Presentation on theme: "Mediation between People, Languages, Cultures, and Machines Pieter E Zanstra Radboud University Nijmegen Medical Center Co-ordinator EU SemanticHEALTH."— Presentation transcript:
1 Mediation between People, Languages, Cultures, and Machines Pieter E Zanstra Radboud University Nijmegen Medical Center Co-ordinator EU SemanticHEALTH Specific Support Action: Semantic Interoperability Deployment and Research RoadmapeHealth2006: High Level Conference and Exhibition, Malaga, May 12, 2006
2 Where are we coming from.. Reviewed. Primip FT No ANC probsF/D at 08:45Needed synto for contractions about 7cmDecent progress since.Epidural in-situNo urges to push really according to patientContractions 4:10 but poor duration & strength (on 60 u/s /synto)PA: Ceph 0/5VE: Head at +1Caput +1 No ???OA positionCx F/D NO DESCENTTried pushing – poor maternal effort despite instructionAlthough epidural working well, doesn’t stop longstandingspasmodic hip pain.Very problematicFHR CTG No descent with attempts at pushing – poor effort.Plan… a) Push synto b) Need really try to push & work on techniquec) reassess at interval 15 mins & D/W consultantWould not be happy to have to exert traction withForceps when no effort & no descent
3 Competing demands on recording ICD, ICPMClassifierReferral lettersReimburseManage?GrouperDRGDocumentationCategoriseRecord
4 What kind of business logic do we need? ICD, ICPMClassifierGrouperDRGDocumentationReferenceTerminologyServiceRecord
5 CEN/ISSS eHealth FG Recommendation 13 (2005) The Member States, with the Commission, should:ensure the Europe wide referencing and easy access to the content of existing health coding systems based on registration of such systems by the Eurorec Institute;support the international convergence towards a common framework for formal representation, and eventually the development and maintenance of a multilingual clinical reference terminology. This effort should build on existing efforts in formal representation as GALEN, FMA and SNOMED, and be carried out in liaison with the WHO Family of International Classificationsmake the targeted reference clinical terminology publicly available free of charge;support a common approach to link national classifications of procedures, to support cross-border reimbursement of health care.
6 Clinical terminologyA clinical terminology is the collection of standard terms with their synonyms, which in the context of patient care support the recording of complaints, signs, symptoms, circumstances, process of illness, interventions, results, diagnoses, as well as the decision making of the care providers
10 What is a term referring to? Blood pressureEvaluation result (high, low)Measurement (diastolic, systolic) Archetype/Template?Guideline (how to measure?)Rheumatoid arthritisEvaluation resultMeasurement (criteria)
11 Semantic interoperability (example of drugs with different trade marks) The example:A patient coming from Switzerland to a German pharmacy is looking for a drug well known in Swiss:„DROSANA Resiston Trpf.“The name of this drug is not known in German pharmacies!The pharmacistwill not find this drug in his drug data bases,is not able to identify the ingredients of the drug,can not look for an equivalent drug available in Germany.Reinhold A. Mainz, BMGS, Germany, Project Group Telematics – Health Card14./15. February , Bruxelles, EC / WHO Workshop on Semantic Interoperability
12 Multiprofessional Records and terminology Differences in vocabularyDifferences in the meaning of the vocabularyDifferences in aspects/abstractionsNurse: ‘constipation’ is an elimination problemDoctor: ‘constipation’ is a bowel function disorderDifference in operational significanceReflecting differences in professional tasks35
15 Codes, codes everywhere... SNOMED-3READ-2MeSHICD-9ICD-9-CMICD-ONCSPICPMOXMISECRI-UMDNSSNOPHCFAACR-NEMAIUPAC-NPULOINCDICOM-SDMMCTGECDAMNGAPICPCOPCS-4CPT-4NDCNANDAICNPAIDSLINEMED80MED66AIDSDRUGSAIDSTRIALSChemIDCHEMLINEGENE-TOXHISTLINESDLINETOXLINETOXLINE65TOXLITPDQAVLINEBIOETHICSCANCERLITCATLINEDENTALPROJMEDLINEPOPLINESERLINEDOCUSERDxplainAI/RHEUMIliadGenBankOMSPSYTRIFACTSNIOSHNPIRSNEDRESMED85MED75HSTATHDAMED90HealthSTARACR92AIR93BRMP96NICULTBRMS96COSTARCPMCRISPCOSTARTDMDDSM III & IVDORHHCINSLCHMCMMIMNeuronamesWHOARTCTV3CCHI (Canada)MBS-E (Australia)ICD-10-PCS (USA)ICPM-NL (Netherlands)NCSP (Swedish Version)NCSP (Finnish Version)ICPM-DE (Germany)CCAM (France)SNOMED-CT (USA-UK)OPCS-5 (UK)SKS (Denmark)ICIDH (WHO)Digital Anatomist (UW)Nomina Anatomica….ranging from terminologies which aim to encompass the whole of clinical care to those focussed on a particular subdomain, like AIDS or radiology.
