Veterinary Informatics Standards Development and Harmonization

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Veterinary Informatics Standards Development and
Harmonization

• AVMA Stakeholders Meeting
• July, 2002
• Nashville, TN

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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

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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 Willebrands Disease).
• This dog has VWD
• This dogs littermate has VWD
• Dog has family history of VWD

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SNOMED history / future
SNOMED III
SNOMED RT
SNOMED CT
SNOP
SNOMED
SNOVET
1965
2000
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
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Funding models

• LOINC NIH Grant from inception
• HL7 Membership (dues) from 2200 medical
  records vendors, hospitals, medical device
  suppliers, government organizations
• SNOMED 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.

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What standards are incomplete, underutilized or
missing?

• Vocabulary
• Laboratory tests
• Disorders / findings
• Procedures
• Anatomy, organisms, substances, etc.
• Data structure
• Messaging

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Veterinary standards?
Without standards 13 vocabulary technologies, 13
transmission formats
With standards 2 vocabulary technologies, 1
transmission format
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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.

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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

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Complaints about global standards

• Its too
• Big
• Complicated
• Expensive

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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

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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.

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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

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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

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Equine medical record

• Equine Breeds
• Equine lab tests
• All applicable disorders, findings, procedures
• Message structures
• lab to clinic
• clinic to lab
• clinic to clinic

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Subsets of standards
SNOMED-CT, HL-7, LOINC
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1 three independent subsets
2 one subset of necessary messages
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AVMA-adopted standards

• HL-7
• Messaging and medical record infrastructure
• LOINC
• Lab test vocabulary
• SNOMED
• General medical vocabulary

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Questions for audience discussion
Are veterinary-wide information standards worth
pursuing?
Whats the appropriate time-frame?
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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.

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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.

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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.

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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.

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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

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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.

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Current funding
Nominal NOT Optimal
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What does AVMA offer?

• Technical expertise
• Infrastructure providing connection to users,
  vendors, etc.
• Established relationships with standards
  organizations
• Past and ongoing investment

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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.

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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.

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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

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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