One of the greatest challenges when implementing an integrated medical computer system is to make sure that its use results in tangible improvements both in the quality of medical care and the safety of patients.
Another major concern in these cases is to insure that the new system being adopted is accessible enough for doctors to feel that it is a key resource for their profession and not an obstacle that will disrupt the natural flow of their practice.
It is clear that the system must at heart be efficient at developing diagnoses, that it diminish the risk of interruptions when prescribing medicine, that it must be capable of taking into account factors which might otherwise be overlooked and that, at the same time it be an ideal tool to aid decision-making.
Faced with such challenges, it is worth asking how it is possible to develop systems which meet all these objectives, bearing in mind the complexity of medical science, the unique and unrepeatable nature of the clinical history of each patient and the impossibility of generalizing diagnoses or treatments?
In order to get his point of view on these questions Ehealth Reporter spoke with Dr. Alejandro López Osornio, a specialist in medical information technology.
Lopez Osornio worked on the implementation of the medical information technology system at the Hospital Italiano – a major health establishment in Argentina, which is also a leading provider of pre-paid medicine, was in charge of the implementation of the terminology server and currently, in addition to continuing his role as a family doctor at the center, is working on updating SNOMED CT standards, in both the international English and Spanish versions.
He performs this task at the TermMed consultancy which was founded four years ago by Guillermo Reynoso, also an expert in medical terminology.
ER: Why is it important for the success of a health information technology program to have a system of medical terminology standards such as SNOMED?
ALO: In principle because it is a means of facilitating interoperability between medical information technology systems. Sharing the same vocabulary allows the exchange of clinical information, the re-use of expert systems and joint statistical analysis, amongst other things. The use of SNOMED CT allows the medical information technology system to precisely determine the clinical situation described by the professional without needing to use technical classification such as ICD-10 or ICD-9-CM, in which they are forced to summarize the clinical situation by making use of a statistical categorization system with no clinical significance. Doctors can carry on using vocabulary which is much closer to the one they use in reality, with general terms for uncertain concepts and very specific terms where certainty exists. The structure of SNOMED provides the mechanisms to determine the relationship between these concepts for use in and information retrieval from databases of clinical data, regardless of the original language used for the data entry.
ER: Can it be said that SNOMED has become a necessary requirement for interoperability?
ALO: Today, SNOMED would appear to be the best option for interoperable terminology in the absence of other standards which compete at the same level of clinical terminology. The creation of the IHTSDO has ensured its implementation in member countries, which include the great majority of national health information technology projects in the world, transforming SNOMED CT into the “lingua franca” of interoperable terminology in health care. Furthermore, the World Health Organization (WHO) has established an agreement with the IFTSDO which states that SNOMED CT will form part of ICD-11 which will be composed of similar statistical categories to ICD-10 but with formal definitions based on SNOMED, generating an automatic and natural bridge between both terminologies.
ER: What does TermMed offer to support this process?
ALO: We are all hired by the International Health Terminology Standards Organization (IHTSDO), which publishes SNOMED CT, to provide consultancy and tools for the maintenance of the international version. We also update the Spanish version of SNOMED CT, which was originally translated by Guillermo Reynoso over 10 years ago with each edition being updated in Buenos Aires. This version was originally developed for the Spanish speaking population of the United States. It is currently being updated for Spain as a member country of the IHTSDO and there is interest in several Latin American countries, so more regional Spanish adoptions can be expected.
ER: What does your work consist of?
ALO: At TermMed we provide support for the SNOMED CT editing processes. SNOMED editors work mainly in Chicago, in the College of American Pathologists (CAP). At TermMed we help them to organize the editing processes, quality control and publication of SNOMED, as well as providing consultancy related to the terminology content, ensuring that concepts are correctly communicated for their later clinical examination.
Additionally, the IHTSDO has hired TermMed to develop the software tools to support these processes. These tools will be published as Open Source products by the IHTSDO for member countries and affiliates. TermMed is in charge of several projects which are in various stages of progress, such as the SNOMED CT translation tool which can be used to translate quality control tools, part of the publication process, conversion tools and others into any language.
For each weekly edition of SNOMED CT, TermMed is sent the new concepts in the International edition and we carry out the translation of these into Spanish, making sure that the meaning of the concepts is maintained, rendering variable medical vocabulary into neutral Spanish.
Because of our extensive experience in the area, we often receive enquiries from institutions and companies in the local market and although it is not our main focus, we often provide introductions and training for the first steps in implementing the standard.
ER: What are the consequences of standardization of medical terminology in Argentina and the rest of Latin America?
ALO: Up until recently there was little interest in Latin America in the use of anything other than ICD-10 but in the last two years we have seen a marked rise in interest, given the increased amount of enquiries we have received and the participation of Latin Americans in international meetings of SNOMED CT. We have not yet seen its implementation in public institutions, only in highly computerized private institutions such as the Hospital Italiano, but it is a long process that begins with interest.
ER: Do you think that the perspective for adoption of SNOMED in Latin America is optimistic?
ALO: SNOMED has already reached a clear international standard, but I believe that the adoption of SNOMED by the Spanish government will have a major impact on Latin America. Furthermore, Brasil, although it is not an official member of the IHTSDO, has sent representatives from its health ministry to several different SNOMED meetings and the country will clearly be a trendsetter in the region.
ER: What changes are necessary to improve public health systems in Argentina?
ALO: In our area of work we believe that a national information system would be of great benefit at all levels, allowing better diagnosis of the national health situation, better planning for interventions, better evaluation of results, detection of epidemics, etc. In the context of a national health information system the use of SNOMED CT would seem to be a fundamental ingredient in ensuring greater clinical benefits and facilitating interoperability. SNOMED CT maintains maps which can automatically generate reports in CIE-10 which is the obligatory classification system in many aspects of our health system allowing programs based in CIE-10 to carry on functioning as normal, but giving doctors and software developers all the power and detail of SNOMED CT.