SNOMED-CT Implementation issues

and opportunities

Heather Grainheather@lginformatics.com

Presented at HIMAA Symposium 2008

Implementation means•Coding in the clinical world•Options

▫Give the clinician a list (sometimes a really big list) to choose from…..

▫Develop other mechanisms

Photo Coppyright Steffen Foerster

Trail of natural language AND ICD-10-AM coding automation in Emergency

Issues to conquer first

Language of the Language

•We don’t all describe the concepts of terminology the say way........

•Work at ISO on an International Glossary being established to clarify meaning. Internet based tool

•Available openly in 2009 (Australian Leader of international activity)

Mapping is…..

Creation of a relationship between the code or term used to represent a health concept in one system and the code or term that would be used to represent the same concept in another coding or terminological system

ABC = XYZAS5021-2005

Mapping – does and doesn’tTerm SNOMED-CT ICD-10-AM

ProblemUrinary Tract Infection

25374005 – Urinary Tract Infection (disorder)

O03.3 with obstetric spontaneous abortionO86.2 Urinary tract infection following deliveryN39.0 – Urinary Tract Infection, site not specifiedAdditional logic is required to determine which code is appropriate.There are also rules in the coding standards that indicate:“do not code the following:N39.0 Urinary tract infection, site not specified, when only microbiology results show organism(s) have been cultured ”.

Mapping – does and doesn’tTerm SNOMED-CT ICD-10-AM

Patient had heart attack during laparoscopic appendicectomy, surgery not completed.

51316009- Laparoscopic appendectomy385660001 - Not done 57054005 - AMI74477009 – exploratory laparotomy

30373-00 – Exploratory Laparotomy

Reference Sets for implementation•Select appropriate terms for use in

specific situations•Lists can be short or long

▫ Can include hierarchy (children) information

▫ Can ensure correct part of the hierarchy is being used

▫ Restricts and guides entry

What we have•Access capacity (ability to access

codes/terms – terminology servers or engines)

•Ability to represent concepts (SNOMED-CT)

•Clinically acceptable mechanism for data capture

•Recognition of context in the use of terminologies

What we don’t have

Austin investigation - Triage text•What is in text•54,543 cases from 12 months at Austin

Emergency•9525 different textual descriptions (82%

common)•Context informs the intended meaning....

▫PALP + CP - palpitations and chest pain

Content of the text• 21% have additional qualifiers that indicate

additional information about the concept▫? # 3RD DIGT L

• 15% of entries had additional specific laterality▫e.g. R Groin pain

• 12% of entries had more than one concept ▫e.g. foot inj.fever

• 5% have other information such as causes of injuries, finding sites.▫e.g. fall head inj

• 90% use short forms or have spelling challenges.▫e.g. bowel obstr ▫ > 32 different spellings of .......

Objectives of test

•Identify capacity to process text to SNOMED

•Identify ability to convert to ICD-10 for reporting purposes (avoiding clinical input entirely) - achieved

Testing Results• Coded manually in SNOMED-CT and

confirmed by clinical staff in emergency• Batch processed identifying variations from

expected SNOMED-CT returned.• Established quality measure

5th test achieved95% = 100% confidence2% = 90% confidence3% = 80% confidence – require user

confirmation(17 cases) 0% e.g.: ? gib

Queries to SNOMED – sent to NEHTA e.g.: ? DRINK SPIKE

Sample of result

Next steps

•Trial in clinical environment•Trial to inform clinical pathways and risk

assessment•Returning SNOMED-CT into different

fields (concepts)

Issues

•Testing environments and support•Inhibitors

▫Belief▫Fear▫System capacity (interface) – HL7

developing standards for V3 and V2 using Common Terminology Services, Clinical Document Architectures and OpenEHR Archetypes.