SNOMED CT. Don Sweete IHTSDO

Transcription

1 SNOMED CT Don Sweete IHTSDO

2 Agenda Interoperability and Standards The Bigger Picture Coordination of Standards IHTSDO Who We Are SNOMED CT What is SNOMED CT? The Way Forward Q&A

3 Standards in Health Why are They Crucial? Healthcare is comprised of many silos, many solutions, and different data models, all of which make the portability of data extremely difficult. Current health organizations and governments are trying to stem the growth of a system that has no controls, payment functions that do not reward efficiency, safety or effectiveness.yet no real data is available in a meaningful way to measure performance. Unlike other industries, healthcare is stuck in the 80s: lots of paper, lots of standards, but no real light at the end of the tunnel.

4

5

6 The Challenge of the Data Tens of Thousands to 10+ Million Patients Years of Data Per Patient Thousands of Features Demographics Diagnoses Labs Procedures Claims Sparse, Irregular Data Unstructured Physician Notes Imaging Uncertainty Missing Data

7 Big Data in Healthcare Big Data is flourishing because of the promise of cost savings, and more predictable care. Each Big Data solution has at the core a methodology that mines data and uses proprietary algorithms. The challenge is how to apply these methodologies to unstructured data and get the true picture, given the complex and interdependent nature of healthcare. Big Data is not meant to replace structured data, rather it is meant to complement it.

8 Semantic Interoperability The Holy Grail! ehealth in general has defined semantic interoperability as one of the main priorities. Most national strategies for ehealth address semantic interoperability as a main priority. Global digital health initiatives have stressed the need for ability of two or more ehealth systems to use and exchange both computer interpretable data and human understandable data and knowledge. We all prioritize it, but still it seems so hard to do.

9 Semantic Interoperability What Does This Really Mean? Data can be moved seamlessly between systems and across borders and it will mean the same thing regardless of what system it is located in. Patient Safety will improve because clinicians will be able to see the whole picture on a patient regardless of the system or the location. Unnecessary or duplicate tests will be reduced. Consistency in treatment protocols may be increased. Information can be used either retrospectively or in real time to allow decision makers to make smart decisions in the deployment of scarce resources.

10 The Way Forward Coordination of Standards If we are to realize the potential of true interoperability the time for standards organizations to begin working together on a single interoperability framework. Standards organizations must change.the world of technology is changing and we will not be able to keep pace with the rapid change or the need to be agile. Governments and funders have the right and opportunity to embrace change and stop reinventing the wheel with numerous studies or initiatives that slowly move the yardsticks..action must happen now not in the next decade.

11 IHTSDO- INTERNATIONAL HEALTH TERMINOLOGY STANDARDS DEVELOPMENT ORGANISATION International not-for-profit association Based in Denmark Owned by National Members Governed by General Assembly of its Members Management Board elected by General Assembly Funded by countries based on national wealth (GNI) A product and service organization Delivers SNOMED CT Licensed to registered Affiliates Free use in Member countries Low-cost licenses for institutions in other countries Free in poorest countries Free for Public Good applications 11

12 IHTSDO Current Members

13 Affiliate Usage in Non-IHTSDO Member Countries Brazil China South Korea Germany Iran Chile France Mexico Switzerland UAE Saudi Arabia Ethiopia Greece Bulgaria Italy Colombia Turkey Egypt Philippines Hungary Luxembourg Finland Ireland Norway Serbia Russia Austria

14 Our Products and Services to members Main Products / Services SNOMED CT Subsets Description Content development & maintenance of international SNOMED CT release Development of sharing of subsets of concepts that enable user friendly implementation Mapping Translation Release Management Tooling Education Development & maintenance of mapping from SNOMED CT to other terminologies, such as ICD-9CM, ICD-10, ICPC-2; as well as LOINC and GMDN. Maintenance of SNOMED CT translation in Spanish. Best practice sharing, new translation policy that helps members start translating core content. Technical release and distribution of international SNOMED CT release Open source tooling platform to support the terminology authoring, mapping and other business functions Develop educational material and provide guidance on use of SNOMED CT and its implementation

15 SNOMED CT Products & Services Roles & Responsibilities IHTSDO International core release of SNOMED CT IHTSDO Product and Business Services Units Content Development Mapping Operations Technology Education Customer Engagement SNOMED CT Product IHTSDO Services Ref sets Mapping OTF Tooling Release Management Requests for Change Education & Training Translation Toolkits Communications NRC in a box License management EASILY CONSUMABLE PRODUCT Implementers Encode clinical information Clinical decision support Reporting clinical and health system information Portability of information Local maps & ref sets Vendors/ Regulators CIS, LIS, DIS, EHR, EMR, PHS Internal maps & ref sets SNOMED CT USE & LOCAL PRODUCTS Effective and efficient health care

16 Member, Vendor and User Engagement IHTSDO Member Forum National bodies involved in SNOMED CT development and implementation IHTSDO Affiliate/Vendor Forum Vendors and other SNOMED CT Licensees working with the IHTSDO to identify and address the needs of implementers IHTSDO Working Groups Open collaborative environment Topic-focused Special Interest Groups Assignment-focused Project Groups

17 IHTSDO Collaboration with Other SDO s Our approach: Coordination of standards. Find a workable semantic interoperability by cooperating with others. WHO SNOMED CT mapping with ICD 10 to be complete this fiscal year. LOINC Initial work out for review included in July Release. GMDN Phase 1 work complete, included in July Release. HL 7 Discussions on Value Set work that can be applied to the EU Setting. Orphanet discussions underway. Rad Lex discussions underway.

