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The Practical Challenges of Implementing a Terminology on a National Scale. Professor Martin Severs. Key Lessons. Terminology implementation is difficult and expensive The implementation of a terminology exposes data practices Data practices are not well developed - PowerPoint PPT Presentation
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The Practical Challenges of Implementing a Terminology on a
National ScaleProfessor Martin Severs
Key Lessons
• Terminology implementation is difficult and expensive
• The implementation of a terminology exposes data practices
• Data practices are not well developed• It is easier to blame the terminology than face
the data practice shortcomings• Patient real time access to their record, the cost
of data collection and decision support are the most likely stimuli for better terminology production and data practice
From the Micro-perspective
Patient Clinician
Consultation
From the Micro-perspective
Patient Clinician
Patient Record
From the Micro-perspective
Patient Clinician
Patient Record
No uniform routine synchronous or asynchronous access by the patient
Definitions
Lay Terms
Short Forms
Impact on Terminology [T]
From the Micro-perspective
Patient Clinician
Patient Record
No uniform Routine synchronous or asynchronous access by the patient
No Profession or inter-professional [team] standard syllabus for record keeping
Definitions
Lay Terms
Short Forms
Clinical Authority for definitions and preferred terms
Priority on work items
Quality of relationships
From the Micro-perspective
Patient Clinician
Patient Record
SECONDARY PURPOSES
Audit
Central Returns
Registers
Other dataset demands
From the Micro-perspective
Patient Clinician
Patient Record
SECONDARY PURPOSES
Audit
Central Returns
Registers
Other dataset demands
Manual Transcription of record and human interpretation of source and target data
Secondary purposes completely miss the recording challenges
From the Micro-perspective
Patient Clinician
Patient Record
SECONDARY PURPOSES
Audit
Central Returns
Registers
Other dataset demands
Manual Transcription of record and human interpretation of source and target data
Poorly costed ‘normal practice’
Semantic interoperability not important
Data quality driven by specific secondary purpose
Poor policy drive for terminology
Overall data quality poor
Aggregate data items
Definitions may be different from that in record
From the Micro-perspective
Patient Clinician
Patient Record
SECONDARY PURPOSES
Audit
Central Returns
Registers
Other dataset demands
Secondary purposes completely miss the recording challenges
Specified in aggregate data items
Human readable form not clear enough for terminological expression
No standard format for expression
No testing of system implementation
This step missed out in costing
From the Micro-perspective
Patient Clinician
Patient Record
Secondary Purposes
From the Micro-perspective
Patient Clinician
Patient Record
Secondary Purposes
PRIMARY PURPOSES
Clinical Communications
Clinical Audit
Order Communications
Knowledge Support
Common User Interface
Automated Decision Support
Referral
Discharge
Notifications
Death Certs.
Record transfer
Emergency Sum.
From the Micro-perspective
Patient Clinician
Patient Record
Secondary Purposes
PRIMARY PURPOSES
Clinical Communications
Clinical Audit
Order Communications
Knowledge Support
Common User Interface
Automated Decision Support
Referral
Discharge
Notifications
Death Certs.
Record transfer
Emergency Sum.
Significant drivers BUT
Reliance on other standards
Quality and quantity tensions in terminology
Management of clinical phrases
Consistent implementation challenge
From the Macro-perspective
• Data Migration• Patient Safety• Terminology Shared risk• Terminology Shared costs• Terminology Capacity• The global citizen• Conversion of development to implementation• Policy versus technology versus clinical care
SNOMED CT & SDO helps the Macro-agenda
• More costly develop alternative [$25-50m]• Delay the e-health agenda by developing an
alternative [<5 years]• Vendor costs would increase with multiple
standards• Avoid huge cost of data migration later
[$28B]• Avoid patient safety risks from data
migration [both deaths and injury]
SNOMED CT & SDO helps the Macro-agenda
Commercial Benefits
• Costs are minimal (compared to an Electronic Patient Record System ~ $100s of millions)
• Charges are affordable and shared, and based on the ability to pay
• Charges reduce as new Members join OR greater investment in improvement
• The investment risks are significantly reduced
• Protect Healthcare IT investment now
SNOMED CT & SDO helps the Macro-agenda
Improved Governance
• Validated Product
• Shared Ownership
• Localisation Support
• Global Collaboration
• Compatible with Other Standards
Enhanced Contribution
• Sustainable Model
• Code of Conduct
• Simple Licensing
• Vendor Engagement
• Clear and transparent management processes
SNOMED CT & SDO helps the Micro-agenda
• Validated Product BUT it needs to be better
• Leading Global Terminology from independent
assessment [Problems noted]
• Most ready for Local Implementation
• $100 million already invested in SNOMED CT [let
us build on the intellectual & financial resources]
Management Board
Finance & Operations Committee
Harmonisation Boards
SNOMED SDO Structure
Research Teams
Vendor Forum
Research & Innovation Committee
Technical Committee
Content Committee
Task & Finish Groups
Working Groups
Working Groups
GENERAL ASSEMBLY
SNOMED CT helps the Micro-agenda
Int. SNOMED
SDO
NationalReleaseCentre
Local/National Health Entities
Shared technology environment enables collaboration
NationalReleaseCentre
NationalReleaseCentre
NationalReleaseCentre
Key Lessons
• Terminology implementation is difficult and expensive
• The implementation of a terminology exposes data practices
• Data practices are not well developed• It is easier to blame the terminology than face
the data practice shortcomings• Patient real time access to their record, the cost
of data collection and decision support are the most likely stimuli for better terminology production and data practice
Questions ?
