Jon Patrick, Robert Herkes & Angela Ryan.
Abstract
The Royal Prince Alfred Intensive Care Service and the School of Information Technologies, University of Sydney have been collaborating for over two years, developing pioneering software initiatives for enhancing clinical information systems (CIS). The collaboration between the two groups has resulted in the development of two prototype technologies that enhance the ICU's current Clinical Information System, CareVue.
In order to achieve the full potential of information technology in healthcare, information systems must have the ability to reliably report on patient health states, and share and exchange data, which requires the support of standardised formal medical encoding ontology, such as the Systematised Nomenclature of Medicine – Clinical Terms (SNOMED-CT).
The Ward Round Information System (WRIS) has been designed to convert clinicians’ electronic clinical notes into SNOMED-CT concepts, thereby introducing the foundations for semantic interoperability, while exacting SNOMED-CT on an unwitting clinician population. WRIS thus enables more consistent descriptions of patient conditions and allows large scale retrieval and analysis from the narrative part of the patient record. The purpose of the WRIS is to improve the efficiency of collecting data about patients during ward rounds, and demonstrate the automatic computation of SNOMED-CT codes as clinicians write their progress notes. The WRIS achieves its purposes by two processing steps. It computes a tailored extract of the patient’s clinical record from the ICU CIS, relevant to the needs of completing the ward round. This extract includes pertinent haemodynamic and laboratory data which is presented to the clinician on a screen, who then adds the relevant progress notes. After analysing the progress notes, WRIS computes the SNOMED-CT codes in real-time, which the clinician then verifies. This information constitutes indexing of the narrative text of the clinical record which is available for later semantic retrievals from the CIS, enabling speedier and more accurate information retrieval and data analytics.
The Clinical Data Analytics Language (CDAL) system has also been developed as an enhancement to the CIS, and is designed to answer questions and perform statistical analyses, including the exploitation of the SNOMED CT indexing created by WRIS. CDAL provides clinicians with the ability to frame any question about their data in their database in a restricted natural language and get the answer almost immediately. It assists clinicians in the management of large amounts of complex information generated during an ICU admission and ultimately improves the quality and efficiency of care. Both systems went live in October 2007 and this paper summarises the background, purpose and progress thus far.
The software has been engineered to make it transportable to any clinical information system and is currently being ported to the Eclipsis CIS in the Paediatric ICU at the Children's Hospital Westmead. Discussions have commenced with a Sydney-based Area Health Service for installation of these systems and other technology throughout the hospitals of their area.