Quality Improvements Based on Detailed and Precise Terminology

EFMI on Iceland June 2010

Kirsten Bredegaard, Senior ManagerConnected Digital Health in Denmark

kibr@sdsd.dk

Agenda• SNOMED CT in DK• Coding clinical data

using SNOMED CT• Advantages &

challenges using SNOMED CT

• Clinical documentation and reimbursement data at the same time?

SNOMED CT in Denmark

• National Release Center placed in National Board of Health

• Is translated into Danish• Is in very limited use• Smaller projects - ”pathfinder projects” –

conducted by Digital Health in cooperation with the National Board of Health

Quality Improvements based on detailed and precise Terminology

• Comparative study, carried out by – Digital Health– Intensive Care Units– Daintel, vendor of ”Critical Information System”

• Validated visualized subset of SNOMED CT– Concepts selected and qualified by clinicians

• Questions to be answered: Using SNOMED CT will we then achieve– increased possibilities for quality monitoring?– increased possibilities for quality benchmarking?– faster access to evidence for new ways of treatment?

Method – making relevant subsets’

XxxxXxxxXxxxXxxxXxxxXxxxXxxXxxxXxxxXxxxXxxxXxxxXxxxXxxx

’

Xxxx xxx xxx xxxXxxx xxx xxxXxxxx xxx xxxXxxxx xxx xxxXxxxx

Currentlyused codes

Relevant groupings

Identifying similargroupingsin SNOMED CT

Marking recommended concepts

Subset to be shown in theCIS system when doing clinical documentation

Ambiguous terms are given a full textual definition

Coding clinical data using SNOMED CT

What can we gain using SNOMED CT – in short terms

• Detailed data• Precise overview – also

graphical• Quality monitoring • Direct benchmarking• Efficiency of treatment • Faster access to results

of new treatments• Faster change in

treatment strategy

What can we gain using SNOMED CT – Long term

• Reuse of data for many purposes

• Information exchange between systems – semantic interoperability

• Better possibilities for decision support

• Different kind of warnings, ex– drug interactions – alerts information – allergy notifications

Challenges• Reimbursement

– ICD-10 is used in all DRG-algorithms• National statistics based on ICD-10

– How can we compare data across the years if we change registration strategy?

• New EHR-systems increase the need for official clinical terminology developed for clinical use– Can we handle national subsets?

• So - How do we overcome the challenges and bring SNOMED CT in daily clinical use?

Clinical documentation and reimbursement data at the same time?

• Purpose– Investigate and examine

possibilities for reimbursement using DRG on clinical documentation with SNOMED CT

• Possible to make a reliable mapping between ICD-10 and SNOMED CT when documenting?

• Compute and compare DRG on different registrations

SKS

Senile cataract XXXX

XXXX

SNOMED

Search cataract

SKS SNOMED

Senile cataract + Senile cataractSenile cataract + Senile cataract

Other cataract + CataractOther cataract + Cataract

XXX XXXXXX XXX

Conclusion• The clinicians (ICU) want very much to use

SNOMED CT• Focus on the challenges and find future

solutions using international terminologies– we need a different kind of clinical documentation

in the year of 2010• We need to accept

– Small problems find quick solutions while big problems take a little while longer …… but there is a solution to every problem

Questions?