Physician nurse care: A new use of UMLS to measure professional contribution

Abstract

Background Physician and nurses have worked together for generations; however, their language and training are vastly different; comparing and contrasting their work and their joint impact on patient outcomes is difficult in light of this difference. At the same time, the EHR only includes the physician perspective via the physician-authored discharge summary, but not nurse documentation. Prior research in this area has focused on collaboration and the usage of similar terminology. Objective The objective of the study is to gain insight into interprofessional care by developing a computational metric to identify similarities, related concepts and differences in physician and nurse work. Methods 58 physician discharge summaries and the corresponding nurse plans of care were transformed into Unified Medical Language System (UMLS) Concept Unique Identifiers (CUIs). MedLEE, a Natural Language Processing (NLP) program, extracted “physician terms” from free-text physician summaries. The nursing plans of care were constructed using the HANDS© nursing documentation software. HANDS© utilizes structured terminologies: nursing diagnosis (NANDA-I), outcomes (NOC), and interventions (NIC) to create “nursing terms”. The physician’s and nurse’s terms were compared using the UMLS network for relatedness, overlaying the physician and nurse terms for comparison. Our overarching goal is to provide insight into the care, by innovatively applying graph algorithms to the UMLS network. We reveal the relationships between the care provided by each professional that is specific to the patient level. Results We found that only 26% of patients had synonyms (identical UMLS CUIs) between the two professions’ documentation. On average, physicians’ discharge summaries contain 27 terms and nurses’ documentation, 18. Traversing the UMLS network, we found an average of 4 terms related (distance less than 2) between the professions, leaving most concepts as unrelated between nurse and physician care. Conclusion Our hypothesis that physician’s and nurse’s practice domains are markedly different is supported by the preliminary, quantitative evidence we found. Leveraging the UMLS network and graph traversal algorithms, allows us to compare and contrast nursing and physician care on a single patient, enabling a more complete picture of patient care. We can differentiate professional contributions to patient outcomes and related and divergent concepts by each profession.

Using nursing notes to improve clinical outcome prediction in intensive care patients: A retrospective cohort study

“…16 Additionally, nursing notes describe aspects of the patient’s condition that are not addressed in the flowsheet or other structured data, such as change in status, nursing interventions, and patient responses (ie, precipitating factors of pain, patients’ response to symptom management, or discussion about plan of care in a family meeting). 17 In summary, nurses and physicians focus on different aspects of patient care 18 and need integration of these clinical notes to gain a comprehensive understanding of the patient’s health status.…”

Natural Language Processing of Nursing Notes

“…18,38 The most common standard terminologies used were the SNOMED-CT (Systematized Nomenclature of Medicine, approximately 40%, n = 17) [12][13][14]16,22,25,27,29,31,32,36,41,42,45,[51][52][53] and the UMLS (Unified Medical Language System, approximately 35%, n = 15). 9,[12][13][14]19,22,25,[28][29][30]36,41,42,49,51 Nursing standard terminologies, such as the International Classification for Nursing Practice and the Omaha System, were used in only eight studies. 18,25,28,31,33,[35][36][37] Other standard terminologies were also used in some studies including the International Classification of Diseases, 18,25,28,31,33,35,<...…”

“…Nursing documentation differs from documentation by other health providers, including physicians. For example, a recent study found that only 26% of patients' notes in EHRs included synonyms between the physician's and the nurse's clinical notes 9 . Today, there is a major gap in our knowledge regarding the extent to which NLP is applicable to nursing notes.…”

The Usability of IT Systems in Document Management, Using the Example of the ADPIECare Dorothea Documentation and Nurse Support System

“…Electronic IT systems should collect all appropriate normalised data generated by health care employees, such as nurses and doctors, in order to improve the quality and effectiveness of services provided to the patients [ 1 ]. Unfortunately, electronic medical records (EMR) may currently not be used to study the independent contribution of nursing to health care outcomes [ 2 ], thus the use of nursing terminology in this project, which will enable not only care planning, but also obtaining medical history and describing the health care status of the patient [ 3 ]. This enables the unification of care and its standardisation [ 4 , 5 ].…”