Healthcare XBRL: the Language of Concepts

All the cool kids that read my presentations about XBRL know that XBRL is really two things that work well together – a language of facts, and a language of concepts. If we want to go looking for places that XBRL can be gainfully employed improving the efficiency of healthcare, both of these languages need to be explored for the opportunities. For the language of concepts, XBRL taxonomies, ICD-10 is a huge opportunity.

And I do mean huge. As a medical coding vocabulary, ICD-10 is about 10 times larger than its predecessor ICD-9. As if the US healthcare system wanted another time sensitive technology issue, support for ICD-10 is required by October, 2014.

Capturing ICD-10 as an XBRL taxonomy would have many benefits.

Standalone intellectual property – the taxonomy would be independent of any one software system. Indeed, multiple systems could all use the common base of metadata for their systems, improving interoperability.

Multiple language support – it is easy to add multiple languages to an XBRL taxonomy, because the human readable labels have been factored out and put in a separate document. Does your office staff need to communicate with doctors and clients that speak Spanish? In XBRL it would straightforward to add a  Spanish language extension to the base taxonomy, either to be donated to the public or as a value add activity for a commercial implementation of medical coding support.

Leverage existing taxonomy search tools – ICD-10 will include more than 140,000 separate items. Searching the vocabulary for the correct term will be critical, and near impossible without technology support. For many, code lookup is still a manual process in printed volumes.

Integrate multiple coding vocabularies in one technology framework – medical coding requires the se of multiple code vocabularies and crosswalks between them. All of this metadata infrastructure can be handled by existing XBRL taxonomy systems. Because XBRL was designed to handle extension taxonomies and multiple taxonomies in use in a single reporting document, this is a solved problem.

And did I say extension taxonomies? – the idea of extending ICD-10 for new medical situations, new diseases, new procedures, new equipment is clearly possible with XBRL as a technology base. We’ve seen that XBRL can handle reporting environments that use a fixed set of taxonomies, and other implementations that allow multiple, ad hoc taxonomies.

Now some might point out that ICD-10 is already managed as an XML markup language, ClaML. Yes, and that should make translation into XBRL much easier, it doesn’t say the idea is unnecessary. The ClaML markup tries to capture the printed manual rather than the underlying universe of discourse.

<ModifierClass code=".2" modifier="S04E10_4" usage="dagger"><SuperClass code="S04E10_4"/>
<Rubric kind="preferred" id="D0003601">
xml:lang="en" xml:space="default">With renal complications
</Rubric>

Dagger? And ‘aster’ for asterisk? Really? This like bold and italic vs. strong and emphasis in HTML.

.2+
With renal complications

I think it is safe to say that ICD-10 support can be done in off-the-shelf XBRL software once the transformation has been done from ClaML to XBRL. That will require some effort, but effort that is straightforward. And the payback could be huge.

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One thought on “Healthcare XBRL: the Language of Concepts

  1. Hi David

    I recalled your interest in things medical when I read a few of Prakash Nadkarni’s pages at the following website.

    Adjunct Faculty, Yale Center for Medical Informatics

    http://ycmi.med.yale.edu/nadkarni/

    I have had a quick read of that page and the following two: The EAV/CR Model of Data Representation and Using a few tables to hold all Domain values: Good Idea or Bad?

    http://ycmi.med.yale.edu/nadkarni/eav_cr_frame.htm
    http://ycmi.med.yale.edu/nadkarni/DomainLists.htm

    There appears to be some correspondence between (1) Dr Nadkarni’s data model and that of XBRL and (2) the information problem that each of XBRL and Dr Nadkarni seek to solve.

    I imagine if Dr Nadkarni wanted to move his biomedical database from one university or hospital to another he would simply move the whole database holus bolus without XBRL, but if he wanted to copy part of it from one university or hospital to another, would XBRL be the tool for the job? Or if he needed a feeder for his database?

    – Brendan

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