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. "
-----Original Message-----
From: Stephen Chu [mailto:[EMAIL PROTECTED]
Sent: Saturday, 11 February 2006 9:50 AM
To: [email protected]
Subject: RE: Gpcg_talk Digest, Vol 5, Issue 36Ian:I am making this comment in the capacity of a health informatician and based on the research experiences of my past professional life as an academic.Super-specialisation in medicine creates what I call "tribualism in medicine/health" with each tribe rigorously guard a set of language/terminology claimed to be unique to its own. The only hope to true interoperability is the adoption of a standardised terminology. But this does not mean that we such forced our clinicians to learn and use codes from the standardised terminology. They should be allowed to keep the terninology they use due to practical and cultural reasons. There are excellent tools available today to allow subsets of terminology relevant and applicable to each clinical domain/tribe to be extracted from the superset. Apelon is one such tool, as an example. The selected subset can then be incorporated into clinical applications/EHR systems so that the appropriate codes can be automatically attached to the clinical terms used by clinicians with minimal interventions from clinicians.SNOMED-CT is an excellent standardised terminology/nomenclature. I used it extensively in a conceptual graph researc project in the mid to late 90's. It has two major problems: (1) complexity and (2) high cost. Problem (1) can be effectively dealt with by tools that allow effective extraction of tribal specific subsets. Problem (2) can be addressed by collective bargaining power at government levels. It does not have to cost an arm and a leg to use the terminology.My 2c worth.Stephen
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Today's Topics:
1. Re: COAG & E-Health? (David More)
2. Re: COAG & E-Health? (Ian Cheong)
3. Re: COAG & E-Health? (David More)
4. Re: COAG & E-Health? (Tim Churches)
----------------------------------------------------------------------
Message: 1
Date: Sat, 11 Feb 2006 07:44:09 +1100
From: David More <[EMAIL PROTECTED]>
Subject: Re: [GPCG_TALK] COAG & E-Health?
To: General Practice Computing Group Talk <[email protected]>,
General Practice Computing Group Talk <[email protected]>
Message-ID: <[EMAIL PROTECTED]>
Content-Type: text/plain; charset="us-ascii"
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
----
Dr David G More MB, PhD, FACHI
Phone +61-2-9438-2851 Fax +61-2-9906-7038
Skype Username : davidgmore
E-mail: [EMAIL PROTECTED]
On Fri, 10 Feb 2006 20:59:40 +1000, Ian Cheong wrote:
> At 2:21 pm +1100 10/2/06, Horst Herb wrote:
>> On Fri, 10 Feb 2006 08:32, Ken Harvey wrote:
>>> http://www.thesundaymail.news.com.au/common/story_page/0,5936,18086337%255E
421,00.html
>>>
>>> "The states and the commonwealth are also expected to each pledge $65 million towards
>>> improving e-health records..."
>>>
>>> We live in hope!
>>>
>> Hope? My crystal ball suggests that half of that money will be spent on "consultancies"
which
>> will invariably just repeat the messages from the past decade, and the other half will
be
>> spread across just enough uncoordinated projects to ensure that none of them has enough
funding
>> to actually succeed.
>>
>> If we'd use the money to buy some collection containers to be attached to bovine
behinds, we
>> could collect a lot more bullshit for the money I reckon.
>>
>> Horst
>>
> Personally, I'd rather spend it on resurrecting MediConnect and making HealthConnect go
in some
> form, but based around generating business value to transacting partners.
>
> But in life a great swathe will probably end up going toward SNOMED licencing,
infrastructure and
> training.
>
>
> Ian.
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Message: 2
Date: Sat, 11 Feb 2006 06:53:58 +1000
From: Ian Cheong <[EMAIL PROTECTED]>
Subject: Re: [GPCG_TALK] COAG & E-Health?
To: [EMAIL PROTECTED], General Practice Computing Group Talk
<[email protected]>
Message-ID: <[EMAIL PROTECTED]>
Content-Type: text/plain; charset="us-ascii" ; format="flowed"
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.
Ian.
>
>----
>Dr David G More MB, PhD, FACHI
>Phone +61-2-9438-2851 Fax +61-2-9906-7038
>Skype Username : davidgmore
>E-mail: [EMAIL PROTECTED]
>
>On Fri, 10 Feb 2006 20:59:40 +1000, Ian Cheong wrote:
> > At 2:21 pm +1100 10/2/06, Horst Herb wrote:
> >> On Fri, 10 Feb 2006 08:32, Ken Harvey wrote:
> >>>
><http://www.thesundaymail.news.com.au/common/story_page/0,5936,18086337%255E>http://www.thesundaymail.news.com.au/common/story_page/0,5936,18086337%255E
>421,00.html
> >>>
> >>> "The states and the commonwealth are also expected to each
>pledge $65 million towards
> >>> improving e-health records..."
> >>>
> >>> We live in hope!
