snomed ct in the nhs care records service
DESCRIPTION
SNOMED CT in the NHS Care Records Service. Ian Arrowsmith NHS Connecting for Health Terminology workshop Sandefjord, Norway 3 rd November 2005. Structure of presentation. An overview of the NHS Care Record Service ‘Spine’ SNOMED CT NHS Implementation activities - PowerPoint PPT PresentationTRANSCRIPT
NHS Connecting for Health is delivering the National Programme for Information Technology
SNOMED CT in the NHS Care Records Service
Ian ArrowsmithNHS Connecting for Health
Terminology workshopSandefjord, Norway3rd November 2005
NHS Connecting for Health is delivering the National Programme for Information Technology
Structure of presentation
• An overview of the NHS Care Record Service ‘Spine’
• SNOMED CT NHS Implementation activities• International Standards Development
Organisation
NHS Connecting for Health is delivering the National Programme for Information Technology
Will enable details of the key events of a persons healthcare history throughout their life to be;
● collected, stored & retrieved● made available at all times ● across the whole country ● to those with authority to view
“A better use of information and communication technology within the NHS would improve efficiency and cut costs”
Wanless Report April 2002
The NHS Care Record Service ‘Spine’
NHS Connecting for Health is delivering the National Programme for Information Technology
Simplified ‘Spine’ architecture
SecondaryUses
Service
Transaction &Messaging Service
ElectronicBookingService
PersonDemographics
Service
PersonalSpine
InformationService
HL7
v3
Social Care Primary /Community Mental Health Acute Care Pathology Ambulance
NHS Connecting for Health is delivering the National Programme for Information Technology
Contractual arrangements
• National services (NASP)• 5 regions (clusters)• 4 main regional contractors (LSPs)• 3 main sub-contractors • Small number of other National sub-
contractors• Large number of existing/legacy system
suppliers
NHS Connecting for Health is delivering the National Programme for Information Technology
NHS CRS domain Patient care domain
LSP Service
Information
Clinical Event
Healthcare service
Local System• GP systems
• Hospital systems … etc.,.
● A clinical event takes place in a healthcare service● The Local service requests information from Spine● Information is used to inform current care● Care given – details placed onto local system● The Spine is also updated with recent care details
A single clinical event …
The Spine
Example SpineInformation
Personal Details
Previous Care Summaries
Details of Clinical EventsClinical correspondenceDischarge summaries
Referral information
Current Care Providers
Medication Information
NHS Connecting for Health is delivering the National Programme for Information Technology
LSP
Patient info
Broken Leg
Patient visits A&E
Patient info
LSP
Back Pain
Patient visits GP
LSP
Patient info
Chest infection
Patient visits hospital
Spine
Multiple events over time…
NHS Connecting for Health is delivering the National Programme for Information Technology
NCRS Spine ‘Vision’• The “Continuity of Care Record”
– The NHS Care Record Spine is a universally accessible (to those with an authority to view) repository of Health Care information for every person in England.
– The content of the record can be thought of as the minimum information required by a clinician when seeing a patient for the first time in the absence of a referral from a clinical colleague. That is not to say that the record will only be used in unplanned and emergency situations.
NHS Connecting for Health is delivering the National Programme for Information Technology
SNOMED CT in the NCRS
• Ensuring the NHS is ready for SNOMED and….. – SNOMED is ready for the NHS)
• The challenge:– Pace of change– Scale of implementation– Lack of implementation experience (of SNOMED CT)– Large installed legacy terminology user base– Supplier resistance – contracts !!
