tag:blogger.com,1999:blog-23447705.post3903670073923894678..comments2024-03-28T17:49:03.998+11:00Comments on Australian Health Information Technology: I Wonder What Is Going On With the Terminology Function At NEHTA?Dr David G More MB PhDhttp://www.blogger.com/profile/06902724829795199526noreply@blogger.comBlogger21125tag:blogger.com,1999:blog-23447705.post-89470701227731284752011-09-06T16:20:13.278+10:002011-09-06T16:20:13.278+10:00Graham,
Its most accurate to say that compared to...Graham,<br /><br />Its most accurate to say that compared to the SNOMED-CT core AMT lacks the functionality to make it useful for decision support. The allergy question is one serious shortcoming, but the drugs themselves are in quite a flat list as well with no upper level hierarchy. SMOMED-CT is about computability and AMT is devoid of this ability, apart from generic <-> trade name Andrew McIntyrehttp://www.medical-objects.com.aunoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-76024341432136005032011-09-06T12:54:02.604+10:002011-09-06T12:54:02.604+10:00#Eric. I think it's more accurate to say that ...#Eric. I think it's more accurate to say that the mechanism exists but is incompletely implemented.<br />Obviously the outcome - having two substance lists that are not mapped - is not good. After digging around, I find that certainly wasn't the original intent - The problem is that the Snomed substance lists was believed to unstable, and this has not been resolved (as far as I can tell)Grahame Grievehttps://www.blogger.com/profile/08635283945076545993noreply@blogger.comtag:blogger.com,1999:blog-23447705.post-65284052909359097402011-09-06T11:02:26.530+10:002011-09-06T11:02:26.530+10:00#Grahame
I stand by my assertion that the AMT sup...#Grahame<br /><br />I stand by my assertion that the AMT supports no mechanism for determining if a given ingredient of a product is a penicillin.<br /><br />Things are even worse than that. Several days ago NEHTA published a number of Detailed Clinical Models, including one for Adverse Reaction, in which, on page 18, the value set to be used ( I assume in the PCEHR) for the agent to which one Eric Brownehttp://www.healthbase.infonoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-65272439603617895192011-09-05T22:50:05.296+10:002011-09-05T22:50:05.296+10:00#Eric and Andrew M
The specific complaints "...#Eric and Andrew M<br /><br />The specific complaints "AMT should extend the snomed-CT hierarchy" (which would be nice) or "AMT doesn't relate penicillin and amoxycillin anyway" are rather different from "The AMT supports no mechanism for determining if a given ingredient of a product (Trade or medicinal) is a penicillin". btw, I haven't explored RxNorm or Grahame Grievehttps://www.blogger.com/profile/08635283945076545993noreply@blogger.comtag:blogger.com,1999:blog-23447705.post-66136605634090442122011-09-05T21:02:13.245+10:002011-09-05T21:02:13.245+10:00Grahame Grieve wrote:
"If this isn't &quo...Grahame Grieve wrote:<br />"If this isn't "a mechanism for determining if a given ingredient of a product (Trade or medicinal) is a penicillin", then what do you want?"<br /><br />Well I don't think so.<br />a. Who is to say that "phenoxymethylpenicillin" is a "penicillin"? Simply because it is a superstring?<br />b. It is a totally unreliable Eric Brownehttp://www.healthbase.infonoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-51369666113397795512011-09-05T21:00:55.915+10:002011-09-05T21:00:55.915+10:00Hi Graham,
Its a totally inadequate mechanism bec...Hi Graham,<br /><br />Its a totally inadequate mechanism because there is no substance hierarchy to compute the result using the terminology. I should be able to say Beta lactam allergy and pick up cephalothin as well but you just can't.<br /><br />Compare AMT to the real SNOMED-CT relationships and you will realise that AMT is totally inadequate for decision support.<br /><br />I have tried Andrew McIntyrehttp://www.medical-objects.com.aunoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-80697214143455132892011-09-05T20:32:57.687+10:002011-09-05T20:32:57.687+10:00Grahame, as I understand it, the complaint is that...Grahame, as I understand it, the complaint is that because phenoxymethylpenicillin is an 'AU substance' and not the actual international SNOMED phenoxymethylpenicillin concept (i.e. the AMT is a self contained terminology set) - we miss out on the upper part of the substance hierarchy that goes<br /><br /><br />372725003|Penicillin V (substance)|<br />is-a<br />372598006|Penicillinase Andrew Pattersonhttp://www.federationhealth.comnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-69477399582822395762011-09-05T20:03:25.661+10:002011-09-05T20:03:25.661+10:00> The AMT supports no mechanism for
