NEHTA National Clinical Terminology Information Service · SNOMED CT® Terminology Authoring...

National E-Health Transition Authority www.nehta.gov.au1

NEHTA National Clinical

Terminology Information

Service

March 2016

Elizabeth Donohoo

Manager Clinical Terminology

2 National E-Health Transition Authority www.nehta.gov.au

• National Clinical Terminology & Information Service current state

• High level overview of the NCTS Project

• Products and services

• Benefits

• Which products and services are relevant to me?

• Engagement & collaboration

• Questions and comments

Agenda


National Clinical Terminology & Information Service current state

Current state


• Managing, developing and distributing national terminology to support the eHealth requirements of the Australian healthcare community.

• Licensing SNOMED CT on behalf of the International Health Terminology Standards Development Organisation (IHTSDO®).

• Provision of product support to assist licence holders in their understanding and implementation of SNOMED CT-AU and the AMT.

High level overview of the current service: Responsibilities

http://www.ihtsdo.org/


• SNOMED CT-AU and Australian Medicines Terminology (AMT)

• A variety of file formats including

• RF2 file bundle (full, delta and snapshot)

• Tab Separated Values (TSV)*

• Comma Separated Values (CSV)*

• JavaScript Object Notation (JSON)*

• Third party reference and value sets, e.g. Royal College of Pathologists of Australasia (RCPA)

*only active members of the reference set or value set included

High level overview of the current service: Products


• Dedicated product support specialists

• Email and phone support

• General overview and technical workshops and webinars

• Individual technical support at your workplace

• Access to files and a large range of technical and business resources via the NEHTA website https://www.nehta.gov.au/implementation-resources/ehealth-foundations

High level overview of the current service: Services

https://www.nehta.gov.au/implementation-resources/ehealth-foundations


Project overview


• Terminologies like SNOMED CT are very rich and thus very complex to understand and use.

• There are many different code systems, terminologies, and maps with varying release formats, release frequency, and quality.

• Tooling is limited which makes development of local content difficult.

• Developed content is difficult to share or discover leading to duplicated effort.

Adoption and implementation


• Simplify the use of clinical terminology by addressing the key challenges faced by implementers.

• Encourage vendors, jurisdictions, and other organisations to adopt terminology products and services in their solutions.

• Improve collaboration between producers and consumers of terminology products and services.

• Enable the realisation of the benefits of clinical terminology adoption

Project aims


• New, standards-based, technical specification publications to simplify implementation and use of terminology in interoperable terminology solutions.

• Production ready applications (based on the above specifications) to simplify the creation and meaningful use of terminology.

• National infrastructure services to encourage collaboration and provide access to terminology products and services.

• Governance, policy and oversight.

Deliverables


• Terminology Management

• Supporting EMRs, Templates, eForms

• Authoring

• Registry Service

• Submission Service

Key use cases for users


Products and Services being delivered under the NCTS ProjectProducts and services


The National Clinical Terminology Services (NCTS) Project will deliver three broad categories of additional product and services.

1. Content types

2. Software applications - to create, distribute and share terminology content. This will include both:

• the technical specifications to “build your own”; and

• conformant software implementations to deploy and use

3. Infrastructure - for the distribution and sharing of national terminology and receipt of content submission requests.

Products and services


• SNOMED CT® based terminologies

• LOINC

• HL7 Fast Healthcare Interoperability Resources (FHIR®):

• Code System: A self defining code system, or a FHIR resource representation of an existing coding system

• Value Set: Use-case specific sets of codes from one or more code systems, terminologies e.g. a list of AMT and non-AMT orderable medication codes

• Concept Map: A context specific map from one Value Set to another with explicitly stated equivalence e.g. a map from PBS to AMT where pack-size is irrelevant.

Contents and types


FHIR Authoring Application

• Lightweight application for creation and management of NCTS FHIR resources. CSIRO’s Snapper as a Service will be provided as the FHIR Authoring application within the NCTS Portal.

SNOMED CT® Terminology Authoring Application

• An application to support creation and management of a SNOMED CT terminologies including medicines extensions and production of releases in the RF2 format. NEHTA’s LINGO™ will be provided as the conformant application within the NCTS Portal

Software application services


LINGO™

• NEHTA’s authoring, maintenance, release and integration tool.

• Used to develop and release SNOMED CT-AU and the AMT (since July 2014).

• Is standards based, using a central server architecture and a rich web client

• Has an integrated classifier (using CSIRO’s Snorocket)



Conformant Terminology Server Application (CTSA)

An infrastructure application which will support

• storage and indexing of all NCTS Content Types

• optional provision and consumption of a Syndication API for distribution of content from one CTSA instance to another

• provision of an Integration API to expose stored content to design and production applications which require access to terminology e.g. application User Interfaces which present search/pick lists

CSIRO’s Ontoserver will be provided as a conformant TerminologyServer Application.



Integration API

This API provides a means for design

and production applications to integrate with

CTSA instances through an API which

implements the HL7 FHIR® Terminology Service

specification.

