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Monday, July 12, 2010

Words, Words, Words

This week I'm in Oakbrook, IL at IHE PCC meetings.  This post is prompted by one of the discussions we were just having there.

What is the difference between a care plan and a treatment plan?  It depends upon who you are talking to, and what your context is.  The problem I have is that many clinical documents in use today use the phrases "plan", "treatment plan", "plan of treatment", "care plan", and "plan of care" to mean what LOINC describes as the "plan of treatment" (18776-5) section.

From another perspective, the plan of care is an overall document describing how a patient will be cared for, similar to what is found in the IHE PCC Patient Plan of Care Profile.  From a nursing perspective, this describes how a patient will be cared for overall, rather than what specific treatments (interventions, medications or procedures) will be applied to cure their ailment.  LOINC has another Document level code for "Treatment plan" (56447-6).

Many of the times that I've been engaged into similar discussions the approach that I've taken is that I don't care what you call it, so long as I know what "it" is. 

The challenge here is that across different domains in healthcare, different people use different terms to describe "it".  Domain 1 uses term A, and Domain 2 uses term B, but in Domain 1, term B means something else.  It's all very confusing.

The lack of human readable definitions in some of the controlled terminology (e.g., LOINC and SNOMED), make it difficult to determine when you are using them correctly.  Eventually, I hope vocabulary creators includes human readable definitions for some of this terminology.  It's not needed for things like medications where chemical names and structures pretty clearly define boundaries.  Socialized concepts need it though. 

Another simple change would be to have some editorial consistency in how these terms are created.  There's not reason to use "Treatment Plan" in one place and "Plan of Treatment" in another.  I'm fine with having the two concepts (document and section), where I have problems is that they use different phrases.

P.S. OK, and now we are talking about complications and problems. Same problem, and like I said, it's complicated.


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