> >>>
> >> Hope? My crystal ball suggests that half of that money will be
>spent on "consultancies" which
> >> will invariably just repeat the messages from the past decade,
>and the other half will be
> >> spread across just enough uncoordinated projects to ensure that
>none of them has enough funding
> >> to actually succeed.
> >>
> >> If we'd use the money to buy some collection containers to be
>attached to bovine behinds, we
> >> could collect a lot more bullshit for the money I reckon.
> >>
> >> Horst
> >>
> > Personally, I'd rather spend it on resurrecting MediConnect and
>making HealthConnect go in some
> > form, but based around generating business value to transacting partners.
> >
> > But in life a great swathe will probably end up going toward
>SNOMED licencing, infrastructure and
> > training.
> >
> >
> > Ian.
>
>_______________________________________________
>Gpcg_talk mailing list
>[email protected]
>http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
--
Dr Ian R Cheong, BMedSc, FRACGP, GradDipCompSc, MBA(Exec)
Health Informatics Consultant, Brisbane, Australia
Elected Member, GPCG Management Committee
Internet: [EMAIL PROTECTED]
(for urgent matters, please send a copy to my practice email as well:
[EMAIL PROTECTED])
PRIVACY NOTE
I am happy for others to forward on email sent by me to public email lists.
Please ask my permission first if you wish to forward private email
to other parties.
------------------------------
Message: 3
Date: Sat, 11 Feb 2006 08:09:33 +1100
From: David More <[EMAIL PROTECTED]>
Subject: Re: [GPCG_TALK] COAG & E-Health?
To: Ian Cheong <[EMAIL PROTECTED]>, General Practice Computing Group
Talk <[email protected]>
Message-ID: <[EMAIL PROTECTED]>
Content-Type: text/plain; charset="us-ascii"
Ian,
A few points.
1. EDS is machine processing - hence the need for some form of terminology to improve
quality and consistency in care
2. Given the cost of medical errors - the costs of having and maintaining terminology are
trivial.
3. Just what is the comprehensive terminology that covers medical practice with only 2000
or so terms.. I don't think it exists. It is important to distinguish between codes and
terminology in this regard - they do and support different things.
I would be interested in your view of just what is appropriate for a national clinical
terminology as you seem convinced the bureaucrats have it wrong. For once I happen to
agree with them.
Cheers
David
----
Dr David G More MB, PhD, FACHI
Phone +61-2-9438-2851 Fax +61-2-9906-7038
Skype Username : davidgmore
E-mail: [EMAIL PROTECTED]
On Sat, 11 Feb 2006 06:53:58 +1000, 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.
>
>
> Ian.
>
>
>> ----
>> Dr David G More MB, PhD, FACHI
>> Phone +61-2-9438-2851 Fax +61-2-9906-7038
>> Skype Username : davidgmore
>> E-mail: [EMAIL PROTECTED]
>>
>> On Fri, 10 Feb 2006 20:59:40 +1000, Ian Cheong wrote:
>>
>>> At 2:21 pm +1100 10/2/06, Horst Herb wrote:
>>>> On Fri, 10 Feb 2006 08:32, Ken Harvey wrote:
>>>>
>>
<http://www.thesundaymail.news.com.au/common/story_page/0,5936,18086337%255E>http://www.th
esundaymai
>> l.news.com.au/common/story_page/0,5936,18086337%255E
>> 421,00.html
>>
>>>>> "The states and the commonwealth are also expected to each
>>>>>
>> pledge $65 million towards
>>>>> improving e-health records..."
>>>>>
>>>>> We live in hope!
>>>>>
>>>> Hope? My crystal ball suggests that half of that money will be
>>>>
>> spent on "consultancies" which
>>>> will invariably just repeat the messages from the past decade,
>>>>
>> and the other half will be
>>>> spread across just enough uncoordinated projects to ensure that
>>>>
>> none of them has enough funding
>>>> to actually succeed.
>>>>
>>>> If we'd use the money to buy some collection containers to be
>>>>
>> attached to bovine behinds, we
>>>> could collect a lot more bullshit for the money I reckon.
>>>>
>>>> Horst
>>>>
>>> Personally, I'd rather spend it on resurrecting MediConnect and
>>>
>> making HealthConnect go in some
>>> form, but based around generating business value to transacting partners.
>>>
>>> But in life a great swathe will probably end up going toward
>>>
>> SNOMED licencing, infrastructure and
>>> training.
>>>
>>>
>>> Ian.
>>>
>> _______________________________________________
>> Gpcg_talk mailing list
>> [email protected]
>> http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
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------------------------------
Message: 4
Date: Sat, 11 Feb 2006 09:27:29 +1100
From: Tim Churches <[EMAIL PROTECTED]>
Subject: Re: [GPCG_TALK] COAG & E-Health?
To: General Practice Computing Group Talk <[email protected]>
Message-ID: <[EMAIL PROTECTED]>
Content-Type: text/plain; charset=ISO-8859-1
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
------------------------------
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