The Practical Challenges of Implementing a Terminology on a National Scale

1. The Practical Challenges of Implementing a Terminology on a National Scale Professor Martin Severs

2. 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

3. From the Micro-perspective Consultation Patient Clinician

4. From the Micro-perspective Patient Record Patient Clinician

5. From the Micro-perspective Impact on Terminology [T] Lay Terms Definitions Short Forms No uniform routine synchronous or asynchronous access by the patient Patient Record Patient Clinician

6. From the Micro-perspective Lay Terms Definitions Quality of relationships Short Forms Clinical Authority for definitions and preferred terms No uniform Routine synchronous or asynchronous access by the patient Priority on work items No Profession or inter-professional [team] standard syllabus for record keeping Patient Record Patient Clinician

7. From the Micro-perspective SECONDARY PURPOSES Registers Central Returns Audit Other dataset demands Patient Record Patient Clinician

8. From the Micro-perspective SECONDARY PURPOSES Registers Central Returns Manual Transcription of record and human interpretation of source and target data Audit Other dataset demands Patient Record Secondary purposes completely miss the recording challenges Patient Clinician

9. From the Micro-perspective Overall data quality poor SECONDARY PURPOSES Semantic interoperability not important Registers Poorly costed ‘normal practice’ Central Returns Data quality driven by specific secondary purpose Manual Transcription of record and human interpretation of source and target data Audit Other dataset demands Aggregate data items Poor policy drive for terminology Patient Record Definitions may be different from that in record Patient Clinician

10. From the Micro-perspective SECONDARY PURPOSES Registers No testing of system implementation Central Returns Human readable form not clear enough for terminological expression This step missed out in costing Audit Other dataset demands No standard format for expression Specified in aggregate data items Patient Record Secondary purposes completely miss the recording challenges Patient Clinician

11. From the Micro-perspective Secondary Purposes Patient Record Patient Clinician

12. From the Micro-perspective PRIMARY PURPOSES Automated Decision Support Common User Interface Knowledge Support Order Communications Clinical Audit Secondary Purposes Clinical Communications Death Certs. Referral Patient Record Record transfer Discharge Patient Clinician Emergency Sum. Notifications

13. From the Micro-perspective Quality and quantity tensions in terminology Consistent implementation challenge PRIMARY PURPOSES Automated Decision Support Common User Interface Significant drivers BUT Knowledge Support Reliance on other standards Management of clinical phrases Order Communications Clinical Audit Secondary Purposes Clinical Communications Death Certs. Referral Patient Record Record transfer Discharge Patient Clinician Emergency Sum. Notifications

14. 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

15. 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]

16. 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

17. 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 Macro-agenda

18. 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]

19. SNOMED SDO Structure GENERAL ASSEMBLY Harmonisation Boards Vendor Forum ManagementBoard Content Committee Technical Committee Research & Innovation Committee Finance & Operations Committee Working Groups Working Groups Task & Finish Groups Research Teams

20. SNOMED CT helps the Micro-agenda National Release Centre Int. SNOMED SDO National Release Centre National Release Centre Local/National Health Entities National Release Centre Shared technology environment enables collaboration

21. 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

22. Questions ?