Hello Ian, Sunday, November 27, 2005, 9:57:52 AM, you wrote:
>> >> After about 20 years of this and numerous committee meetings you would >> end up reinventing HL7. IH> I disagree, given "time again" you could make many improvements to HL7. IH> Would it be "better enough" to justify moving away from the standard: IH> that's a different question. IH> The Australian extensions are poorly drafted and very ambiguous. I doubt you would improve on it. HL7 V3 was an attempt to wipe the slate clean and start again and its been going 10 years without getting there. A lesson from nature is that evolution works, but intelligent design does not. It is convoluted in places because of backward compatibility, but at least there are lots of implementations that need that. Most of our DNA is inactive baggage from the past, no one has managed to clean out the DNA dross and still produce a working person.... If the Australian extensions are not to your liking EMail me the details and I will take the issues to the standards committee. They could certainly be improved but the labour is all volunteer... >> Snomed CT is the national terminology for the UK and US and has been >> nominated as the choice for Australia, you can dispute the choice (I >> actually think its a good choice) but if we have made a choice we need >> to get on with it and make it available. IH> Big $$$, and quite path-specific (i.e. don't try coding a discharge from IH> a psychiatric ward with SNOMED) IH> Again the problem is, whose prepared to pay? Vendors will (in fairness must) IH> pass the cost to GPs, who don't want to, hospitals are quite happy with ICD10 IH> (with is basically free), so everyone points the finger at NETHA, and round we go again.... What would happen is that Australia would buy a nation wide license and then its freely available to all providers. Thats the only way it would work and that's the situation in the US. LOINC is mostly Pathology, will some clinical test names, but no clinical "values". ICD10 is a classification and does not have the granularity needed for proper EHR's. If clinical nodes were coded in SNOMED-CT then producing the required ICD10 codes would be much easier to do, for hospital reporting requirements. Snomed-CT is definitely not a Pathology coding system any more. It has rich clinical terms and basically absorbed all the Read "Clinical Terms" from the UK - thats the "CT" bit. If your patient had depression then you have a wealth of codes, at various levels of detail to choose from: They are all related by inheritance as well. At the risk of spamming...This is a dump of "Depressive Disorder" and its children. Depressive disorder (SNOMED-CT:***89007) Agitated depression (SNOMED-CT:***58005) Atypical depressive disorder (SNOMED-CT:***659001) Bipolar I disorder, most recent episode depressed with atypical features (SNOMED-CT:***29003) Major depressive disorder, single episode with atypical features (SNOMED-CT:***25002) Bipolar affective disorder, current episode depression (SNOMED-CT:***627008) Bipolar affective disorder, currently depressed, severe, with psychosis (SNOMED-CT:***632009) Bipolar affective disorder, currently depressed, moderate (SNOMED-CT:***630001) Bipolar affective disorder, currently depressed, mild (SNOMED-CT:***629006) Bipolar affective disorder, currently depressed, in full remission (SNOMED-CT:***634005) Bipolar I disorder, most recent episode depressed with melancholic features (SNOMED-CT:***52004) Bipolar II disorder, most recent episode major depressive (SNOMED-CT:***95005) Bipolar II disorder, most recent episode major depressive with atypical features (SNOMED-CT:***68002) Bipolar II disorder, most recent episode major depressive with postpartum onset (SNOMED-CT:***87003) Bipolar II disorder, most recent episode major depressive with melancholic features (SNOMED-CT:***15001) Bipolar II disorder, most recent episode major depressive with catatonic features (SNOMED-CT:***07005) Chronic bipolar I disorder, most recent episode depressed (SNOMED-CT:***37008) Chronic bipolar II disorder, most recent episode major depressive (SNOMED-CT:***6001) Depressed bipolar I disorder (SNOMED-CT:***68007) Depressed bipolar I disorder in remission (SNOMED-CT:***07008) Depressed bipolar I disorder in full remission (SNOMED-CT:***21000) Depressed bipolar I disorder in partial remission (SNOMED-CT:***12000) Mild depressed bipolar I disorder (SNOMED-CT:***86005) Moderate depressed bipolar I disorder (SNOMED-CT:***31006) Severe depressed bipolar disorder without psychotic features (SNOMED-CT:***03008) Severe depressed bipolar I disorder with psychotic features (SNOMED-CT:***17007) Severe depressed bipolar I disorder with psychotic features, mood-incongruent (SNOMED-CT:***03008) Severe depressed bipolar I