Hi Tim, Just three comments..
1. The original SNOMED CT business case for NEHTA strongly recommended a separate entity to look after the terminology area going forward - possibly to incorporate both the U Syd Centre and others into a real terms powerhouse for Australia. I still think that would be the best way to go. 2. Its a pity NEHTA rushed this out, or so it seems, just before Christmas when its not ready - as they say in the covering document. 3. > But Australia has the necessary expertise and capacity to carry out > that R&D, all that is needed are some funding bodies with the vision to fund > it. If it is left to "the market", I fear the results will be disappointing and > expensive, and will need to be paid for in US$ and Euros. Amen to that - I am not holding my breath however. Cheers David ps - isn't the SDO planned to be in Denmark? D. ---- Dr David G More MB, PhD, FACHI Phone +61-2-9438-2851 Fax +61-2-9906-7038 Skype Username : davidgmore E-mail: [EMAIL PROTECTED] HealthIT Blog - www.aushealthit.blogspot.com On Sat, 23 Dec 2006 08:39:07 +1100, Tim Churches wrote: > Ian Cheong wrote: >> At 6:38 am +1100 22/12/06, Tim Churches wrote: >>> See >>> >>> http://www.nehta.gov.au/component/option,com_docman/task,cat_view/gid,122/Itemid,139/ >>> >>> >>> Worth scrutinising and commenting upon, in writing, to NEHTA (but perhaps >>> comments can be CCed to this list to promote discussion firts?). But don't only >>> send comments to this list, send them to NEHTA as well as formal responses, >>> for goodness sake. >>> >>> and >>> >>> http://www.nehta.gov.au/component/option,com_docman/task,cat_view/gid,151/Itemid,139/ >>> >>> >>> For path test and result codes, it seems like SNOMED CT is where it is >>> going to be at, and the Auspath codes (see ), which are based on LOINC codes, are >>> deprecated, which makes sense to me since LOINC, although freely available, >>> doesn't adequately cover all of health and health care, and ultimately it >>> doesn't make sense to have to build decision support and other information >>> systems which have to deal with one terminology and corresponding set of codes >>> for pathology, another for procedures, another for more general diagnoses, >>> yet another for disabilities and so on. >>> >>> Usual grumbles about the use of Microsoft Excel files as the format used to >>> distribute the draft code sets, when three more clicks by the >>> relevant NEHTA functionary could have rendered the lists as CSV text files, >>> acceptable to everyone. >>> >>> Tim C >>> >> >> The Auspath codes are here: >> http://www.austpath.uow.edu.au/index.cgi >> > Thanks, forgot to include that URL in my post. > >> lack of revision could mean one of two things: >> 1. lack of use - which probably applies to request codes >> 2. good fitness for purpose - which probably applies to report codes sent >> routinely in HL7 messages daily. >> > > Over the last 18 months we have been talking to a lot of labs with a NSW > presence, both public and private sector, regarding electronic > communicable disease reporting, and the take-up of and enthusiasm for LOINC > request and result codes seems very low. One large lab that we have dealt with > seems to use them, the rest don't. > > We also found large gaps in AusPath result codes, and smaller gaps in the > request codes, with respect to microbiology (including NAT and > serology). Some of these gaps reflect gaps in LOINC, others reflected gaps in > AusPath which seems to be a slightly divergent subset of LOINC. We did > initially try to fill these gaps but no-one seemed to be > maintaining or monitoring submissions tot he AusPath web site, so we gave up > and decided to recommend SNOMED CT to labs for all coding purposes with respect > to comm disease reporting in NSW. The labs > greeting that suggestion warmly, although all indicated that it would take > time to change over, but we expected that. > >> The NEHTA effort reads like 1 steps forward, 3 steps back. >> >> Auspath request codes have: >> * preferred terms >> * synonyms >> > SNOMED CT has equivalents of these too, out of the box. > >> * infinite extensibility based on usage - if you want a new code or synonym >> you can have it and someone will figure out a preferred term and linkage >> > > NEHTA is supposed to be establishing a mechanism to allow local > extensions to SNOMED CT using a local (Oz) namespace assigned to it by the > College of American Pathologists (CAP), and shortly by SDO, the international > Belgium-based SNOMED CT governance body that will be > taking over from CAP. The idea is that new, local codes can be assigned > quickly and then, if indicated, they can be sent up for international consideration > by the SDO for inclusion in SNOMED CT itself in due course as a single, > world-wide code (which may mean translation or mapping from the local code). I gather > that NEHTA wants to operate this local SNOMED CT code maintenance facility > itself and has been recruiting (or trying to recruit) suitably experienced people > to do so. That's the only bit I am dubious about - would have been better to > outsource such operational work to an existing centre of nosological excellence, > like the National Centre for