descriptions related to the virus.

Finally, IMO aims to future-proof our content. We recognize that numerous drug manufacturers and researchers are racing to develop a COVID-19 vaccine. While not yet out of clinical trials, vaccines are in development, and when they are in production, providers will have access to IMO’s standardized terminology around vaccine contraindications and availability.

Within a few months, COVID-19 has spread to nearly 900,000 people and caused more than 45,000 deaths around the world (as of April 2, 2020)2. Governments are struggling to contain the spread by enforcing quarantines, the public is under tremendous stress, and the global economy is suffering. Meanwhile, healthcare providers remain on the front lines caring for their patients. IMO stands by these providers to arm them with the standardized, clinician-friendly terminology needed to confidently document their exposed, symptomatic, or diagnosed patients.

To learn more about IMO’s response to the COVID-19 pandemic, click here.

1 In IMO’s next release, all Wuhan coronavirus terms will be demoted in favor of the formally recognized terms, SARS-CoV-2, COVID-19 virus, 2019 novel coronavirus, and 2019-nCoV. In that release, Wuhan coronavirus terms will no longer be visible upon search. IMO makes such term demotion decisions on a per-case basis after weighing all relevant factors, including cultural sensitivity and data integrity.

World Health Organization. Coronavirus Disease 2019 (COVID-19) Situation Report – 73

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