Open Source EHR at the Americal Academy of Family Physicians ...
Christopher Feahr wrote: My understanding is that the US open-licence period for SNOMED CT begins Jan 1, 04. I have also been told that Centers for Medicare and Medicaid Services are planning a number of demonstration projects early in 2004, involving EHR systems and SNOMED CT terms. Therefore, I would agree with Ed and others who seem to be suggesting that we move forward with whatever steps are necessary to get SNOMED CT into production systems. In the context of a reasonably homogenous terminology space like the U.S., what would you see as the main problems with SNOMED that would have to be fixed? Pre-coordination issues have been mentioned along with some even more fundamental (??) issues that Thomas Beale suggests will take several years or possibly a decade to straighten out. Of course, from my point of view, my biggest problem will likely be scarcity of special vision care concepts/terms. So, what would we have to do exactly? And which standards organization would coordinate such a project... HL7? my feeling (with apologies to those who have been working for years in terminology and I realise know the semantic space much better than I do) is that a new process could emerge: a) some people develop some archetypes , e.g. American College of Opthalmologists (not sure what the proper title is) b) these archetypes will have local vocabulary which defines meanings for exactly what terms need to mean in the exact context of the archetypes. c) The mundane task of mappings to ICD or similar classifiers needed for reimbursement and various population efficiency studies is easy. This will take care of the practical need for these codes. d) mappings to ontologies are more challenging, and it may well be that local archetype terms form capsule vocabularies that could be the basis of change requests to developers of ontologies. Snomed is probably more in this space than pure terminology, so it may be that we send change requests of some kind to them, based on archetyps. e) due to d), ontologies may change over time in such a way that more direct mappings from archetypes become possible. - thomas beale - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
Antw: Re: Open Source EHR at the Americal Academy of Family Physicians ...
William E Hammond wrote: William, I do not think you are over reacting. I agree with you. My only point is that we should be driven by what is best and what is a true solution, and not by the wrong reasons. I would be most interested in seeing us compile a list of candidates for terminologies that should be considered and a process by which we could blend the terminologies. I don't know what the best method might be and what organization(s) might be best for doing the work and distributing the product. What is the level of trust for the NLM around the world? Peter Elkin (Mayo) claims to have identified about 40 or so candidate terminologies for use in an open terminology system, according to his paper in MIE 2003. But I don't believe the correct methodology in this area has yet surfaced. It will start to when small, targetted knowledge models start being used more widely, and terminologists start to see that there is no solution based on the idea of a single , perfect holy grail terminology. It just doesn't work like that. There are capsules of meaning everywhere which link back into ontologies, and I think that a theory and methodology based on this idea will begin to surface in the next few years. Snomed-ct will be then seen as a best effort without this theory, and may end up being the biggest single resource for re-enginering into a new typology of terminologies / ontologies / small knowledge models (archytpes, HL7 models, guidelines etc). Right now I really think people need to understand that there is still a lot of intellectual work ot go in this area, and that finalising licencing situations will not particularly change things. - thomas beale - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
Antw: Re: Open Source EHR at the Americal Academy of Family Physicians ...
On Fri, 2003-09-26 at 23:01, Thomas Beale wrote: Right now I really think people need to understand that there is still a lot of intellectual work ot go in this area, and that finalising licencing situations will not particularly change things. And theoretical health informaticists need to understand that the absence of a widely available termonology/classification is badly hurting real-life efforts to improve and protect health, right now. I don't particularly like SNOMED CT - its bulky and inelegant (although fairly comprehensive), and as Thomas points out, uses way too much pre-coordination. But from where I sit, as a practicing epidemiologist who works with practicing clinicians, we need a terminology now. As I said, SNOMED CT seems to be the best bet, at least for English-speaking countries, and the license costs at the national level - US$32 million for the whole US for 5 years, presumably rather less for, say, all of Australia - are not unsustainable, and at least SNOMED is essentially a non-profit organisation, not a rapacious multinational corporation. But efforts on open terminologies, both niche and global, should definitely continue. Hopefully SNOMED CT can then be replaced in a decade or so with a free, global alternative. -- Tim C PGP/GnuPG Key 1024D/EAF993D0 available from keyservers everywhere or at http://members.optushome.com.au/tchur/pubkey.asc Key fingerprint = 8C22 BF76 33BA B3B5 1D5B EB37 7891 46A9 EAF9 93D0 -- next part -- A non-text attachment was scrubbed... Name: signature.asc Type: application/pgp-signature Size: 189 bytes Desc: This is a digitally signed message part URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20030927/84b11c58/attachment.asc
Antw: Re: Open Source EHR at the Americal Academy of Family Physicians ...
