What SNOMED CT ®  means to New Zealand Brendan Kelly Ministry of Health 14 December 2007
Introduction <ul><li>Your understanding of SNOMED CT ®  on a scale of 1 to 10 </li></ul><ul><li>Do you possess a mobile ph...
A day in the life … 157 babies are born 73  people die 105,000  prescriptions are filled 50,000  people take a cholesterol...
<ul><li>Pressures </li></ul><ul><li>Aging population </li></ul><ul><li>Chronic conditions – esp diabetes CVD and cancer </...
6 uses of information in the health context <ul><li>Supporting self-management </li></ul><ul><li>Supporting clinical inter...
The  Population  Primary  Care Specialist Care Secondary  Care (Hospitals) Chronic Condition Palliative Care Mortality Dat...
Health Information Hierarchy Community Population Individual National Views District / Regional  Views Local Views Appropr...
Electronic Health Records - A change in focus <ul><li>A change from: </li></ul><ul><li>collecting administrative data for ...
Key Initiatives  – what we’re watching <ul><li>Australian Medicines Terminology (AMT) </li></ul><ul><li>Sector initiatives...
Why do we need SNOMED CT ® ? <ul><li>Read Codes </li></ul><ul><li>Transferable health records (interoperability) </li></ul...
Key Issues  Motivation <ul><li>Terminologies have succeeded for three reasons </li></ul><ul><ul><li>Coercion - use them or...
Key Issues Application Centric Development <ul><li>If it is built for everything it will be fit for nothing! </li></ul><ul...
changing from continuity of  carer  to continuity of  care <ul><li>Primary, secondary and community care </li></ul><ul><li...
The joys of handwritten records…. <ul><li>Very flexible </li></ul><ul><li>Expressing uncertainty easy </li></ul><ul><li>Ex...
Key Issue Role of the MOH <ul><li>Secured the right to use SNOMED CT ® </li></ul><ul><li>Standards </li></ul><ul><li>Coord...
Key Issue Decision Support <ul><li>Meaningful decision support is still rare </li></ul><ul><ul><li>Terminology is not the ...
Key Issue Scope <ul><li>Language technology will help </li></ul><ul><ul><li>But will always have limitations </li></ul></u...
Applications centric Development Common Terminology/ Ontology clinical applications authoring environments Intermediate Re...
The Healthy Population  (from birth) Primary & Com. Care Specialist Care Hospital  Care (2/3/4) Chronic Condition Palliati...
 
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What SNOMED CT® means to New Zealand

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Brendan Kelly
Ministry of Health
14 December 2007

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  • What SNOMED CT® means to New Zealand

