CAP STS - SNOMED Terminology Solutions
SNOMED STS SNOMED Terminology Solutions CAP

 

 

 

 

 

CAP STS™-A Leader in Transforming Health Information

SNOMED Terminology Solution™ (STS), a division of the College of American Pathologists (CAP), is the leading organization in pursuing semantic interoperability for clinically accurate electronic health records (EHRs) by offering customized best-practice terminology implementation and education services.

CAP STS’ Professional Services specializes in customized best-practice health information solutions from strategy and planning to implementation and maintenance.

The Diagnostic Intelligence and Health Information Technology (DIHIT) team, also a part of CAP STS, is committed to improving and/or developing health IT standards, practices, tools, and standardized reporting. The CAP Diagnostic Work Station and the CAP electronic Cancer Checklists (CAP eCC) are two examples of such initiatives. DIHIT further advances health IT through collaboration with leading systems designers, providers, and standards organizations.

CAP STS’ Clinical Informatics team develops and maintains SNOMED Clinical Terms®(SNOMED CT®), the globally recognized clinical terminology, on behalf of the Copenhagen, Denmark-based International Health Terminology Standards Development Organisation (IHTSDO®). The IHTSDO is comprised of 15 member countries spanning the globe, and CAP STS provides regular education and consulting services to many of these countries.

CAP STS Professional Services, DIHIT, and Clinical Informatics teams together seek to improve quality of care through supporting the pathologist's role as chief diagnostician/clinical care advisor and advancing interoperable EHRs.

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CAP STS Services and Solutions

Professional Services

  • Clinical Informatics
  • IHTSDO and SNOMED CT support
  • Clinical Terminology
  • Education
  • Customized education
  • Classroom Sessions
  • Self-directed Learning Courses
  • Web Teleconferences
  • Health Exchange Initiatives
  • Health IT Strategy and Planning
  • Quality and Performance Improvement
  • Reporting and Quality Metrics
  • Research Data Management
  • Semantic Interoperability
  • Synoptic Reporting

DIHIT Initiatives

  • CAP eCC
  • CAP Diagnostic Work Station
  • CAP Virtual Informatics College

Why CAP STS?

  • Champion of semantic interoperability in health IT implementations to improve quality of care
  • Experience with Meaningful Use key standards SNOMED Clinical Terms® (SNOMED CT®) and ICD-9-CM (and soon-to-come ICD-10-CM)
  • Experience in health information technology and standards development such as HL7, CCHIT, HITSP, IHE, and IHTSDO
  • Developer of SNOMED CT; currently maintains SNOMED CT on behalf of the International Health Terminology Standards Development Organisation (IHTSDO®)
  • Developer of cross mappings to ICD-9-CM, nursing terminologies (NANDA, NIC, NOC, PNDS, etc.), and CPT as well as laboratory and pharmacy coding schemas
  • Health IT resources and competencies in: Clinical Terminology, Business and Clinical Process, Project Management, Technology and Integration, and Education
  • Originator of the CAP electronic Cancer Checklists (CAP eCC), recognized as a “gold standard” in cancer case summary reporting
  • Specialist in developing, implementing, and supporting multidisciplinary structured reporting

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CAP STS Expertise and Engagements

Clinical Terminology and Related ServicesClinical Informatics Quality and Performance ImprovementHealth IT Strategy and Planning
    •Assessments
     and Planning
     services

    •Implementation
     and Delivery
     Services

    •Reporting and
     Data Quality
     Services

    •Education
     Services 		    •Best Practices
     and Informatics
     Assessment
     and Planning

    •Best Clinical
     Care Practices
     and Informatics
     Implementation

    •Reporting and
     Quality Metrics
     Development 		   •Organizational
     Benchmarks,
     Metrics, and
     Dashboards

    •Implementation
     and Delivery
     Services 		    •Health
     Exchange
     Initiatives

    •Disease
     Registries

    •Research Data
     Standardization
  • Clinical Terminology and Related Services
  • Assessments and Planning Services
  • Regional Health Authority
    Performed an extensive terminology assessment to determine ideal state of terminology use, CAP STS produced a technical report outlining the strategic alternatives to facilitate wide adoption of SNOMED CT at a national level. The report informed a European-wide project as well.
  • Ambulatory EHR Vendor
    Reviewed an ambulatory EHR application to provide advice and guidance on terminology requirements. Work included a technical review of terminology storage, strategies for pre- and post-coordination, terminology update management, mapping templates strategies, and forms encoding.
  • EHR Vendor
    Reviewed EHR application including the existing clinical content choices, development of a strategy to map clinical content to SNOMED CT, and identification of implications for application users.
  • Implementation and Delivery Services
  • Large Hospital
    Provided a terminology strategy and implementation plan, as well as the clinical and technical expertise to help the healthcare provider build a lexicon based on open source DTS (Distributed Terminology System). A model was provided to show how terminology standardization could be applied to the client's other documentation and clinical applications to improve the quality of clinical records for reporting, operational efficiencies, and outcomes.
  • Reporting and Data Quality Services
  • CAP eCC
    The electronic structured and encoded assessment and patient data collection forms used for the Cancer Checklists have been developed with the vision that this is an architecture and standard that should be applied to many types of processes and guidelines that require structured methods for data collection and reporting in healthcare.
  • Education Services
  • CAP STS has delivered custom education to numerous clients worldwide and continues to offer education in a variety of formats: Web teleconference, self-directed learning, and classroom sessions.
  • Clinical Informatics
  • Best Practices and Informatics Assessment and Planning
  • Health Content Provider
    Assessed current state of content provider databases as well as the structure, coding, and indexing of information. Included a technical database assessment and the development of a content transformation plan.
  • Best Clinical Care Practices and Informatics Implementation
  • Hospital Network
    Overall project focused on the strategic information needs and standardization of nomenclature for the activities that directly pertain to clinical care, quality, and patient safety.
  • Reporting and Quality Metrics Development
  • Hospital Network
    Structured analysis of the data and terminology needs and gaps for recording and reporting meaningful use quality measures across the patient continuum of care.
  • Health IT Strategy and Planning
  • Health Exchange Initiatives
  • Chicago Regional Extension Center (REC)
    CAP STS will develop and offer a Web teleconference to all providers in the service area focused on SNOMED CT, the National Library of Medicine's (NLM) Clinical Observations Recording and Encoding (CORE) Problem List and other standards such as ICD-9-CM and ICD-10-CM. In addition to the Web teleconference course, CAP STS will provide onsite and telephone implementation guidance, education, and mentoring.
  • Disease Registries
  • University of South Florida (USF) Collaboration: Rare Diseases Grant
    The primary objective of the grant is to develop standardized questions for patient registries across many different rare diseases, which can be used to develop new registries or revise existing ones. In this project, a combination of domain experts in rare diseases research (USF and the Rare Disease Clinical Network) and technical experts (CAP STS) will be used to develop a coded library of standardized questions relevant to various rare diseases, with plans for implementation into the broader rare diseases research community. The library questions will use consistent structure and language, and the underlying data elements (i.e., questions + answers + definitions) will be encoded using data standards, including SNOMED CT, that will facilitate reliable and consistent data collection and enhance opportunities for question re-use and data sharing. This project is modeled after the CAP eCC.
  • Research Data Standardization
  • CAP eCC
    The electronic structured and encoded assessment and patient data collection forms used for the Cancer Checklists have been developed with the vision that this is an architecture and standard that should be applied to many types of processes and guidelines that require structured methods for data collection and reporting in healthcare.

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