nationwide management of laboratory information with the npu terminology
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Nationwide management of laboratory information with the NPU terminology. Ulla Magdal, MI National Board of Health, Denmark. What the NPU terminology is. Coding system for identification of medical laboratory results Developed jointly by IFCC and IUPAC via the - PowerPoint PPT PresentationTRANSCRIPT
Nationwide management of laboratory information with the NPU terminology
Ulla Magdal, MINational Board of Health, Denmark
What the NPU terminology is
Coding system for identification of medical laboratory results
Developed jointly by IFCC and IUPAC via the (Sub)Committee on Nomenclature for Properties and Units
IFCC – International Federation of Clinical Chemistry and Laboratory Medicine
IUPAC - International Union of Pure and Applied Chemistry
In nationwide use in Denmark and Sweden
Who I am and what I do
Manager of the Danish version of the NPU terminology for the Board of Health
Titular member for IFCC of the international ’NPU committee’
Laboratory technologist – clinical biochemistry
Degree in Health Informatics
Work on laboratory informatics concept analysis translation of SNOMED CT
Ulla Magdal Petersen
Denmark
Why a terminology for laboratory results?
ensure that examination results are fully defined in the clinical context transferable between systems comparable to others of same kind reuseable – for decision support, calculations,
research, statistics
For this you need (common IDs) clear and stable definitions of result types
Describe the property examined
Use structured definitions - describing what part of the universe you are observing what component you observe in that part what property of that component you estimate
(add SI unit and more detail where relevant)
Use standard scientific concepts and terms
Patient—Body; mass = ? kilogramBlood—Erythrocytes; volume fraction = ?
Blood—Hemoglobin(Fe); substance concentration = ? millimole per litre
Translation of structured NPU definitions
Keep the structure as a carrier of meaning Translate each term of the definition Assume that the translated definition describes the same concept
NPU03431
Urine—Sodium ion; substance concentration = ? millimole per litre
Urine—Ion sodium; concentration en matière = ? millimole/litre
Urin—Natrium-ion; stofkoncentration = ? millimol per liter
Systemterm
Componentterm
Kind of propertyterm
Unitterm
Systemterm
Componentterm
Kind of propertyterm
Unitterm
Health care in Denmark
The National Health Service serves all 5,5 mill. citizens
27 hospitals owned by 5 Regions (no major private hospitals)
15 600 hospital beds 3600 general
practitioners have 90% of all patient contacts
GPs are largely publicly funded
NPU in Denmark
1998 – 2001 Danish Board of Health supports development of the NPU coding system and of its Danish version
2001 NPU coding system recommended for national use in Denmark. Most biochemistry labs implement it
2003 Biochemistry labs with EDI - 95 % NPU coded 2006 20 million NPU coded results from labs to GPs 2007 Web applications for GPs to order and access results
from labs nationwide – NPU is main coding system 2009 NPU use slowly spreading into immunology,
microbiology and genetics. A few local and proprietary coding systems remain in use
The Danish NPU Release Center
2 specialists (with a laboratory and informatics background) translate the NPU terminology into Danish manage and publish the Danish NPU version via a
national website publish a Users’ Guide support and advise users (laboratories and system
developers) manage a (small) non-standard extension for specific
Danish use analyse ’coding needs’ of Danish users for
communication to the international NPU committee
EHR in Danish health care 2009
About 35% of hospital beds are served by Electronic Health Records (EHR), usually combined with direct access to local lab systems (LIS)
All general practitioners use EHR - about 20 different systems!
All GP’s receive laboratory data messages directly into the EHR
MedCom - the Danish Health Data Network
Co-operative venture between authorities, organisations and private firms linked to the Danish healthcare sector
Nationwide transmission of messages between GPs and hospitals and health authorities
discharge reports referrals laboratory requests laboratory reports drug prescriptions reimbursement
www.medcom.dk
Messages to/from GPs (1992 – 2008)
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
1000000
1100000
1200000
1300000
1400000
1500000
92 93 94 95 96 97 98 99 20 O1 O2 O3 O4 O5 O6 O7 O8
MedCom -The Danish Health Data NetworkMessages/Month Prescriptions
1039105 = 73%Prescriptions1389023 = 84%
Disch. Letters 682923 = 85 %Disch. Letters 1131750 = 94 %
Lab. reports543040 = 82 %Lab. reports988151 = 99 %
ReferralsReferrals177525 = 65 %ReferralsReferrals
Reimbursement
21049 = 99 %
Lab Requests349840 = 85 %
Source: www.medcom.dk July 2009
Web based ordering of laboratory tests
on-line laboratory requesting from GP to laboratory of choice
Web based access to laboratory information
GP may search for laboratories that hold recent results for a certain patient
look up the results right away
- dependant on proper permissions, secure software and digital signature!
It was not that easy – some challenges
Conceptual - a new medical language using standard terminology and SI units naming the information produced, not the process describing properties of the patient, not of the sample
Technical long names vs. screen sizes and field lengths primitive information models
Organizational and cultural distrust of ’codes and numbers’ in parts of the medical
environment it-setback caused by a total makeover of public
administration in 2007
Tradition for naming results ’by process’
50 years ago Red cell microscopywas a good name for
Blood—Erythrocytes, number concentration– but the process has changed
Definitions by ’patient property estimated’ last longer And are clinically more relevant
But they make unwieldy names, especially on screens Local names and and abbreviations are often used NPU information can be available ’behind the screen’
Tradition for naming results ’by process’
50 years ago Red cell microscopywas a good name for
– but the process has changed
Definitions by ’patient property estimated’ last longer And are clinically more relevant
But they make unwieldy names, especially on screens Local names and and abbreviations are often used NPU information can be available ’behind the screen’
NPU01960 Blood—Erythrocytes; number concentration
1012/litre
Complexity of lab data is underestimated
Clinical, administrative and technical data often needed Not ’slots’ in systems or messages There is always a ’test code’ slot But there are no NPU definitions with ’extra info’
Local ’test codes’ replace NPU codes in order to convey e.g.: New, more sensitive method POCT result Patient is in pregnancy care program Bill the sports clinic for this
The information models need revision If you only have a hammer, all your
problems must be nails
Harmonization is a long process
The Danish release center does almost all the initial coding work for ’first
time’ laboratories publishes a national ’User’s Guide’ sends out a monthly NPU newsletter regularly offers all regions to send in their coding
tables for checking and updating helps create Danish ’shortcut names’ for use in
EHR result overviews
Visible gains
Reusable information in EHRs calculation of clinical indexes graphical representation of results
Security when transmitting lab results nationwide result values end up in the right row every time
A national reference laboratories gradually achieve a common language NPU codes are used in laboratory documentation, e.g. in
certification or accreditation processes
6
6,5
7
7,5
8
8,5
9
1 2 3 4 5 6 7
Serie1
Useful links
Short description of the terminology - with links http://www.sst.dk/English/NPULaboratoryTerminology.aspx
Latest version of the NPU terminology for download(abbreviated definitions, .csv files)http://www.labterm.dk/Enterprise%20Portal/NPU_download.aspx
All the background litteraturehttp://old.iupac.org/divisions/VII/labinfo/English/IFCC_Documents.html
Please ask questions