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The Clinical Care Classification nursing standard

Since the nursing process is an indispensable part of healthcare, nursing terminologies must be integrated and interoperable with other clinical terminologies. Recognizing this need, the Clinical Care Classification (CCC), a nursing standard recognized by the American Nurses Association (ANA), has established mappings to SNOMED CT and LOINC, other standard terminologies used in health care.

The CCC nursing standard represents nursing practice concepts in Electronic Health Records (EHRs). There are two interrelated terminologies within the CCC – Nursing Diagnoses & Outcomes, and Nursing Interventions & Actions. The CCC begins with 21 care components that are part of the nursing assessment process and categorize the diagnoses and interventions. In total, there are 182 CCC nursing diagnoses concepts, 792 nursing intervention action concepts and 546 nursing outcome concepts.

In order to achieve comparable and sharable data, the intricacies of modeling CCC concept codes and relationships to SNOMED CT and LOINC must be addressed. Each of the terminologies are represented with different models, formats and granularity. This limits the ability of this data to be interpreted across systems and limits secondary data use.

Dr. Virginia Saba, CCC’s author, helped to integrate the CCC into the 3M Healthcare Data Dictionary (HDD), which contains multiple standard terminologies required to document clinical care, including SNOMED CT, LOINC and now, CCC, ,mobilizing the data via HL7 standard compliant runtime services. Now the data entered at the point of care can be used (interpreted) across the care continuum and across heath care settings.

Rachael Howe is a nurse informaticist with the Clinical Terminology group at 3M Health Information Systems, and is a member of the Healthcare Data Dictionary (HDD) team.


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  • Last modified on Tuesday, 26 September 2023 14:27
Rachael Howe

Rachael Howe, RN, MS has been a member of the 3M HDD team since 2010. She is the Clinical Informatics manager co-leading the Healthcare Data Dictionary (HDD) team. She directs the team in process flow, operating procedures, and information and terminology modeling, in addition to designing for standardization and interoperability in various projects. Rachael leads projects that integrate standard terminologies such as SNOMED CT, LOINC, ICD-10-CM, ICD-10-PCS, CPT and RxNorm into the HDD, as well as developing content for customer specific use cases and integration of the HDD into other products within 3M. Her interests include using terminology models and principles to improve interoperability in EHRs, implementation of value sets and map sets, in addition to content support for 3M clinical NLP solutions. Rachael obtained her Masters of Science in Healthcare Informatics from the University of Colorado Denver.