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Summary

Why Standardized Clinical Statements?

Standardized clinical statements provide a structure that allows clinical terminology data to be used to its fullest potential. Consider medical data as its own language that requires both terminology and a structure to effectively communicate a patient’s health story. In language, words each have their own inherent meaning, but a word on its own communicates very little. However, providing structure and order to the words allows for the creation of sentences, resulting in higher levels of communication and understanding.

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  • Questionnaire and questionnaire responses

  • Event-Condition-Action rules

  • General-purpose clinical data analysis

  • Structured-data capture technologies

  • Decision-logic engines and frameworks

  • SMART on Fast Healthcare Interoperability Resources (FHIR) CDS Hooks

  • Order set EHR triggers

  • NLP processing of Consult notes

What are ANF Statements?

ANF statements are a type of standardized clinical statement that follow the principle of separation of concerns. Simply put, ANF statements are designed to allow the clinical terminology (i.e., SNOMED, LOINC, etc.) and the data structure (i.e., clinical statement framework) to each operate as intended; the clinical terminology is responsible for defining clinical terms, such as, types of procedures, disorders, findings, and so on while the data structure is responsible for considering how clinicians and health information systems will form and use the data.

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  • Ensuring ANF statements can be understood without referencing private or inaccessible information

  • Simplifying data representation and creation of equivalent statements across both users and sources

  • Mandating ANF statements are fit-for-purpose to data analysis, supporting CDS, research, and extensive clinical data analysis initiatives (e.g., Population Health, Pandemic Preparedness Assessments)

ANF and High Reliability

ANF is a foundational standard for improved data representation, thereby enhancing data association and querying, improving analytical and searching capabilities, and promoting usability and shareability. Utilizing ANF can also facilitate healthcare organizations with becoming high reliability organizations (HROs)—characterized as having high safety levels under inherently risky, demanding, and technologically complex conditions. In most cases, the greatest barrier to measuring and improving outcomes is the quality of data that is aggregated from various systems. ANF aims to minimize these data quality challenges and provides a common format with semantic clarity, which allows for normalized data sets and meaningful secondary use of clinical data for patient care.

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ANF, on the other hand, produces highly reliable and URU-based clinical statements by establishing order and rules for how clinical terminology data is structured, expanding the capabilities of the data for future use and analysis. This approach allows HROs to gain insight into their clinical data and reach high levels of safety, thereby producing the blueprint to replicate HROs across the industry.

Creating an ANF Clinical Statement

In order to successfully build out reproducible, standardized ANF statements, one must understand the pieces that fit together to form the ANF clinical statement. The flow chart below highlights the three main steps of taking a clinical narrative and building out a standardized ANF statement. Additional detail for each step is provided in the following sections:

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Impact on Strategies

References

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