16 And there is more to come…… Official Inventory on IT systems52 ‘exotic’ patient record systems1 ‘summary-system’ used by 250 physicians of which 70 daily containing patientsInventory by studentsEstimated 200 ‘exotic’ systemsAt least 200 shortlists for diagnosis, treatmentOnly some terminologies properly documented/maintained
17 The exploding bicycle accidents ICD-9 (E826) 8READ-2 (T30..) 81READICD
18 The next Challenge: Adequate data capture ! Structured Data EntryFile Edit HelpCycling AccidentWhat you hitYour RoleActivityLocation
19 The classification of Chocolate SNOMED-CTTermReadV3C-F0811C-F0816C-F0817C-F0819C-F081AC-F081BC-F081CC-F0058Bounty barCrème eggKit KatMars BarMilky WaySmartiesTwixSnickersUbOVvUbOW2UbOW3UbOW4UbOW5UbOW6UbOW7Ub1pT?
20 Evidence Based Medicine Some MythsStage of developmentOpen SourceOpen source will most definitely not be free of cost; A complex terminology is required, and we should not expect this to appear without significant investmentThe critical mass of skilled & dedicated contributors to a large Health terminology is too small for a sustainable systemEvidence Based MedicineOnly about 5-8% of present medical knowledge is based on sound evidence. RCT’s are very costly and time-consuming. We can not longer ignore the need for routinely collected observational data of high quality.Problem of finding ‘outliers’ in the literature
21 A bit of Archeology (1) 2nd EU/CEN Workshop (1997) Central resources - public or private - are urgently needed for European Industry to address a single marketCentral reference resource of conceptsMultilingual lexiconsLanguage independent development toolsA strategy to maximise European influence on international developments is neededNew developments in HL7, CorbaMed, DICOM, UMLSEstablishing evolutionary pathways from existing systems to future systemsCommunication architectures should address mediation & conversion
22 A bit of Archeology (2) SESAME Committee (1990) Medical Semantics Advisory Task (Mesat)Establish national standardisation organisations for semantical aspects in medicineEuropean medical termbank (Eumet)European Model of Health Care (Euromodel)European Classification of Medical Procedures (Euclamep)Harmonization of validation and coding rules for ICD
23 Still many open questions What level of detail is requiredRevolutionairy/evolutionairy implementationHow do we cope technicallyHow do we cope in the business processHow do users cope cognitivelyHow do we cope with version control in the new highly interdependent architectures
24 Observations Development still driven by ‘perceived need’ No yet hard evidence to prove added valueFor the next five year seen by industry as exhaustive list of fixed termsGrowing evidence to reconsider the ontologies behind systemsBoth SNomed CT and GALEN stem from early 90sSystems not plug and playSignificant cost of translationMultitude of base cost goes into localisation
25 Clinical Terminology Summary Evolving use caseEpidemiologyOrganising careDocumenting CareAccess to knowledgeEvolving TechnologyEnumeration – ICDInterlingua – UMLSFormal Ontology – SNOMED CTTechnological BarriersEnumeration doesn’t scaleComputers can’t readHumans can’t organiseTower of BabelUnsolved ProblemsQuality AssuranceEfficient data captureInterrater variabilityCost ModelBut this turns out to be very hard, for the reasons given above.Perhaps the most important problem is that humans can’t be bothered to spend the time needed to give the computer what it needs.
26 Recommendation: Establish the process Focus on real immediate needs, and realistic time scalesBe prepared to throw away what you loved and cherised!Be aware and secure solutions for different cultures/ languagesDo not just select a single product, but join forces to redesign with best of breedInvolve and explain to those who have the burden of recording (registration dividend)Without a well managed network of compentent expertise centres, the process is likely to fail
27 AcknowledgementsSpecific Support Action co-funded by the European Commission SIXTH FRAMEWORK PROGRAMMERadboud University Nijmegen Medical CenterDepartment of Medical Informatics (Co-ordinator)World Health Organisation Dept. Measurements & Health Information Systems, SwitzerlandUniversity College London Centre for Health Informatics, UKUniversity of Manchester Health and Bioinformatics Group, UKUppsala University Nordic Centre for Classifications in Health Care, SwedenNational Institute for Strategic Health Research HungaryUniversity of St. Etienne Department of Public Health & Medical Informatics, FranceCommunication & Technology Research, Germany
28 Thank you for your attention! Further information:Pieter E ZanstraRadboud University Nijmegen Medical Center