18 SNOMED CT

19

20

21

22

23 SNOMED Clinical Terms A controlled, coded clinical terminology for use in Electronic Health Records Content from: SNOMED 3.5 and SNOMED RT, developed and owned by the College of American Pathologists Read Codes, owned by & widely used in the UK NHS Design based on Identified user requirements Practical experience Scientific principles established in peer reviewed publications First released in 2002 Acquired for the public good by IHTSDO in 2007

24 Why SNOMED CT? SNOMED CT is the only terminology standard comprehensive enough to support the needs of clinicians from across healthcare disciplines and settings. Pick and choose what you need from SNOMED CT to meet your specific business or clinical needs Ref sets, which are comprised of a group of similar concepts, can also be utilized to make SNOMED CT easier to use. Makes it easier for data to be portable from one system to another Designed by clinicians for clinicians. Clinicians have the flexibility to record information in a way you prefer without losing its intended meaning when its shared across the continuum of care.

25 Why SNOMED CT? Making health records electronic A significant step forward Improves communication Increases availability of relevant information but it is only a partial solution; the real challenge is Making health records meaningful Identifying significant facts in oceans of data Enabling effective meaning-based retrieval Linking the EHR to authoritative clinical knowledge SNOMED CT represents clinical information meaningfully as part of a well-designed EHR.

26 One language has many expressions The value of SNOMED CT can be illustrated through the example of heart attack. While there are many different ways to describe the condition (e.g. myocardial infarction, cardiac infarct) they all share the same unique code.

27 1 SNOMED CT and Classifications Classifications like ICD-9 and ICD-10 Essential to the big picture view of healthcare Limited value in an individual patient EHR SNOMED CT Rich semantic structure adds meaning to the EHR Adequate detail for clinical recording Broad scope of coverage SNOMED CT maps to Classifications Existing maps to ICD-9 (US) and ICD-10 (UK NHS) Enhanced rule-based approach to mapping Being applied to ICD-10 by the IHTSDO Adopted by the NLM for mapping to ICD-10-CM. WHO - FAMI LY OF I NTERNATI ONAL CLASSI FI CATI ONS NETWORK ANNUAL MEETI NG 2013 A Common Ontology for I CD 11 and SNOMED CT James R Campbell, Christopher Chute, Monica Harry, Vincenzo Della Mea, Alan Rector, Jean Marie Rodrigues, Stefan Schulz, Harold Solbrig, Kent Spackman, Jane Millar, Bedirhan Üstün, A joint effort to harmonize SNOMED CT with I CD 11 & other WHO Classifications has been established by a Collaboration Agreement between WHO and I HTSDO with a Joint Advisory Group, and has has agreed principles for a Common Ontology for I CD 11 and SNOMED CT I NTRODUCTI ON SNOMED Common Ontology SNOMED CT is a standardized health CT (definitions) terminology for health records. SNOMED CT formulated definitions in a description Foundation Component Contingent knowledge: logic. signs, symptoms, causes,, Common Ontology I CD11 is a multi-purpose linkage entities) a subset of SNOMED CT classes and axioms disease classification extending ICD s traditional uses for statistical reporting Title and remuneration I CD 11 has a novel twolevel architecture: Mortality Morbidity Primary Care Foundation Component- a Linearizations polyhierarchical collection of all relevant classes 1 Purpose-specific linearizations (mortality, morbidity, primary care) with an exhaustive and mutually Links between monohierarchies Foundation Component and Linearizations We are exploring the feasibility of a All linearization Common Ontology for SNOMED CT and entities are represented as queries against the Foundation Component Common Ontology SELECT?CN WHERE Morbidity Morbidity (?CN SubclassOf Hypertension) Results Linearization Hypertension MINUS excluding Pregnancy (?CN SubclassOf Title Disorders of Pregnancy) The best interpretations of both SNOMED CT and ICD- Foundation Ccomonent Nodes: classes is as Clinical In ICD / SNOMED common ontology (CO) Situations. e.g.: IN SNOMED, not in CO Anemia denotes the class In ICD, not in CO Residuals, only in linearizations of situations (life periods) ICD Headings of patients having anemia. e Carrying ICD exclusions Most of current taxonomic Links: links in both systems are is-a compatible with Situation aggregation interpretation e e e Title Exclusion statements are pervasive throughout e e e e e e e e e ICD 10. In ICD 11 they will be limited to linearizations e e e Foundtion Component entities not in Common Ontology: References - Chapter headings typically using 1. World Health Organization. WHO - IHTSDO Collaboration. plurals ( Diseases of ) 2. Schulz, S; Rector, A; Rodrigues, JM; Chute, C; Üstün, B; Spackman, - Fine-grained parts of ICD, more K. Ontology-based convergence of medical terminologies: SNOMED specific than SNOMED CT CT and ICD 11. ehealth 2012, MAY 10-11, 2012; Vienna, AT. 3. Schulz, S; Rector, A; Rodrigues, JM; Spackman, K Competing - Non-ontological content (signs, Interpretations of Disorder Codes in SNOMED CT and ICD. AMIA Annu Symp Proc. 2012; 2012: symptoms, diagnostic criteria) 4. Rodrigues JM, Schulz S, Rector A, Spackman K, Üstün B, Chute C, Della Mea V, Millar J, Brand Persson K. Sharing Ontology between - Exclusions (not in Foundation ICD 11 and SNOMED CT will enable Seamless Re-use and Semantic Interoperability. MEDINFO 2013, Copenhagen, DK. Component, only in linearizations) October 2013 Beijing, China Title METHODS Conclusions Poster Number WHO/ CTS to insert Ontological Commitment: Which kind of things are classified / represented by - SNOMED CT disorders - ICD foundational component - ICD linearizations Analysis of hierarchical relations: which ones correspond to subclass relations, which ones have a different meaning Analysis of exclusions and residuals in ICD Construction of a general framework - scope of common ontology (CO) - scope of foundation component (FC) - Characterization of non-co nodes in FC - Identification of linearizationspecific nodes Testbed: draft of ICD11 chapter on cardiovascular diseases Harmonization of SNOMED CT and ICD-FC feasible based on a common ontology The SNOMED-CT / ICD Common Ontology to be the core of the ICD Foundation Component ICD linearization codes to be linked by queries on Foundation Component (not subclasses) Negation in queries to be negation Conclusions as failure Residuals (NEC, NOS) to be only in linearizations Outlook Consolidation of the ICD revision architecture and integration into ICD editing and QA processes Experimental release of the ICD cardiovascular chapter supported by common ontology Extension to other WHO classifications

