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WHO – SNOMED SD O

WHO – SNOMED SD O. Opportunity Potential Relations Challenges & Other issues. T. Bedirhan Üstün MD World Health Organization Classifications & Terminology www.who.int/classifications. Outline. WHO's vision for Health Information Systems SNOMED-CT summary evaluation

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WHO – SNOMED SD O

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  1. WHO – SNOMED SDO Opportunity Potential Relations Challenges & Other issues T. Bedirhan Üstün MD World Health Organization Classifications & Terminology www.who.int/classifications

  2. Outline • WHO's vision for Health Information Systems • SNOMED-CT summary evaluation • Declaration of possible Conflict of Interest • Vision for a global terminology standard • Possible Options for WHO involvement • Organizational Issues towards as an international public good • Summary: • Desiderata for a global terminology • Future Steps

  3. ICD ICF Mappings ICHI Classifications e-Health Record Systems Terminologies • Population Health • Births • Deaths • Diseases • Disability • Risk factors • Clinical • Decision Support • Integration of care • Outcome • Administration • Scheduling • Resources • Billing • Reporting • Cost • Needs • Outcome WHO Vision for Classifications and Terminology in HIS

  4. SNOMED-CT • SNOMED-CT is currently the most advanced system of health care terminology • Centrally maintained and updated by CAP and UK NHS • About 414,808 terms (about 15% have definitions) and 1.465 million (and counting) relations defined which supports consistency in communication • Gaps in some areas & questions about underlying ontology • Key to computerization of health information: electronic health records for coding, retrieval and analysis • Increased benefits for Health Information Systems: • Mainly ICD and potential to link to ICF, ICHIthrough adequate mapping and knowledge representation • Potential Use for: • Decision support for clinical users  Map of Medicine • error reduction & patient safety  Reduced prescription errors • Administrative support  Payment by results

  5. ICD-11 Terminology Tools ICD-10 Plus ICD-11 draft Experts/Workgroup Members that draft ICD-11 Using the joint-authoring web application the experts draft and share portions of ICD-11. ICD-10 + WEB Revision application Protege/OWL OpenGALEN Hi-Ki Joint-authoring WIKI like application • WHO EDITORS • Taxonomic rules • Definitions • Diagnostic criteria 1.Proposals, 2.Comments3.Discussions are all stored in a central searchable database ANY USER can connect to the web application and send their revision proposals or comments. Also review other proposals and discuss them SNOMED and/or any other terminology WHO and Clinical Modification Owners enter their Codes to represent the Standard and CM versions. ALL USERS can see drafts and comment. • Mappings • Algorithms • Clinical Interface/ Decision support system for diagnosis Declaration of Possible Conflict of Interest

  6. Declaration of Possible Conflict of Interest Rewriting ICD Using SNOMED an example: F32.0 Depressive Disorder • Low mood {41006004} Loss of interest {417523004 } Low energy {248274002} • Appetite (decrease, increase){64379006, 72405004} • Body weight (decrease, increase) {89362005, 8943002} • Sleep (decrease, increase) {59050008, 77692006} • Psychomotor (decrease, increase) {398991009, 47295007} • Libido loss {8357008} • Low self esteem {286647002, 162220005} • Guilt, self blame {7571003} • Thoughts of death … • Suicide Ideation {102911000, 6471006} B.

  7. National Centre National Centre National Centre SNOMED SDO National Centre Current SNOMED Enterprise National Centre National Centre National Centre National Centre Open Market Activity National Centre Network National Centre Global Overall Health Care SNOMED : Old and Proposed and Future College American Pathologists Open Enterprise Multi-county Medicine

  8. WHO and Proposed SNOMED SDOPossible Options: Degrees of Collaboration • -1: WHO leads opposite development – competing terminology/(ies) • 0: WHO remains inert / ignores SNOMED SDO • +1: WHO watches/regulates the health terminology space • Establishes HIS needs, application rules that SNOMED applies • +2: WHO takes part in the SNOMED SDO Management Board • Representing 104/192 Countries • Takes part in "Harmonization Board" for Classifications –Terminology link • Takes part in R&D • Includes SNOMED in WHO e-Health Projects • +3 WHO owns the IPR of SNOMED CT • Runs the Executive Secretariat • Management operations • Translation platform

