Last week's Snomed announcement has been a topic of some discussion on several listservs … on Fam-Med, Dr Mullins cuts right to the chase in this little dialogue:

"For anyone interested there is an EMR, CliniFlow, that is fully functional and uses SnoMed for all diagnosis codes.

Kate Galambos, RN, MSN"

.. and he responds:

"Thanks …  If I read your email correctly, CliniFlow utilizes  SNOMED for "diagnostic codes" not as a clinical vocabulary which would  be used to codify clinical information contained in the EMR.

If that is what you were saying, there are a number of EMRs which do that. My focus is on "terming" something to code non diagnosis information such as history physical, etc. The clinical narrative.

   Once again, thanks very much.
   Moon Mullins"

Sometimes Moon's ability to "get it" rubs people the wrong way.  He's a visionary .. and he doesn't mince his words.  Most vendors (and most users) don't get the difference that he's pointing out – yet his point drives home the essential component of a well structured note.  The meaning of the words in the note are lost in the quicksand of free text if the note isn't created from an alphabet of terms that are attached to clear definitions.  Products that use templated to create a note often just use those templates (derived from hierarchies of clinical findings) to create … free text! .. which is then causes all of the meaning of the composition to erode.

Huh?  you say?  (am I losing you in TechSpeak?  Are you wondering .. So What?) …

Here's why it's important.   MIllie comes in and I build her note in my EMR.  If it helps me build the note with clinical terms and retains these links, then I might read a part of the note as:

"Here today for Type 2 Diabetes, Shortness of breath and bilateral LE swelling"  .. but rather than free text, the database behind the note reads:

"Here today for 44533, 12345 and 57686"

where the database holds:

TermID     TermText
44533       Type 2 Diabtes – no complications

12345       Shortness of breath
57686       bilateral LE swelling

So now my system can help me.  Apply rules to help me make decisions?  Sure .. since the system really knows what is going on .. not just free text.  I can also do reports on the data .. with real clinical terms, not billing codes.