the principles of electronic transfer of radiology reports to gps ian arrowsmith nhs information...
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The Principles of Electronic Transfer of Radiology
Reports to GPs
Ian Arrowsmith
NHS Information Authority
The NHS Plan
An “NHS designed around the patient”. Stresses the need to support well co-ordinated
“seamless” services across “whole systems”. The right information available at the right place, at the
right time for the right care provider (and in a useful form)
(Why) do we need electronic clinical messaging ?
What is a clinical message ?
What is a message ?Main Entry: 1mes·sage
Pronunciation: 'me-sijFunction: nounEtymology: Middle English, from Old French, from Medieval Latin missaticum, from Latin missus, past participle of mittereDate: 14th century1 : a communication in writing, in speech, or by signals2 : a messenger's errand or function3 : an underlying theme or idea
Merriam-Webster
What is a clinical message ?
What is communication?Main Entry: com·mu·ni·ca·tion
Pronunciation: k&-"myü-n&-'kA-sh&nFunction: nounDate: 14th century1 : an act or instance of transmitting.....information.....a verbal or written message....a process by which information is exchanged between individuals through a common system of symbols, signs, or behavior...
Merriam-Webster
What is a clinical message ?
‘Clinical information’ as defined by CEN:
Information about a patient, relevant to the health or treatment of that patient, that is recorded by or on behalf of a healthcare professional.
CEN - Commite Europeen de Normalisation; a Brussels based organisation of 18 national standards bodies in Europe. The Health Informatics Technical Committee of the European Standardization Committee is known as CEN TC251
What is a clinical message ?
A communication in writing, in speech, or by signals which contains information about a patient, relevant to the health or treatment of that patient, that is recorded by or on behalf of a healthcare professional.
A simple clinical message
Clinical messaging in the 21st Century
NHS Definition
Clinical Messaging can be defined as
“The secure electronic transmission of structured data that contains patient information, between healthcare parties."
Basic Clinical Message Types
Request/Order Report/Result Query/Update Acknowledgement
Clinical message examples
Pathology requests and reports to GPs Radiology requests and reports to GPs Discharge summaries to GPs Out of Hours messages to GPs NHS Direct messages to GPs GP to GP record transfer GP to Outpatient referrals
What do we want to achieve ?
Faster delivery of report ‘Safer’ delivery of report More timely treatment of patient Possible provision of links to images Information incorporated directly in GP
patient record
Current Practice
Pony Express Snail Mail Fax Unstructured text report emailed Structured text ‘message’ delivered Notification that a report is available for
browsing sent to GP by email
Disadvantages of current practice
Data may be unstructured -incorporation into GP record not automated
Data may be structured in different ways Inconsistency in composition of data
transferred - coding schemes Variable levels of Security/Confidentiality
Properties of a National Message Specification
The Message should be Structured The Message structure should be
Standardised The Message content should be
Standardised The Message should be transferred
securely
Structured Message
System A System B
Message
Diagnosis
Family history
Messaging standards Security/Confidentiality Infrastructure Coding Browsing
Technical aspects
Security/Confidentiality
Content Integrity Clinical domain-domain encryption Origin authentication by application Secure confirmed receipt by application
(non-repudiation) Access control
Message Development Issues
Developing standards Emerging technologies Government Edicts NHS Strategy Stakeholder buy-in Patient access to reports
Benefits
Delivery times for diagnostic imaging reports to GPs are improved
Availability and speed of access of diagnostic imaging reports by GPs is improved
Confidentiality is enhanced due to direct clinician-clinician communication
Reliability of delivery of reports is increased
Clinical terminology and its application to Radiology
Ian Arrowsmith
NHS Information Authority
Clinical Terminology• What is a clinical terminology?
• Why do we need one?
• What do we use it for?
• What are the properties of a terminology
• SNOMED CT
A collection of health related terms to allow healthcare providers
to accurately record all aspects of patient-related activity
consistently
NHS Information Authority definition
What is a clinical terminology ?
These terms describe the care and
treatment of patients covering areas such
as diseases, operations, treatments, drugs
and administrative items
What does it cover ?
The terminology enables computer
systems to accurately capture, and then
retrieve on demand, patient information,
in a natural clinical language
What is a clinical terminology used for ?
Practical uses
• Clinical summaries
• Integrated computerised decision support
• Prescribing
• Referral/Discharge letters
• Clinical Messaging
• Aggregated data analysis
Fundamental properties of a Terminology
• Codes, Concepts, Terms• Synonyms• Hierarchies• Compositionality• Semantic Definition• Dynamism
Codes, concepts and terms
• “Concept” includes:
• Term: Stomach• Code: 7N301
• Symbol:
Preferred terms and synonyms
• Each concept has one unique preferred term without ambiguity, and may have any number of synonyms
• Synonyms may be shared with other concepts
Ambiguity
• Absent thumb PF263 (Read V2)
• Could be congenital or acquired
Ambiguity
P…. Congenital anomalies
PF… Other congenital limb anomalies
PF2.. Reduction deformity of upper limb
PF26. Agenesis of radial ray
PF263 Absent thumb
Ambiguity in radiology
• Barium enema• Single contrast ?• Double contrast ?• Unprepared ?• Via colostomy ?
Synonymy
Spinal cord compression Xa0NkCord compression
Umbilical cord compression X40CcCord compression
Synonymy in radiology
atlantoaxial X-ray (procedure) atlantoaxial X-ray C1 C2 X-ray craniocervical junction X-ray plain X-ray atlas/axis odontoid peg X-ray
Hierarchies•Arrange randomly
•Arrange by spelling A D O ZApple Dog Orange Zebra
•Arrange by meaningFruit AnimalApple DogOrange Zebra
Hierarchies
Compositionality - eg Laterality
• Departmental system • Left thumb X-ray code 001a
• Terminology• Thumb X-ray code 241074003
• Laterality code 272741003• Left code 7771000
Or Enumeration ?
Primary open fixation of fracture of left femur using locked reamed intramedullary nail
32 possible combinations
Semantic definition
Emergency amputation of leg
Priority: Emergency
Method: Amputation
Site: Leg
Dynamism
• Things change over time – terminology needs to reflect this• Molegraphy• Clivogram• Air encephologram
• Update mechanism
SNOMED® Clinical Terms
Collaboration between the NHS and the
College of American Pathologists
History of Read Codes
• 1985 4 Byte set introduced• 1988 Recommended standard GP computing• 1990 Crown Copyright + Version 2 introduced• 1992 Terms Projects • 1994 Clinical Terms (Version 3) released• 1995 First hospital use Version 3• 1999 Collaboration with SNOMED
History of SNOMED
• 35 year history
• SNOP 1965
• SNOMED International 1993
• SNOMED® RT 2000
SNOMED CT - a superset
SNOMED RT CT V3
International Relations
• Healthcare sub-language
Oesophagus/esophagus
Anaemia/anemia
• General
Cortico-pontine fibres/fibers
Grey/gray matter
Thank you for listening..
• Further information available from
• www.snomed.org• www.nhsia.nhs.uk