Clinical vocabulary as a boundary object in multidisciplinary care management of multiple chemical sensitivity, a complex and chronic condition

Figures & data

Figure 1 Challenges in the management of complex and chronic conditions.

Figure 2 Boundary object in multidisciplinary care.

Figure 3 Schematic of the methodology for the creation of the boundary object.

Table 1 Concepts retrieved from the chart audit process

Physical	Psychosocial	Nutrition
Instances of frequently used clinical terms (>60%)
Fatigue	Difficulty coping with illness	Food sensitivity
Light-headedness	Hypervigilant behavior	Abdominal bloating
Light sensitivity	Avoidance coping	Abdominal pain
Pain	Anxiety	Constipation
Heightened perception of sound	Overly accommodating	Sinus congestion
Heightened sense of smell	Self sacrificing	Constipation
Sinus congestion	Pain	Light-headedness
Instances of moderately used clinical terms (30%–60%)
Health problems as a child	History of child abuse	Abdominal cramps
Musculoskeletal pain	Withdrawn	Diarrhea
Poor balance	Feels angry	BMI > 25
Low energy	Anxiety	Reflux
Instances of infrequentely used clinical terms (<30%)
Increasing sensitivity	Emotional eating	IBS
Metallic taste in mouth	Obsessive compulsive	Nausea
Migraine	Emotional hypersensitivity	Obese
Skin symptoms	Difficulty coping with pain	Emotional eating
Throat irritation	Paranoid ideation	Food allergies

Figure 4 Sample view of the controlled vocabulary - nutrition profile.

Table 2 Standardization of multidisciplinary clinical vocabulary (semantic) using SNOMED CT

Terminologies in clinical notes and areas of health focus	SNOMED CT concepts (hierarchy) and concept ID
Fatigue, low energy, very tired, extremely tired heavy feeling	Fatigue (finding) 84229001 Parents: Energy and stamina finding
Area of health focus: Medical, physical, psychosocial, nutrition	General problem AND/OR complaint (finding) Synonyms: Tiredness, wearness
Light sensitivity, hypersensitivity to light, intolerance to light	Light intolerance (finding) 62481005
Area of health focus: Medical	Parents: Sensory intolerance Synonyms: Intolerance to light, sensitiveness to light
Fibromyalgia, FM, Myalgia	Fibromyositis (disorder) 24693007
Area of health focus: Medical	Parent: Myositis Synonyms: Fibromyalgia, Myofascial pain syndrome
Poor balance, balance impairment, loss of balance, Unsteady	Impairment of balance (finding) 387603000
Area of health focus: Physical	Parents: Finding of balance Synonyms: Problem with balance

Figure 5 Response to the survey questionnaire in the multidisciplinary group of clinicians (%).

Figure 6 Response to the survey questionnaire from clinicians in the community (%).

Table 3 Cronbach’s alpha by the discipline of care

Discipline of care	Cronbach’s alpha
Physicians	0.69
Dietitians	0.84
Occupational therapists	0.6
Physiotherapists	0.77
Nurses	0.65
Psychologists	0.41

Table 4 Feedback from clinicians in the community

Discipline of care	Feedback
Dietician	Standardization is helpful to understand conditions like MCS; we are commencing standardization within our group
Occupational therapist	Standardization is helpful
Psychologist	Helpful to understand the condition but unable to decide about the standardization
Physician	Will standardization be restrictive in describing the condition, need to see and understand more about standardization
	Organization of the information was helpful to understand the condition
Nurse	Could understand the condition better
Physiotherapist	Unable to fully appreciate the benefits of standardization