Rick, Paul, Tony:
Many thanks for your quick replies and positive perpspectives. your
perspectives actually correspond with several lines of effeort that have
been going on for some time. The challenge has been to get laboratorians
actively involved in the many efforts. LOINC work closely with IFCC/IUPAC
from the beginning and its conventions include many of those of
IFCC/IUPAC. The IHTSDO effort is currently in active discussion with both
IFCC/IUPAC and LOINC about a common effort. Kent Spackman of CAP is aware
of AACC's interest in promoting these common efforts as is Clem McDonald
of the LOINC Project. More will emerge after the upcoming IHTSDO meeting
in Denmark later this month and AACC will help promote awareness of what
is happening and its implications. Also the Open EHR is an effort of which
both health informatics standatds bodies here in the US have been aware of
all along; how that EHR subdomain realtes to the clinical laboratory
subdomain of the full health information domain still requires substantial
illumination and efffort. AACC has all along been interested in
collaborative efforts that deal with both the health
professsionaldisciplines and industry. In differnt fashions both Europe
and the US have been dealing with the fragmented nature of
awareness/education about informatics knowledge/skills as enablers of what
the US Institute of Medicine defined in 2003 as the "Core Competencies".
This situation, in different profiles, is international as is the posture
of the approaches to solution. Hence, AACC's interest in developing joint
work with ACB and other health specialties in working on the building
blocks laeding to solution to this problem.
I have included my key AACC colleagues in order to promote the robust
involvement of all members who have a desire to contribute. I think that
your current issue of Units of Measure is a good tangible focus that can
result in a common position on "common concventions" (standards) for this
data type which is a part of the broader effort on Measurement/Observation
names which is itself part of the challenge for an "Ontology" for
healthcare terms. AACC has worked with several individuals active in this
broader framework and they have presented at AACC Annual Meetings. Thus,
joint work between ACB and AACC/NACB will provide a solid foundation for
the needed common conventions. Our work in the arly 1990s with various
individuals from the CEN effort are auspicious exmaples of what can be
done. I and my colleagues will be most interested in you ideas, comments
and suggestions. I urge that you use our LISMID Cahir Al Jekelis as a
focus for dialog with the appreciation of potential involvement of many
other of our members.
Sincerely,
Arden Forrey
On Thu, 11 Oct 2007, Paul Schmidt wrote:
> Re LOINC adoption in US vs READ codes: I can understand why, it is more
> logical/comprehensive/systematic...you name it...however LOINC is not
> perfect at all: eg it is not object oriented at present. But at risk of
> misrepresenting history, I understood that one of the influences the
> European/UK views brought to the SNOMED collaboration was the object
> orientation that SNOMED CT adopted. A similar influence may come about with
> more collaboration in this area....
>
> I'll check out OpenEHR
>
>
> -----Original Message-----
> From: IT working group of the Association of Clinical Biochemists
> [mailto:[log in to unmask]] On Behalf Of Richard Jones [Pathology]
> Sent: 11 October 2007 09:58
> To: [log in to unmask]
> Subject: Re: Conversion units
>
> Just a little clarification - my understanding was that the Read codes for
> tests were offered to SNOMED but the US insisted in going with LOINC and
> hence initially isolating Pathology.
>
> In the end there will be one global code scheme - complex I know but
> necessary. OpenEHR is worth a view as it's based on open architecture and is
> object orientated. Problems with early code systems were that they were too
> rigid and lacked the ability to deal with the rapidly changing world. It's
> noteworthy that SNOMED is beginning to emerge into the new world of open
> standards - see also Microsofts open source moves with the common user
> interface.
>
> In the new world it pays more to collaborate than compete - sadly we are
> still paying the price for previously mis-guided attempts to corner the
> market in codes.
>
> As to who's in charge of UK pathology coding - I'd love to find out.
