snomed-ct implementation issues and opportunities heather grain [email protected] presented...
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SNOMED-CT Implementation issues
and opportunities
Heather [email protected]
Presented at HIMAA Symposium 2008
Implementation means•Coding in the clinical world•Options
▫Give the clinician a list (sometimes a really big list) to choose from…..
▫Develop other mechanisms
Photo Coppyright Steffen Foerster
Trail of natural language AND ICD-10-AM coding automation in Emergency
Issues to conquer first
Language of the Language
•We don’t all describe the concepts of terminology the say way........
•Work at ISO on an International Glossary being established to clarify meaning. Internet based tool
•Available openly in 2009 (Australian Leader of international activity)
Mapping is…..
Creation of a relationship between the code or term used to represent a health concept in one system and the code or term that would be used to represent the same concept in another coding or terminological system
ABC = XYZAS5021-2005
Mapping – does and doesn’tTerm SNOMED-CT ICD-10-AM
ProblemUrinary Tract Infection
25374005 – Urinary Tract Infection (disorder)
O03.3 with obstetric spontaneous abortionO86.2 Urinary tract infection following deliveryN39.0 – Urinary Tract Infection, site not specifiedAdditional logic is required to determine which code is appropriate.There are also rules in the coding standards that indicate:“do not code the following:N39.0 Urinary tract infection, site not specified, when only microbiology results show organism(s) have been cultured ”.
Mapping – does and doesn’tTerm SNOMED-CT ICD-10-AM
Patient had heart attack during laparoscopic appendicectomy, surgery not completed.
51316009- Laparoscopic appendectomy385660001 - Not done 57054005 - AMI74477009 – exploratory laparotomy
30373-00 – Exploratory Laparotomy
Reference Sets for implementation•Select appropriate terms for use in
specific situations•Lists can be short or long
▫ Can include hierarchy (children) information
▫ Can ensure correct part of the hierarchy is being used
▫ Restricts and guides entry
What we have•Access capacity (ability to access
codes/terms – terminology servers or engines)
•Ability to represent concepts (SNOMED-CT)
•Clinically acceptable mechanism for data capture
•Recognition of context in the use of terminologies
What we don’t have
Austin investigation - Triage text•What is in text•54,543 cases from 12 months at Austin
Emergency•9525 different textual descriptions (82%
common)•Context informs the intended meaning....
▫PALP + CP - palpitations and chest pain
Content of the text• 21% have additional qualifiers that indicate
additional information about the concept▫? # 3RD DIGT L
• 15% of entries had additional specific laterality▫e.g. R Groin pain
• 12% of entries had more than one concept ▫e.g. foot inj.fever
• 5% have other information such as causes of injuries, finding sites.▫e.g. fall head inj
• 90% use short forms or have spelling challenges.▫e.g. bowel obstr ▫ > 32 different spellings of .......
Objectives of test
•Identify capacity to process text to SNOMED
•Identify ability to convert to ICD-10 for reporting purposes (avoiding clinical input entirely) - achieved
Testing Results• Coded manually in SNOMED-CT and
confirmed by clinical staff in emergency• Batch processed identifying variations from
expected SNOMED-CT returned.• Established quality measure
5th test achieved95% = 100% confidence2% = 90% confidence3% = 80% confidence – require user
confirmation(17 cases) 0% e.g.: ? gib
Queries to SNOMED – sent to NEHTA e.g.: ? DRINK SPIKE
Sample of result
Next steps
•Trial in clinical environment•Trial to inform clinical pathways and risk
assessment•Returning SNOMED-CT into different
fields (concepts)
Issues
•Testing environments and support•Inhibitors
▫Belief▫Fear▫System capacity (interface) – HL7
developing standards for V3 and V2 using Common Terminology Services, Clinical Document Architectures and OpenEHR Archetypes.