TerminologiesHow do they impact my

world?

Heather Grainheather@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 definedConcept ID: 21522001Description: 38112013 Abdominal PainFully 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 supportsRetrieval of clinical data based upon context and

clinical knowledgefind 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: 21522001Description: 38112013 Abdominal Pain

(finding)

Described using SNOMED-CT V2008/1in field: Triage Assessmentassessed by: 234N Mary Smith

Terminology supportsFully 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 ICD11 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 follow others

Which are you?

•Leader•Follower•Extinct!