Software application services: CTSA


Provides the following web service operations:

a) Creation, Reading, Updating, Deleting, and Searching for NCTS FHIR resources

Standard life cycle operations to manage NCTS FHIR Code System, Value Set, and Concept Map resources.

b) Expanding a Value Set

Obtaining an on-demand list of codes and associated descriptions based on a stored Value Set.

c) Concept Lookup against a Value Set

Finding all codes and associated descriptions from a stored Value Set which where the description matches some provided text.

Software application services: CTSA Integration API


d) Concept Validation against a Value Set

Validating one or more codes against a stored Value Set.

e) Concept Validation against a Value Set

Validating one or more codes against a stored Value Set.

f) Concept Translation against a Concept Map

Translating a source concept to a target concept based on a stored Concept Map.

Software application services: CTSA Integration API


Syndication API†

CTSA instances may be connected to each other to facilitate the distribution of selected NCTS Content Types from an upstream CTSA instance.

This provides:

•scalability, performance and availability

•support for localisation

•continuous operation

•centralised management of content

•local autonomy

† syndicated pre-built indexes are Ontoserver-specific



CSIRO Ontoserver

• is an existing “turnkey” Terminology Server application from the CSIRO

• manages complexity of SNOMED CT® RF2 distributions & multiple versions

• supports fast search with state-of-art ranking algorithms

• already has support for LOINC, FHIR® Value Sets, Concept Maps, and the Terminology Service Subsystem

• already in production in Tasmania, RACS, and in NEHTA



National terminology infrastructure services operated by NEHTA for distribution, sharing, receipt of content submission requests.

Portal

A web-based application which will allow organisations to access all the national infrastructure services through a web browser interface.

National Terminology Server

A NEHTA-operated CTSA instance to centralise all national product releases, LOINC, and NEHTA-maintained Value Sets and Concept Maps for syndication to downstream CTSA instances.

Shared Registry Service

A NEHTA operated registry to allow sharing of local content and adoption of existing technical artefacts from the registry for use within the health community.

Infrastructure


April 2016 – pilot implementations commence

July 2016 – progressive rollout out of application and infrastructure services for national use begins

Timelines


Which Products and Services are relevant to me?

Benefits


Easier access

• A terminology access portal, available anywhere any time

• Ability to share content you have developed with the broader terminology community

Latest terminology content all the time

• Confidence that you are accessing the latest versions of terminology content

Reduction in effort

• Less duplicated effort with the ability to access content developed by other users

Benefits


Reduction in development effort and maintenance:

• Access to proven terminology authoring and mapping tools

• Ability to store and access content from a central service

• Access to a fully operational support service when you need it

• Access to implementation support and training services

Benefits


What are the anticipated benefits to me?

Which products and services are relevant to me?


Understand local use cases

Where could terminology services be practically applied and most useful within your organisation?

• Terminology authoring?

• Mapping?

• Consistent use and adoption of terminology?

• Maintenance of terminology content?


National Clinical Terminology Services lend themselves to an incremental/phased adoption

Broad levels of adoption are:

• National Infrastructure Services only

• National Infrastructure Services and a local Design Time Terminology Servers

• National Infrastructure Services and local Design and Run Time Terminology Servers

Levels of adoption


The national infrastructure may be leveraged by vendors according to the following key integration patterns:

Design-time integration

• Vendor systems adopt content from the National Clinical Terminology Server at design time and include them in the build of their software. Regular patches or configuration to manage future updates.

• Pros: no dependency on availability of a Terminology Server instance

• Cons: higher vendor cost or administration overhead to update terminology content

Run-time integration

• Vendor systems leverage the Integration API of a local Terminology Server instance for production use

• Pros: latest terminology content readily available

• Cons: dependency on the Terminology Server instance being available.

Vendor integration patterns


Run-time integration with caching

Vendor systems leverage the Integration API of a configured Terminology Server Instance to maintain a local cache for operational use.

Pros:

• continuous operation even when the Terminology Server instance is unavailable;

• ability to stage or buffer change

Cons:

• more complex implementation for vendors and potentially more complex configuration/administration.

Vendor integration patterns


Engagement & Collaboration


Webinars

Regular Webinars to ensure stakeholders are informed and feedback obtained across the stages of development of the NCTS Project solution.

• Webinar 2 – Preparing for Implementation (licences, licence structure, etc).

• Webinar 3 – Implementation focus

Connectathons

Participation from jurisdictions, vendors and other stakeholders, to test out the technical specifications and obtain feedback to inform the specification development process.

Connectathon #2 is scheduled for 18 / 19 May in Melbourne.

Channels


Pilot implementations of NCTS project solutions

with jurisdictional partners to test out the solutions and associated services.

Pilot site implementations


[email protected]

1300 901 001

National E-Health Transition Authority www.nehta.gov.au

Thank You!

NEHTA National Clinical Terminology Information Service · SNOMED CT® Terminology Authoring...

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