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The Challenge and SNOMED CT

The Challenge and SNOMED CT. Karen Gibson. The Challenge. Significant investment in eHealth is underway Clinical records: Not only a record for the author Essential to inform the next person in the care team Clinical safety risks of poor quality, ambiguous communication Desire to:

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The Challenge and SNOMED CT

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  1. The Challenge and SNOMED CT Karen Gibson

  2. The Challenge Significant investment in eHealth is underway Clinical records: Not only a record for the author Essential to inform the next person in the care team Clinical safety risks of poor quality, ambiguous communication Desire to: make systems more interoperable improve data quality improve ability to re-use information for reporting, management etc.

  3. Clinical Terminology is complex Humans spend 4-10 years learning medical terminology at University! We need to make their language computable No silver bullets

  4. Clinicians say things in many different ways Sometimes legibly Often in shorthand • Terminology needs to maintain fidelity of information – be true to what clinician is trying to say

  5. EHR’s need to source information from many different systems Legacy systems with legacy data Legacy terms and ways of coding (if coded at all) How do we begin to bring this together? And do so in a way which ensures stakeholders can be confident that the information is accurate and capable of being aggregated and reused.

  6. What is the answer? SNOMED CT Most comprehensive clinical terminology available ~ 350,000 concepts ~ 1,000,000 terms Purchased and maintained by a group of collaborating nations for use in their eHealth initiatives (IHTSDO) Only part of the answer: Supplemented by other terminologies – eg. medicines and administrative Knowledge of the information model (context) Other emerging technologies (eg. NLP)

  7. What is the problem? SNOMED CT Complexity ~ 350,000 concepts ~ 1,000,000 terms Only part of the problem Lack of implementation knowledge Lack of tools to assist Lack of funding to meet costs of implementation ? Lack of will

  8. Some problems have been addressed IHTSDO has addressed (or is working to address): International Governance Open Standard Intellectual Property Quality ? Mapping to other standard terminologies/ classifications Others are being tackled by NEHTA: Cost – free to use in Australia (as member of IHTSDO) ‘Australianisation’ National reference sets Medicines component

  9. Key principles/ Traps for new players Do look to SNOMED CT-AU first It is endorsed by COAG It is the most comprehensive clinical terminology available It is supported by NEHTA and IHTSDO

  10. SNOMED CT-AU • A concept and its descriptions SCTID: 22298006 Fully Specified Name Myocardial infarction (disorder) SCTID: 751689013 Myocardial infarction Preferred term Myocardial infarction SCTID: 37436014 SynonymMI - Myocardial infarction SCTID: 1784872019 SynonymInfarction of heart SCTID: 37441018 SynonymCardiac infarction SCTID: 37442013 SynonymHeart attack SCTID: 37443015

  11. Relationships • Links concepts within SNOMED CT • Ensures unambiguous meaning • Create hierarchies which aid navigation and retrieval Structural disorder of heart Injury of anatomical site Myocardial disease SCTID: 128599005 SCTID: 123397009 SCTID: 57809008 Is a Is a Is a Myocardium structure Myocardial infarction Infarct Associated morphology Finding site SCTID: 55641003 SCTID: 74281007 SCTID: 22298006

  12. Key principles/ Traps for new players Consider the user interface carefully: Don’t show Fully Specified Names to users They’re intended to provide a unambiguous reference point for computability They are not worded in a way clinicians speak Do choose a preferred term

  13. Unambiguous Reference Point Fully specified name • Semantic tag: • indicates hierarchy • not needed at clinical level Amebic appendicitis (disorder) US Spelling Preferred term (Australia) Amoebic appendicitis

  14. Key principles/ Traps for new players Consider the user interface carefully: Don’t show all of SNOMED CT in a drop down list (too many terms!) Unless you have tools to assist searching Do use Reference sets to assist implementation: Reduce the complexity for the user Speed identification of the correct term

  15. Problem/diagnosis : Select term SNOMED CT in Drop down list without any parameters implemented

  16. Problem/diagnosis : Appendi Improved searching – limited to clinical finding hierarchy Could be further improved through Refset development

  17. Key principles/ Traps for new players Reference sets Do require maintenance Therefore: Douse NEHTA reference sets wherever possible (because NEHTA maintain them!) Douse the hierarchies of SNOMED CT to guide creation of RefSets wherever possible Recognise that if you pick ad hoc terms across hierarchies you will need to manually maintain the list Sometimes there is no choice – eg. allergies – but there is a cost

  18. Key principles/ Traps for new players Minimise mapping and data translation: There is a safety risk introduced every time the clinician’s language is translated (Chinese whispers…) If you do need to map or translate: Do keep the original wording/ data entry as well as the mapped equivalent

  19. Key principles/ Traps for new players Trap for new players: Synonyms may be found in the wrong hierarchy (different meaning) This is why when translating SNOMED CT translators look at the words within the hierarchy to establish true meaning However, this trap is not just for translators, but also when mapping or creating reference sets.

  20. Is it worth the effort? Even simple use of SNOMED as a flat code list can add value: Allows meaningful exchange of data Both end-points can cross-reference to a standard unambiguous definition Simple decision support can be enabled For example – US Centre for Disease Control, HITSP and NHS all publish simple lists

  21. Is it worth the effort? But for those up to the challenge, more advanced use of SNOMED CT offers further potential value

  22. Is it worth the effort? Ability to Exchange data knowing it can be explicitly and accurately interpreted Ability to improve data quality: More structured data entry Agreed constraints can be applied

  23. Is it worth the effort? Ability to run externally developed queries: For example: Automatically run mandatory reporting Identify at-risk populations Identify cohorts for clinical trials Trigger presentation of evidence based guidelines when first released Note Kaiser Permanente have a central area which develop queries/ scripts which are then distributed throughout the organisation

  24. Is it worth the effort? Ability to utilise external decision support engines: Already happening in medicines area Opportunity for improved decision support applications in other areas Ability to contribute to PCEHR

  25. Is it worth the effort? Ultimate aim is improving health outcomes and patient safety: Through better sharing information Ensuring accuracy of information Identifying those at risk

  26. Clinical Terminology is essential Perhaps speaking to the converted, but unless we can agree and implement consistent terminology we will never achieve the goal of better information sharing…. We’ll just be sharing data….

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