National E-Health Transition Authority nehta HIMAA SYMPOSIUM October 2006 NEHTA Clinical...

National E-Health Transition Authority

nehta

HIMAASYMPOSIUMOctober 2006 NEHTA Clinical Terminologies and SNOMED CT Overview

Alice Livingston-Vail – Project Lead Clinical Terminology

2National E-Health Transition Authority

nehta

What is NEHTA doing?


nehta

Existing Infrastructure…. Can be limiting


nehta

Solid foundations are essential


nehta

Hospitals And Other Providers

Administrators & Funders

Researchers

Results of lab tests

Request lab tests

Health record

Event summary

Consumers

LongitudinalHealth Record

Health ITVendors

Clinicians

Systems and people in healthcare need common specifications, languages and identification to successfully communicate

NEHTA’s Mission is to Create a Platform for Reform


nehta

Shared EHR Specifications

User Authentication

NEHTA’s Work Program

Secure Messaging

Hospitals And Other Providers

Administrators & Funders

Researchers

Results of lab tests

Request lab tests

Health record

Event summary

Consumers

LongitudinalHealth Record

Health ITVendors

Supply Chain

Clinicians

Interoperability Framework

Clinical Terminologies

Medical Product Directory

Clinical Information

Individual Healthcare Identifier

Healthcare Provider Identifier

Standards Implementation

eHealth Policy Framework

Benefits Realisation


nehta

Objective:

To identify, develop and promote the adoption of optimal standards and specifications for the exchange of clinical information which will improve the quality and efficiency of healthcare.




nehta

Interchange Specifications

EHR

Event Summary

Data Group

Element

Folder

Element

Element Element

Element Element

Value Domain

Terminologies

& Codesets

Data Group

Which Clinical Information Standards?

Data Structures(Clinical Information Initiative)

Terminologies


nehta

Clinical Information Specifications - products

Data Group Specifications( information structures )

Structured Reports/Event Summaries

Interchange Specifications( implementable technical

specifications )

requirementsanalysis

medication

pathology

imaging

adversereaction

+ ... others

dischargesummary

referral

+ ... others

(prescription,med. review,pathologyresults, ...)

AS4700.6(HL7 v2)

HL7 CDA?

CEN 13606 ?

conformantsolutions

Information technical

Value DomainsTerminology


nehta

Data Group Specifications: Adverse Reaction Medication Pathology Episode Diagnostic Imaging Medical Alert Clinical Synopsis Immunisation Observation Reason for Encounter Problem/Diagnosis Clinical Intervention Person Identifiers

Status :

Released HIC 2006

Publication 2007

Publication 2007

Clinical Information Initiative


nehta

Hospital Discharge Summary

Specialist Referral

Community Referral

Status:

Publication 2006

Commencing Work

Commencing Work

Under Consideration

Under Consideration

Clinical Information Initiative

Structured Reports

Interchange Formats

Discharge/ Referral

E-Prescribing


nehta

Identifying appropriate Terminology for Data Elements within Data Group Specifications

Conducting field testing of NEHTA’s specifications using compatible e-health systems already in place, and for which significant benefits to adoption can be predicted,

Establishing processes to support feedback from, and evaluation of, field implementations of NEHTA data group specifications

Clinical Information - facilitating implementation



nehtaClinical Terminologies

Objective:

Ensuring consistency of language in Clinical communication as required to achieve semantic interoperability for critical communication




nehta


ClinicalInformation


National Approach endorsed and funded by Council of Australian Governments

NEHTA developing national capability to develop, maintain, distribute and support health terminology

Global collaboration – working to establish an International Standards Development Organisation for ongoing management and development of Health Terminology and related standards


nehta

SNOMED National License

NEHTA has negotiated National licensing arrangements for SNOMED CT: free national access available ([email protected] ) Allows vendors to begin exploring opportunities

Includes all core content, technical documentation and tool kits required for implementation

NEHTA to approve the creation and assignment of SNOMED namespaces for use in Australia

Upon termination, Australia retains perpetual rights to use the last version of SNOMED CT provided under the license


nehta

SNOMED will be supplemented by specialised ‘Domain’ terminologies, customised to meet Australian needs

