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Zac Whitewood-MooresClinical Data Standards SpecialistRN, MSc NursingDepartment of Health Informatics Directorate / NHS Connecting for HealthUnited Kingdom Terminology Centre

Part 2

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NeedGoal• Activity• Activity

Goal• Activity

NeedGoal

Goal

Activity

Activity

Activity

Many similarities may exist including the same goal

A goal to activity linkage in the absence of the need

has been found to be inappropriate

Critical differences in the activities related to the need

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• needs may also be identified as activities• wound care as an activity may be enough post-op • wound care may become a need if the wound

breaks down

Granularity may change over time

• Legacy terminologies and classifications• Regime/therapy hierarchy tidy up pending

Content inconsistencies

Used principally for “bundles”

Used principally for “frameworks”

Care regimes management Regimes and therapies

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• Some applications use no formal terminology• Some applications use SNOMED CT descriptions without the

underlying metadata and relationships• Some applications use an interface terminology• Some post-coordination exists

Terminology

• May isolate applications and limit interoperability • Activity and goal statuses• Application vendors/configuration personnel may feel "forced"

down a particular methodology by the existing terminology.

Often ‘post-coordination’ requirement dealt with in the information model

• Resistance to creating some pre-coordinated concepts pending the outcome of project• Guidance may remain considering each on a case by case basis

New content requests to terminology centre

• Impact on UI needs to be considered, especially where SNOMED CT being used natively

• Interface terminology may increase risk that content may not be refreshed as frequently• Consistent interface difficult if content spread between pre and post-coordinated

concepts

User interface

• May be unhelpful as different approaches may be incompatible for transfer of information between systems

Fuzzy line between terminology and information model

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• AMI vs Acute myocardial infarction

Acronyms and abbreviations

• normal / NAD vs defined parameter

Ambiguity / disambiguation

• unambiguous clinical descriptions vs lay descriptions

Patient / client viewing of record

• legal abortion vs termination of pregnancy / TOP

Sensitive areas of terminology

• peripheral venous catheter vs peripheral venous cannula

International / national differences

• Extensive analysis of existing technical preview content• Use of inclusion and exclusion criteria• Limited use of exceptions to criteria• Constant re-evaluation alongside content development

Content review

• Consultation with Royal College of Nursing and other professional bodies

• Feedback from users of early adopter application in test• Feedback from supplier of early adopter application

External consultation

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• Early adopter testing planned for single specialty hospital• Consultation ongoing with a number of suppliers and NHS organisations

Supplier testing and deployment

• Technical Preview – to April 2012• Draft for Trial Use – provisionally October 2012• Supported Product – provisionally April 2015

Standard development

• Further refinement of element subsets• Specialty content development – care planning content• Regime/therapy clean up – IHTSDO/UKTC

Terminology to support care planning

Zac Whitewood-MooresClinical Data Standards SpecialistMSc Nursing, PG Dip, RN

Dr Ken LunnDirector of Data Standards and ProductsPhD Computer Science, BSc

Department of Health Informatics Directorate / NHS Connecting for HealthUnited Kingdom

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• restricted to findings• increasing amounts of content being identified as situations• specific issues with negation in goals (absence of problem,

e.g. vomiting)• multiple contexts could make expressions ambiguous as the

relationships may not be clear cut• Context values for goals (achievement statuses)

Terminology model

• interdependency on the information model for time• Consistency between applications

SMART goals are difficult to represent in full

• Period pain absent (finding)

Findings

• Chest pain not present (finding) – retired• Chest pain not present (situation)

Situations

• Decreased nausea and vomiting (disorder)

Disorders

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• Should a wider group of concepts be available as goals?• If yes, situations?• If yes, disorders?• If yes, others?

Goal context model

• Should goals be available within other logical associations?• Goals for bundles?• Goals for templates?

Care planning model

• Is identification of a procedure concept as a “need” desirable? Procedures context model

Feedback on the approach overall

• Contact:– Zac Whitewood-Moores– <zac.whitewood-moores@nhs.net>

• Link to NHS Care Plan subpack:– http://www.uktcregistration.nss.cfh.nhs.uk/trud3/user/guest/group/0/pack/17