Developing public health information system fluency through undergraduate community assessment

Purpose: To develop student fluency in a standardized terminology used in public health informatics. Background: One of the standardized terminologies embedded in Snomed CT® is the Omaha System, a complex multiaxial hierarchical classification system amenable to automation and implementation within public health information systems. A community-level modifier in the Omaha System Problem Classification Scheme allows for documentation of community level assessments, interventions and outcomes. Community assessment is a key component of undergraduate population-based nursing curricula. Students utilize the Community Assessment Instrument for Baccalaureate Learners (CAIBL) to assess a community's strengths and opportunities for improvement as part of the nursing process with a community. Method: A feasibility test was done to determine if Omaha System terminology could be matched with CAIBL data. A sample of 6 archived student community assessments provided data in the form of narrative statements about community strengths and opportunities for improvement. An expert panel of 5 experienced Omaha System users independently applied the Omaha System Problem Classification Scheme to 73 narrative items (39 strengths, 34 opportunities for improvement). Resulting problem and sign/symptom terms were compiled and agreement evaluated using a criterion of 80% or 4/5 panel members with the same term. Results: Expert panelists found matches within the Omaha System for each of the students' narrative statements, and reached 80% agreement on Problem Classification Scheme problems for 67% of the items. Agreement was greatest (74%) for opportunities for improvement compared to strengths (62%). The most common problems were communication with community resources and neighborhood/workplace safety. Conclusion: It was feasible to map student community assessment statements to Problem Classification Scheme terms, supporting use of Omaha System terms in conjunction with CAIBL for data standardization. The Omaha System can provide a standardized language for measuring community-level outcomes for comparison across time, populations, and geographical locations.