Representation of ophthalmology concepts by electronic systems: Intercoder agreement among physicians using controlled terminologies

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Limited Study for Ophthalmology Terminology Use Shows the Level of Intercoder Agreement is Imperfect

In order to solve the “grand challenges” for sharable electronic health data, a common vocabulary and a controlled terminology is required that allows human thought to be captured, processed and stored for retrieval by machines in manner that is reliable, reproducible and communicates medical information accurately. There are two critical factors outlined in this study that are required to support electronic health records in this specialty – adequate coverage in a terminology to represent ophthalmic and required medical concepts and consistency of physician terminology/code selection. If the intercoder agreement of concept representation by physicians is neither consistent nor sufficiently high, information retrieval will not be accurate or complete. Five candidate terminologies were used to compare three physician’s coded data outcomes and the results were judged to be concerning, as at best there was at best 64% complete agreement between the physicians and consistent with previous studies conducted on intercoder reliability.

The researchers outlined five different limitations to the study, but a clear case was made for further work in terminology systems refinement, utility of electronic terminology tools and additional terminology training for clinicians. This is the only way the health care industry can make progress for reliable sharing of medical concepts between health care providers or create a digital longitudinal health record. Physicians express medical concepts using different words or phrases and the context of the terms chosen affects their meaning. Candidate controlled terminologies, including those included in this study, sometimes allow clinician (human) interpretation to affect the code(s) used for reliable data storage and retrieval.

Comments: This research indicates a need for additional standardization of terminologies and the need for enhanced informatics tools, There is a need to guide clinicians to appropriate terms for expressing patient data that can be reliably used to represent clinical findings and interventions used in health care delivery in a digital(machine readable and machine stored) format. This guidance could include improved concept modeling with the terminology used and improved tools and resources in this area of informatics practice.

Without a controlled terminology foundation and clearly defined data elements for electronic health records designed into the clinical data architecture, it will be impossible to exchange clinical data without data integrity concerns. Structured data entry required to streamline information capture requires adequate content coverage by the terminology selected for use and adequate reproducibility between users.