disorder with psychotic features, mood-congruent (SNOMED-CT:***61006) Chronic depression (SNOMED-CT:***080009) Chronic recurrent major depressive disorder (SNOMED-CT:***8002) Cotard's syndrome (SNOMED-CT:***705009) Depressive conduct disorder (SNOMED-CT:***542000) Dysthymia (SNOMED-CT:***67006) Early onset dysthymia (SNOMED-CT:***6003) Primary dysthymia early onset (SNOMED-CT:***51003) Secondary dysthymia early onset (SNOMED-CT:***9008) Generalised neuromuscular exhaustion syndrome (SNOMED-CT:***42000) Late onset dysthymia (SNOMED-CT:***94002) Primary dysthymia late onset (SNOMED-CT:***11008) Secondary dysthymia late onset (SNOMED-CT:***70009) Primary dysthymia (SNOMED-CT:***76005) Primary dysthymia early onset (SNOMED-CT:***51003) Primary dysthymia late onset (SNOMED-CT:***11008) Secondary dysthymia (SNOMED-CT:***80004) Secondary dysthymia early onset (SNOMED-CT:***9008) Secondary dysthymia late onset (SNOMED-CT:***70009) Endogenous depression (SNOMED-CT:***706003) Endogenous depression - recurrent (SNOMED-CT:***948002) Recurrent major depressive episodes, in full remission (SNOMED-CT:***615005) Recurrent major depressive episodes, mild (SNOMED-CT:***610000) Recurrent major depressive episodes, moderate (SNOMED-CT:***611001) Recurrent major depressive episodes, severe, with psychosis (SNOMED-CT:***613003) Endogenous depression first episode (SNOMED-CT:***499006) Involutional depression (SNOMED-CT:***717001) Single major depressive episode (SNOMED-CT:***620009) Single major depressive episode, in full remission (SNOMED-CT:***606003) Single major depressive episode, mild (SNOMED-CT:***601008) Single major depressive episode, moderate (SNOMED-CT:***602001) Single major depressive episode, severe, with psychosis (SNOMED-CT:***604000) Major depressive disorder (SNOMED-CT:***143000) Major depression in remission (SNOMED-CT:***10003) Major depression in complete remission (SNOMED-CT:***12003) Major depression, single episode, in complete remission (SNOMED-CT:***27009) Recurrent major depression in complete remission (SNOMED-CT:***44001) Major depression in partial remission (SNOMED-CT:***05009) Major depression single episode, in partial remission (SNOMED-CT:***47007) Recurrent major depression in partial remission (SNOMED-CT:***35002) Recurrent major depression in remission (SNOMED-CT:***19004) Recurrent major depression in complete remission (SNOMED-CT:***44001) Recurrent major depression in partial remission (SNOMED-CT:***35002) Major depression, melancholic type (SNOMED-CT:***751009) Major depression, single episode (SNOMED-CT:***23009) Chronic major depressive disorder, single episode (SNOMED-CT:***83003) Major depression single episode, in partial remission (SNOMED-CT:***47007) Major depression, single episode, in complete remission (SNOMED-CT:***27009) Major depressive disorder, single episode with postpartum onset (SNOMED-CT:***22000) Major depressive disorder, single episode with catatonic features (SNOMED-CT:***92006) Major depressive disorder, single episode with atypical features (SNOMED-CT:***25002) Major depressive disorder, single episode with melancholic features (SNOMED-CT:***78009) Mild major depression, single episode (SNOMED-CT:***98009) Moderate major depression, single episode (SNOMED-CT:***39000) Severe major depression, single episode, with psychotic features, mood-congruent (SNOMED-CT:***11002) Severe major depression, single episode, with psychotic features, mood-incongruent (SNOMED-CT:***50007) Severe major depression, single episode, without psychotic features (SNOMED-CT:***41001) Mild major depression (SNOMED-CT:***12008) Mild major depression, single episode (SNOMED-CT:***98009) Mild recurrent major depression (SNOMED-CT:***79007) Moderate major depression (SNOMED-CT:***007) Moderate major depression, single episode (SNOMED-CT:***39000) Moderate recurrent major depression (SNOMED-CT:***18009) Recurrent major depression (SNOMED-CT:***44007) Chronic recurrent major depressive disorder (SNOMED-CT:***8002) Mild recurrent major depression (SNOMED-CT:***79007) Moderate recurrent major depression (SNOMED-CT:***18009) Recurrent major depression in remission (SNOMED-CT:***19004) Recurrent major depression in complete remission (SNOMED-CT:***44001) Recurrent major depression in partial remission (SNOMED-CT:***35002) Recurrent major depressive disorder with postpartum onset (SNOMED-CT:***36009) Recurrent major depressive disorder with catatonic features (SNOMED-CT:***09009) Recurrent major depressive disorder with atypical features (SNOMED-CT:***94004) Recurrent major depressive disorder with melancholic features (SNOMED-CT:***768000) Recurrent major depressive episodes (SNOMED-CT:***621008) Severe recurrent major depression with psychotic features (SNOMED-CT:***75009) Severe recurrent