Kaiser Permanente Opens Access to CMT to Support HHS Health IT Goals
Frequently Asked Questions
What is CMT?
- CMT stands for Convergent Medical Terminology. It is a set of clinician- and patient friendly terminology, linked to US and international interoperability standards, and related vocabulary development tools and utilities. It was developed by Kaiser Permanente over many years for use within its health-IT systems. CMT includes more than 75,000 concepts.
- CMT can be incorporated in the underlying architecture of health-IT systems to support data flow between health care providers, as it is in Kaiser Permanente today. It provides uniform concept definitions so that systems used for labs, vaccines, observations, and other medical data can communicate with each other in a common language, making data transferable between systems and among care teams.
- CMT allows care teams to interact with health information technology systems by providing more familiar names and descriptions so that they can coordinate with each other in an easy to understand way.
- Because CMT links to U.S. national standard vocabularies and code sets, such as SNOMED CT and ICD-9-CM, health data created using CMT’s clinician-friendly language can be translated as needed to standards required for quality measurement, statistical reporting, and health care reimbursement.
How was CMT developed?
- The terminology itself was developed by doctors, nurses, specialists, and pharmacists working together with IT. The tools and utilities were created by technology specialists with input from those clinicians every step of the way.
- It was developed to extend and link published standards that have now been adopted by the U.S. government.
- The development and implementation of CMT was difficult and time consuming at first. It was a strategic investment as part of Kaiser Permanente’s commitment to improving the quality of care.
Has CMT been tested? How has it been used?
- CMT is a core component of Kaiser Permanente’s comprehensive electronic health record KP HealthConnect®. It has been in use for years and and is used to coordinate care for more than 8.6 million patients today. Doctors and patients have been exceedingly satisfied with KP HealthConnect with all clinicians using it in both inpatient and outpatient settings and more than 3 million patients registered to use the personal health record linked to KP HealthConnect, My Health Manager on KP.org.
Is there a distinct and novel terminology standard that Kaiser Permanente intends to preserve with this CMT donation?
- No. Kaiser Permanente has no intention of creating a unique standard. Our objective is to accelerate the adoption of existing terminology standards.
Why is Kaiser Permanente making CMT publicly available now?
- Numerous parties, including government agencies in the US and other countries, have been interested in gaining access to CMT to facilitate clinician adoption of EHRs capable of generating comparable data for health care and public health.
- Use of CMT can reduce the need for repetitive, duplicative development and linking (e.g., by many different vendors and health care institutions) of clinician- and patient-friendly terminology to underlying standard vocabularies.
- CMT’s clinician-friendly terminology is linked to SNOMED CT, ICD-9-CM, LOINC, and other standards required in certified EHR products that will be used by Medicare and Medicaid providers to achieve meaningful use. CMT has therefore become even more valuable as a tool to aid effective use of EHRs by clinicians while also supporting adherence to US national health data standards.
- Kaiser Permanente is making CMT available now so it can support the Administration’s goals for adoption and meaningful use of EHRs in the U.S.
Will CMT be useful outside of Kaiser Permanente?
- Yes. This clinician-driven terminology will be familiar and useful to health professionals and patients in other settings in the U.S. and worldwide.
How will transferring CMT benefit Kaiser Permanente?
- Making CMT publicly available will allow Kaiser Permanente to become part of a distributed international network of terminology developers, who will work together to ensure that SNOMED CT and other standard vocabularies are quickly updated and enriched with clinician- and patient-friendly terminology. Over time, this distributed approach will reduce the level of terminology development effort required by any single institution, vendor, or country. It is a “win-win” benefit.
How will Kaiser Permanente make CMT available?
- Kaiser Permanente will transfer ownership of internationally relevant CMT content, the relationships between this content and SNOMED CT, and the associated vocabulary development tools and processes to the International Health Terminology Standards Development Organisation (IHTSDO) and the National Library of Medicine. This transfer will occur in stages over time, with the initial focus on terminology content for health problems.
- Kaiser Permanente will make US-specific CMT content, including relationships to other standards required for use in the US, available via the National Library of Medicine (NLM). This content will become part of an official US extension to SNOMED CT and/or be distributed within the UMLS Metathesaurus (http://www.nlm.nih.gov/research/umls/knowledge_sources/metathesaurus/index.html), as separate mapping files, or in other formats as useful. Transfer of content to NLM will also occur in stages.
What is the IHTSDO and why is Kaiser Permanente transferring ownership of CMT content and vocabulary tools to it?
