HL7AU - HL7V2 WG : 2021-5-11 Meeting Notes

11 May 2021 10:00 AEDT

Meeting 35

Attendees

Andrew McIntyre (Co-Chair)

Michael Legg (Co-Chair)

Jared Davison

David McKillop

Liam Barnes

Gil Carter - Voronoi

Jakub Sielewicz

Nick Ferris

Peter Scott

Madison Black

Anthony Cruice

kyle macdonald

Dalisay Giffard

Cindy Chiu Chong

Lawrie Sim

Loma Avery

Appologies

Gil Carter - Voronoi engaged by RANZCR to perform landscape scan. Preferred terminology set, recommendations to ADHA.

Nick updated from RANZCR workshop from Friday:

1. desire not disrupt workflow of referrers by introducing new terminology (names of procedures) - don't make them learn new terms
2. survey of what was is in use. terminology sets. 
   1. majority so far of replies - MBS 13/22  (doesn't fully cover what is done)
   2. locally hand made catalogues 9/22 
   3. 5/22 state health department catalogues mostly in Qld
   4. 4/22 claimed SNOMED
   5. 4/22 claimed LOINC
   6. ACR (American College of Radiology) system
3. what would motivate their choice
   1. 17 billing
   2. integrated with other systems. 
   3. 12 legacy reasons
   4. EMR of the hospital they do the work for
4. what they would like in a selected catalog
   
   1. fit for purpose
   2. easy to use
5. Perceptions
   1. comprehensive
   2. fit for purpose
6. Discussion about challenges in adopting a catalogue
   1. mapping
   2. maintenance
      
      
7. Candidates
   
   1. RADLEX (developed in 1990s, after review of SCT, harmonised with LOINC in last 5 years. Structured Ontologies. Large vendors are claiming to use it. Not widely used in AU. Not in practice wide use in US)
   2. SNOMED
   3. Mapping between the two is lacking artifacts
8. mapping to MBS is useful
9. mapping to and from snomed is supported by tools
10. need to be manageable by small practice through to large enterprises
11. local Australian version control would be important

Interested to hear ideas on selection criteria

Most terms in radiology are organised by modality and anatomic region of interest.

Both HL7v2 and FHIR both use Table 0074 and a coded terminology for test ordered.

Protocols

Michael Legg: suggested to establish principles of terminology - refer to SPIA for what has been done previously in pathology. Determining synonyms frequency. Agree on information model before get too carried away with terminology. Pre and post coordination becomes important.

preferred term unambiguous but most acceptable to largest number of users

NCTS 

SCT was chosen for pathology. would be nice if radiology aligned as they may have reason to share codes

How can terminology be used after it is received. can be influential in choice. Once terminology is chosen the hard work begins.

RADLEX: Radiology vendor support

SCT: NCTS supportable (Australian version)

How close disciplines in diagnostics work together?

Andrew McIntyre: SNOMED has fairly official language for primary terms but also supports synonyms

collect all interface terms, abbreviations, 

smaller set of common codes. code that tells you what it is.

A neuro surgeon will order a specific sub test of CT Head. Whereas a GP will order a CT Head.

A hierarchy is useful to reason from more specific to more generic.  Walk back up hierarchy to 

Sub specialised versions of the same thing.

Preferred term goes on the order form, but users search with interface terms. Find it via familiar term.

For decision support need to be able to reason on an order code. 

How you can use. Search for all Cat scan for a patient. A patient with 2000 individual results, being able to show all cat scans that is very useful (at report code level). Show me the cadiothoracic ratios for patient and graph over time (search report content). 

RADLEX radiology specific terminology - unusable outside of radiology specialty and vendors.

Gil: interested in how iEMR.

Adopting patient common identifier. IHI preferred? What would 

Lawrie replied the amount of effort and time that is put in to maintain catalogues across 3 RIS and one iEMR. Enormous effort → getting all terms. looking at term frequency of items in the catalogue. Synchronizing terms across. A smaller catalogue of orderables, eg. CT Head can be ordered but that expands into a list of 20 other sub procedures that that the radiographer can choose appropriate for the condition of the patient. Emphasized that there is an 

Code and plain text

Short code and long code (descriptor)

Interface uses code or short code.

Qld Catalogue: Modality, Body part, Laterality. Reviewed in light of SCT, alignable with SCT, minor gaps. Clinical notes - some orderers provide large amount of detail, others provide none to very little

Peter Scott: Systems such as Best Practice choose term via modality and then region, but also free text.

 Outstanding Meeting actions:

• Next Meeting to be scheduled for 25th May 2021. 10:00-11:30 AEST (Sydney Time).