healthcare system

Healthcare System: Increasing and Unavoidable System Complexity

As companies grow and expand, they acquire and merge with information systems. Each time an additional system gets added or a system’s capabilities expand, the complexities and intricacies subsequently increase. Samuel Arbesman believes that system complexity is not a good or bad thing, but rather an inevitable thing (Lucky, 2017). He believes that everything done in the technological realm usually diverts us from elegance and understandability, and towards complexity and unexpectedness. This is illustrated by two important factors: accretion and interconnection. Accretion occurs when newer, larger systems are added to older, smaller systems. This is a common business practice where organizations have a system issue, and instead of fixing the system, they add another system on top of the defective one. It’s more common that a system is so complex that no one individual can fully understand it. Complexity does not need to be a scary thing; it’s to be expected.

Corporations have various acronyms that they use. Even if they’re in the same industry, ie: Medicare Part D, they often use different acronyms to reference the exact same thing. For example, one company might say “Patient Residence Code (PRC)” and another company might say “Patient Location Code (PLC)”. Even between hospitals this occurs. Sometimes different abbreviations for units differ. For example, one hospital might have 3 intensive care units: NICU (neonatal), PICU (pediatric), and SICU (severe/adults). While smaller hospitals may only have 2 intensive care units: one unit for patients age 0-17 and one unit for patients over the age of 17.

Three challenges with creating standardized medical terminology are variances in organizational structures, information system capabilities, and the reporting formats requested by regulatory bodies. Different organizational structures can cause different terminology to be used. Rural hospitals may be smaller, have fewer medical units, and be delayed in receiving updated regulatory guidance. Varying information system capabilities can also negatively impact the creation of standardized medical terminology. Lastly, depending on the agency a hospital reports to, the agency often requests different naming and reporting formats (ie: CMS, NCQA, FDA, NIH, etc.). Coding and naming schemes vary greatly between medical institutions and is highly dependent on organizational structures, information systems, and regulatory bodies.

Medical professionals are trained to have a questioning attitude. They are also initially trained in a variety of settings where they can see the lack of standardized terminology. Typically, anatomy terminology is standardized via Latin terms and English abbreviations. This is the most important. All of the other reporting, coding, and slang terms are usually not standardized but can be easily learned overtime. The standardization of medical terms is needed if computers will be used to automate clinical decisions. It’s easier to train computers to operate on a standardized terminology rather than add an additional layer of logic to convert between different terminologies between different institutions.