>
> Rick
>
> Dr Rick Jones
> Assoc Clin Director, Yorks and Humber SHA NPfIT
> Sen Lect, Yorkshire Centre Health Informatics, Univ of Leeds
> [log in to unmask]
> http://www.ychi.leeds.ac.uk <http://www.ychi.leeds.ac.uk/>
> http://elipse.redirectme.net <http://elipse.redirectme.net/>
> http://www.pathology.leedsth.nhs.uk <http://www.pathology.leedsth.nhs.uk/>
> 0113 343 4961
>
>
> ________________________________
>
> From: IT working group of the Association of Clinical Biochemists on behalf
> of Paul Schmidt
> Sent: Thu 11/10/2007 09:40
> To: [log in to unmask]
> Subject: Re: Conversion units
>
>
>
> Hi Arden,
>
> I think this call for a collaborative effort is very commendable. There is
> just one problem with it: the US have decided a few years ago that they are
> adopting the LOINC database for the names/codes of laboratory tests and
> other clinical observations, and whoever in the UK is in charge of these
> things seem to view it with antipathy or at least indifference. As I
> understand it there is collaboration with SNOMED CT so that the domains will
> be complementary. Several other countries in Europe has also agreed to adopt
> the standard.
>
> http://www.clinchem.org/cgi/content/full/49/4/624
>
> Nobody is saying it is yet the complete package, but it is a damn sight more
> comprehensive and systematic with potential for improvement (eg in
> describing ordering panels) than anything else I have seen. The issue of
> developing a single framework for standard units of measurement is one which
> should also tie in to that (and in the US I guess it does??).
>
> For my part I have never understood why we in the UK cannot see the sense of
> joining the collaborative and influencing the changes one might want to see
> from the UK perspective, just like the situation was with READ codes (UK)
> and SNOMED RT (US). Then the NHS and College of American Pathologists joined
> hands and SNOMED CT hasn't looked back since. Instead there is constantly
> new little initiatives here in the UK bubbling up under various
> organizations uncluding the Southern cluster in NPfIT which seems keeps
> re-inventing the wheel (yawn!)
>
> The point I am making is: if the UK is not even part of the broader
> collaborative of agreeing names and codes for test results, then the issue
> of agreement on SI units is almost moot, as there is unlikely to be any
> universal exhange standard.
>
> I would be very interested if someone could enlighten me why this is
> happening (or not happening!)
>
> Paul Schmidt
>
> Queen Alexandra Hospital
> Portmsouth UK
>
>
>
> -----Original Message-----
> From: IT working group of the Association of Clinical Biochemists
> [mailto:[log in to unmask]] On Behalf Of A. Forrey
> Sent: 10 October 2007 18:24
> To: [log in to unmask]
> Subject: Re: Conversion units - PMIP[MESSAGE NOT SCANNED]
>
> I would like to urge that the UK clinical laboratorians dvelop a
> collaborative effort with those in the US with respect to the common units
> and their representations (whether in messages or in data structures
> such as the EHR). The IFCC/IUPAC SI represerntations are those recommended
> both by national and international groups. The educational challenge for
> the health professional (useers and producers of measurments/observations)
> has been a majo one over the 16 years that work of the US with the EU
> CEN TC 251 groups has been pursued. Much more could and should be done
> collbaoraively and synergistically. AACC LISMID Chair Al Jekelis is a key
> contact and he is working with LISMID memeber pam Banning on a
> terminology program for the AACC 2008 Annual meeting in July in Washington
> DC. There is still time to develop a joint effort with ACB to address this
> specific challenge and have useful information by the time of that
> presentation. I invite those interested to contact these individuals on
> this subject.
> Sincerely,
>
> Arden W. Forrey PhD
> Dept of Restorative Dentistry
> University of Washington School of Dentistry
>
> On Wed, 10 Oct 2007, Jonathan Kay wrote:
>
>> On 10 Oct 2007, at 10:40, Gethin Roberts wrote:
>>> In Wales we are currently working towards procurement of an "integrated"
>>> LIMS. OJEU ? Feb 2008.
>>> I'm heading a project to standardize biochemistry test names, codes,
>>> units and (where possible!) reference intervals.
>>
>> I think the key question is whether that is going to give transferable
>> results...
>>
>> Best wishes
>>
>> Jonathan
>>
>>
>>
>> On 10 Oct 2007, at 10:40, Gethin Roberts wrote:
>>
>>> In Wales we are currently working towards procurement of an "integrated"
>>> LIMS. OJEU ? Feb 2008.