    1. 1. What SNOMED CT ® means to New Zealand Brendan Kelly Ministry of Health 14 December 2007
    2. 2. Introduction <ul><li>Your understanding of SNOMED CT ® on a scale of 1 to 10 </li></ul><ul><li>Do you possess a mobile phone? </li></ul><ul><li>What year did you start using a mobile phone? </li></ul><ul><li>Who in the group is the “early adopter”? </li></ul>
    3. 3. A day in the life … 157 babies are born 73 people die 105,000 prescriptions are filled 50,000 people take a cholesterol-lowering drug 50,000 people take one of the new antidepressants, eg: Prozac 40,000 laboratory tests are analysed 1,167 people are admitted to our hospitals (7,127) 4,000 outpatients visit hospitals for care 432 people have elective surgical operations 1,960 people are seen in Emergency Departments 27 people are admitted to hospital with asthma 50,000 people visit their GP 30,000 people receive a home care visit 21 people have heart attacks 19 people are diagnosed with diabetes 637 children are immunised 2,124 children and adolescents have a dental check up 3,000 new claims received by ACC
    4. 4. <ul><li>Pressures </li></ul><ul><li>Aging population </li></ul><ul><li>Chronic conditions – esp diabetes CVD and cancer </li></ul><ul><li>Fiscal constraints </li></ul><ul><li>Globalisation of workforce </li></ul><ul><li>etc </li></ul><ul><li>Responses </li></ul><ul><li>Focus on wellness and prevention </li></ul><ul><li>Focus on primary care (population, tailored, supported self-management, collaborative) </li></ul><ul><li>Primary, secondary, community care integration </li></ul><ul><li>etc </li></ul>Pressures and responses:
    5. 5. 6 uses of information in the health context <ul><li>Supporting self-management </li></ul><ul><li>Supporting clinical intervention </li></ul><ul><li>Clinical Governance </li></ul><ul><ul><li>Professional and practice standards </li></ul></ul><ul><ul><li>Education & Training </li></ul></ul><ul><ul><li>Research, evaluation & development </li></ul></ul><ul><ul><li>Great accountability through risk mgmt & significant event monitoring </li></ul></ul><ul><ul><li>Clinical Audit, team development, peer support, effective relationships </li></ul></ul><ul><ul><li>Patient and community input into service development </li></ul></ul><ul><li>Administration (in all parts of Health) </li></ul><ul><ul><li>Includes evaluation, quality assurance and payments/funding </li></ul></ul><ul><li>Strategy and policy development </li></ul><ul><li>Research </li></ul>
    6. 6. The Population Primary Care Specialist Care Secondary Care (Hospitals) Chronic Condition Palliative Care Mortality Database Point of Limited Return Symptom Referral if serious Referral if serious If fixed If fixed If fixed Return to Population Return to Population If fixed • Managed • No fix • Quality of life • Over an extended time • Hospices • Terminal • Elderly Care • End Stage Management Primary Secondary Primary Secondary
    7. 7. Health Information Hierarchy Community Population Individual National Views District / Regional Views Local Views Appropriate views / subsets of the information below. Relevant views of information above. Capture, use, and share information locally at the point of care. Standards Indicators Health Outcomes
    8. 8. Electronic Health Records - A change in focus <ul><li>A change from: </li></ul><ul><li>collecting administrative data for administrative purposes </li></ul><ul><li>To: </li></ul><ul><li>Collecting clinical data for clinical purposes and deriving administrative data as a by-product </li></ul><ul><li>A change from: </li></ul><ul><li>conceiving of data as a collection or repository with a focus on secure storage </li></ul><ul><li>To: </li></ul><ul><li>A focus on accessibility to support appropriate use, with a focus on secure sharing </li></ul>
    9. 9. Key Initiatives – what we’re watching <ul><li>Australian Medicines Terminology (AMT) </li></ul><ul><li>Sector initiatives </li></ul><ul><ul><li>e-referrals </li></ul></ul><ul><ul><li>e-prescribing </li></ul></ul><ul><li>Cancer data view </li></ul><ul><li>GP to GP </li></ul><ul><li>Maternity </li></ul>
    10. 10. Why do we need SNOMED CT ® ? <ul><li>Read Codes </li></ul><ul><li>Transferable health records (interoperability) </li></ul><ul><li>e-prescribing </li></ul><ul><li>e-referrals </li></ul><ul><li>Warnings | Alerts | Decision support </li></ul><ul><li>Essential ingredient of a fully functional EHR </li></ul>
    11. 11. Key Issues Motivation <ul><li>Terminologies have succeeded for three reasons </li></ul><ul><ul><li>Coercion - use them or don’t get paid </li></ul></ul><ul><ul><ul><li>ICD-10AM, Read 2 </li></ul></ul></ul><ul><ul><li>They belonged to the community and were useful or key to software </li></ul></ul><ul><ul><ul><li>LOINC, HL7v2, Read 1 … </li></ul></ul></ul><ul><ul><li>They gave access to a key resource </li></ul></ul><ul><ul><ul><li>Decision support … </li></ul></ul></ul>
    12. 12. Key Issues Application Centric Development <ul><li>If it is built for everything it will be fit for nothing! </li></ul><ul><ul><ul><li>Must have a way to see if it works </li></ul></ul></ul><ul><ul><li>If it is built for just one thing it will not be fit even for that </li></ul></ul><ul><ul><ul><li>Change is the only constant </li></ul></ul></ul><ul><li>Cannot predict which specific terms will be needed in advance </li></ul><ul><ul><li>Even very large ontologies tend to be missing some terms in practice </li></ul></ul><ul><ul><ul><li>Compose them when you need them and share </li></ul></ul></ul><ul><li>Is there a optimal ‘90-10’ point? </li></ul><ul><ul><li>You can only tell against a specific application </li></ul></ul>
    13. 13. changing from continuity of carer to continuity of care <ul><li>Primary, secondary and community care </li></ul><ul><li>Public and private sector </li></ul><ul><li>Clinical networks and care pathways </li></ul><ul><li>Health and social care systems </li></ul>
    14. 14. The joys of handwritten records…. <ul><li>Very flexible </li></ul><ul><li>Expressing uncertainty easy </li></ul><ul><li>Expressing negation easy </li></ul><ul><li>Adding contextual information easy </li></ul><ul><li>Don’t have to be confined to a particular structure </li></ul><ul><li>Easy to write retrospectively </li></ul><ul><li>Great if sharing info for small co-located groups </li></ul><ul><li>Lose them and you are a goner.. </li></ul><ul><li>Have you had the experience of searching through vast numbers of paper records to get the information you need? </li></ul><ul><li>Ever tried analysing that information to compare like with like? </li></ul><ul><li>Tried sharing information accurately with many practitioners in a wider geographical distribution accurately at the same time? </li></ul>Still the norm in acute settings
    15. 15. Key Issue Role of the MOH <ul><li>Secured the right to use SNOMED CT ® </li></ul><ul><li>Standards </li></ul><ul><li>Coordination </li></ul>
    16. 16. Key Issue Decision Support <ul><li>Meaningful decision support is still rare </li></ul><ul><ul><li>Terminology is not the only problem </li></ul></ul><ul><ul><li>Ontology should be the scaffolding </li></ul></ul><ul><ul><ul><li>But requires the terminology to be computable </li></ul></ul></ul><ul><ul><li>Inter-rater reliability crucial </li></ul></ul><ul><ul><ul><li>Can we afford GIGO for patient management? </li></ul></ul></ul><ul><ul><li>Semantics of combined EHR+Terminology must be well defined </li></ul></ul><ul><ul><li>Standards </li></ul></ul>
    17. 17. Key Issue Scope <ul><li>Language technology will help </li></ul><ul><ul><li>But will always have limitations </li></ul></ul><ul><li>Tailored forms will help </li></ul><ul><ul><li>But we must beat the combinatorial explosion </li></ul></ul><ul><li>… but the key issues are organisational, social & clinical </li></ul><ul><li>… and needs empirical data </li></ul>Requires serious investment and Commitment
    18. 18. Applications centric Development Common Terminology/ Ontology clinical applications authoring environments Intermediate Representations clinicians / Applications builders Empowered Authors templates/ views templates/ views Meta-authoring Meta-authoring
    19. 19. The Healthy Population (from birth) Primary & Com. Care Specialist Care Hospital Care (2/3/4) Chronic Condition Palliative Care Mortality Database Point of Ltd. Return If fixed If fixed If fixed Return to Population Return to Population If fixed • DoB • Address • Family Details • Personal History • Managed • No fix • Quality of life • Over an extended time • Hospices • Terminal • Elderly Care • End Stage Management Primary Secondary Primary Secondary

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