> deter...> The AMT supports no mechanism for <br />> determining if a given ingredient <br />> of a product (Trade or medicinal) is a penicillin<br /><br />That's not entirely true. Or maybe I should ask whether it's entirely untrue. Let's take a containered product pack:<br />------------<br />19917011000036103: LPV (phenoxymethylpenicillin (as potassium) 500 mg) capsule: hard, 50 Grahame Grievehttps://www.blogger.com/profile/08635283945076545993noreply@blogger.comtag:blogger.com,1999:blog-23447705.post-15578707099667334322011-09-05T19:29:28.005+10:002011-09-05T19:29:28.005+10:00Anonymous said of the HealthSMART AMT implementati...Anonymous said of the HealthSMART AMT implementation "Therefore any temporary code additions, deletions and modifications will need to be performed manually until Cerner Multum and NEHTA AMT return to sync".<br /><br />Two points:<br />1. What evidence is there that Cerner Multum and NEHTA AMT have <b>ever</b> been in sync?<br />2. Why would HealthSMART be pumping out identifiers for Eric Brownehttp://www.healthbase.infonoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-74703236667637027962011-09-05T18:23:44.789+10:002011-09-05T18:23:44.789+10:00On NEHTAs website, search for "Victoria AMT&q...On NEHTAs website, search for "Victoria AMT". You will find 2 press releases. AMT has been implemented within HealthSMART clinical system (Cerner Millennium) for Acute Hospitals.<br /><br />A core component of prescribing within Cerner Millennium is the Multum drug information that enables appropriate medication interaction (drug-drug, drug-allergy, drug-disease) and therapeutic Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-25550412268719210512011-09-05T18:22:56.863+10:002011-09-05T18:22:56.863+10:00Anonymous said: "Every penicillin maps down t...Anonymous said: "Every penicillin maps down to one of 8 concepts". Could you please explain the relevance to Andrew McIntyre's post. <br />The AMT supports no mechanism for determining if a given ingredient of a product (Trade or medicinal) is a penicillin. e.g. amoxycillin contains amoxycillin is as good as it gets. An additional linked knowledge source would be needed. This is Eric Brownehttp://www.healthbase.infonoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-65685712532080702822011-09-05T14:10:58.310+10:002011-09-05T14:10:58.310+10:00"btw, it's very hard to get traction with..."btw, it's very hard to get traction with people when you call them pencil necks in public."<br /><br />I think that just might be a reflection of extreme frustration - but then how would one know. I know for certain being nice has not often been successful!<br /><br />David.Dr David G More MB PhDhttps://www.blogger.com/profile/06902724829795199526noreply@blogger.comtag:blogger.com,1999:blog-23447705.post-71917174465296531162011-09-05T13:32:31.758+10:002011-09-05T13:32:31.758+10:00Every penicillin maps down to one of 8 concepts (p...Every penicillin maps down to one of 8 concepts (procaine penicillin, benzylpenicillin sodium, benzathine penicillin, phenoxymethylpenicillin potassium, benzylpenicillin, phenoxymethylpenicillin, phenoxymethylpenicillin benzathine, benzathine benzylpenicillin). But those 8 are not linked to a single concept for penicillin. That's certainly a lacking semantic, but it's not like you have toAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-20980451169353294802011-09-05T12:28:20.285+10:002011-09-05T12:28:20.285+10:00I would agree that AMT lacks the semantics to func...I would agree that AMT lacks the semantics to function in a way that allows for proper allergy checking, short of manually flagging every drug that is a type of penicillin, for example.