Classification in Health at Uni of Sydney - they > maintain ICD-10-AM and several other widely used classifications, as well as > doing research into health classifications and being involved in teaching > medical information managers etc. > >> Auspath report codes are based on a simplified set of LOINC codes, because >> proper LOINC codes go down to method of analysis, which makes them too unique >> for cross-comparison. LOINC codes are part of SNOMED last I looked. (Has it >> changed???) >> > > This simplification was problematic for our requirements (notification of > communicable diseases to health depts). > >> The general method for codifying reports is described in AS4700.2 and HB262 >> which is presently under revision I think. Not all reports are encoded as >> LOINC, as it depends on the nature of the report. Certainly individual >> biochemical analytes are LOINC coded. >> > > Ian will be pleased to know that our proposed NSW comm dis notification HL7 > message formats, with which the labs seem happy, are backwardly > compatible with AS4700.2 and HB262, but extend those to overcome the > ambiguities and close the interpretation gaps in those documents. We have been planning > to submit these extensions to Standards Australia once our public health > colleagues in other states and territories agree to what we propose (they broadly > do, I think). We have been keeping the relevant NEHTA people in the loop the > whole way along. > >> From memory (it is over a year since we pored over AS4700.2 and HB262), >> > LOINC coding for request types is recommended but not mandated by the > standards, and results reporting is not specified at all. Or is it the other way round? > Anyway, for one anything can be used and for the other LOINC is recommended > but not mandated (and the standards are just recommendations anyway, of course). > >> Pap smears are SNOMED >> coded as one would expect. The general principle is the test/analyte name >> would have a LOINC code and the result value would be numeric or SNOMED coded. It >> should be a piece of cake to translate unique LOINC test codes to unique >> SNOMED Procedure codes, but the complexity of pathology reporting is not well >> described in the available NEHTA >> documents. It is well understood by the pathology informaticians who actively contribute to standards development in Australia and NZ. >> > > Mapping test, result, specimen, specimen site and other relevant LOINC and > mostly lab-specific codes from the 5 or 6 biggest labs in NSW to SNOMED CT, just > for the sub-domain of communicable diseases notification, took an experience microbiologist and an assistant > several person-months (part of that was getting up to speed with SNOMED CT). > But only needs to be done once - maintenance of SNOMED CT subsets thereafter > should not be too taxing, we think. > >> Perhaps someone can understand the rationale for flying a new flag when >> everyone is happy standing behind the old one. >> > > Our impression was that almost everyone was indifferent to the old LOINC > flag, and that in general path labs saw the advantages of using a single coding > scheme (ie SNOMED CT) for requests, results, specimens, analytes, test > classes, anatomical locations, diagnoses, procedures, presenting problems and so on. > The future is one in which the clinical setting for a path request is > described in SNOMED CT codes in the electronic request message to the path lab from the > GP or elsewhere, and the lab then sends back the results and documentation of > the test and specimen as SNOMED CT codes to the GP, also electronically. All > these SNOMED CT codes can be grist for electronic decision support and other value-adding tools at the lab, and in the GP's information system, and these > tools can have access to a more wholistic picture of the patient encoded with > a single coding system, not just LOINC-coded path test results (and ICD-10-AM > coded diagnoses, MBS-coded procedures, ICPC-2 coded presenting problems and > so on). > > None of which is to say that SNOMED CT is perfect - far from it - but it is > far more comprehensive than any other terminology and its > comprehensive nature confers very powerful "network effects" on it, I think. > But there is a lot of R&D work which needs to be done yet to make SNOMED CT > readily deployable in clinical information systems. In lab and other > "back-room" information systems, there is some slog work to be done in deploying SNOMED > CT, but not much R&D rocket science is needed. Not so for clinical > deployment, though. But Australia has the necessary expertise and capacity to carry out > that R&D, all that is needed are some funding bodies with the vision to fund > it. If it is left to "the market", I fear the results will be disappointing and > expensive, and will need to be paid for in US$ and Euros. > > Tim C > > _______________________________________________ > Gpcg_talk mailing list > [email protected] > http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk > > __________ NOD32 1935 (20061222) Information __________ > > This message was checked by NOD32 antivirus system. > http://www.eset.com
_______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