  9. WHO and Proposed SNOMED SDOOption 1: WHO leads opposite development – competing terminology/(ies) • Pro's: • more global multilingual health care terminology can be created with open source technology involving multiple partners • Competition  may induce better products • … • Con's: • will take time  delays in eHR • Will require substantive funding • Redundancy – duplication of effort • Multiple standards – at least two… • Not conducive to collaboration • …

  10. WHO and Proposed SNOMED SDOOption 2: WHO remains inert / ignores SNOMED SDO • Pro's: • No WHO involvement – no effort - invest energy in other areas • Neutrality may increase chances for free development • … • Con's: • Seems to neglect a core function of WHO • Future complications with classifications (& terminologies) • Multiple terminologies may evolve • Digital divide for the developing countries !! • …

  11. WHO and Proposed SNOMED SDOOption 3: WHO watches/regulates the health terminology space • Pro's: • WHO involvement solely in regulation for health terminology • Better content management (input from health sector) • … • Con's: • Multitude of players & SOs – mandate confusion • Not leading by example – top down regulation role • Limited implementation – penetration • Digital divide for the developing countries • …

  12. WHO and Proposed SNOMED SDOOption 4: WHO takes part in Management Board and SD Activities • Pro's: • Opportunity to represent 104/192 Member States' overall concerns • Harmonization with Classifications and other HIS elements • Work towards global multilingual health care terminology • … • Con's: • May seem as undue preference declaration • Will require substantive resources • Reduce competition • …

  13. WHO and Proposed SNOMED SDOOption 5: WHO owns and runs the SNOMED SD Activities • Pro's: • WHO represents all Member States – more participation and acceptance • Work towards global multilingual health care terminology in which SNOMED becomes an international public good like ICD • Support of the WHO International Terminology Network • Harmonization HIS elements ( classifications, patient safety, e-health…) • Expertise on Multiple languages and translations/ cultural adaptations • Provision to developing countries for free with appropriate arrangements • … • Con's: • WHO bureaucracy may slow down progress • Will require substantive resources • …

  14. Added Value of WHO • WHO expertise on: • International Health Systems & Health Information Systems • Networking multiple stakeholders • Multiple languages and translations - Cultural adaptations • Management and consensus building • Link to other HIS elements ( classifications, patient safety, e-health…) • More international participation - representation • Acceptance by Member States, other IGO, NGO's, stakeholders • Acceptance by Academic Research Centers • Acceptance by Industry • Easier set-up and swifter take-off & maintenance

  15. Future Steps on SNOMED SDO Proposal • Discussions, clarifications and establishing a mutual agreement by all stakeholders • Member States discussion in WHO Executive Board May 2006 • Finalization of current options and take off and implementation • Further Research and Development on Standardized Terminologies

  16. Reinventing the Wheel?

  17. Designing Wheels for Future

  18. Alternatives • No wheel solutions: • Legs • Sledge, Sleigh, skis… • Spheric wheels • Rolling bands • Hovercrafts • Magnetic rails • Nature mimicry: • Wheel bugs (Arilus cristatus) Toy cars …

  19. Connecting for Health // GSM

  20. Desiderata for a global terminology • Comprehensiveness: • Coverage for all aspects of health care • Adequacy: • Is it fit or purpose – multiple purposes? • Does it have a good information model and ontological basis? • Multilingual applicability • language independent formal concept representation • Representation in multiple languages – more than translation • Utility: • Is it beneficial for: • Care providers : decision making, outcome evaluation • Consumers : participation – ownership – evaluation – risk reduction • Policy/Decision Makers : informed decision making on costs, benefits, efficiency • Reliability: • does it give the same results in different users • Validity: • Does it indicate the right things – and does the indication make sense • Interoperability • Technical: Can information systems exchange information and use it? • Semantic Can information systems interpret the data with the same meaning? • Sustainability • Secured maintenance: commitment to stability with earlier versions • Openness to address emerging technical issues

  21. Summary • Network Management of an International Public Good • Harmonization with overall Health Information Systems • Analog to Digital: Needs for eHR • Reporting frameworks: Population Health, Clinical, Admin… • Linguistic, cultural adaptation know-how, Knowledge Representation •  Better ontology • Future research and development • Vision for a European/ Global standard system • EC, CEN, eHSCG, ISO… • Action plan formulation and implementation

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