Veterinary Informatics Standards Development and Harmonization

1. Veterinary Informatics Standards Development and Harmonization AVMA Stakeholders Meeting July, 2002 Nashville, TN

2. Where do we need standards? • Generally… • Communication between computer systems • Laboratory-to-clinic data transmission • Laboratory-to-government agency, clinic-to-government agency • Central data repositories (all kinds) • Cancer registries • Eye-disease registries • Electronic health certificates • Portable electronic medical records • “You talk - it types” medical record keeping

3. Where do we need standards? • Specifically… • When we need to transmit or receive the correct meaning of a concept. • “Test for Equine Infectious Anemia” – which one? • When we need to transmit the specific “context” of a concept (Von Willebrand’s Disease). • This dog has “VWD” • This dog’s littermate has “VWD” • Dog has family history of “VWD”

4. SNOMED history / future SNOMED III SNOMED RT SNOMED CT SNOP SNOMED SNOVET 1965 2000

5. Funding models • LOINC – NIH Grant from inception • HL7 – Membership (dues) from 2200+ medical records vendors, hospitals, medical device suppliers, government organizations • SNOMED – College of American Pathologists (99%), AVMA (1%) • SNOMED hopes to establish a government-funded national license. Not clear if veterinary medicine will share in this support.

6. What standards are incomplete, underutilized or missing? • Vocabulary • Laboratory tests • Disorders / findings • Procedures • Anatomy, organisms, substances, etc. • Data structure • Messaging

7. Practice System A Practice System B Reference Lab A Reference Lab B Regulatory Agency A Regulatory Agency B Registry A Registry B Veterinary standards? Without standards: 13 vocabulary technologies, 13 transmission formats With standards: 2 vocabulary technologies, 1 transmission format

8. Effects of “global” veterinary standards? • Reduce cost to system developers • IF amortized across multiple projects • Learn, manage, deploy a single technology for each major standards component. • Reduce total cost of standards development. • Facilitate outcomes assessment, epidemiology, disease surveillance, etc.

9. Effects of global veterinary standards? • Increased cost to system developers • Adhering to a global standard • Increased costs of cooperation? • Perceived loss of control, loss of specificity

10. Complaints about global standards • It’s too… • Big • Complicated • Expensive

11. Is this work “expensive?” • Yes, but… • We are currently losing opportunities: • Early discovery of new diseases • Critical evaluation of outcomes of therapy, surgery • Early alerts of disease outbreaks (reportable, foreign) • Ability to analyze and forecast trends

12. Is this work “expensive?” • IF the long-range goal is useful… • Costs shift from individual organizations that would build “mini” standards to a central organization. • There may be cost savings to the profession as a whole. • The selected standards are more complex, complete and (we believe) more functional than those likely to be undertaken by individual organizations. • The cost of standards development may be somewhat higher to the profession as a whole.

13. Is this work “expensive?” • IF the long-range goal is useful… • The selected standards adhere to design specifications that have developed through hard experience in the medical profession. • Essential / desirable features have been documented. • The selected standards represent extraordinary functionality, produced and maintained at great cost to the medical profession. • We can leverage these standards for 10¢ / $1.00

14. Equine reportable disease system. • Equine breeds • Equine “occupations” • Brief list of reportable diseases • Lab tests that support disease list • Message structures • clinic to regulatory authority • Lab to regulatory authority

15. Equine medical record • Equine Breeds • Equine lab tests • All applicable disorders, findings, procedures • Message structures • lab to clinic • clinic to lab • clinic to clinic

16. Equine Reportable Equine disorders Equine practice Mixed practice Subsets of standards SNOMED-CT, HL-7, LOINC

17. Disease reporting system LOINC1 SNOMED1 HL72 Rabies WNV FMD 1 = three independent subsets 2 = one subset of necessary messages

18. AVMA-adopted standards • HL-7 • Messaging and medical record infrastructure • LOINC • Lab test vocabulary • SNOMED • General medical vocabulary

19. Questions for audience discussion: Are veterinary-wide information standards worth pursuing? What’s the appropriate time-frame?

20. What has been accomplished so far? • All three standards are (literally) open and committed to veterinary inclusion. • All three standards publicly recognize veterinary commitment and expertise.

21. What has been accomplished so far? • LOINC • Extensive list of veterinary-specific concepts are present in the nomenclature. • HL7 • Standard now recognizes animals, animal identification, animal groupings, owners, etc. • SNOMED • Considerable veterinary content is present. • Mechanisms for improving the functionality of veterinary anatomy.

22. Can standards be implemented now? • Yes, but NOTHING about standards is, currently, “off the shelf.” • LOINC – yes, veterinary labs can manage their test lists in LOINC (with an investment in mapping). • HL7 – yes, although specific veterinary messages definitions must be derived… • SNOMED – yes but capturing the medical information currently requires considerable manual labor.

23. What has to be done to make standards “practical” • LOINC – consensus and mapping by labs, distribution to computer system vendors. • HL7 – develop a library of messages, maintain work-group to continue development. • SNOMED – make anatomy functional, make species functional, develop subsets for all conceivable purposes in a medical record system.

25. Current funding / costs… • SNOMED • ½ time veterinarian • ½ time full professor • Travel to 7 - 8 working meetings per year • LOINC • 1/6 time full professor • Travel to 3 meetings per year • HL-7 • 1/6 time full professor • Travel to 6 meetings per year

26. Current funding / costs… • SNOMED - $100,000+ per year • LOINC – $30,000 per year • HL-7 - $30,000 per year • AVMA covers 40% • UC Davis and Virginia-Tech currently cover almost 60%. • VMDB provided start-up funding for standards selection, development. Continues to support veterinary health information managers at veterinary schools.

27. Current funding… Nominal NOT Optimal

28. What does AVMA offer? • Technical expertise… • Infrastructure providing connection to users, vendors, etc. • Established relationships with standards organizations… • Past and ongoing investment…

29. What does your group have to offer? • A market… • Content expertise… • Presence • Definition • Subsetting expertise… • Financial support… • Willingness to understand… • Contacts with foundations, granting agencies, etc. • Subject-specific grant writing expertise.

30. Veterinary Information Standards Development Institute (VISDI) • Purpose: provide infrastructure and expertise necessary to develop and deploy veterinary information standards. • Approach: membership-based as an initial funding mechanism. • Activities: standards liaison, standards development, project consultation, subsetting and mapping services.

31. Veterinary Information Standards Development Institute (VISDI) • Resources: • Human • Board of Directors (drawn from “membership”) • Case & Wilcke • Veterinarians • Computer systems support personnel • Business staff • Technical • Computer (hardware, database, communications and internet services) • Office

32. Veterinary Information Standards Development Institute (VISDI) • Membership • ABVS Colleges (ACVO, ACVIM, ACVS, etc.) • Professional organizations (AVMA, AAEP, AAHA, AASP, etc.) • Data Repositories (VMDB, etc.) • Government Organizations • Veterinary Schools / Teaching hospitals • Medical records vendors • Private practices