Analysis of Free Text with Omaha System Targets in Community-Based Care to Inform Practice and Terminology Development

Summary

The Omaha system is one of the most widely used interface terminologies for documentation of community-based care. It is influential in disseminating evidence-based practice and generating data for health care quality research. Thus, it is imperative to ensure that the Omaha system reflects current health care knowledge and practice. The purpose of this study was to evaluate free text associated with Omaha system terms to inform issues with electronic health record system use and future Omaha system standard development. Two years of client records from two diverse sites (a skilled homecare, hospice, and palliative care program and a maternal child health home visiting program) were analyzed for the use of free text as a component of the intervention when structured targets for interventions were not identified. Intervention text entries very commonly contained duplicate “carry forward entries”, multiple concepts, mismatched problem focus, or failure to identify an existing appropriate target. Our findings support the need to better address education gaps for clinicians. We identified additional suggested targets for Omaha system problems, and propose new targets for consideration in future Omaha system revisions.

Keywords

Interface terminology - Omaha system - Content coverage - community health care - nursing assessment

 

• References

• 00 The Omaha System (Web site) from http://www.omahasystem.org. Retrieved December 1, 2010.
• 2 Martin KS. The Omaha System –A key to practice, documentation, and information management. 2nd ed: Saunders; 2005
• 3 Bowles KH, Martin KS. Three decades of Omaha System research: Providing the map to discover new directions. Stud Health Technol Inform 2006; 122: 994.
• 4 Monsen KA, Fulkerson JA, Lytton AB, Taft LL, Schwichtenberg LD, Martin KS. Comparing maternal child health problems and outcomes across public health nursing agencies. Matern Child Health J 2010; 14: 412-421.
• 5 Monsen KA, Westra BL, Yu F, Ramadoss VK, Kerr MJ. Data management for intervention effectiveness research: comparing deductive and inductive approaches. Res Nurs Health 2009; 32: 647-656.
• 6 Westra BL, Oancea C, Savik K, Marek KD. The feasibility of integrating the Omaha system data across home care agencies and vendors. Comput Inform Nurs 2010; 28: 162-171.
• 7 Martin KS, Monsen KA, Bowles KH. The Omaha system and meaningful use: applications for practice, education, and research. Comput Inform Nurs 2010; 29: 52-58.
• 8 Westra BL, Solomon D, Ashley DM. Use of the Omaha System data to validate Medicare required outcomes in home care. J Healthc Inf Manag 2006; 20: 88-94.
• 9 Garvin JH, Martin KS, Stassen DL, Bowles KH. The Omaha System. Coded data that describe patient care. J AHIMA 2008; 79: 44-49 quiz 51-52.
• 10 Yu F, Lang NM. Using the Omaha System to examine outpatient rehabilitation problems, interventions, and outcomes between clients with and without cognitive impairment. Rehabil Nurs 2008; 33: 124-131.
• 11 Westra BL, Savik K, Oancea C, Choromanski L, Holmes JH, Bliss D. Predicting improvement in urinary and bowel incontinence for home health patients using electronic health record data. Journal of Wounds; Ostomy: & Continence Nursing. Accepted 2011.
• 12 Westra BL, Dey S, Fang G, Steinbach M, Kumar V, Savik K. et al. Data mining techniques for knowledge discovery from electronic health records. Journal of Healthcare Engineering. Accepted 2011; 2(1).
• 13 Bates DW, Gawande AA. Improving safety with information technology. N Engl J Med 2003; 348: 2526-2534.
• 14 Patel VL, Arocha JF, Kushniruk AW. Patients’ and physicians’ understanding of health and biomedical concepts: relationship to the design of EMR systems. J Biomed Inform 2002; 35: 8-16.
• 15 Morrison FP, Kukafka R, Johnson SB. Analyzing the structure and content of public health messages. AMIA Annu Symp Proc 2005: 540-544.
• 16 Stetson PD, Johnson SB, Scotch M, Hripcsak G. The sublanguage of cross-coverage. Proc AMIA Symp 2002: 742-746.
• 17 Hyun S, Johnson SB, Bakken S. Exploring the ability of natural language processing to extract data from nursing narratives. Comput Inform Nurs 2009; 27: 215-223 quiz 24-25.
• 18 Bakken S, Hyun S, Friedman C, Johnson S. A comparison of semantic categories of the ISO reference terminology models for nursing and the MedLEE natural language processing system. Stud Health Technol Inform 2004; 107: 472-476.
• 19 Bakken S, Hyun S, Friedman C, Johnson SB. ISO reference terminology models for nursing: applicability for natural language processing of nursing narratives. Int J Med Inform 2005; 74: 615-622.
• 20 Melton GB, Westra BL, Raman N, Monsen KA, Kerr MJ, Hart CH. et al. Informing standard development and understanding user needs with Omaha system signs and symptoms text entries in community-based care settings. AMIA Annu Symp Proc 2010: 512-516.
• 21 Monsen KM, Melton-Meaux G, Timm J, Westra B, Kerr M, Raman N, Farri O, Hart C, Martin K. An empiric analysis of Omaha System Targets. Appl Clin Inf 2011; 2: 317-330.