1. Terminologies How do they impact my world? Heather Grain heather@lginformatics.com Presented at HIMAA Symposium 2008

2. Feeling Lost? Photo: Heather Grain

3. There is light! Why does terminology matter? What is terminology? How does it impact your world Views through the window (threat or opportunity). Photo: Heather Grain

4. Why Terminology? Grain, H., Clinical Terminology and Why and the What, in Health Informatics an Overview, E. Hovenga, S. Garde, and C. Hullin, Editors. 2008, Churchill Livingstone: South Melbourne

5. What you can’t do without Terminology Clinical decision support Clinical pathways Multi-axial retrieval of clinical information

6. What is a Terminology Structured collection of descriptive terms used in clinical practice Precise – no ‘other’ or ‘unknown’ Uses Description Logic to describe a concept in a manner the computer can ‘understand’ and use to support retrieval

7. A SNOMED-CT concept is defined Concept ID: 21522001 Description: 38112013 Abdominal Pain Fully defined as: Is A General finding of the abdomen (119415007) Pain of truncal structure (454497018) Finding Site( abdominal structure(113345001)

8. Multiple access hierarchies Grain, H., Clinical Terminology and Why and the What, in Health Informatics an Overview, E. Hovenga, S. Garde, and C. Hullin, Editors. 2008, Churchill Livingstone: South Melbourne

9. Terminology supports Retrieval of clinical data based upon context and clinical knowledge find me all cases of PAIN (ALL CHILDREN OF PAIN IN THE FINDING HIERARCHY) – includes headache Allows clarity of meaning over time, distance and discipline concept: 21522001 Description: 38112013 Abdominal Pain (finding) Described using SNOMED-CT V2008/1 in field: Triage Assessment assessed by: 234N Mary Smith

10. Terminology supports Fully defined unambiguous description of an individual concept in a logical, machine processable way. Allows construction of concepts (post-coordination) # humerus + Right(laterality) + mid shaft(body structure) And pre-constructed concepts (pre-coordination) # humerus (fracture + body structure) International

11. How does this impact your world! SNOMED-CT has a different job to ICD-10-AM They are in the same family and work to support some similar tasks. Will coding continue – there is likely to be a need for a classification that aggregates data for reporting and analysis into the future. Will this be ICD-10-AM Yes – though ICD11 may have a terminological basis that more closely aligns with SNOMED-CT

12. However! There is a move to invest in the use of data and to reduce the costs of data collection. This means…. ▫Automation of coding at discharge can be achieved for many common processes and is likely to occur sooner rather than later (it is seen, in part at least, as a deliverable of SNOMED-CT and mapping to ICD-10-AM) ▫Greater need for those who can extract and analyse clinical data

13. National Developments Reference Sets: Select appropriate terms (SNOMED-CT Concepts) for use in specific situations – test ordering, medications, alerts International participation in IHTSDO – International Health Terminology Standards Development Organisation as a founding member ▫Sharing the load and the learning ▫Building focused capacity

14. Views of the world It’s not going to happen for years! ▫Don’t wait or expect a big bang – it’s already happening you just can’t see it yet! Options (the green house effect) ▫Buy a bigger car (ignore it – ICD-10 is God) ▫Invest in solar power production (get on board and try and influence the result and benefit from it) ▫Wait and see – aware, learning, but waiting to follow others

15. Which are you? Leader Follower Extinct!