Challenges relating to the inter-facility transport of high acuity paediatric cases.

INTRODUCTION: The motivation for this study came from anecdotal reports and observations that there was a potential need for improvement to the systems that support inter-facility transfers of high acuity paediatric cases between referring and receiving facilities in Johannesburg, South Africa. In this exploratory study, we formally document and describe challenges being experienced by members of the healthcare team in facilitating the inter-facility transport of high acuity paediatric cases. METHODS: A qualitative, explorative design was applied, making use of interviews with purposefully-identified role players involved in paediatric transportation and care. Verbatim transcripts from audio recorded interviews underwent content analysis to allow for the identification of common categories. RESULTS: Participants described a number of challenges, which included time delays, lack of qualified ambulance personnel, poor communication between role players, and lack of appropriate equipment. DISCUSSION: There are significant challenges experienced by members of the healthcare team with regard to inter-facility transport of high acuity paediatric and neonatal cases in Johannesburg, South Africa. Whilst we acknowledge the African context and resource constrained setting, health systems managers need to explore the feasibility of establishing dedicated and suitably resourced retrieval teams who specialise in the transfer of high acuity paediatric and neonatal patients in order to improve quality of care and overall patient outcomes in this population.

The impact of SNOMED CT revisions on a mapped interface terminology: terminology development and implementation issues.

Large-scale mapping efforts have been done in attempts to migrate systems that use proprietary concepts to ones that use terminological standards such as SNOMED CT. As efforts move towards implementation, the target maps should retain a predictable structure including those targets requiring post-coordination of SNOMED CT concepts. In this paper, we compared the editorial guidelines of two versions of SNOMED CT (January 2005 and July 2006, respectively) and noted how the revisions affected a single, comprehensive set of mapped concepts (n=2002) from a legacy system. Changes made to the categories and guidelines for approved attributes were noted and then evaluated against the post-coordinated maps (n=1570) from the original mapping effort. Seventy-one percent (n=1118) of the concepts were affected due to changes made in either SNOMED CT categories or to the revision of approved attributes. While the efforts of each subsequent SNOMED CT version aim for continual improvement, changes made to its core structure and post-coordination guidelines make it more difficult to migrate proprietary data to this reference standard. Attention must be paid to auditing the processes used in terminology development to include the impact that their revisions may have on real-world clinical implementation.

Experiences mapping a legacy interface terminology to SNOMED CT.

BACKGROUND: SNOMED CT is being increasingly adopted as the standard clinical terminology for health care applications. Existing clinical applications that use legacy interface terminology need to migrate to the preferred SNOMED CT standard. In this paper, we describe our experience and methodology for mapping concepts from a legacy system to SNOMED CT. METHODS: Our approach includes the establishment of mapping rules between terminologists and back and forth collaboration of the mapped results through one or more iterations in order to reach consensus on the final maps. RESULTS: We highlight our results not only in terms of the number of matches, quality of maps, use of post-coordination, and multiple maps but also include our observations about SNOMED CT including inconsistencies, redundancies and omissions related to our legacy mapping. CONCLUSION: Our methodology and lessons learned from this mapping exercise may be helpful to other terminologists who may be similarly challenged to migrate their legacy terminology to SNOMED CT. This mapping process and resulting discoveries about SNOMED CT may further contribute to refinement of this dynamic, clinical terminology standard.

Assessing voids in SNOMED CT for pediatric concepts.

Reference terminologies such as SNOMED CT may have voids in their representation of concepts important to the practice of pediatrics. In this project, relevant pediatric concepts were extracted from an American Academy of Pediatrics guideline and were mapped to SNOMED CT. Concepts were identified that should be included in the standard reference terminology. A process for formally evaluating voids in reference terminologies for concepts needed in pediatric clinical decision-making is planned as a next step.

Aligning tissue banking data models for caBIG interoperability.

MD Anderson Cancer Center strives to share data from its central tissue bank with other institutions via the caBIG data sharing framework. To conform to "NCI Best Practices for Biospecimen Resources", a caGRID compatible model (i.e. caTissue Core/Suite) must be adopted or an existing tissue banking application (TissueStation) must be adapted for interoperability. We present a data model assessment and method used in development of an enterprise strategy for ensuring inter-institution data sharing capabilities.