NHS Connecting for Health is delivering the National Programme for Information Technology
Traditional role of the NHS Terminology Service
• UK-specific SNOMED CT and READ codes maintenance• Maintenance of dictionary of medicines and devices
(dm+d)• Production of SNOMED CT UK Edition on behalf of all 4
home countries• Maintain cross-maps to UK-specific classifications• Subset maintenance/management• Clinical content enhancement• Distribution• Licensing
NHS Connecting for Health is delivering the National Programme for Information Technology
Additional responsibilities
• Ensuring consistent approach across regions/supplier
• Ensuring consistent approach across work-streams
• Coordination of design activities• Provide forum for risk and issue resolution• Provide authoritative and explicit guidance/advice
NHS Connecting for Health is delivering the National Programme for Information Technology
(some) Key activities/issues
• Subsets• Model of use vs Model of meaning• Managing legacy environment• Training• Distribution• Contribution to related work• Contribution to internationalisation effort
NHS Connecting for Health is delivering the National Programme for Information Technology
Subsets • A collection of terminology, selected and grouped
for a particular purpose• May be composed of anything from a single
component to the entire set of concepts, descriptions or relationships
• Commonly needed for: – Data quality improvement– Message field validation– Simplified data entry and retrieval– Elimination of ‘noise’
NHS Connecting for Health is delivering the National Programme for Information Technology
Subsets - approach• Devolved responsibility• National control• Provide effective tools:
– Simple to use and individually configurable to allow subsets to be created/edited with the minimum of effort (including tutorials)
– Ability to set permissions/rights to allow viewing and/or editing rights
– Workflow elements– The tool must support multiple synchronous users– To support the distributed working environment it must be
possible to undertake all of the above processes over the www
NHS Connecting for Health is delivering the National Programme for Information Technology
Typical subset creation Methodology
• 2 main variants– 1) Select directly from SNOMED– 2) Describe in own words and compare with
SNOMED
NHS Connecting for Health is delivering the National Programme for Information Technology
Direct interaction
NHS Connecting for Health is delivering the National Programme for Information Technology
Clinicianscreating raw
contentSubset
Processing byauthorised subset authors
able to invite clinicians who are not so computer
literate and those who may not have any knowledge of
SNOMED terminology
In your own words….
NHS Connecting for Health is delivering the National Programme for Information Technology
Need to create a subset of a list of “Orthopaedic procedures of the knee joint”
In this instance, Orthopaedic Clinicians are invited by email to give their input on the content for this subset
Clinicians are asked to give their input in a simple format –Such as a spreadsheet using their own words
First steps
NHS Connecting for Health is delivering the National Programme for Information Technology
NHS Connecting for Health is delivering the National Programme for Information Technology
A team of authorised subset authors will map the clinicians words to a SNOMED equivalent concept
The mapped list is then distributed back to the clinicians to validate that the SNOMED CT description chosen is unambiguous and that it has
retained the meaning of the clinician’s words
At no stage during this process clinicians
are exposed to the coding element of
Terminology
Next step
NHS Connecting for Health is delivering the National Programme for Information Technology
NHS Connecting for Health is delivering the National Programme for Information Technology
Subset
NHS Connecting for Health is delivering the National Programme for Information Technology
Model of use vs Model of meaning
• Model of Meaning – What is known and can be inferred about the instances of a given concept
• Models of Use – When, where and why to use, store, or display a concept or group of concepts
NHS Connecting for Health is delivering the National Programme for Information Technology
Managing ‘Legacy’ issues• Mixed economy
– Paper based systems– Non-compliant electronic systems– Partially compliant electronic systems– Totally integrated electronic systems – Alternative coding systems– Secondary uses
• Principles– Maximum use of existing information– No interruption to existing flows– Information entered only once
NHS Connecting for Health is delivering the National Programme for Information Technology
Translation/mapping• There will be no widespread mapping exercise to enable non-
SNOMED systems to be able to send clinical information to the Spine.
• Centrally maintained formal mapping between Read codes and SCT will be utilised to allow translation of clinical content in local systems for messaging to NCRS Spine
• Exceptions for Pathology and Radiology• Examining use case for reverse mapping from classifications
NHS Connecting for Health is delivering the National Programme for Information Technology
Training – who needs it ?
• Health record and communication practice standards• What sort of staff need to understand about SNOMED CT• How much do they need to know• Whose responsibility is it to train them• Where are the gaps
NHS Connecting for Health is delivering the National Programme for Information Technology
What sort of users are there ?• ‘Typical’ front-line user• Users of legacy terminology• Front-line application support (super-user)• Enthusiasts• Basic trainer• Analysis experts (clinical audit, clinical coder
etc)• Advanced trainer• Application configuration expert (tailoring)• System developer/configuration expert• Policy developer/implementer• National experts
NHS Connecting for Health is delivering the National Programme for Information Technology
Distribution• Aim = more frequent release
– Tooling/processes– Synchronisation/distribution– Core vs extension– New partners
• Subsets• Distribution formats• Non NPfIT suppliers• Relationship with legacy products
NHS Connecting for Health is delivering the National Programme for Information Technology
Parallel work
• Common user interface– Rendering– Post-coordination– Search strategies
• Cultural change/implementation• terminfo
NHS Connecting for Health is delivering the National Programme for Information Technology
In conclusion….
