On “Toward a rehabilitation treatment taxonomy: summary of work in progress.” Dijkers MP, Ferraro MK, Hart T, et al. Phys Ther. 2014;94:319–321.

I enjoyed the March 2014 article by Dijkers and colleagues¹ and the invited commentaries,^2–5 which point to some of the history, challenges, and ramifications of this much needed taxonomy. Its establishment and utilization are critically necessary, not just for treatment but also for evaluation and outcomes terminology and classification.⁶ Our research and health policy administration communities are up against this challenge on an intimate basis. Additionally, articles such as this may help our physical therapy clinician community connect with the foundational importance of a taxonomy for our ability to participate in and adapt to a changing health care environment. I highly appreciate that both the research and health policy administration perspectives were well communicated in the article and in White's invited commentary,⁵ as I believe her perspective summarizes well such concerns.

In her commentary, White stated: “The lack of specificity of treatment descriptions in research studies makes it difficult to conduct comparative effectiveness studies to determine whether certain treatments are more or less effective than surgery, medication, or other more costly or invasive interventions,”^5(p327) and “Decisions are made about the total costs, number of hours, days, or sessions of therapy that will be approved for payment but rarely about the type of treatment or its specific purpose. Knowledge about the intent and mechanism of action of interventions could help payers and policy makers understand which interventions are of high value for specific patient conditions and subsequently lead to better decision making regarding payment.”^5(p327) These are very important perspectives for our physical therapist community to understand and rally around.

What comes to mind is an additional perspective related to a taxonomy and to a strong determinant of our role in patient care as we move through the current health care revolution. Decisions are being made by payers and health care organizations the same way that decisions have been made in other industries for many years, based upon analytics. Information is required to move toward bundled payments and more effective, patient-centered models such as accountable care organizations. In the absence of research to directly answer organizational questions and challenges around value, available data are utilized. It typically involves a combination of utilization data (eg, billing, hours worked) and clinical data (eg, outcomes, treatment provided, timing and priority of care such as medications, radiology, surgery) for all pertinent providers of care for patients in a given diagnostic category. To achieve this information exchange, electronic data are extracted, conformed, aggregated, and loaded into a reporting application (ETL [extract, transform, load]). A taxonomy for rehabilitation care (evaluation, treatment, outcomes) is the first step toward having information to share in this process. The second step is the conversion from an “on paper” taxonomy to a formal electronic vocabulary, such as in SNOMEDCT or LOINC. Without these steps, physical therapy data in the ETL process and at a higher level in the health information exchange (HIE) are not available, not well described, or not standardized. I commend the American Physical Therapy Association in its diligent work to address these new frontiers through a registry, and there is just enough standardized outcomes information for it to reach its goals. However, there is a great lack of specificity and, in some cases, no information at all in the analytical process that is often the primary determinant in ultimate organizational and payer decision making affecting most of our physical therapist practitioners.

In looking for solutions to this challenge, we find that there are lessons to be learned from the nursing, physician, pharmacy, and lab professions, who are at least 20 years ahead of us. As a profession, there is an urgent need for a coordinated pathway and for physical therapist “boots on the ground” to advance a full taxonomy and then to convert it to an electronic format for vocabulary and transport as quickly and thoughtfully as possible.

• © 2014 American Physical Therapy Association