Enhancing biomedical terminologies to include behavioral health: a prerequisite to improving the quality of healthcare

University of Minnesota Ph.D. dissertation. May 2013. Major: Health Informatics. Advisor: Christopher G.Chute, MD, DrPH. 1 computer file (PDF); iv, 76 pages, appendices A-F.Developing high quality information systems capable of supporting research and clinical care in behavioral health requires the existence of robust clinical terminologies and information models. These terminologies and information models must be capable of representing the same breadth and depth of constructs in the psychological domain that we demand of terminologies in the medical domain. Focusing specifically on psychological assessment instruments and their role in healthcare, we present three distinct studies assessing the extent to which existing healthcare terminologies can be used to capture, code, aggregate, and retrieve information in this domain. We begin with the premise that representation of psychological assessments instruments and instrument-related data must be addressed early in the terminology enhancement process. Psychometric instruments are, by definition, the foundation upon which all empirical knowledge in this domain is based. These instruments play a central role in shaping current understanding of both clinically relevant phenomena and specific mental health conditions. Moreover, results obtained using instruments are the grounds upon which clinical practice in this domain is designated as "evidence based". The results of the each of the three studies demonstrate significant gaps in terminologies relative to behavioral health; gaps that hamper the application of health information technology (HIT) in this domain and undermine efforts to improve the quality of healthcare. We discuss the details and implications of these findings and recommend a more aggressive, interdisciplinary effort to enhance healthcare terminologies to include behavioral health