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NEHTA terminology analysts.
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| Subject: |
Online health care information services
(Management) E-health (Management) Medical terminology (Standards) |
| Authors: |
Bramley, Michelle Richards, Robyn Cordell, Matthew Richardson, Cathy Guo, Michael |
| Pub Date: | 10/01/2009 |
| Publication: | Name: Health Information Management Journal Publisher: Health Information Management Association of Australia Ltd. Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2009 Health Information Management Association of Australia Ltd. ISSN: 1833-3583 |
| Issue: | Date: Oct, 2009 Source Volume: 38 Source Issue: 3 |
| Topic: | Event Code: 200 Management dynamics; 350 Product standards, safety, & recalls Computer Subject: Online health care service; Company business management |
| Geographic: | Geographic Scope: Australia Geographic Code: 8AUST Australia |
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| Accession Number: | 216961597 |
| Full Text: |
The National E-Health Transition Authority (NEHTA) was established
by the Australian commonwealth, state and territory governments on 5
July 2005 to develop better ways of electronically collecting and
securely exchanging health information. NEHTA's National Clinical Terminology and Information Service (NCTIS) was tasked by Australia's governments to create, maintain, and represent in a standardised form terminology content for health care domains (predominantly clinical) so that the resulting data can be unambiguously and meaningfully described and used to support ongoing, efficient and accurate information exchange across the health sector. The way clinical information is captured and shared by healthcare providers is vital to the success of Australia's future e-health system. The NCTIS is developing software that will be able to record and interpret all clinical information about a patient. Forming the basis of this software is SNOMED CT. It will effectively form the data source of e-health, enabling clinicians to exchange their traditional paper-based records for a modern, electronic system. NEHTA employs a number of Terminology Analysts to undertake this work. They have three main responsibilities: 1. Develop local SNOMED CT terminology reference sets and extensions (and this includes modelling new content where required). 2. Assist in the management of the integration between the concept model and clinical information data specifications. 3. Validate and test new content, including structure and content prior to release. To work as a Terminology Analyst, a degree qualification in health sciences, biological science or medicine is essential. The team works with concepts and materials that are complex and technical in nature so the ability to communicate with their audience simply and clearly is important. Having healthcare sector experience is crucial. Terminology Analysts have to understand the environment in which they work, particularly when analysing and integrating the concept (or terminology) model with clinical data models (specifications) and making sense of both structures. In line with this, it is useful for them to have experience working with health information or clinical information systems. Essential to success in the role is the ability to acquire new knowledge quickly, especially in terminology development and in the tools that are used to facilitate this. NEHTA's current team of Terminology Analysts find it helpful to have some knowledge of health informatics and standards development in this area. While it is not necessary for a new Terminology Analyst to have experience or a solid understanding of SNOMED CT it is helpful for them to have some knowledge of nosology principles, and the coding systems that are used in clinical practice in Australia. NEHTA helps their development by providing on the job training in SNOMED CT. Read about four of NEHTA's Terminology Analysts, their different backgrounds and the rewarding work they are doing. Robyn's career began in a traditional health information management role which proved a solid foundation for future opportunities (in both Australia and the UK) such as a project officer role for an early e-health project, clinical practice improvement projects and cancer data management. Robyn joined NEHTA seeking to return to the challenges of the e-health arena and to broaden her skills from the clinical classification world into clinical terminologies. As Robyn explains, 'I underwent a steep learning curve to familiarise myself with the SNOMED CT concept model and the back-end technicalities of how it is delivered.' She has now developed the first iteration of the Problem and Diagnosis Reference Set for Discharge Summary and been involved in scoping test requirements and testing the software environments against these requirements, enabling the creation of clinically relevant reference sets. 'Bridging the knowledge between clinical relevance and system functionalities is an area I love to get my hands dirty in', she says. In addition to reference set creation Robyn has taken the lead in a recent terminology alignment assessment triangulating NEHTA's existing clinical information models against applicable SNOMED CT hierarchies and externally available archetypes. The purpose of this work was to identify priority areas for development and promote the relationship between information models and SNOMED CT in order to maximise the benefits of both. Robyn has also been exposed to what is happening in the international arena where she is involved in user acceptance testing for the IHTSDO (1) terminology workbench, which allows her to contribute to the long-term goals of the IHTSDO and the promotion of SNOMED CT. Robyn believes that clinical terminology and its applications are essential ingredients for an electronic medical record for every Australian. Her balance of information management skills and health sector knowledge allows her to work effectively in her role at NEHTA. Matthew Cordell Matthew started work in pathology while studying to become an analytical chemist. He then worked in a number of different disciplines at a regional laboratory before moving to a large metropolitan biochemistry laboratory. Matthew's work at NEHTA has to date primarily been focused on developing standardised terminology to be used in the communication of requests and results for pathology and other diagnostic services. As Matthew says, 'I've been able to draw on my existing clinical knowledge whilst also needing to learn a lot of new material, not just associated with informatics but also improving my clinical knowledge in areas I wasn't experienced in.' As a Terminology Analyst Matthew has become more aware of the nuances of language commonly used in health communication and the difficulties in unambiguously representing this information in an electronic health record. 