<br /><br />If you look at RXNorm in the US its done much better and even has free rest based APIs to use if you want to. In the US they have added semantics to allow for meaningfull use, where AMT has removed 90% Andrew McIntyrehttp://www.medical-objects.com.aunoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-22814102422229830022011-09-05T11:03:00.275+10:002011-09-05T11:03:00.275+10:00Interestingly, a correspondent has pointed out tha...Interestingly, a correspondent has pointed out that the planned pause in SNOMED-CT and AMT delivery might have the purpose of permitting a review of where all this is going, what is working and what is not and how the issues (perceived or real)can be addressed.<br /><br />If indeed the pause is to permit a 'strategic review and rethink' this could only be a good thing IMVHO. No point 'Dr David G More MB PhDhttps://www.blogger.com/profile/06902724829795199526noreply@blogger.comtag:blogger.com,1999:blog-23447705.post-37635264693416256942011-09-05T10:55:44.722+10:002011-09-05T10:55:44.722+10:00I think you will find that any current implementat...I think you will find that any current implementations of AMT in clinical environments are in hospitals that aren't operating on a monthly drug list update cycle anyway (nor would they be particularly interested in additions to the PBS). Hence a lack of updates for 4 months won't affect them.<br /><br />I don't think AMT has been implemented in any GP or community prescribing clinicalAndrew Pattersonhttp://www.federationhealth.comnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-13097080981414074802011-09-05T10:41:44.215+10:002011-09-05T10:41:44.215+10:00If we have to have anonymous comments, can we at l...If we have to have anonymous comments, can we at least have good quality ones? <br />- what makes AMT not fit for use?<br />- what terminology functionality is missing?<br />- What real terminology would it be mapped to?<br />- why would it's use be a token gesture?<br />- what terminology would you use for allergy checking? (do you mean just drug checking or more?)<br /><br />Another note, Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-31366365637753349902011-09-05T09:49:21.765+10:002011-09-05T09:49:21.765+10:00AMT is another Nehta stuff up. Its not fit for use...AMT is another Nehta stuff up. Its not fit for use in a clinical system and is not really SNOMED-CT either, as most of the functionality a terminology should offer is absent. Its use in a clinical system would be a token gesture, as it would have to be mapped to a real terminology to allow the functionality required to allow safe drug use via an EHR. eg Allergy checking is not really possible Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-48185520806241227582011-09-05T09:24:38.363+10:002011-09-05T09:24:38.363+10:00Sunday, September 04, 2011 8:12:00 PM said "i...Sunday, September 04, 2011 8:12:00 PM said "it's likely AMT will start to emerge early next year".<br /><br />So when NEHTA says in the above release "While the AMT has been implemented in clinical systems in Australia... " .... it is distorting the truth. <br /><br />The correct position from NEHTA therefore should have been "The AMT has yet to be implemented in Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-43821013270065348102011-09-04T20:12:25.265+10:002011-09-04T20:12:25.265+10:00AMT is a key deliverable for the 'Vendor Panel...AMT is a key deliverable for the 'Vendor Panel' members. Based on the timeframes they are working towards, it's likely AMT functionality will start to emerge in clinical systems early next year, at least in the Wave 1 sites.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-23447705.post-55859199363007795752011-09-04T18:54:18.187+10:002011-09-04T18:54:18.187+10:00David, I would like NEHTA to provide a list of the...David, I would like NEHTA to provide a list of the sites where “the AMT has been implemented in clinical systems in Australia” – by implemented, I mean implemented and currently in routine day-to-day use.<br /><br />There are two reasons for this:<br />(1)we would like to consider collaborating with one or more of those sites<br /><br />(2)despite our best efforts we have been unable to ascertainAnonymousnoreply@blogger.com