Sunday, December 04, 2011

NEHTA's Unreality Just Seems To Roll On And On. This Will Take Years. What Planet Are They On?

The following announcement appeared last week

NEHTA licenses CSIRO software for e-health rollout

The software will aid the transition to a standardised dictionary of clinical terms
The National E-Health Transition Authority (NEHTA) has licensed software from the Commonwealth Scientific and Industrial Research Organisation (CSIRO) to aid the move to a standardised dictionary of clinical terms as part of the Federal Government’s Personally Controlled Electronic Health Record (PCEHR) project.
The $467 million project involves the establishment of a PCEHR system that encompasses patient health summaries which both patients and their healthcare providers can access by 1 July 2012.
Australian e-Health Research Centre (AEHRC) chief executive, David Hansen, told Computerworld Australia that the Department of Health and Ageing (DoHA) and NEHTA would soon require healthcare software vendors to make the transition to SNOMED CT, a clinical terminology which encompasses a group of terms that would underpin the PCEHR going forward.
“Whenever there’s a problem, a diagnosis or a clinical description that’s needed to be put in our electronic health records, clinicians, whether they know it or not because it’s in the software, will be picking a term from the SNOMED CT vocabulary,” Hansen said.
NEHTA adopted SNOMED CT about five years ago when they started standardising electronic health information, but usage is still quite low, Hansen said.
CSIRO will provide a free download of the software, called Snapper, which was developed at the AEHRC – a joint venture between CSIRO and the Queensland Government – from November 2011 until 30 June 2013 to support software companies and healthcare providers in making the move.
“Most existing electronic systems do not use the SNOMED CT dictionary, but a mix of existing standard and local data dictionaries. The Snapper tool will help to translate terms in the existing system to terms from SNOMED CT,” Hansen said.
“The Snapper tool will enable information captured in an emergency department computer system to be understood by the computer systems used for hospital in-patients, and again by GP computer systems once the patient has been discharged.
“It will also help with the maintenance as SNOMED is released every six months and help them know which terms they might want to add and so on.”
The Java-based software, compatible with PCs, Macs and Linux, is standalone and while SNOMED CT comes as part of the package, Hansen said, users will be able to update automatically in the future.
More here:
Being curious I thought I would see just what Snapper was.

Snapper

Developed at the Australian e-Health Research Centre, CSIRO’s Snapper incorporates rich semantic feedback to produce the most fully-featured and easiest to use tool for creating mappings from existing term lists or value sets to SNOMED CT and AMT. These semantic mappings enable the meaning of terms in existing clinical terminologies to be described using concepts or expressions from SNOMED CT.
In addition, the intuitive graphical interface allows quick and easy generation and maintenance of customised term lists (Reference Sets) that can then be exported into current software or accessed via an RF2-conformant terminology server.
  • All-in-one: Map your existing terminology to SNOMED CT or build SNOMED CT compliant Reference Sets without needing to fiddle around with browsers and a spreadsheet.
  • Easy to use: Snapper provides a full browsing experience to enable users to understand the SNOMED CT and AMT content.
  • Time-saving: Snapper imports a list of source terms for mapping each term to SNOMED CT and provides an automap feature to provide a "first pass" mapping.
  • Fully featured: Snapper supports the full semantics of SNOMED CT and AMT. Full support is given for creation and syntactic and semantic checking of SNOMED CT’s post-coordination expression syntax, where required.
  • Intuitive GUI: Snapper has unique visualisation features, such as the interactive ontology visualiser and the expression editor. Drag and drop functionality provides for a modern user interface experience.
  • Full lifecycle: Ongoing maintenance of Reference Sets is supported through the use of RF2-based timestamps and timestamp-aware comparison algorithms.
More information, necessary licenses and downloads are here:
So, in summary what Snapper is, is a terminology mapping tool  to allow systems that have an embedded terminology that is presently used for coding information to convert their present term set to a SNOMED-CT set of associations.
I assume what this means is that if you have an existing set of say drug names or say ICPC codes these can be converted to the SNOMED equivalent in a partially automated way - because - as it made clear, the automap feature only provides a “first pass” map.
A few things occur to me with all this:
A review of the Information Requirements for the PCEHR’s Shared Health Summary (SHS) shows that while SNOMED-CT is preferred, free text is still going to be OK. It is going to be a good while before most software that might create a SHS will be SNOMED-CT compliant.
Any mapping that is done will inevitably introduce all sorts of problems that will need to be manually reviewed and resolved. Any errors could have some rather nasty consequences.
Third if SNOMED-CT is the be used - and it is really the only kid on the block at present - would it not be more sensible to use it directly and not via a map. If terms are going to be applied to text I would feel a direct use would be appropriate - remembering there is a need to minimise user effort by using focussed sub-sets etc. Really it is vital that the clinician is the one that attaches the meaning to a code and this is best done using a direct interaction with the SNOMED hierarchy I would think. This becomes especially relevant if clinical decision support is to be driven from the codes.
This really means provider software need to be configured and tailored to use the terminology from the ground up in an ideal world!
I am also reminded of the comments of Prof. Alan Rector (who really understands this stuff like few in the world) that are found here:
“Until comprehensive quality assurance has been undertaken, anyone using, or mandating, SNOMED should be aware that the hierarchies contain serious anomalies. Should a ‘Reference terminology’ classify diabetes as a disease of the abdomen; fail to classify myocardial infarction as ischemic heart disease; place the arteries of the foot in the abdomen?
Without further quality assurance, clinicians may not realize the implications of what they are saying; researchers may not realize what their queries should retrieve, and post-coordination cannot be expected to be reliable. Interoperability, and therefore meaningful use, will be limited.”
I also note the arrangement only goes until 2013. I suspect that with most involved in e-Health in Australia rather pre-occupied with PCEHR related activities the focus on SNOMED may not be very intense at this stage.
It also seems a little odd that there was not some form of procurement process undertaken for software and services to support SNOMED implementation. There are companies like Healthlanguage and (http://www.healthlanguage.com/)  and Apelon (http://www.apelon.com/) out there who do this work globally.
Interestingly Apelon have just won a contract to help Canada with a similar program.
See here:
Somehow, while being very pleased we have Australian effort and expertise in the area, I feel this is another NEHTA  initiative which may not lead very far in terms of real clinical outcomes in the short or even medium term.
Recognising the limited progress in the five years since SNOMED-CT was adopted I fear we may be waiting another few before some real clinical benefits flow.
To speed things up things some real funds and support need to be provided along with things like Snapper. To date it is not clear that is the plan - to say the least! As of now the expectations of rapid adoption are really pretty unreal - pressure from NEHTA and DoHA or not!
Bottom line. This is not a solution to an urgent problem. We need a total reboot of governance and leadership in Australian E-Health to get us back on the rails.
For those who can access it (at the NETHA Vendor Portal) the NEHTA Version 2.0 Blueprint reveals all sorts of reality checks on time-lines and delivery which really need serious public discussion. Dream on David!
David.

2 comments:

EA said...

Ross Anderson (Cambridge) on third-party use of data in NHS patient records.
http://www.lightbluetouchpaper.org/2011/12/04/here-we-go-again/
David, do you know whether Crown use provisions have ever been invoked to protect innovations in Health IT?

Dr David More MB PhD FACHI said...

Sorry, I have no idea.

David.