Ian Cheong wrote: > At 7:44 am +1100 11/2/06, David More wrote: >> Ian, >> >> I think it is important to remember the lack of terminology was a key >> reason for the failure of a number of the HealthConnect trials. >> >> Spending on terminology capability and development may not be a bad >> investment at all in my view - it is required if any form of real >> inter-operation between systems is to be achieved. Communication 'by >> blob' helps - communication of understanding and context is way better. >> >> Cheers >> >> David > > Yes, but terminology is mainly for machine processing. > > Detailed comprehensive terminology costs a bomb and leads to enormous > downstream costs. > > A limited terminology with classification is probably all one needs to > do most decision support - something closer to 2000 terms, according to > various experts around the traps. > > It is likely that yet another tiny little bureaucratic decision will > point us in a less than optimal direction for decades.
A few observations: 0) Yes, encoding information using a clinical terminology is indeed mainly for machine processing. But that's the point - it better enables the machines to do the information processing drudge work, to allow us humans to concentrate on more interesting things. Health informatics is not only about speeding up human-to-human communication. 1) The US Dept of Health and Human Services paid teh College of American Pathologists (CAP) a once-off US $35m fee for a perpetual license for all of SNOMED CT for all of US (available to everyone, public and private sectors) with updates for 5 years and an option to renew for updates after that. 2) On a population prorata basis that equates to about AUD$3m for a similar five years of updates for all sectors of all of Australia, or about $600k per annum. That's probably less than the annual fancy sandwich meeting catering bill for the DoHA... 3) Just because SNOMED CT has several hundred thousands concepts in it doesn't mean that you need to use them all. You can easily pick subsets of SNOMED CT for particular purposes. But if you need more deatil, with SNOMED CT, it is already there (in most cases - there are still some gaps in its detailed coverage of concepts, but these can be filled in due course, especially now that CAP is more open to shared governance and ownership of SNOMED CT). 4) The challenge is to develop smarter technologies for automatically encoding medical concepts expressed or chosen via structured pick lists or look-ups, in free text notes, and via natural language speech into SNOMED CT codes. It's doable, and Jon Patrick's group at Sydney Uni has already made a start. There is a big opportunity for the development of home-grown technologies to do this which don't cost a bomb, and which can be incorporated in next-generation clinical information systems or retro-fitted to existing ones. Tim C _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
