Veterinary Informatics Standards Development and Harmonization

AVMA Stakeholders Meeting

July, 2002

Nashville, TN

Where do we need standards?

Generally… Communication between computer systems

Laboratory-to-clinic data transmission Laboratory-to-government agency, clinic-to-government

agency Central data repositories (all kinds)

Cancer registries Eye-disease registries

Electronic health certificates Portable electronic medical records “You talk - it types” medical record keeping

Where do we need standards?

Specifically… When we need to transmit or receive the correct

meaning of a concept. “Test for Equine Infectious Anemia” – which one?

When we need to transmit the specific “context” of a concept (Von Willebrand’s Disease).

This dog has “VWD” This dog’s littermate has “VWD” Dog has family history of “VWD”

SNOMED history / future

Reduce storage size Reduce Storage size No longer relevant

Categorize information

Multiple code-based hierarchies

Poly-hierarchical categorization

Pathology content “All Medicine” Veterinary content separate, then integrated

Integrated content

“Computability” for retrieval.

Natural language, artificial intelligence, decision support

SNOP

SNOMED

SNOVET

SNOMED III

SNOMED RT

SNOMED CT

1965 2000

Funding models

LOINC – NIH Grant from inceptionHL7 – Membership (dues) from 2200+ medical records vendors, hospitals, medical device suppliers, government organizationsSNOMED – College of American Pathologists (99%), AVMA (1%) SNOMED hopes to establish a government-

funded national license. Not clear if veterinary medicine will share in this support.

What standards are incomplete, underutilized or missing?

Vocabulary Laboratory tests Disorders / findings Procedures Anatomy, organisms, substances, etc.

Data structure

Messaging

Veterinary standards?

ReferenceLab A

ReferenceLab B

RegulatoryAgency A

RegulatoryAgency B

RegistryA

RegistryB

Practice System A Practice System B

Without standards: 13 vocabulary technologies, 13 transmission formats

With standards: 2 vocabulary technologies, 1 transmission format

Effects of “global” veterinary standards?

Reduce cost to system developers IF amortized across multiple projects Learn, manage, deploy a single technology for

each major standards component.

Reduce total cost of standards development.

Facilitate outcomes assessment, epidemiology, disease surveillance, etc.

Effects of global veterinary standards?

Increased cost to system developers Adhering to a global standard

Increased costs of cooperation?

Perceived loss of control, loss of specificity

Complaints about global standards

It’s too… Big Complicated Expensive

Is this work “expensive?”

Yes, but… We are currently losing opportunities:

Early discovery of new diseases Critical evaluation of outcomes of therapy, surgery Early alerts of disease outbreaks (reportable,

foreign) Ability to analyze and forecast trends

Is this work “expensive?”

IF the long-range goal is useful… Costs shift from individual organizations that would

build “mini” standards to a central organization. There may be cost savings to the profession as a whole.

The selected standards are more complex, complete and (we believe) more functional than those likely to be undertaken by individual organizations.

The cost of standards development may be somewhat higher to the profession as a whole.

Is this work “expensive?”

IF the long-range goal is useful… The selected standards adhere to design

specifications that have developed through hard experience in the medical profession.

Essential / desirable features have been documented. The selected standards represent extraordinary

functionality, produced and maintained at great cost to the medical profession.

We can leverage these standards for 10¢ / $1.00

Equine reportable disease system.

Equine breeds

Equine “occupations”

Brief list of reportable diseases

Lab tests that support disease list

Message structures clinic to regulatory authority Lab to regulatory authority

Equine medical record

Equine BreedsEquine lab testsAll applicable disorders, findings, proceduresMessage structures lab to clinic clinic to lab clinic to clinic

SNOMED-CT, HL-7,LOINC

Mixed practice

Subsets of standards

Equine practice

Equine disorders

Equine Reportable

WNVRabies

FMD

SNOMED1 LOINC1

HL72

Disease reporting system

1 = three independent subsets

2 = one subset of necessary messages

AVMA-adopted standards

HL-7 Messaging and medical record infrastructure

LOINC Lab test vocabulary

SNOMED General medical vocabulary

Questions for audience discussion:

Are veterinary-wide information standards worth pursuing?

What’s the appropriate time-frame?

What has been accomplished so far?

All three standards are (literally) open and committed to veterinary inclusion.

All three standards publicly recognize veterinary commitment and expertise.

What has been accomplished so far?

LOINC Extensive list of veterinary-specific concepts are

present in the nomenclature.

HL7 Standard now recognizes animals, animal

identification, animal groupings, owners, etc.

SNOMED Considerable veterinary content is present. Mechanisms for improving the functionality of

veterinary anatomy.

Can standards be implemented now?

Yes, but NOTHING about standards is, currently, “off the shelf.” LOINC – yes, veterinary labs can manage their

test lists in LOINC (with an investment in mapping).

HL7 – yes, although specific veterinary messages definitions must be derived…

SNOMED – yes but capturing the medical information currently requires considerable manual labor.

What has to be done to make standards “practical”

LOINC – consensus and mapping by labs, distribution to computer system vendors.

HL7 – develop a library of messages, maintain work-group to continue development.

SNOMED – make anatomy functional, make species functional, develop subsets for all conceivable purposes in a medical record system.

Manual Semi-Automatic Intuitive Staying current

Functionality

Inve

stm

ent

Current funding / costs…

SNOMED ½ time veterinarian ½ time full professor Travel to 7 - 8 working meetings per year

LOINC 1/6 time full professor Travel to 3 meetings per year

HL-7 1/6 time full professor Travel to 6 meetings per year

Current funding / costs…

SNOMED - $100,000+ per year

LOINC – $30,000 per year

HL-7 - $30,000 per year

AVMA covers 40%

UC Davis and Virginia-Tech currently cover almost 60%.

VMDB provided start-up funding for standards selection, development. Continues to support veterinary health information managers at veterinary schools.

Current funding…

NominalNOT

Optimal

What does AVMA offer?

Technical expertise…

Infrastructure providing connection to users, vendors, etc.

Established relationships with standards organizations…

Past and ongoing investment…

What does your group have to offer?

A market…Content expertise… Presence Definition

Subsetting expertise…Financial support…Willingness to understand…Contacts with foundations, granting agencies, etc.Subject-specific grant writing expertise.

Veterinary Information Standards Development Institute (VISDI)

Purpose: provide infrastructure and expertise necessary to develop and deploy veterinary information standards.

Approach: membership-based as an initial funding mechanism.

Activities: standards liaison, standards development, project consultation, subsetting and mapping services.

Veterinary Information Standards Development Institute (VISDI)

Resources: Human

Board of Directors (drawn from “membership”) Case & Wilcke Veterinarians Computer systems support personnel Business staff

Technical Computer (hardware, database, communications and internet

services) Office

Veterinary Information Standards Development Institute (VISDI)

Membership ABVS Colleges (ACVO, ACVIM, ACVS, etc.) Professional organizations (AVMA, AAEP, AAHA,

AASP, etc.) Data Repositories (VMDB, etc.) Government Organizations Veterinary Schools / Teaching hospitals Medical records vendors Private practices