Briefing on ehr Content Hong Kong Clinical Terminology Table (HKCTT) By Maggie LAU Health Informatician, ehriso
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1 Briefing on ehr Content Hong Kong Clinical Terminology Table (HKCTT) By Maggie LAU Health Informatician, ehriso
2 Agenda Background Application Adoption Management
3 RecognisedTerminologies in ehr Registered Pharmaceutical Products (RPP) Hong Kong Clinical Terminology Table (HKCTT) International Classification of Diseases, 10th Revision (ICD 10) International Classification for Primary Care, 2 nd Edition (ICPC2) Logical Observations, Identifiers Names and Codes (LOINC) Systematized Nomenclature of Medicine, Clinical Terms (SNOMED CT)
4 RecognisedTerminologies in ehr Registered Pharmaceutical Products (RPP) Hong Kong Clinical Terminology Table (HKCTT) International Classification of Diseases, 10th Revision (ICD 10) International Classification for Primary Care, 2 nd Edition (ICPC2) Logical Observations, Identifiers Names and Codes (LOINC) Systematized Nomenclature of Medicine, Clinical Terms (SNOMED CT)
5 Hospital Authority Clinical Vocabulary Table (HACVT) Diagnosis Procedure ICD 9 CM ICD 10 Drug Lab. Lab. Laboratory Lab. Lab. Lab.
6 Building HKCTT Diagnosis ICPC2 ICD 10 Procedure SNOMED CT Drug Registered Pharm Products Laboratory Others
7 Reference Terminology Reference Terminologies in HKCTT HKCTT Nature Diagnosis Procedure Organism Specimen Laboratory Test Drug RPP Yes * ICD-10 Yes * ICPC-2 Yes Yes LOINC# Yes * SNOMED CT# Yes * Yes * Yes * Yes * Yes Yes * Mandatory mapping # Local extensions created
8 HKCTT SNOMED CT Diagnosis Procedure HKCTT Drug Laboratory Others ICPC2 ICD 10 Registered Pharma Products Secondary Use ehr Clinical Data Repository ehr
9 Adoption of Health Information Standard HK Clinical Terminology Table (HKCTT) ehr IS Office Local Terminology 2 Mapped Local Terminology 3 Recognised Terminology 3 HKCTT 3
10 Application of HKCTT Support clinical documentation Alias Frequency count Facilitate decision support Provide organised data in ehr Viewer Assist data retrieval/reporting
11 3 ways to Adopt HKCTT HKCTT App HKCTT Offline HKCTT Core Serving On-ramp / Adaptation Provider s system All HCPs HKCTT Content Y Y Y (view + download) Terminology Engine Y Y Search Panel Y
12 Assign 3 nature-specific coordinators Subscribers Problem / Procedure concepts coordinator Laboratory concepts coordinator Pharmaceutical concepts coordinator HKCTT from registration to release Institution Coordinator 1 Registration Approval / Account creation 2 ehr inbox ehriso Subscriber registry 6 HKCTT 5 updates releases Reference 4 Terminology updates releases 7 HKCTT Core Download from ehr download centre 8 HKCTT deployment in clinical management information systems 9 Submission of new concepts / concept amendments HKCTT administrator
13 Governance ehr IS CG, ehr IS DGs, HKCTT EG Development Terminology management principles & editorial rules Special handle : nonspecific / vague terms Maintenance Management of HKCTT Information Architecture Management System (IAMS) Quality management Submission request mechanism Regular update Distribution
14 Tips for Terminology Management Meaningless identifier to allow expansion Unique meaning To facilitate searching Synonyms Common list Mapping Check rules of individual terminologies What you see, what you get Must be validated by professionals Keep updating
15 Editorial Rules Editorial Guide on HKCTT Overview Drug Laboratory Problem & Procedure Guide on Implementation & Maintenance of HKCTT
16 Handling of non-specific Concepts Concepts include multiple meanings Carbuncle and furuncle of neck Redness or discharge of eye Concepts with vague meaning Rubella with complication NOS Screening examination for other viral disease
17 Handling of non-specific Concepts Concepts include multiple meanings Carbuncle and furuncle of neck Carbuncle of neck Furuncle of neck Redness or discharge of eye Redness of eye Discharge of eye Concepts with vague meaning Rubella with complication NOS Screening examination for other viral disease
18
19 Request Submission HKCTT Search
20 HKCTT Concept Search (Draft)
21 HKCTT Concept Search Results (Draft)
22 Concept Details Source : HACVT
23 HKCTT Request Submission Request Submission
24 Request submission (Draft) New Diagnosis * * * Term ID Request No. * Request No. Request No. would be auto-generated once submit button is clicked. Reference Information Examples: 1. Nature of condition (inflammation, infarct, neoplasm, injury, ) 2. Body system or site (circulatory, respiratory, digestive, nervous, ) 3. Cause (genetic, congenital, organism, drug, trauma, post surgery, ) 4. Onset & course (acute, chronic, intermittent, ) * Mandatory field
25 Workflow of Request Submission for ehr Healthcare staff HCP Terminology / Nature Specific Terminology Coordinator Identify request Phase III HKCTT UPDATE Phase I REQUEST SUBMISSION Request Submission System Submit request Review & verify requests Map to corresponding Reference Terminologies Consult specialists for recommendations if required Phase II REQUEST VERIFICATION Approval of request Promotion of request Request promoted in HKCTT monthly update release
26 Get to IAMS in ehr Information Architecture Management System
27 Maintenance of HKCTT Via Information Architecture Management System (IAMS) A tool for managing HKCTT Only maintenance users have access right Provide functions including Concept module Provide to-do list
28 ehr Download Centre Recognised
29 ehr Download Options for RecognisedTerminologies (Draft)
30 Summary Medical terminology Fundamental & essential for management of modern medicine Complex, highly specialised A global effort Management of medical terminology Labour intensive Requires specialised management toolset Ongoing activity Recommend native use of RecognisedTerminologies rather than mapping your own
31 THANK YOU
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