National Clinical Terminology & Information Service Terminology Update Hi, Quick update on what’s happening at the NCTIS National Clinical Terminology & Information Service Terminology Update Margaret Prichard – Product Manager Terminology

Detailed Clinical Models SNOMED CT Overview Submission process Detailed Clinical Models SNOMED CT ICD10 LOINC Australian Medicines Terminology (AMT) Resources Touch briefly on the following

Within terminology scope? Overlap existing terminology? Submission Process Add, modify concepts, descriptions & relationships Within terminology scope? Overlap existing terminology? National & International relevance? Clinical relevance? Should you be working on an implementation and there is a requirement of additions, modification, new concepts, or descriptions of either AMT or SNOMED CT-AU then you can submit a request First part of the process our TAs go through is evaluation and they will ask these sorts of questions. Following this if they feel it is more of international relevance for example, the request will be given up (in the case of SNOMED CT) to IHTSDO for consideration for inclusion Otherwise it will be reviewed and if appropriate modelled here

NCTIS Secure Site – Request Submission (Licence holders) Submission Process Add, modify concepts, descriptions & relationships NCTIS Secure Site – Request Submission (Licence holders) Email NCTIS Service Desk terminologies@nehta.gov.au There are two ways that you can currently make a submission,

Detailed Clinical Models SNOMED CT Overview Submission process Detailed Clinical Models SNOMED CT ICD10 LOINC Australian Medicines Terminology (AMT) Resources

Detailed Clinical Model (DCM) Clinical information models + terminology integration enable semantic interoperability Library of reusable “building blocks” from which specific solutions constructed Discharge, referral, health summary I just wanted to touch briefly DCMs as their development is currently our focus because of the requirements for the pcehr Our current SNOMED CT-AU work is directly related to building the reference sets that support these clinical models. Currently we have worked on discharge, referral and health summary

Detailed Clinical Model (DCM) This is just a simple representation of a DCM. The DCMs we are developing are maximal so that they will be able to be used in a diverse range of settings

Artefact Process Archetypes / Templates CDA Mappings DCM Implementation Archetypes / Templates DCM Structured Content Specifications (eHRs & DCMs) Terminology Reference sets CDA Mappings Binding of the Reference Sets This is high level view of the artefacts that are part of the process of binding the SNOMED CT-AU reference sets that we created to the DCMs which then inturn are part of the Structured content specifications. Robyn would be happy to explain this is greater details if anyone is interested?

DCM Development Process NEHTA Detailed Clinical Models (DCM) Library Constraints Tools Governance Discharge Medication Adverse Reactions Problems/ Diagnosis Pathology Imaging Family Hx Social Clinical Synopsis Requested Services Referral Medications Adverse Reactions Problem/Diagnosis Family History Social History Lifestyle/Risk Factors Diagnostic Imaging Clinical Synopsis Requested Services Recommendations Health Summary Specialist Letter So as I mentioned before the DCMs are the building blocks or library components that we can now use to form the structured content specifications such as discharge, etc.

Scalable Approach to Generating Coded Data Minimising the change Stability of components Reduce Standards Australia iterations & System Change Scalability & reuse Many use cases

Detailed Clinical Models SNOMED CT Overview Submission process Detailed Clinical Models SNOMED CT ICD10 LOINC Australian Medicines Terminology (AMT) Resources

Classification maps ICD10 Semi-automated coding of ICD -10 classification data from a clinical record which is clinically encoded in SNOMED CT I just wanted to touch on briefly a couple of international work items that are underway. Firstly the mapping of ICD10. IHTSDO is working on this project with some assistance from member nations. The current scope of this project is to be able to support a semi-automated coding of icd 10 from a clinical record which has been encoded with SNOMED Ct

Classification maps ICD10 IHTSDO and WHO are developing a map from SNOMED CT to ICD-10 Map will support epidemiological, statistical and reporting requirements Phase 1 9,500 SNOMED-CT concepts based on the US National Library of Medicine core problem list

Classification maps Phase 2 Map an additional 110,000 ICD10 Phase 2 Map an additional 110,000 Plan for a preview release September 2011

Other code sets LOINC IHTSDO have consulted with member nations and have a positive response to moving ahead with a collaboration with LOINC

Detailed Clinical Models SNOMED CT Overview Submission process Detailed Clinical Models SNOMED CT ICD10 LOINC Australian Medicines Terminology (AMT) Resources I know today’s focus was around SNOMED but I wanted to give those who aren’t familiar with AMT a quick overview and also give you an update on the work plan

AMT 2007 - 2011 Dec 2007 – First national release Apr 2009 – AMT Support Group formed Nov 2009 – v3 model nationally agreed Nov 2010 - First state based implementation achieved

AMT 2007 - 2011 Feb 2011 – v3 alpha release to limited audience Mar 2011 - First reference sets released (RF2) Aug 2011 – v3 (beta) in development Dec 2007 – Jul 2011 – Monthly releases

AMT Strengths Unique identification Standardised representation Model review – simplified v3 Persistent National / across healthcare setting Strong clinical development team Interoperable Possible links to other codes Internationally aligned

AMT Plan Not achieved implementation expectations Provide 3 Year plan and approach Set expectations for Year 1 Collaboratively decide on 2 - 3 Year plan

AMT Implementation Plan Mapping Compliance and Conformance Governance and Support AMT information Architecture AMT Implementation Guide AMT v2 to v3 Migration Plan AMT v3 in RF2 Format NCTIS Release Cycle and Versioning AMP Technical Specification Reference Implementations AMT Mapping Policy Guide to mapping of Terminology for Australian e-health AMT Conformity Assessment – Mapping Implementations AMT Conformity Assessment – Native Implementations AMT Licensing Agreement AMT Governance Model AMT Service Level Agreement NEHTA AMT Work plan 21

Phased Approach Phase 1: Short-term future state resulting in single implementation date of July 2012 Long-term future state: delivering future releases of AMT for implementation from July 2013 (Phase 2) and July 2014 (Phase 3)

Phase 1 – July 2012 Mapping AMT Early adopters PCEHR Wave 1 & 2 Implementations e-health sites ETP specifications e-Health Summaries

Phase 1 Implementation Plan

DRAFT AMT Implementation Maturity

What’s next Pause AMT releases until December 2011 Finalise & publish implementation plan Release mapping guidelines Release of v3 Beta & production Escalate continued consultation for phase 2 & 3

Detailed Clinical Models SNOMED CT Overview Submission process Detailed Clinical Models SNOMED CT ICD10 LOINC Australian Medicines Terminology (AMT) Resources

Resources SNOMED CT-AU and AMT release documentation Tools –listed on eHealth Collaborate site Education videos – YouTube www.nehta.gov.au > Connecting Australia > Terminology & Information > Education Resources