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Making Terminology Work

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    James "Jim" Arthur Lovell, Jr., (born March 25, 1928) One of the reasons I am doing this work is to better understand how we can give clinicians more of what they want by understanding what the practical constraints are to what they want.One of the problems is how to implement effective use of terminology within a HIT pattern of data gathering

    Patient has morbiditySees GP/presents to ERClinician (GP/Other) records notes in any preferred mannerThese notes are stored in the clinical EMR systemA classification or terminology is applied as per the context/standards/ policy of the locationBut need to share the informationTo share need to use a terminology for contextual interop of data … e.g. SNOMEDApply to patient data (say CDA)By using OOXML we are able to embed the CDA in a human readable format and distribute

    Drop-down – pre-populated, generally static, easier to control from IUT perspectiveFree Text – better for clinician, very bad for interop and IT controlHybrid – usually cumbersome and “not the best” of both worlds above

    Riddel and Webber (1973)“…one of the most intractable problems is that of defining problems and of finding where in the complex causal networks the trouble really lies…”Westbrooke et al (2007)Wicked problems are dynamic with multiple sets of complex, interacting issues that evolve in an emergent social context.SNOMED-CT300,000 Current Concept; 750,000 Descriptions;(English & Spanish); 900,000 RelationshipsSource www.IHTSDO.orgICD-10(AM)34000 entries (A00.0 [“Cholera due to Vibrio cholerae 01, biovar cholerae”] to Z99.9 [“Dependence on unspecified enabling machine and device”])Source: NCCH Usyd ICD-10-AM book

    No-one seems to look at the value within the infrastructure to provide a common platform for clinician noting purposes.If we look at the complex scenario of clinical noting with terminology and at infrastructure then we can suggest that clinical noting follows the commoditized processes of word processing software.If this is taken as a possibility then can we use commoditized word processing software to accept clinical noting while allowing us to embed contexutalisation data (in the form of terminology) and a clinical contextualisation structure on the data (in the form of CDA, etc)We should aim to remove the “Guru” syndrome requirements in HIT.

    “sCCOW” is “simplified” CCOW – currently CCOW may be too complex and not versatile enough for many controlled environments. It may be possible to simplify the process using process engines and contextualisaiton based upon patient-clinician time-in-motion studies.

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    Making Terminology Work - Presentation Transcript

    1. Making Terminology work
      Driving in situ use of wicked classification schemes with commoditised software
      Werner van Huffel
      Regional Strategist, Microsoft APAC
      wvhuffel@microsoft.com
      Associations:
      The Author is an employee of Microsoft and undertaking health Informatics field studies.
      Masters degree in Health Information Management (Health Informatics) [HIM-HI], University of Sydney, Australia
      Acknowledgements as:
      Raphael Mastier (Microsoft, France)
      Marc Horowitz (HealthLanguage, Global)
      Andrew Kirby (Microsoft, UK)
      Neil Jordan (Microsoft, Global)
      Brian Levy (HealthLanguage, USA)
      Knowledge Driven Health
    2. “…Houston, we've had a problem...”
      - Apollo 13, Lovell J. A. , 1970
      Due to MANY “wicked“ influences.
      Got this
      Clinicians wanted this
      Why is this work being done?
      What thu?!?
    3. Agenda
      Scenario
      What is Wicked about classification?
      Why commoditized software?
      Demo
    4. Scenario
      EMR
      Classification
      patient
      Clinical notes
      “multi-modal”
      data entry
      injury
      Possible Patterns:
      • Referral Process
      • Discharge Summary
      • Rx Distribution
      • CPOE
      • …
      Human Readable
      Machine Readable
    5. 2 (+ a bit) ways of data entry
      Source: An Applied Evaluation of SNOMED CT as a Clinical Vocabulary for the
      Computerized Diagnosis and Problem List; Wasserman H, et al; AMIA Symposium Proceedings 2003; pp 207.
      Dropdown Lists
      Free Text
      Source: “Smart Forms” in an Electronic Medical Record: Documentation-based Clinical Decision Support to Improve Disease Management; SCHNIPPER J L, et al; J Am Med Inform Assoc. 2008;15:513–523. DOI 10.1197/jamia.M2501.
      Hybrid (the bit)
      Source: Plug-and-Play XML: A Health Care Perspective; SCHWEIGER R, et al; J Am Med Inform Assoc. 2002;9:37–48
    6. “Wicked” Concept
      Religious
      Sport
      Riddel and Webber (1973)
      Westbrooke et al (2007)
      Summarized paraphrase:
      A fuzzy solution space in which the problem locus is variably re-referential
      As one thing is solved another introduces itself and, potentially, re-influences the original point from this the current solution was derived.
      Geography
      Vegetable
      Disney
      Network
      Clinical Terminologies
      Health messaging
      Clinical Communications
    7. Word Processor!
      Project premise
      Wicked clinical system
      Clinical Noting
      With terminology
      Infrastructure
      Embed Terminology
      ICD <-> SNOMED
      Clinical Data container
      CDA, CCR, CCD, Archetype, …?
      Why Commoditized software?
      • Because it is part of the infrastructure
      • Has the container abilities required
      • Had the technology extensibility needed
      Without the “guru-needed” syndrome
    8. Concept Demonstrator (Demo time)
      Commoditized Clinical noting:
      Embedded Machine readable structures for data mining combined with Human readable formats for knowledge gathering using Commoditized software
      MS Word 2007+ document/templates
      CDA/Archetype/other XML document
      Services:
      • Terminology (HLi)
      • ID services
      • sCCOW
      • PKI
      • Medications
      • Decision Support
      • Integration…
      HealthLanguage Language Engine (LE) Web-services linkage
      What Clinician sees
    9. Recognized issues
      IHE-XDS.b
      X12N
      CCD
      HTML
      SAML
      Continua
      IEEE-SA
      Doctors don’t work like this
      SOAP
      HL7 CDA
      ISO
      FTP
      OMG
      CEN
      OASIS
      IHE-XDS.a
      ASTM
      REST
      There are many standards that can be incorporated
      CDISC
      DICOM
      W3C
      openEHR
      HL7 v3
      AHIC
      MTOM
      PKI
      BPEL
      HL7 v2
      SOAP
      IHE
      HTTP
      There are a wicked number of ways to solve the clinical noting problem
      ICD-9
      SNOMED-RT
      LOINC
      We may be trying to stuff too much in
      XPDL
      NCPDP
      HIMS CCHIT
      ISO 29500
      ICPC
      WS-i*
      S/MIME
      HIPAA
      SNOMED-CT
      ICD-10
      SNOP
      WEDI-SNIP
      XAML
      WSRP
      CCR
      CEN 13606
      SMTP
      Not stress tested within an evidence based evaluation framework
      Guru’s are important
    10. DynaBS
      “If an idea seems new to an individual, it is an innovation”
      - Diffusion of Innovations 5th Ed, Rogers E., 2003
      gloStream
      Knowledge Driven Health

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    Microsoft Asia-Pacific
    www.micr more

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