One-Way and Round-Trip Analysis Demonstrates Surprising Limitations of Standards-Based Terminology Maps

Area of Science:

• Health Informatics
• Clinical Data Standards
• Interoperability Research

Background:

• The vision for seamless patient data flow requires robust semantic interoperability.
• Current standards-based mapping approaches are being evaluated for their effectiveness.

Purpose of the Study:

• To assess the sufficiency of standards-based mapping for semantic interoperability.
• To evaluate data transmission success between VA and DoD systems.

Main Methods:

• Simulated large-scale clinical data transmission using SQL queries.
• Employed production standards-based maps for medications, allergens, document titles, vitals, and payers.
• Conducted one-way testing (OWT) and round-trip testing (RTT).

Main Results:

• Local code mapping success varied (62.5%–100%).
• One-way testing success rates ranged from 8.52% to 62.7%.
• Round-trip testing success rates were lower, from 1.7% to 76.3%.

Conclusions:

• Standards-based mapping alone is insufficient for full semantic interoperability.
• Identified an error framework and proposed mitigating steps to improve data exchange.
• Enhancing semantic interoperability is crucial for improving care quality and safety.