Terminologies How do they impact my world Heather

Terminologies How do they impact my world? Heather Grain heather@lginformatics. com Presented at HIMAA Symposium 2008

Feeling Lost? Photo: Heather Grain

There is light! • Why does terminology matter? • What is terminology? • How does it impact your world • Views through the window (threat or opportunity). Photo: Heather Grain

Why Terminology? Grain, H. , Clinical Terminology and Why and the What, in Health Informatics an Overview, E. Hovenga, S. Garde, and C. Hullin, Editors. 2008, Churchill Livingstone: South Melbourne

What you can’t do without Terminology • Clinical decision support • Clinical pathways • Multi-axial retrieval of clinical information

What is a Terminology • Structured collection of descriptive terms used in clinical practice • Precise – no ‘other’ or ‘unknown’ • Uses Description Logic to describe a concept in a manner the computer can ‘understand’ and use to support retrieval

A SNOMED-CT concept is defined Concept ID: 21522001 Description: 38112013 Abdominal Pain Fully defined as: Is A General finding of the abdomen (119415007) Pain of truncal structure (454497018) Finding Site( abdominal structure(113345001)

Multiple access hierarchies Grain, H. , Clinical Terminology and Why and the What, in Health Informatics an Overview, E. Hovenga, S. Garde, and C. Hullin, Editors. 2008, Churchill Livingstone: South Melbourne

Terminology supports Retrieval of clinical data based upon context and clinical knowledge find me all cases of PAIN (ALL CHILDREN OF PAIN IN THE FINDING HIERARCHY) – includes headache Allows clarity of meaning over time, distance and discipline concept: 21522001 Description: 38112013 Abdominal Pain (finding) Described using SNOMED-CT V 2008/1 in field: Triage Assessment assessed by: 234 N Mary Smith

Terminology supports Fully defined unambiguous description of an individual concept in a logical, machine processable way. Allows construction of concepts (post-coordination) # humerus + Right(laterality) + mid shaft(body structure) And pre-constructed concepts (pre-coordination) # humerus (fracture + body structure) International

How does this impact your world! • SNOMED-CT has a different job to ICD-10 -AM • They are in the same family and work to support some similar tasks. • Will coding continue – there is likely to be a need for a classification that aggregates data for reporting and analysis into the future. • Will this be ICD-10 -AM Yes – though ICD 11 may have a terminological basis that more closely aligns with SNOMED-CT

However! • There is a move to invest in the use of data and to reduce the costs of data collection. • This means…. ▫ Automation of coding at discharge can be achieved for many common processes and is likely to occur sooner rather than later (it is seen, in part at least, as a deliverable of SNOMED-CT and mapping to ICD-10 -AM) ▫ Greater need for those who can extract and analyse clinical data

National Developments • Reference Sets: Select appropriate terms (SNOMED-CT Concepts) for use in specific situations – test ordering, medications, alerts • International participation in IHTSDO – International Health Terminology Standards Development Organisation as a founding member ▫ Sharing the load and the learning ▫ Building focused capacity

Views of the world • It’s not going to happen for years! ▫ Don’t wait or expect a big bang – it’s already happening you just can’t see it yet! • Options (the green house effect) ▫ Buy a bigger car (ignore it – ICD-10 is God) ▫ Invest in solar power production (get on board and try and influence the result and benefit from it) ▫ Wait and see – aware, learning, but waiting to

Which are you? • Leader • Follower • Extinct!