These will be developed as an extension of SNOMED core

Australia will liaise internationally on approach to ensure consistency

Initial implementation may require mapping of existing term sets to SNOMED, but maintenance demands mean that ongoing mapping requirements should be minimised

Migration is the preferred strategy

Clinical Terminologies - Commissioning a national approach


nehta

Implementation paths may vary

Simplest implementation may be a pick-list

True power of terminology comes through more sophisticated use of hierarchies and relationships allowing complex queries and decision support

NEHTA will work with key stakeholders to develop a conformance framework with varying levels



nehta

NEHTA will undertake work in priority domains including: Medicines Pathology Radiology Adverse Reactions and

Allergies Devices Procedures Problems/ Diagnoses



nehta

Pathology Terminology: Under Development Review existing work in this Domain complete

SNOMED, LOINC, AustPath Mapping existing terms sets for order test names underway Planned First release:

Order test names February 2007

Radiology Terminology: Initiation Phase Strategy development and staff recruitment underway

Clinical Terminologies - Other Priority Domains


nehta

An expert reference group has been formed

The reference group has agreed upon editorial rules for the preferred term for pathology test names

Comparison of Australian pathology test names to SNOMED CT has commenced

Quality processes for development and review are being implemented

Clinical Terminologies - Pathology Domain


nehta

Medicines Terminology and Catalogue

Objective:

To provide a consistent approach to the identification and naming of medicines and devices which can support management and activity across the entire health domain


Medical Product Directory



nehta

Australian Medicines Terminology: Under Development Proof of concept: complete

demonstration tool Terminology specification complete

Draft for comment released at HIC Aug 2006 UML Model Technical Specification

First release: Limited set of codes to PBS for Pharmbiz project August 2006 All PBS products January 2007 Extend to all TGA registered medicines June 2007 High risk/ high use other TGA listed products June 2007

Medicines Terminology


nehta

Medicines Terminology- as an extension of SNOMED Currently, different identifiers for regulatory (ARTG),

prescribing, dispensing, reimbursement (PBS), procurement (GTIN)

Aim: uniquely identify medicines with common descriptors

Proof of Concept delivered

Build commenced

Technical Workshop was held 30 March 2006

Liaison with UK and US continuing – papers presented to SNOMED Working Group June 2006

Medicines Terminology – Under Development


nehta

Medicines- a key building block for e-prescribing

Federal announcement - legislation change enables e-prescribing

Medicines Data Group Specification Specification for e-scripts & dispense notifications

Medicines Terminology Product ID- both generic and brand prescribing Includes GTIN (barcode) to support Barcode dispensing PBS XML release to include map to AMT


nehta

Adverse Reactions and Allergies: Review harvested Australian termset Review SNOMED Reference set for Allergens

Devices: Viewed as an extension to Medicines Terminology

Problems, Diagnoses, Procedures: Strategy for implementation – GP sector, MBS and PBS termsets,

high frequency procedures etc.

Clinical Terminologies - Other Priority Domains Planned


nehta

Clinical Information - Issues

Governance – National and International Need for distributed contribution network – within quality control

framework Implementation –

Adoption approach – early days Need for conformance framework

Expertise – NEHTA currently recruiting staff with an interest in

terminologies


nehta


Shared EHR Specifications

Supply ChainClinical

TerminologiesMedical Product

DirectoryClinical

Information

Individual Healthcare Identifier

Healthcare Provider Identifier


Secure MessagingUser Authentication

Dr Peter Sprivulis: Modeling benefits and costs associated with the paths of

investment Benefits realisation plan


nehta

High level benefits pathFoundations

Benefits


nehta

What is the need forterminology?


nehtaThe Current Situation:Paper Records Persist


nehta

Current State of Healthcare

Patients are treated in many settings across

the continuum of healthcare

Many healthcare facilities have limitations on which aspects of information they can electronically exchange within their facility or with other facilities

Inability to access electronic patient record information is a barrier to delivering the best patient care


nehta

Types of Coding Systems

Classification systems (e.g. ICD-10-AM)

Terminologies (e.g. SNOMED CT)


nehta

ICD-10-AM Classification Systems

Groups concepts

Concepts are categorized by where they fall in the classification system

Category coding


nehta

SNOMED CT: A Standardized Clinical Terminology

Provides codes with explicit formal definitions of their meaning

Can be implemented in software applications to represent clinically relevant information


nehta

Why we need standardized terminology?

