[PPT] - Experiences from a Large- scale Implementation of SNOMED CT in PowerPoint Presentation

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Experiences from a Large- scale Implementation of SNOMED CT in Argentina.

Dr. Alejandro Lopez Osornio
Dr. Guillermo Reynoso

termMed IT

Buenos Aires, Argentina

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Hospital Italiano de Buenos Aires

Located in Buenos Aires, Argentina Founded on 1853 500 bed hospital 10,000 visits a day in the ambulatory system 140,000 patients private health insurance system

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Argentina, December 2001

Protests on the streets demanding the resignation of the president President De la Rua resigned Argentine Peso devalues from 1 U$S to 0.30 U$S Restrictions to cash withdrawal Credit crisis

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Hospital Italiano, December 2001

“Management based on accurate clinical information will let us survive this crisis” (Dr. FGB Quiros) Great boost to the IT program Extension of the Hospital Information System to all areas:

Ambulatory visits Inpatient episodes Emergency Department Diagnostic procedures Pharmacy and Medical Devices Home care

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Terminology use cases

Health insurance services management board

Chronic disease management program Epidemiology department Clinical trials Primary care Physicians Incentives Program Research and teaching (University Hospital) Clinical decision support systems

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Available vocabularies on 2001

Local Pharmacy terminology Local Devices terminology Local Procedures terminology Argentine Reimbursement vocabulary Diagnosis:

Free text secondary coded with:

ICPC and ICD-10 (outpatient) ICD-9CM and DRG (inpatient)

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Requirements

A new terminology System:

Unobtrusive: clinical users do not like things that step in the middle of their usual workflow Immediate: instant codification is the essential to use any kind of CDSS Precise: allow the user to record exactly what he wants, appropriate detail level

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Design Principles

HIBA will use a local list of terms as user interface, constructed from the free- text entries repository The interface vocabulary will be concept

riented and will support “near natural

language” expressiveness (lot of qualifiers) This Interface Vocabulary will be mapped to a Reference Terminology and the to different classifications

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Extension Mechanism

Terminologies levels and interactions

Aggregate Terminology Reference Terminology Interface Terminology Natural Language CIE-9-CM CIE-10 CIAP DRG ATC CIE-O SNOMED CT Local Vocabulary SCT Core CrossMaps Mechanism

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SNOMED CT content

Concepts: great coverage, but detail is limited to avoid the ‘combinatorial explosion’. There is some regional bias. Descriptions: acceptable, valid and appropriate descriptions, but do not fully covers local jargon and acronyms (Spanish edition)

SNOMED CT is extendable

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Implementation Strategy:

– Standard SNOMED CT

User Experience:
Cost:

– Standard SCT + New descriptions

User Experience:
Cost:

– Standard SCT + New descriptions + New concepts

User Experience:
Cost:

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Plan

Extend SNOMED CT to cover our needs Hide the complexity of the system implementing simple user interfaces:

Templates, pick-lists, checkboxes Search and refine

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Terminology Team

1 Clinical terminologist (MD) (80% time) 1 Full time administrative supervisor 12 part-time medical students 1 Lead Software Analyst and Developer (75% time) and a second for 20% of his time Medical Informatics Department Advisory Board

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SNOMED CT Mechanisms

Extensions Cross-Maps Subsets

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Extensions

Namespace:

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SNOMED CT and Local Extension

SNOMED CT Concepts Relationships Descriptions

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SNOMED CT and Local Extension