28 Global Benefits of SNOMED CT IHTSDO ownership Independent of proprietary code systems Shared collaborative development and maintenance Transparent affordable licensing Free use in Member countries Free use in approved research and public good initiatives Costs elsewhere related to national wealth International approach Standard worldwide coding of clinical concepts Full support for translation to national languages Enables cross-border data sharing in national languages

29 National Flexibility with SNOMED CT SNOMED CT - Extensible design Enables addition of National or local content Configurable to meet National requirements Reference Sets: a standard representation for Subsets and Value-Sets of SNOMED CT Cross Mapping to/from SNOMED CT Other references to SNOMED CT content

30 SNOMED CT Benefits to Vendors It provides the potential for vendors to enable robust clinical decision support functionality, which leads to market differentiation. Can implement the standard once and market globally. Can access the most up to date version that is continuously maintained by the Standards Collaborative with input from stakeholders across the globe. Enables vendors to increase functionality of their solutions and thus providing unique market advantage. Positions vendors for product certification in the market. Decreases development and end-user costs by supporting only one terminology. Provides vendor customers with a key value add through portability of data functionality.

31 SNOMED CT Benefits to Member Countries Richness of the information that allows for proactive management of resources (people, facilities, material etc.) in the delivery of healthcare. Terminology use benefits the entire health system, saving approximately 5% of total healthcare costs ($100 billion per year in the US). Reduces costs to develop alternative terminologies: Estimated cost to develop an alternative terminology: US$34 to $46 Million Estimated cost to maintain and support: US$7 -$8 Million Minimizes the need for duplicate unnecessary tests. Increased cost savings associated with not having to aggregate data from various systems using different local or proprietary codes. Enables broad uses of information including health system management, clinical program management, public health, and research.

32 SNOMED CT Benefits to Patients Decreases the need to repeat health history and unnecessary duplicate tests. Able to be more proactive in management of their own health through the enablement of alerts and text reminders. More complete and accurate information at the fingertips of the clinician, leading to more effective care. Timely reminders to clinicians about when tests need to be completed (e.g. mammogram, annual physical examinations, immunization). Improved patient safety from reduction in errors caused by poor communication between healthcare providers. Improved clinician responsiveness to public health outbreaks (e.g. SARS).

33 The Real Question Is: Where Do WE Go From Here? We need a new approach collectively to work together to coordinate standards with the healthcare stakeholders and system. The approach must be adaptable, agile and able to work within the new generation s requirements mhealth, consumer health, data analytics. We all have an important role to play turf wars, politics within healthcare must end for the good of the consumer. There is a duty to change the system of inefficiency that we as a generation created. Let s embrace the future, not repeat the mistakes of the past!

34 More information at Questions:

35 Q&A