Williamtfgoossen at cs.com wrote: In een bericht met de datum 25-9-2003 15:10:09 West-Europa (zomertijd), schrijft hammo001 at mc.duke.edu: I agree with Ed in that if we can make this resource available, we need to work on that. I think it is OK that HL7 uses SNOMED as preferred terminology. However, I would be very dissapointed if this would become the only terminology that the current v3 RIM and derivates could handle. I believe also local, or specialty or situation specific terminologies / vocabs etc. should be allowed in messages. I agree - I would state even more strongly - I don't think it can be any other way. Recently, Sam did a review of our models of Apgar result (your favourite;-) and discovered that the terms used for various things on US and UK websites were different (e.g. the terms used for the 0,1,2 values for each of the 5 input variables). No single global terminology can deal with this problem - only capsule terminologies which are strongly bound to particular concepts can. - thomas beale - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
Open Source EHR at the Americal Academy of Family Physicians ...
I basically agree. I think I mean both clinical and economical. What I am hoping for is that we can create a single process in which all the appropriate terminologies can be blended, overlaps and mapping, and distribution made common. Do it once not each institution or even each country. I would like to establish a core terminology group that is international that works toward this goal. Ed - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
Open Source EHR at the Americal Academy of Family Physicians ...
Dear Ed, I fully agree with you. We do need an international vocabulary. We need to make translations to other languages and it is no so easy to convince the ones who pay the bill that to translate SNOMED ( for example) to Portuguese should be done. If this is an international effort with many other countries aligning maybe we can try to find funds together. The sooner the better. At the moment we are defining a new vocabulary for health procedures - sort of Brazilian CPT... Best regards, Beatriz - Original Message - From: William E Hammond hammo...@mc.duke.edu To: Thomas Beale thomas at deepthought.com.au Cc: Gerard Freriks gfrer at luna.nl; Mark Shafarman mark.shafarman at oracle.com; Gunnar Klein gunnar at klein.se; Nan Besseler Nan.besseler at nen.nl; Magnus Fogelberg magnus.fogelberg at vgregion.se; P Zanstra p.zanstra at mi.umcn.nl; openehr-technical at openehr.org; Shah, Hemant HShah at coh.org; Eline Loomans Eline.loomans at nen.nl Sent: Friday, September 26, 2003 10:42 AM Subject: Re: Open Source EHR at the Americal Academy of Family Physicians ... I basically agree. I think I mean both clinical and economical. What I am hoping for is that we can create a single process in which all the appropriate terminologies can be blended, overlaps and mapping, and distribution made common. Do it once not each institution or even each country. I would like to establish a core terminology group that is international that works toward this goal. Ed - If you have any questions about using this list, please send a message to d.lloyd at openehr.org - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
Open Source EHR at the Americal Academy of Family Physicians ...
I agree with Gerard that we need to be careful. However, that does not mean that we go to the lowest denominator. IF we think SNOMED is the best solution, then we need to spend our time and energy on finding how to make SNOMED available to the rest of the world. We have a debate in our school system in Durham. The poorer kids do not have access to the Internet and to laptops. The debate is whether to prohibit the use of computers and Internet for school work or to try to find methods that will provider laptops and Internet access to the poorer kids. I think the answer is simple. However, I do think it is important to make sure that SNOMED is the answer and will be acceptable before we move aggressively. Ed Hammond - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
Antw: Re: Open Source EHR at the Americal Academy of Family Physicians ...
In een bericht met de datum 25-9-2003 15:10:09 West-Europa (zomertijd), schrijft hammo001 at mc.duke.edu: I agree with Gerard that we need to be careful. However, that does not mean that we go to the lowest denominator. IF we think SNOMED is the best solution, then we need to spend our time and energy on finding how to make SNOMED available to the rest of the world. We have a debate in our school system in Durham. The poorer kids do not have access to the Internet and to laptops. The debate is whether to prohibit the use of computers and Internet for school work or to try to find methods that will provider laptops and Internet access to the poorer kids. I think the answer is simple. However, I do think it is important to make sure that SNOMED is the answer and will be acceptable before we move aggressively. Ed Hammond - If you have any questions about using this list, please send a message to d.lloyd at openehr.org I agree with Ed in that if we can make this resource available, we need to work on that. I think it is OK that HL7 uses SNOMED as preferred terminology. However, I would be very dissapointed if this would become the only terminology that the current v3 RIM and derivates could handle. I believe also local, or specialty or situation specific terminologies / vocabs etc. should be allowed in messages. But maybe I am overreacting, I did not hear / read that this would not be the case. William Goossen -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20030925/e072ddfc/attachment.html
Antw: Re: Open Source EHR at the Americal Academy of Family Physicians ...
