Transcript Where do we need standards?

Veterinary Informatics Standards
Development and Harmonization
AVMA Stakeholders Meeting
July, 2002
Nashville, TN
Where do we need standards?
Generally…
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Communication between computer systems
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Laboratory-to-clinic data transmission
Laboratory-to-government agency, clinic-to-government
agency
Central data repositories (all kinds)
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Cancer registries
Eye-disease registries
Electronic health certificates
Portable electronic medical records
“You talk - it types” medical record keeping
Where do we need standards?
Specifically…
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When we need to transmit or receive the correct
meaning of a concept.
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“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”
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SNOMED history / future
1965
2000
Reduce storage size
Reduce Storage size
No longer relevant
Categorize
information
Multiple code-based
hierarchies
Poly-hierarchical
categorization
Pathology content
“All Medicine”
Veterinary content
separate, then
integrated
Integrated content
“Computability” for
retrieval.
Natural language,
artificial intelligence,
decision support
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%)
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SNOMED hopes to establish a governmentfunded national license. Not clear if veterinary
medicine will share in this support.
What standards are incomplete,
underutilized or missing?
Vocabulary
Laboratory tests
 Disorders / findings
 Procedures
 Anatomy, organisms, substances, etc.
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Data structure
Messaging
Veterinary standards?
Practice System A
Reference
Lab A
Reference
Lab B
Practice System B
Regulatory Regulatory
Agency A Agency B
Registry
A
Registry
B
Without standards: 13 vocabulary technologies, 13 transmission formats
With standards: 2 vocabulary technologies, 1 transmission format
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.
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Reduce total cost of standards development.
Facilitate outcomes assessment,
epidemiology, disease surveillance, etc.
Effects of global veterinary
standards?
Increased cost to system developers
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Adhering to a global standard
Increased costs of cooperation?
Perceived loss of control, loss of specificity
Complaints about global
standards
It’s too…
Big
 Complicated
 Expensive
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Is this work “expensive?”
Yes, but…
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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
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Is this work “expensive?”
IF the long-range goal is useful…
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Costs shift from individual organizations that would
build “mini” standards to a central organization.
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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.
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The cost of standards development may be somewhat higher to
the profession as a whole.
Is this work “expensive?”
IF the long-range goal is useful…
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The selected standards adhere to design
specifications that have developed through hard
experience in the medical profession.
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Essential / desirable features have been documented.
The selected standards represent extraordinary
functionality, produced and maintained at great
cost to the medical profession.
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We can leverage these standards for 10¢ / $1.00
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
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Equine medical record
Equine Breeds
Equine lab tests
All applicable disorders, findings,
procedures
Message structures
lab to clinic
 clinic to lab
 clinic to clinic
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Subsets of standards
Equine Reportable
Equine disorders
Equine practice
SNOMED-CT, HL-7,
LOINC
Mixed practice
Disease reporting system
LOINC1
SNOMED1
HL72
1 = three independent subsets
2 = one subset of necessary messages
Rabies
WNV
FMD
AVMA-adopted standards
HL-7
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Messaging and medical record infrastructure
LOINC
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Lab test vocabulary
SNOMED
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General medical vocabulary
Questions for audience
discussion:
Are veterinary-wide information
standards worth pursuing?
What’s the appropriate time-frame?
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.
What has been accomplished so
far?
LOINC
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Extensive list of veterinary-specific concepts are
present in the nomenclature.
HL7
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Standard now recognizes animals, animal identification,
animal groupings, owners, etc.
SNOMED
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Considerable veterinary content is present.
Mechanisms for improving the functionality of
veterinary anatomy.
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.
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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.
Investment
Manual
Semi-Automatic
Intuitive
Functionality
Staying current
Current funding / costs…
SNOMED
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½ time veterinarian
½ time full professor
Travel to 7 - 8 working meetings per year
LOINC
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1/6 time full professor
Travel to 3 meetings per year
HL-7
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1/6 time full professor
Travel to 6 meetings per year
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.
Current funding…
Nominal
NOT
Optimal
What does AVMA offer?
Technical expertise…
Infrastructure providing connection to users,
vendors, etc.
Established relationships with standards
organizations…
Past and ongoing investment…
What does your group have to offer?
A market…
Content expertise…
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Presence
Definition
Subsetting expertise…
Financial support…
Willingness to understand…
Contacts with foundations, granting agencies, etc.
Subject-specific grant writing expertise.
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.
Veterinary Information Standards
Development Institute (VISDI)
Resources:
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Human
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Technical
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Board of Directors (drawn from “membership”)
Case & Wilcke
Veterinarians
Computer systems support personnel
Business staff
Computer (hardware, database, communications and internet
services)
Office
Veterinary Information Standards
Development Institute (VISDI)
Membership
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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