Transcript Implementing a Clinical Terminology

Implementing a Clinical Terminology
David Crook
Subset Development Project Manager
SNOMED in Structured electronic Records Programme
NHS Connecting for Health
Content
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What is a clinical terminology?
What are we implementing?
Make the terminology usable
The terminology does not sit alone.
What is a Clinical Terminology?
• A structured collection of descriptive terms for
use in clinical practice.
• Allows consistent use, communication and
analysis of clinical data.
• SNOMED CT adopted in England and will
replace or subsume existing code systems.
What Are We Implementing?
What are we implementing?
• The terminology?
• A clinical system?
or
SUPPORT FOR HEALTHCARE PROCESSES
Why change?
• Changing a process has costs
• There must be benefit
• The benefits must be relevant to
clinicians.
What are the potential benefits?
• Unambiguous communication/interoperability
• Clinical process support
- Care pathways
- Decision support
• Analysis
- Evidence based practice & clinical audit
- Research
- Planning
Focus on the benefits
• Where in the clinical process will the benefits accrue?
• What benefits can the system support?
• How do you get clinical buy in?
- Involve clinicians in the design
- Communicate the potential and let clinicians
identify and own the benefits
Make The System Usable
Coverage
SNOMED CT coverage:
• Over 350 000 individual healthcare concepts
• Ability to combine concepts (post-coordinate)
• Mayo Clinic:
- 5000 most common terms (95% of all terms used)
- >50% represented without post-coordination
- >90% represented with post-coordination
Remove the “clutter”
• Subsets or rules:
- May only require a small set - the rest irrelevant
- Easier to find if irrelevant terms filtered out
• User interface design:
- Form design e.g. embedded check boxes and drop
down lists
- Free text parsing
Form design
Diabetic assessment
Ulcer details
Location
left ankle
right ankle
left foot
right foot
SNOMED coding in the background
| diabetic skin ulcer | :
363698007 | finding site | = 418380001 | skin structure of
medial malleolus | :
272741003 | laterality | = 7771000 | left |
422183001
Free text parsing
Analysis
• A terminology offers more detail. e.g. hip prosthesis
audit:
- Now - use OPCS to pick notes for hip replacement.
- Clinical terminology - identify specific prosthesis
and assess outcomes
• Skills required enhanced:
- Now - OPCS knowledge and skill in analysing
notes.
- Clinical terminology - also need terminology and
more IT analytical skills
The Terminology Does Not
Sit Alone
The whole picture
• Not just the terminology.
• Meaning can reside in:
- User interface
- Record architectures
- Messages
• Supporting interoperability relies on the ability to
generate and transform messages.
Clinical scenario
• Hospital doctor records adverse reaction to new drug
• Information included in discharge summary sent via
spine to GP
• Information is integrated to the GP system
• Audit proves drug is dangerous and it is withdrawn
• Alert triggered when GP subsequently prescribes a
related drug to that patient
Interoperability
• Hospital doctor records adverse reaction to new drug
- User interface and data storage
• Information sent via spine to GP
- Entry and storage consistent with message structure
• Information is integrated to the GP system
- GP system able to transform, store and represent
information without loss of semantics
Analysis and decision support
• Analysis proves the drug is dangerous and it is
withdrawn:
- Understand context
- Ability to query and aggregate data
• Alert triggered when GP subsequently prescribes a
related drug
- Manage context
- Rules for dealing with retired drugs
- Ability to manage drug categories
Summary
• A clinical terminology is implemented to support
healthcare processes
• Implementation has both technical and cultural
aspects
• Understanding how the terminology fits into the
technical infrastructure is essential to ensure
information is meaningful and interoperable.
• Successful implementation depends on clinical
ownership of the benefits