- The International Health Terminology Standards Development Organisation (IHTSDO) is an international not-for-profit organization based in Denmark. IHTSDO acquires, owns and administers the rights to SNOMED CT and other health terminologies and related standards. The IHTSDO seeks to improve the health of humankind by fostering the development and use of suitable standardized clinical terminologies, notably SNOMED CT, in order to support safe, accurate, and effective exchange of clinical and related health information. The focus is on enabling the implementation of semantically accurate health records that are interoperable.
- Support to IHTSDO Members and Licensees is provided on a global basis allowing the pooling of resources to achieve shared benefits. Use of SNOMED CT is free of charge in Member countries. The US National Library of Medicine was one of 9 charter Members that founded the IHTSDO in 2007. There are currently 15 Member countries (Australia, Canada, Cyprus, Denmark, Estonia, Lithuania, New Zealand, Singapore, Slovak Republic, Slovenia, Spain, Sweden, The Netherlands, United Kingdom, United States). The IHTSDO is supported primarily by annual Member fees.
- Transferring relevant CMT content to the IHTSDO ensures that it is available free of charge throughout the US, while also preventing its evolution independent of a key vocabulary standard adopted for use in the US and other countries. It also allows CMT to be part of IHTSDO’s plan for distributed international vocabulary development.
- Kaiser Permanente is in the process of moving its vocabulary creation and management activities and unique tools to the IHTSDO terminology development Workbench, which is freely available under an open source agreement. Those Kaiser Permanente tools that are useful to the IHTSDO and its Members will eventually be maintained by the IHTSDO as part of the Workbench. Any others will also be made available under an open source agreement.
Why is the National Library of Medicine involved and what is its role in making CMT available?
- The National Library of Medicine negotiated the first US-wide license for use of SNOMED CT with the College of American Pathologists in 2003. At the request of the National Coordinator for Health IT, NLM represented the US in the negotiations that formed the IHTSDO when the College decided to transfer the intellectual property in SNOMED CT to an international organization. As the US Member of the IHTSDO, NLM is the US distributor of SNOMED CT, both in its native format and within the UMLS Metathesaurus where it is interlinked with terminology and concepts from more than 120 biomedical terminologies, classifications, and code sets. NLM also produces and distributes a problem list subset of SNOMED CT, which includes problems frequently seen at 7 large health care organizations, including Kaiser Permanente.
- In addition to serving as the US distribution point for CMT content donated to the IHTSDO, NLM will coordinate an effort to create an official US extension to SNOMED CT, which will contain the relatively small portion of CMT content that is not relevant in other countries. NLM will also distribute the mappings between CMT content and other standards, e.g., ICD-9-CM, used in the US, but not in other countries.
How can the CMT donation help health care providers meet meaningful use standards?
- Clinician-friendly and patient-friendly terms help to ease the adoption of the vocabulary standards that were adopted in federal regulations. When incorporated in certified EHR products, the clinician- and patient- friendly terminology from CMT can ease the implementation and use of EHRs by health providers, help to achieve current meaningful use criteria, and also promote the underlying data standardization required for advanced decision support.
- Evidence-based clinical alerts and reminders are only effective when the terminology in the rules matches the terminology in the medical record.
How can HIT software vendors and health care delivery organizations take advantage of this opportunity and implement the terminology in their own HIT systems, including EHRs?
- HIT software vendors and health care organizations generally use a combination of standard terminology and their own locally developed terminology. Most of their locally developed terminology is either alternative names for the same standard concepts or filling in a gap. This donation is intended to help vendors and health care organizations to implement a more comprehensive set of terms for both providers and consumers. It will also contribute important content to a distributed vocabulary development environment to which vendors and health care organizations can eventually contribute.
What happens next?
- Kaiser Permanente will transfer the many components of this technology incrementally over time. The initial phase is expected to involve terminology to support patient problem lists and diagnoses.
- As portions of CMT are transferred, they will become immediately available in their native format via the IHTSDO Member Exchange site and from NLM’s Unified Medical Language System (UMLS).
- NLM will add information from CMT (e.g., clinician- and patient-friendly terms, mappings to ICD-9-CM) to its existing SNOMED CT Problem list subset.
- Over time, all components of the tools will be transferred and accessible to terminology developers through open source agreements and all CMT terminology work will be available to everyone (providers and consumers) through its integration into established national and international standard terminology sets.
What is the significance of this donation for U.S. health care?
- Facilitates adoption and use of EHRs that will improve caregivers' decisions and patients' outcomes.
- Reduces current duplicative efforts (by many vendors and health care institutions) to develop and link clinician- and patient-friendly terminology to underlying standards.
- Gives smaller EHR vendors and clinician practices that lack the resources to support vocabulary development access to high quality clinician- and patient-friendly terminology.