Using SNOMED CT in ABF initiatives
Dr David Hansen| CEO
May 2013
AUSTRALIAN E HEALTH RESEARCH CENTRE
Operational context
NSW Health, FirstNet and other adopters
SNOMED CT & Emergency Department Reference Set (EDRS)
Activity Based Funding (MDBs and URGs)
Wider context
• PCEHR
• E health
• Health reform agenda
A Reminder: Why are we doing Terminology?
It’s about Data Quality and Interoperability
PRIMARY
SECONDARY
TERTIARY
Clinical users
Care delivery
Interoperability
Decision Support
Public Health
Health Service
Management
Resource Allocation
Funding
Re-use
(within)
Re-purpose
(between)
Re-purpose
(between)
Clinical terms
Classification categories
Funding groups
Data management for ABF in ED
v1.3 specifications
Mapping: inefficient, inaccurate
Changes ?
EDRS content
(as provided)
Concepts = 5 341
Paths = 28 857
EDRS
Paths and maps
(detail, single concept example)
OPEN WOUND
125643001 = T14.1
No ICD-10-AM maps
Disconnected concepts
EDRS (detail)
NOT a properly formed, functional RefSet
Missing terms?
SCT ID
262525000
283473009
55680006
296630001
233604007
312342009
386702006
42085001
SCT concept name
Chest injury
Stab wound of chest
Drug overdose
Vancomycin overdose
Pneumonia
Infective pneumonia
Victim of abuse
Victim of rape
Terms that are important for clinical care not “in scope” of EDRS
Versions synchronised?
SCT ID
SCT concept name
Status 2010
Status 2012
325569000
Haemorrhage from throat
ACTIVE
INACTIVE
No replacement
262954001
Traumatic subarachnoid haemorrhage
ACTIVE
INACTIVE
No replacement
37324003
Superficial injury of leg with infection
ACTIVE
REPLACED
449642006
Superficial injury of lower leg with infection
Not included
NEW
211983004
Full thickness burn of multiple sites of leg
ACTIVE
REPLACED
449719007
Full thickness burn of multiple sites of lower leg
Not included
NEW
EDRS treated as static, SNOMED versioning ignored
Maps from SNOMED to ICD 10 AM invalidated, out-dated or missing
Material effect
SCT concept name
Haemorrhage from throat
Traumatic subarachnoid haemorrhage
Superficial injury of leg with infection
Superficial injury of lower leg with infection
Full thickness burn of multiple sites of leg
Full thickness burn of multiple sites of lower leg
Chest injury
Stab wound of chest
Drug overdose
Vancomycin overdose
URG
MDB
2
2
2
2
2
2
2
2
2
2
SCT ID
325569000
262954001
37324003
449642006
211983004
449719007
262525000
283473009
55680006
296630001
17
10
10
E4
17
E4
10
E4
9
E4
3G
2A
2BA
R041
S066
T1300
6
R223
2B
S299
1B
T509
1
2
233604007
Pneumonia
12
3B
1
1
1
2
2
2
312342009
386702006
42085001
Infective pneumonia
Victim of abuse
Victim of rape
E4
10
E4
Dis
Visit
Triage
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2B
ICD
J189
T741
INACTIVE but achieves MDB and URG
ACTIVE does NOT group
IHPA, URG grouper, v1.3
Clinically relevant does NOT group
How to use SNOMED CT in ABF
Proposal
Build a clinically relevant EDRS
Don’t rely on maps
Aggregate SNOMED CT directly to MDB
Swap out the library files
Development experiment
Build a better EDRS
Find SNOMED CT concept that ‘matches’ MDB
Inherit all descendants (subsumption)
Manage membership, aggregation and versioning
Use proper tooling (Snorocket, Snapper, Ontoserver)
Transitive closure & transitive closure reduction algorithms
Directed Acyclic Graph traversal algorithms, rule based
Proof of concept
Trial with two MDBs
3L: Gynaecological Illness
4: Psychiatric Illness
Tertiary
Primary
Secondary
MDB 3L
Gynaecological Illness
Concepts = 1 568
Paths = 6 492
MDB 4
Psychiatric Illness
Concepts = 1 536
Paths = 3 936
How it would work
Library file
SNOMED CT – EDRS to MDB
OR
Library file
ICD to MDB
OR
Getting there from here
 New approach to terminology management & tools
 New EDRS required
 Adequate and accurate specifications
 Sufficient documentation, content and technical
 Clinical user acceptance testing
 Data testing, with queries and analytic approaches
 Published test results
Key messages
Secondary and tertiary data can be driven by clinical data
Mapping not sustainable
Version management essential
Align with and exploit e-health initiatives
Thank you
Dr David Hansen
CEO
t +61 7 3253 3610
e David.Hansen@csiro.au
w http://aehrc.com
AUSTRALIAN E HEALTH RESEARCH CENTRE