William, I do not think you are over reacting. I agree with you. My only point is that we should be driven by what is best and what is a true solution, and not by the wrong reasons. I would be most interested in seeing us compile a list of candidates for terminologies that should be considered and a process by which we could blend the terminologies. I don't know what the best method might be and what organization(s) might be best for doing the work and distributing the product. What is the level of trust for the NLM around the world? Ed - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
Antw: Re: Open Source EHR at the Americal Academy of Family Physicians ...
Hi Tim, Pieces of the 33 hits are included below: -Sarcomatoid carcinoma of the cervix -An evaluation of the usefulness of two terminology models for integrating nursing diagnosis concepts into SNOMED Clinical Terms -Improved coding of the primary reason for visit to the emergency department using SNOMED -Which coding system for therapeutic information in evidence-based medicine -Automating SNOMED coding using medical language understanding: a feasibility study -An evaluation of the utility of the CEN categorical structure for nursing diagnoses as a terminology model for integrating nursing diagnosis concepts into SNOMED -Semantic features of an enterprise interface terminology for SNOMED RT -Evaluation of a method that supports pathology report coding -Evaluation of SNOMED3.5 in representing concepts in chest radiology reports: integration of a SNOMED mapper with a radiology reporting workstation -Representation by standard terminologies of health status concepts contained in two health status assessment instruments used in rheumatic disease management -An evaluation of ICNP intervention axes as terminology model components -[Medical data in pathology--evaluation of a large collection. (530,000 diagnoses coded in SNOMED II)] -Scalable methodologies for distributed development of logic-based convergent medical terminology -The role of peer review in internal quality assurance in cytopathology -Evaluation of a lexically assign, logically refine strategy for semi-automated integration of overlapping terminologies -Phase II evaluation of clinical coding schemes: completeness, taxonomy, mapping, definitions, and clarity. CPRI Work Group on Codes and Structures -The surgical pathologist in a client/server computer network: work support, quality assurance, and the graphical user interface -Comparison of the reproducibility of the WHO classifications of 1975 and 1994 of endometrial hyperplasia -Planned NLM/AHCPR large-scale vocabulary test: using UMLS technology to determine the extent to which controlled vocabularies cover terminology needed for health care and public health -Mass screening for cervical cancer in Norway: evaluation of the pilot project -The LBI-method for automated indexing of diagnoses by using SNOMED. Part 2. Evaluation -Representing HIV clinical terminology with SNOMED -The LBI-method for automated indexing of diagnoses by using SNOMED. Part 1. Design and realization -A comparison of four schemes for codification of problem lists -Can SNOMED International represent patients' perceptions of health-related problems for the computer-based patient record? -Extraction of SNOMED concepts from medical record texts -Terms used by nurses to describe patient problems: can SNOMED III represent nursing concepts in the patient record? -[Descriptive epidemiology from autopsies at the Ospedale Maggiore di Milano from 1986 to 1987] -[Development of a findings and results data system for forensic medicine autopsy cases] -Medical linguistics: automated indexing into SNOMED -Evaluation of the CAP microcomputer-based SNOMED encoding system -[A new microglossary for biopsy pathology] None of these hits can be related in any significant way to to the implementation and deployment of a system with SNOMED functionality, i.e., based wholly on SNOMED or integrating it as a plug-in or an integral function. My original posting included some major review topics typically encountered in a software product design (the focus immaterial). There is an old saying where I come from: Quiting playing with the design and produce something before the competition does. Design, develop, deploy sustain and upgrade later. The motivation to charge for SNOMED may well prompt competition to action . Right now, in my opinion, SNOMED needs relevant Google/developer entries. Additional comments in your text. Thanks! -Thomas Clark Tim Churches wrote: On Fri, 2003-09-26 at 04:04, lakewood at copper.net wrote: 3)Rigorous testing, including scalability, of SNOMED seems to be sparse: PERFORMANCE; Google search: SNOMED performance | http://etbsun2.nlm.nih.gov:8000/publis-ob-offi/pdf/2000-tal-ob-Ft.pdf (1 hit) SCALABILITY: Google search: SNOMED scalability | (no hits) EFFECTIVENESS: Google search: SNOMED effectiveness | (no hits) RELIABILITY: Google search: SNOMED reliability | (no hits) AVAILABILITY: Google search: SNOMED availability | http://quickstart.clari.net/qs_se/webnews/wed/bx/Bga-mckesson-info-sols.Rn1s_Dl9.html (1 hit); DIFFERENT KIND OF 'availability', i.e., availabile for use COMPLAINTS: Google search: SNOMED complaint | (no hits) ERRORS: Google search: SNOMED error | (no hits) SUSTAINABILITY: Google search: SNOMED sustain | (no hits) OK! I give up! SNOMED, it appears, has never been subjected to any kind of analysis. It appears to be in the same category as home repair contractors who provide an on-the-spot 'tail-light' warranty. Only a tiny percentage of the
Open Source EHR at the Americal Academy of Family Physicians ...