major depression with psychotic features, mood-incongruent (SNOMED-CT:***93003) Severe recurrent major depression with psychotic features, mood-congruent (SNOMED-CT:***78009) Severe recurrent major depression without psychotic features (SNOMED-CT:***74008) Severe major depression with psychotic features (SNOMED-CT:***67007) Severe major depression with psychotic features, mood-congruent (SNOMED-CT:***36005) Severe major depression, single episode, with psychotic features, mood-congruent (SNOMED-CT:***11002) Severe recurrent major depression with psychotic features, mood-congruent (SNOMED-CT:***78009) Severe major depression with psychotic features, mood-incongruent (SNOMED-CT:***99002) Severe major depression, single episode, with psychotic features, mood-incongruent (SNOMED-CT:***50007) Severe recurrent major depression with psychotic features, mood-incongruent (SNOMED-CT:***93003) Severe recurrent major depression with psychotic features (SNOMED-CT:***75009) Severe recurrent major depression with psychotic features, mood-incongruent (SNOMED-CT:***93003) Severe recurrent major depression with psychotic features, mood-congruent (SNOMED-CT:***78009) Severe major depression without psychotic features (SNOMED-CT:***84000) Severe major depression, single episode, without psychotic features (SNOMED-CT:***41001) Severe recurrent major depression without psychotic features (SNOMED-CT:***74008) Masked depression (SNOMED-CT:***500002) Menopausal depression (SNOMED-CT:***88008) Mild depression (SNOMED-CT:***495003) Minor depressive disorder (SNOMED-CT:***89009) Premenstrual dysphoric disorder (SNOMED-CT:***004) Moderate depression (SNOMED-CT:***496002) Post-schizophrenic depression (SNOMED-CT:***485007) Postoperative depression (SNOMED-CT:***18004) Postpartum depression (SNOMED-CT:***03003) Major depressive disorder, single episode with postpartum onset (SNOMED-CT:***22000) Maternity blues (SNOMED-CT:***225001) Mild postnatal depression (SNOMED-CT:***349002) Severe postnatal depression (SNOMED-CT:***350002) Postviral depression (SNOMED-CT:***079006) Reactive depressive psychosis (SNOMED-CT:***676002) Recurrent depression (SNOMED-CT:***616006) Recurrent brief depressive disorder (SNOMED-CT:***68001) Recurrent major depression (SNOMED-CT:***44007) Chronic recurrent major depressive disorder (SNOMED-CT:***8002) Mild recurrent major depression (SNOMED-CT:***79007) Moderate recurrent major depression (SNOMED-CT:***18009) Recurrent major depression in remission (SNOMED-CT:***19004) Recurrent major depression in complete remission (SNOMED-CT:***44001) Recurrent major depression in partial remission (SNOMED-CT:***35002) Recurrent major depressive disorder with postpartum onset (SNOMED-CT:***36009) Recurrent major depressive disorder with catatonic features (SNOMED-CT:***09009) Recurrent major depressive disorder with atypical features (SNOMED-CT:***94004) Recurrent major depressive disorder with melancholic features (SNOMED-CT:***768000) Recurrent major depressive episodes (SNOMED-CT:***621008) Severe recurrent major depression with psychotic features (SNOMED-CT:***75009) Severe recurrent major depression with psychotic features, mood-incongruent (SNOMED-CT:***93003) Severe recurrent major depression with psychotic features, mood-congruent (SNOMED-CT:***78009) Severe recurrent major depression without psychotic features (SNOMED-CT:***74008) Schizoaffective disorder, depressive type (SNOMED-CT:***60002) Seasonal affective disorder (SNOMED-CT:***803002) Severe depression (SNOMED-CT:***497006) Stuporous depression (SNOMED-CT:***42004) This is from the second last version, not the current. >> All the talk of "Web Services" is a distraction. Any messaging >> environment should have a "Service Orientated Architecture" by >> default. What would be more useful is interface definitions and >> national standards for EMail, HTTP Web Services, XML We IH> You've hit the nail n the head. IH> The problem is commerical forces are now arrayed *against* this. IH> If messaging is standardised, there is little incentive to IH> stick with a proprietary vendor once they (the vendor) have put in the hard yards in setting it up, IH> thus destroying their business model. Well SMIME Email ala Argus is there, Thunderbird GNUPG is there, PGP SMIME is pretty easy. We (Medical-Objects) have an open HTTP standard that is very simple and has been implemented by 3rd parties without problems. A standard administrative/discovery interface is what's lacking. You can do it with HL7 master files messages however. We have that but there is no standard. -- Best regards, Andrew mailto:[EMAIL PROTECTED] Andrew McIntyre Buderim Gastroenterology Centre www.buderimgastro.com.au PH: 07 54455055 FAX: 54455047 _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
