National Data and the New Health Informatics

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AHHA Conference Friday 9 October 2009 Will
E-Health bring data wealth? Penny Allbon AIHW
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About the AIHW

• Established through AIHW Act 1987 as Australian
  Institute of Health
• Welfare added through amendment to Act in 1992
• Statutory authority of the
• Australian Government

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AIHW is the national institute for health,
housing and community services data

• Collation, reporting and analysis

• Data development, standards and consistency

• Indicator development

• Research and evaluation

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The Future is e-Health

• Across Australia there is a groundswell of
  support for a better, more connected healthcare
  system. More than 80 percent of Australians are
  in favour of electronic health records and are
  increasingly aware of the safety and quality
  benefits that e-health can deliver.

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• Cover more of the system
• Join up the silos
• Take a longitudinal view
• Understand what works
• See beyond the health sector

• From here to where wed like to be or NOT be

• Obsolescence of our systems
• Discontinuities in our series
• Access difficulties

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Information as a continuum
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Why do clinicians record patient data?
Clinical management

• Aid memory
• Legally document
• Communicate
• Clinical audit/ review
• Support and justify reimbursement
• Satisfy requirements for reporting

System management
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Align clinical data standards with existing
statistical standards, where this is feasible.

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• So what does this mean for governance of the
  system?

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A data supply chain of the future
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Relevant information standards
CostingGroups
Classifications
Terminologies
Data Specifications
Exchange Formats
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Figure out how statistical classification and
counting sits alongside the use of terminology

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• Plenty of thinking, not many answers yet

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London Bills of Mortality Every Thursday 1603-
1830s
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International Classificationof Diseases
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ICD a mono-hierarchy

• 003 Other Salmonella Infections
• 003.0 Salmonella Gastroenteritis
• 003.1 Salmonella Septicemia
• 003.2 Localized Salmonella Infections
• 003.21
  Salmonella Meningitis
• 003.22
  Salmonella Pneumonia

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gene
protein
polysacharide
cell

chronic
lung
acute
infection
inflammation
polymorphism
ischaemic
virus
bacterium
mucus

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SNOMED a poly-hierarchy

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ICD
classifications
terminologies
SNOMED
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ICD a Classification

• ICD Mono-hierarchy
• 003 Other Salmonella Infections
• 003.0 Salmonella Gastroenteritis
• 003.1 Salmonella Septicemia
• 003.2 Localized Salmonella Infections
• 003.21 Salmonella Meningitis
• 003.22 Salmonella Pneumonia

• SNOMED
• Polyhierarchy

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DRG cost homogenous groups

• Based on statistical analysis of factors which
  affect / are most predictive of resource
  consumption
• DRGs
• Original analysis Fetter 1980s
• Length of stay used as surrogate for cost
• Diagnosis clusters were based on Chapters of ICD
• Much less specific than SNOMED or ICD

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Patient (IHI) interacts with clinician

Clinician raises a natural language and/or
form-based record
Human coding assisted by guidelines
Terminology
Map
Unit records with coded values
Aggregate reports eg. NMDS, device
registry, patient records possibly linked by IHI
with consent
Classifications
Map

Clinician or coder raises a terminology or
rule-based record
Machine coding according to maps
Information for research and analysis Possible
pathways
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Draw on the underlying data, not the particular,
purpose-specific clusters of data

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• So how will the data be configured?
• warehouses/repositories
• distributed models

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Unique Identifiers

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• Potentially powerful
• Privacy, security
• What access for policy analysts and researchers?

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The New Informatics Zoo

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The workforce of the future
terminologies
archetypes
ontologies