Summarizes medical information

Facilitates use of medical data Selective retrieval for aggregation and analysis (e.g. “How

many new cases of breast cancer have we seen this month?” “Is this person’s blood sugar improving?”)

Automated reasoning (i.e. clinical decision support)


nehta

SNOMED CT advantages

Information can be recorded at the appropriate level of detail

not forced to be either too general or too specific Consistency over time and across boundaries Transmission of information without loss of meaning Aggregation at more general levels, and along multiple

different perspectives Can be interpreted by automated systems


nehta

SNOMED CT Systematized Nomenclature of MedicineClinical Terms®

A comprehensive, scientifically validated terminology and infrastructure for healthcare Allows for a consistent way of indexing, storing, retrieving and aggregating clinical data across specialties and sites of care Healthcare terminology with content for a variety of clinical domains


nehta

SNOMED CTConcept

SNOMED CTConcept

Clinical FindingClinical Finding

ProcedureProcedure

Context-dependant categoriesContext-dependant categories

Observable EntityObservable Entity

Body StructureBody Structure

OrganismOrganism

SubstanceSubstance

Pharmaceutical/Biologic ProductPharmaceutical/Biologic Product

SpecimenSpecimen

Physical ObjectPhysical Object

Physical ForcePhysical Force

EventsEvents

Environment and geographical LocationEnvironment and geographical Location

Social ContextSocial Context

Staging and ScalesStaging and Scales

Linkage ConceptLinkage Concept

Qualifier ValueQualifier Value

Special ConceptSpecial Concept

Record ArtifactRecord Artifact

19 upper levels (top hierarchies)


nehta

Basic elements of SNOMED CT

Concepts – the basic unit of SNOMED CT

Hierarchies – represent concepts organized under a “root concept”

Relationships – link concepts within a hierarchy (parent-child, attribute)

Descriptions – terms or names assigned to a concept (synonyms)


nehta

What is a Concept?

“Unit of meaning”

Each SNOMED CT concept is a collection of terms and a set of relationships

SNOMED concepts are assembled in “logical definitions”


nehta

What is a Description?

Terms or names assigned to a concept

Human readable

Each concept has one:

Fully Specified Name (FSN)

Preferred Term (display term)

Many concepts have:

One or more synonyms


nehta

Concepts differ from descriptions

A single concept may have multiple descriptions

Separate concepts may share the same description E.g. “cold” is a synonym for:

Common cold Cold sensation


nehta

What are Relationships?

A relationship is an association between two concepts

Two types of relationships:

Is_a relationships: Relationships that link concepts within a hierarchy

Attribute relationships (roles): Allow links between concepts across hierarchies


nehta

Graceful evolution

Content and structure evolve as knowledge grows and as quality issues are revealed

Avoid radical change

Provide history tracking of elements


nehtaExamples of Applications Using SNOMED CT

Electronic medical records Provider order entry

e-prescribing lab order entry

Problem lists Disease templates Evidence-based practice Assessment flow sheets Nursing documentation

A&E charting

Cancer reporting

Therapeutic decision support

Genetic databases

Radiology image bank

Autopsy databases Literature encoding

Clinical research

Global benchmarking

Surgical procedure lists


nehta

Current NEHTA SNOMED CT Release: July 2006

Concepts Table

Descriptions Table

Relationship table

History table

ICD 10 mapping table


nehta


More than 300,000 active concepts organized into hierarchies

More than 770,000 active descriptions

More than 900,000 relationships

3 language editions – use of UK English edition for Australian purposes

Several cross mappings/integrations


nehta


Technical Reference Guide

Technical Implementation Guide

Developers Toolkit


nehta

Current NEHTA Recruitment Strategy

Looking for staff with an interest in the area and willing to learn

We will provide training and tools

Flexible on location

May work part time

Encourage secondment or LWOP from current positions

Please check out NEHTA website for more information about the positions: www.nehta.gov.au/


nehta

Questions?

National E-Health Transition Authority nehta HIMAA SYMPOSIUM October 2006 NEHTA Clinical...

Documents

Transcript of National E-Health Transition Authority nehta HIMAA SYMPOSIUM October 2006 NEHTA Clinical...