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Using SNOMED CT in ABF initiatives Dr David Hansen| CEO May 2013 AUSTRALIAN E HEALTH RESEARCH CENTRE Operational context NSW Health, FirstNet and other adopters SNOMED CT & Emergency Department Reference Set (EDRS) Activity Based Funding (MDBs and URGs) Wider context • PCEHR • E health • Health reform agenda A Reminder: Why are we doing Terminology? It’s about Data Quality and Interoperability PRIMARY SECONDARY TERTIARY Clinical users Care delivery Interoperability Decision Support Public Health Health Service Management Resource Allocation Funding Re-use (within) Re-purpose (between) Re-purpose (between) Clinical terms Classification categories Funding groups Data management for ABF in ED v1.3 specifications Mapping: inefficient, inaccurate Changes ? EDRS content (as provided) Concepts = 5 341 Paths = 28 857 EDRS Paths and maps (detail, single concept example) OPEN WOUND 125643001 = T14.1 No ICD-10-AM maps Disconnected concepts EDRS (detail) NOT a properly formed, functional RefSet Missing terms? SCT ID 262525000 283473009 55680006 296630001 233604007 312342009 386702006 42085001 SCT concept name Chest injury Stab wound of chest Drug overdose Vancomycin overdose Pneumonia Infective pneumonia Victim of abuse Victim of rape Terms that are important for clinical care not “in scope” of EDRS Versions synchronised? SCT ID SCT concept name Status 2010 Status 2012 325569000 Haemorrhage from throat ACTIVE INACTIVE No replacement 262954001 Traumatic subarachnoid haemorrhage ACTIVE INACTIVE No replacement 37324003 Superficial injury of leg with infection ACTIVE REPLACED 449642006 Superficial injury of lower leg with infection Not included NEW 211983004 Full thickness burn of multiple sites of leg ACTIVE REPLACED 449719007 Full thickness burn of multiple sites of lower leg Not included NEW EDRS treated as static, SNOMED versioning ignored Maps from SNOMED to ICD 10 AM invalidated, out-dated or missing Material effect SCT concept name Haemorrhage from throat Traumatic subarachnoid haemorrhage Superficial injury of leg with infection Superficial injury of lower leg with infection Full thickness burn of multiple sites of leg Full thickness burn of multiple sites of lower leg Chest injury Stab wound of chest Drug overdose Vancomycin overdose URG MDB 2 2 2 2 2 2 2 2 2 2 SCT ID 325569000 262954001 37324003 449642006 211983004 449719007 262525000 283473009 55680006 296630001 17 10 10 E4 17 E4 10 E4 9 E4 3G 2A 2BA R041 S066 T1300 6 R223 2B S299 1B T509 1 2 233604007 Pneumonia 12 3B 1 1 1 2 2 2 312342009 386702006 42085001 Infective pneumonia Victim of abuse Victim of rape E4 10 E4 Dis Visit Triage 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2B ICD J189 T741 INACTIVE but achieves MDB and URG ACTIVE does NOT group IHPA, URG grouper, v1.3 Clinically relevant does NOT group How to use SNOMED CT in ABF Proposal Build a clinically relevant EDRS Don’t rely on maps Aggregate SNOMED CT directly to MDB Swap out the library files Development experiment Build a better EDRS Find SNOMED CT concept that ‘matches’ MDB Inherit all descendants (subsumption) Manage membership, aggregation and versioning Use proper tooling (Snorocket, Snapper, Ontoserver) Transitive closure & transitive closure reduction algorithms Directed Acyclic Graph traversal algorithms, rule based Proof of concept Trial with two MDBs 3L: Gynaecological Illness 4: Psychiatric Illness Tertiary Primary Secondary MDB 3L Gynaecological Illness Concepts = 1 568 Paths = 6 492 MDB 4 Psychiatric Illness Concepts = 1 536 Paths = 3 936 How it would work Library file SNOMED CT – EDRS to MDB OR Library file ICD to MDB OR Getting there from here New approach to terminology management & tools New EDRS required Adequate and accurate specifications Sufficient documentation, content and technical Clinical user acceptance testing Data testing, with queries and analytic approaches Published test results Key messages Secondary and tertiary data can be driven by clinical data Mapping not sustainable Version management essential Align with and exploit e-health initiatives Thank you Dr David Hansen CEO t +61 7 3253 3610 e [email protected] w http://aehrc.com AUSTRALIAN E HEALTH RESEARCH CENTRE