>>> I'm heading a project to standardize biochemistry test names, codes,
>>> units and (where possible!) reference intervals. I've also represented
>>> Wales on Jonathan Berg's W Midlands Biochemistry Harmonisation group.
>>> Looking at the spreadsheet I can see how this can easily develop into a
>>> pig's breakfast!
>>> We hope to proceed in Wales by setting up a code list for tests with
>>> agreed names and (SI) units. Any translation necessary for the IHR
>>> and/or clinical portal in Wales would occur further down the line.
>>> Although we hope to agree some consensus reference ranges the reality is
>>> that most results transmitted will (hopefully) have a standard code and
>>> unit but different ref ranges depending on lab.
>>> I would be grateful for any advice on how likely this approach is to
>>> succeed and any other comment on the most effective way forward.
>>>
>>> Gethin Roberts
>>> Consultant Clinical Biochemist
>>> Bronglais Hospital
>>> Aberystwyth
>>> 01970 635784
>>>
>>> -----Original Message-----
>>> From: IT working group of the Association of Clinical Biochemists
>>> [mailto:[log in to unmask]] On Behalf Of Jonathan Kay
>>> Sent: 10 October 2007 08:32
>>> To: [log in to unmask]
>>> Subject: Re: Conversion units - PMIP[MESSAGE NOT SCANNED]
>>>
>>> I don't think its safe for receiving systems to change any components
>>> of reports unless it is known that results between the different
>>> methods are transferable.
>>>
>>> Some minor conversions of units are probably OK (eg mmol to micromol)
>>> and should be based on systems sending well formed ISO units (IFCC/
>>> IUPAC to us), and be limited to those cases.
>>>
>>> If this approach isn't taken it is likely that eg enzyme results from
>>> different laboratories will be merged when the results are not
>>> transferable. (Because system implementers will look at the units and
>>> see they are the same... )
>>>
>>> NB: This is a criticism of UK laboratories, not information system or
>>> projects.
>>>
>>> Jonathan
>>>
>>> On 9 Oct 2007, at 21:23, Richard Jones [Pathology] wrote:
>>>
>>>> TPP (and I assume other GP suppliers) are now receiving data from
>>>> multiple labs with a mixed range of units. Though they store the
>>>> original unit when they display tables or graphs they have a need
>>>> to convert to a common base unit.
>>>>
>>>> They have set up the following conversions. I would be grateful if
>>>> anyone with a little time could check these for me and comment on
>>>> whether you think they are valid. see spreadsheet.
>>>>
>>>> Incidentally they have also noticed a number of labs sending
>>>> messages with 'inappropriate' units and other message content. I
>>>> have contacted CfH (at a very high level) to try to get their help
>>>> desk to resolve it without any reply - clearly the potential safety
>>>> issue is not recognised / understood.
>>>>
>>>> How do you think we should proceed?
>>>>
>>>> I have attached an anonymised list (at least only with lab ID
>>>> codes). Should I share the uncoded version?
>>>>
>>>> My feeling is that CfH should be picking this up and following
>>>> through to the labs.
>>>>
>>>> Comments welcome.
>>>>
>>>> Rick
>>>>
>>>>
>>>>
>>>>
>>>> Dr Rick Jones
>>>> Assoc Clin Director, Yorks and Humber SHA NPfIT
>>>> Sen Lect, Yorkshire Centre Health Informatics, Univ of Leeds
>>>> [log in to unmask]
>>>> http://www.ychi.leeds.ac.uk <http://www.ychi.leeds.ac.uk/>
> <http://www.ychi.leeds.ac.uk/>
>>>> http://elipse.redirectme.net <http://elipse.redirectme.net/>
> <http://elipse.redirectme.net/>
>>>> http://www.pathology.leedsth.nhs.uk
> <http://www.pathology.leedsth.nhs.uk/> <http://
>>>> www.pathology.leedsth.nhs.uk/>
>>>> 0113 343 4961
>>>>
>>>> <Anonymous Copy of Invalid Units.xls>
>>>> <Copy of Invalid Units.xls>
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