On Mon, Aug 18, 2003 at 04:29:37PM -0700, Christopher Feahr wrote: Personally, I would like to see all EHR-related standards work... at least in the US... coordinated under the umbrella of HL7. At the moment, the CCR project does not appear to be headed toward HL7. I really don't know if HL7 would be the way things would go unless they remove the image that they belong to an exclusive club. The response I received from HL-7 (India) is placed below for your perusal. Dr USM Bish --snip You could receive the same from HL7 Inida. This is provided along with HL7 India membership. ( membership fee is Rs 35,000) regards Saji bish at hathway.com wrote: On 2003-04-10 at 03:14:04 I am interested in obtaining the full HL-7 specs valid as on date. It is requested, that I may kindly be advised from where I could obtain the same. USM Bish --/snip - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
Open Source EHR at the Americal Academy of Family Physicians ...
Dr. Bish, I'm not sure that I understand your comment about HL7 being an exclusive club... although you seem to be alluding to the cost of membership. I have only dealt with individual membership dues which run about $500/yr. While it's true that other classes of membership are more costly, I believe this reflects the present operational costs of an ANSI accredited standards committee. X12 costs are similar. I agree that from the provider perspective, the costs to participate in HL7 are often seen as prohibitive... particularly when time, travel, and lodging costs are considered for meeting attendance. The same is true of X12N and UN/CEFACT, which explains the dearth of provider input to these organizations. It also helps to explain why the US govt. is presently attempting to force big-payer-inspired EDI standards onto our entire healthcare community, when the X12 EDI model is clearly of no value to 300,000 provider organizations. However, there were no provider-centric standards that the government could have adopted in lieu of X12's... because there are no provider-centric SDOs, or even Insurance-centric SDOs with significant provider input. HL7 is provider-centric in theory, but all SDOs end up being dues-paying member-centric in actual operation... something that can be changed. simply by having provider associations participate as members. Providers need an SDO that is focused on the functional requirements of *healthcare* delivery in all 30 or so major specialty domains and care settings. From SDO-maintained functional models, vendors should be able to design provider systems with reasonable levels of interoperability... and any sort of EHR system that a user may require. This approach to standards development is not supported by the part-time, all-volunteer, big-enterprise-member SDO model used by HL7. Providers require a standards organization with a predictable revenue stream and reliable, full-time human resources. But... that means provider associations and specialty societies must step forward... as HL7 members... and insist on a mechanism for getting their members' needs baked into our global standards. HL7 will always adapt to the needs of its members, as it has for 15 years. NCVHS, DHHS, CMS, and the agencies behind the Consolidated Health Informatics initiative (DOD, Veterans Adm, Indian Health, Homeland Security, etc.)... are unanimous in selecting HL7 are the lead SDO for health care in the US. The federal govt. is particularly interested in the EHR work and is expecting HL7 to take the lead there, as well. There has never been a better opportunity or a more obvious need for massive provider input than around these EHR issues. It's time providers got themselves onto the Big SDO Radar Screen. At this time, HL7 appears to be our best entry point for providers in the US and abroad. Best regards, -Chris Christopher J. Feahr, O.D. Optiserv Consulting (Vision Industry) Office: (707) 579-4984 Cell: (707) 529-2268 http://Optiserv.com http://VisionDataStandard.org - Original Message - From: USM Bish b...@hathway.com To: openehr-technical at openehr.org Sent: Tuesday, August 19, 2003 2:30 PM Subject: Re: Open Source EHR at the Americal Academy of Family Physicians ... On Mon, Aug 18, 2003 at 04:29:37PM -0700, Christopher Feahr wrote: Personally, I would like to see all EHR-related standards work... at least in the US... coordinated under the umbrella of HL7. At the moment, the CCR project does not appear to be headed toward HL7. I really don't know if HL7 would be the way things would go unless they remove the image that they belong to an exclusive club. The response I received from HL-7 (India) is placed below for your perusal. Dr USM Bish --snip You could receive the same from HL7 Inida. This is provided along with HL7 India membership. ( membership fee is Rs 35,000) regards Saji bish at hathway.com wrote: On 2003-04-10 at 03:14:04 I am interested in obtaining the full HL-7 specs valid as on date. It is requested, that I may kindly be advised from where I could obtain the same. USM Bish --/snip - If you have any questions about using this list, please send a message to d.lloyd at openehr.org - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