• SNOMED CT (in the NHS CRS) will facilitate the sharing of electronic patient records to provide clinical support across all care settings
• SNOMED CT is part of the solution, not part of the problem…..
NHS Connecting for Health is delivering the National Programme for Information Technology
SNOMED® Standards Development Organisation
[SNOMED SDO]
NHS Connecting for Health is delivering the National Programme for Information Technology
Vision Statement
The SNOMED CT® Standard is necessary for international interoperability, conformance and decision support. The SNOMED CT Standard is managed by The SNOMED® Standards Development Organization in such a way that uptake, collaboration, alignment, contributorship and the ability to meet local terminology needs are encouraged.
NHS Connecting for Health is delivering the National Programme for Information Technology
SNOMED SDO top-level StructureManagement Board
Content Com.
Technical Com.
Finance & Ops. Com
Research & Innov. Com
NHS Connecting for Health is delivering the National Programme for Information Technology
Management Board: Function• Management Board is responsible for:
– All the decisions taken in and by the SNOMED SDO; it is the authority
– All aspects of the SNOMED SDO structure, process, outputs, governance, financial sustainability and legal standing
– Upholding the vision, values, principles and articles of the SNOMED SDO
NHS Connecting for Health is delivering the National Programme for Information Technology
Content Committee: Function• Be responsible for the quality of the content
of the international terminology, [the core]• Set the requirements for the concept
modelling and editing processes with the Technical Committee
• Submit to the MB an annual fully funded business plan which is fully conformant to the overall SDO business plan
NHS Connecting for Health is delivering the National Programme for Information Technology
Technical Committee: Function• Lead and recommend the technical strategy for
the SDO • Lead the specification, contracting, testing,
supporting and managing of the global technical components for the SDO. At a minimum this would include: – The SNOMED CT distributed modelling and editing
environment – The SDO terminology distribution systems – The internal automated quality assurance processes
NHS Connecting for Health is delivering the National Programme for Information Technology
Finance & Operations Committee: Function
• Assuring all MB and Executive Board papers are prepared and submitted to MB to time and specification
• Ensuring all support functions especially finance are fully detailed and reported to the Management Board
• Initially investigating and reporting to the MB all adverse incidents including complaints, adverse publicity, and delays in projects.
• Drafting operational policies and procedures as recommended by the MB and managing their implementation
• Monitor progress and delivery from Committees
NHS Connecting for Health is delivering the National Programme for Information Technology
Research & Innovation Committee: Function
• Responsible for:– Developing the Research Strategy for terminology
world wide in consultation with research colleagues outside the SDO
– Recommending costed activity to the MB for either in-house or externally commissioned research, this could be via an annual business plan
– Commissioning external R&I and accounting for SDO money spent
NHS Connecting for Health is delivering the National Programme for Information Technology
Full SNOMED SDO StructureManagement Board
Content Com.
Technical Com.
Finance & Ops. Com
Research & Innov. Com
Vendor Forum
Harmonisation Boards
Support Organisation
Working Groups
Working Groups
Task & Finish
Research Teams
NHS Connecting for Health is delivering the National Programme for Information Technology
New SNOMED Enterprise Model
National Release Centre
SNOMED SDO [Core]
NationalReleaseCentre
NRC[Core and Extension
]
NationalReleaseCentre
Local/National Health Entities
Shared Infrastructure to enable collaboration
NHS Connecting for Health is delivering the National Programme for Information Technology
Component Definitionof SNOMED Enterprise
• SNOMED Standards Development Organisation [SDO]– All components needed for international
conformance, interoperability & maintenance of the principles
• National Extensions– All components needed for national, but not
international conformance, interoperability & maintenance of the principles
NHS Connecting for Health is delivering the National Programme for Information Technology
SNOMED SDO Technical Infrastructure
1. Configuration management2. Workflow management3. Modelling tool4. Lexical tools5. Subset tool6. Mapping tools7. Content submission tools8. Data communications environment9. Support and maintenance processes
NHS Connecting for Health is delivering the National Programme for Information Technology
Other key points• ‘Not for profit’ organisation• Different levels of membership• CAP initially contracted as support organisation• New structures anticipated by April 2006• European workshop in London, 11th November
2005 – contact [email protected]
NHS Connecting for Health is delivering the National Programme for Information Technology
Further information
http://www.cfh.nhs.ukhttp://www.snomed.org