'Learning how to represent the clinical concepts used in pathology, in a way that is useful for information systems, through analysing various data models along with their consequences and limitations can be exciting', says Matthew. For Matthew the e-health environment is quite removed from working in a laboratory but he admits there is more variety in the job and more opportunity for problem solving and analysis. His current tasks include developing internal work processes and documentation, consulting with stakeholders on products and participating in international discussions on issues associated with SNOMED CT. He is also involved with the development of standardised reporting protocols from pathology laboratories to Australian cancer registries as well as working with external groups like the AACB (2) LOINC (3) working party. Cathy Richardson Cathy has had an interest in health for most of her working life. She trained as a nurse after leaving school and while she left the profession a couple of years after graduating, the knowledge and experience she gained has continued to benefit her career. As a mum with three young children she enrolled in the health information management degree at Sydney University in 2000, undertaking the course on a part--time basis. She also began work as a casual coder using ICPC-2 PLUS and on graduating as a Health Information Manager (HIM) worked in a small private hospital. These experiences furthered her interest in nosology and in the development of electronic health records, which led her to NEHTA. Cathy is enjoying the challenging nature of her role. 'Developing the Australian extension of SNOMED CT is the main focus of our work. Managing this is complex and in some areas of our work there's been the exciting challenge of learning as you go', she says. She believes a good understanding of SNOMED CT is essential, as is developing an understanding of description logic. Description logic is a knowledge representation formalism used by a reasoner (or classifier) to determine the inferred relationships as part of the production process. Concept modeling is undertaken by Terminology Analysts in the 'stated view' and the 'inferred view' is what stakeholders see in the released product. The terminology is bound to a data element within a data structure so the Terminology Analysts also require an understanding of data modelling. NEHTA has developed a number of data specifications which contain groups of data elements. Cathy has been involved in high-level analysis of these specifications at the data element level particularly in relation to SNOMED CT as well as assisting in review work for the refinement of specifications. The binding of the terminology is managed by reference sets which are a constrained list of SNOMED CT concepts. SNOMED CT is a large reference terminology and this work assists with making it more user-friendly. Cathy has focused on pathology result reporting for use in messaging. 'I've needed to consider the constraints of the data element--its definition, conditions of use, and the fit with SNOMED CT and community requirements. For some data elements we'll also need to work with relevant Australian standards. The results of this work are released for feedback with accompanying documentation which means lots of writing and reviewing. After feedback and consultation with pathology reference groups we have a public release', says Cathy of the process. Cathy was also involved in the development of the Australian Reference List (ARL), a standardised list of Australian pathology test names. Terms provided by the Jurisdictions were mapped to SNOMED CT, using this to develop the ARL as well as the pathology test name reference sets. It was a challenge to ensure the hundreds of terms in the ARL were consistently named and that those names reflect the meaning of the Jurisdiction terms and SNOMED CT concepts. Naming conventions were developed and refined to assist with this process. Michael Guo Michael has a background in thoracic surgery in China and holds a Masters of HIM degree from Sydney University. Prior to NEHTA he managed healthcare data in clinical trial work. Michael creates reference sets for the SNOMED CT Australian extension through a process which involves selecting suitable candidates (concepts) from the source terminology, analysing them and performing a quality check. This quality helps to ensure that the selection of candidates meets the agreed constraints and definitions, which in turn should mean that the reference sets being created will be clinically relevant and meet stakeholder requirements. He uses the knowledge gained from analysing clinical information models and the concept model to effectively manage issues encountered during the creation of, for example, Discharge Summary terminology and in developing the Discharge Summary Structured Document Template (DS-SDT). Some of the issues encountered included how to effectively capture qualifying information to best represent clinical information for clinical interventions, how to properly use pre- and post-coordinated concepts from SNOMED CT and to avoid information overlap in various parts of the DS-SDT, and how to logically manage contextual information within the DS-SDT. Michael has become proficient at using the terminology development tools deployed within NEHTA and various terminology browsers. 'These tools greatly assist my work, and I have been able to reciprocate somewhat by applying my understanding of clinical terminology and applications to assist in the further development of some of these tools', says Michael. Michael believes his background serves him well for his challenging role, observing that 'Without my background in surgery as well as my HIM knowledge and skills, it would be difficult for me as a Terminology Analyst to be able to understand clinical terminologies and the requirements of clinical terminologies suitable for use in patient care.' Corresponding author: Michelle Bramley MAppSc(HIM) Research, BAppSc(HIM) Knowledge Lead National Clinical Terminology and Information Service nehta--National E-Health Transition Authority Level 25, 56 Pitt Street Sydney NSW 2000 AUSTRALIA Tel: +61(0)2 8298 2640 Mobile: +61(0)414 463 375 Fax: +61(0)2 8298 2666 Email: michelle.bramley@nehta.gov.au Email (NEHTA): www.nehta.gov.au Robyn Richards BBus (HIM) NEHTA Terminology Lead National Clinical Terminology and Information Service nehta--National E-Health Transition Authority Level 25, 56 Pitt Street Sydney NSW 2000 AUSTRALIA Matthew Cordell BChemSc, MRACI CChem NEHTA Terminology Analyst National Clinical Terminology and Information Service nehta--National E-Health Transition Authority Level 25, 56 Pitt Street Sydney NSW 2000 AUSTRALIA Cathy Richardson BAppSc(HIM) NEHTA Terminology Analyst National Clinical Terminology and Information Service nehta--National E-Health Transition Authority Level 25, 56 Pitt Street Sydney NSW 2000 AUSTRALIA Michael Guo MHIM, BMed NEHTA Terminology Analyst National Clinical Terminology and Information Service nehta--National E-Health Transition Authority Level 25, 56 Pitt Street Sydney NSW 2000 AUSTRALIA (1) International Health Terminology Standards Development Organisation (2) AACB = Australasian Association of Clinical Biochemists (3) LOINC = Logical Observation Identifiers Names and Codes Further information on NEHTA's work can be found at www.nehta.gov.au |
| Gale Copyright: | Copyright 2009 Gale, Cengage Learning. All rights reserved. |
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