Terminologies How do they impact my world? Heather Grain 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: Description: Abdominal Pain Fully defined as: Is A General finding of the abdomen ( ) Pain of truncal structure ( ) Finding Site( abdominal structure( )

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: Description: Abdominal Pain (finding) Described using SNOMED-CT V2008/1 in field: Triage Assessment assessed by: 234N 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 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!