Transcript Mediation between People, Languages, Cultures, and

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The case for Clinical Terminology
Pieter E Zanstra
Radboud University Nijmegen Medical Center
Co-ordinator EU SemanticHEALTH Specific Support Action:
Semantic Interoperability Deployment and
Research Roadmap
World of Health IT, Introduction of SNOMED in MS, Geneva, 20061011
Semantic interoperability
(example of drugs with different trade marks)
The example:
A patient coming from Switzerland to
a German pharmacy is looking
for a drug well known in Swiss:
„DROSANA Resiston Trpf.“
Reinhold A. Mainz, BMGS, Germany, Project Group Telematics – Health Card
14./15. February , Bruxelles, EC / WHO Workshop on Semantic Interoperability
The name of this drug is not
known in German pharmacies!
The pharmacist

will not find this drug in his drug
data bases,

is not able to identify the
ingredients of the drug,

can not look for an equivalent
drug available in Germany.
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CEN/ISSS eHealth FG Recommendation 13 (2005)
• The Member States, with the Commission, should:
– ensure the Europe wide referencing and easy access to the content
of existing health coding systems based on registration of such
systems by the Eurorec Institute;
– support the international convergence towards a common
framework for formal representation, and eventually the
development and maintenance of a multilingual clinical reference
terminology. This effort should build on existing efforts in formal
representation as GALEN, FMA and SNOMED, and be carried out in
liaison with the WHO Family of International Classifications
– make the targeted reference clinical terminology publicly available
free of charge;
– support a common approach to link national classifications of
procedures, to support cross-border reimbursement of health care.
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Clinical Terminology
• Clinical Terminology refers to the collection of
standard terms with their synonyms, which in the
context of patient care support the recording of
complaints, signs, symptoms, circumstances,
process of illness, interventions, results,
diagnoses, as well as the decision making of the
care providers
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Competing demands on recording
ICD, ICPM
DRG
Referral letters
Reimburse
?
Manage
Documentation
Categorise, Code
Record
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Where are we?
Stage of development
Open Source
Evidence Based Medicine
A free Open source community will
easily build and maintain the
required term collection in a WIKI
like environment
Only
about 5-8% !of present
medical knowledge is based on
But ultimately
a RCT’s
complex
sound
evidence.
are very
terminology
is required, andWe
wecan
costly
and time-consuming.
should
notignore
expectthe
thisneed
to appear
not
longer
for
without significant
investment.
routinely
collected observational
data of high quality.
The critical
mass of‘outliers’
skilled &in the
Problem
of finding
dedicated contributors to a large
literature
Health terminology is too small for a
sustainable system
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Records, Summaries, Excerpts
• EU Recommendation on Patient Summary
• Emergency data set
• Cross border (emergency) care
• Traveling citizen
• Safe care for eryone
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Linking Record Facts to Knowledge sources
Product Prescribing Dictionary
Ontology
B-Blocker
Antianginal
Atenolol
oral
25mg
Atenolol
Patient Record
Guideline
Iff
Antianginal
then...
© Copyright UMCN-MI
?
Date
Medication
311299
Atenolol 25mg tabs bd
Medische Informatiekunde at the heart of health care
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Terminology generations
• 1st Generation
– Monoaxial, relatively short
– ICD, ICF, MESH,…
• 2nd Generation
– Multiaxial, more detail
– Snomed 2, UMLS, …..
• 3rd Generation
– Network, Compositional, Formal, Software,
– Very detailed
– SNOMED CT, OpenGALEN, FMA,…
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Ontologies The invisible unifying foundation?
Coding &
Classification
Decision
support
Clinical Applications
MeSH
ACRNEMA
UMLS
SNOMED
Axes
ONTOLOGY
Medical
Records
`
ICPC
Data entry
READ
OPCS
ICD-9
ICD-10
The public health case
• Establisment of EU Centre Disease Control
• Focus on communicable diseases
but
• Many more related problems wrt disease detection
• Call for a more generic approach
SemanticHEALTH recommendation of 30-09-2006:
• Activitity on the “Real time public health record”
• Data derived mostly from routine health records
• Common Terminology probably within the EU
mandate
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Observations
• Development still driven by ‘perceived need’
• No yet hard evidence to prove added value
• For the next five year seen by industry as
exhaustive list of fixed terms
• Growing evidence to reconsider the ontologies
behind systems
– Both SNomed CT and GALEN stem from early 90s
• Systems not plug and play
– Significant cost of translation
– Multitude of base cost goes into localisation
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Memberstate Concerns
• Need for more knowledge, sharing of experience
• What are the hidden costs (for users, the health system, ...)?
• ROI, what % of all terms is really needed, business case for
terminologies?
• Evaluation of implementation projects, lessons learned
• Do we need other terminologies, classifications if we have
SNOMED, e.g., LOINC (lab is integrated in SNOMED, but not
clinical LOINC)
• Technology to really make use of SCT is still not there, only
planned to become implemented in MSs
• User involvement: patient, GP, specialists, professional bodies
develop a strategy for user involvement
• …..
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WHO terminology network meeting concerns
• Identification of roles for:
–
–
–
–
–
–
National terminology centres (networked)
Standards bodies
Healthcare providers
Vendors
Governments
Universities
• Alignment of tasks for:
– Snomed SDO
– WHO
– …..
Let this orchestra play in harmony
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Clinical Terminology Summary
• Evolving use case
–
–
–
–
–
Epidemiology
Organising care
Documenting Care
Access to knowledge
Epidemiology?
• Technological Barriers
• Evolving Technology
– Enumeration – ICD
– Interlingua – UMLS
– Formal Ontology – SNOMED CT
• Unsolved Problems
–
–
–
–
– Enumeration doesn’t
scale
– Computers can’t read
– Humans can’t organise
– Tower of Babel
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Quality Assurance
Efficient data capture
Interrater variability
Cost Model
The challenge
Transformation of
Snomed Commonwealth Terminology
into
Snomed Global Terminology
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Acknowledgements
Specific Support Action co-funded by the European
Commission SIXTH FRAMEWORK PROGRAMME
Radboud University Nijmegen Medical Center
Department of Medical Informatics
(Co-ordinator)
University College London
World Health Organization
Centre for Health Informatics and
Multiprofessional Education (CHIME),
UK
Dept. Measurements and Health
Information Systems, Switzerland
University of Manchester
Health and Bioinformatics Group, UK
Uppsala University
Nordic Centre for Classifications
in Health Care, Sweden
National Institute for
Strategic Health Research
Hungary
University of St. Etienne
Communication &
Technology Research,
Department of Public Health &
Medical Informatics, France
Germany
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Thank you for your attention!
Further information:
www.semanticHEALTH.org
[email protected]
Pieter E Zanstra
Radboud University Nijmegen Medical Center
[email protected]
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