1. Quality Improvements Based on Detailed and Precise Terminology EFMI on Iceland June 2010 Kirsten Bredegaard, Senior Manager Connected Digital Health in Denmark kibr@sdsd.dk

2. Agenda SNOMED CT in DK Coding clinical data using SNOMED CT Advantages & challenges using SNOMED CT Clinical documentation and reimbursement data at the same time?

3. SNOMED CT in Denmark National Release Center placed in National Board of Health Is translated into Danish Is in very limited use Smaller projects - ”pathfinder projects” – conducted by Digital Health in cooperation with the National Board of Health

4. Quality Improvements based on detailed and precise Terminology Comparative study, carried out by –Digital Health –Intensive Care Units –Daintel, vendor of ”Critical Information System” Validated visualized subset of SNOMED CT –Concepts selected and qualified by clinicians Questions to be answered: Using SNOMED CT will we then achieve –increased possibilities for quality monitoring? –increased possibilities for quality benchmarking? –faster access to evidence for new ways of treatment?

5. Method – making relevant subsets ’ Xxxx Xxx Xxxx ’ Xxxx xxx Xxxx xxx Xxxxx xxx Xxxxx xxx Xxxxx Currently used codes Relevant groupings Identifying similar groupings in SNOMED CT Marking recommended concepts Subset to be shown in the CIS system when doing clinical documentation Ambiguous terms are given a full textual definition

6. Coding clinical data using SNOMED CT

7. What can we gain using SNOMED CT – in short terms Detailed data Precise overview – also graphical Quality monitoring Direct benchmarking Efficiency of treatment Faster access to results of new treatments Faster change in treatment strategy

8. What can we gain using SNOMED CT – Long term Reuse of data for many purposes Information exchange between systems – semantic interoperability Better possibilities for decision support Different kind of warnings, ex –drug interactions –alerts information –allergy notifications

9. Challenges Reimbursement –ICD-10 is used in all DRG-algorithms National statistics based on ICD-10 –How can we compare data across the years if we change registration strategy? New EHR-systems increase the need for official clinical terminology developed for clinical use –Can we handle national subsets? So - How do we overcome the challenges and bring SNOMED CT in daily clinical use?

10. Clinical documentation and reimbursement data at the same time? Purpose –Investigate and examine possibilities for reimbursement using DRG on clinical documentation with SNOMED CT Possible to make a reliable mapping between ICD-10 and SNOMED CT when documenting? Compute and compare DRG on different registrations SKS Senile cataract XXXX SNOMED Search cataract SKSSNOMED Senile cataract + Senile cataract Other cataract + Cataract XXX

11. Conclusion The clinicians (ICU) want very much to use SNOMED CT Focus on the challenges and find future solutions using international terminologies –we need a different kind of clinical documentation in the year of 2010 We need to accept –Small problems find quick solutions while big problems take a little while longer …… but there is a solution to every problem

12. Questions?