Enhancing our Problem Lists

In my recent posts about the Limitations of Administrative Data and the Lessons Learned, I've concluded that clinical observations of symptoms and conditions coded in SNOMED-CT are the most relevant problem list data to share with patients and use for data analysis.

We have a 3 step approach to implementing SNOMED-CT in BIDMC clinical systems

1. Our existing problem list dictionary was developed in 1998 and hence it's called BI-98. We contributed it to the National Library of Medicine and it was incorporated into the Metathesaurus.

About 70% of the terms we used are easily mapable to SNOMED-CT Codes. The National Library of Medicine will send us a BI-98 to SNOMED-CT mapping in the next few days and we'll incorporate it into our existing dictionary, giving us a SNOMED-CT vocabulary for 70% of the existing problem list entries in our system.

2. The NLM will be giving us a compendium of the 6000 most commonly used terms in the local problem list vocabularies of large health care institutions, and their equivalent SNOMED CT codes. We'll incorporate that list into our systems and create a novel "Problem List Picker" using AJAX technologies that will assist doctors in choosing the best problem description associated with a SNOMED-CT term. This will give us a great framework for the terminology of newly entered problems.

3. I'm working with other organizations, such as Kaiser Permanente, to gather problem list "best practices". We'll leverage their experience to innovate at BIDMC and I'll share the experience broadly via my blog. I'll post their problem list dictionaries as I receive permission to do so.

I look forward to your participation and feedback as we work together to improve the usefulness of data in EHRs and PHRs nationwide.

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