One disease: one name
The foundation of electronic health communication to be put in place. Australia to sign up for a global health language adapted to local circumstances.“The average encounter with a doctor – even for a sore throat – generates a large amount of information which can be easily mis-communicated,” says Dr John Aloizos, GP and Chairman of the Australian Pharmaceutical Advisory Council. “There’s the person’s complaint: say a sore throat. When the doctor looks in the throat there could be all sorts of things like tonsillitis or pharyngitis (inflammation at the back of the throat) or both; they have to note down the possible diagnoses in the patient’s record; order the tests they want to run, if any; and write the referral to an ear, nose and throat specialist where required. Then there’s the treatment: prescribing antibiotics, pain relief, and so on.
“And at almost every point along the way, the doctor is choosing from a huge number of ways and names for describing what they are hearing, seeing, prescribing or deciding to do. This information is communicated to other clinicians - the pathologist who receives the throat swab, the specialist who receives the referral, the pharmacist who fills the prescription. All of whom have their own description preferences. The possibility of a misunderstanding is significant.
“And all this triggered from just a sore throat. Imagine what it’s like if you have chest pain on top of arthritis and diabetes – for which there are at least 38 names alone.”
“With the increasing complexity and intensity of health care, and an ageing population with a rising number of medical problems – and doctors and health institutions visited - per individual, there is no choice but for doctors to communicate more effectively with each other using electronic means,” explains Dr Ian Reinecke, Chief Executive of the National E-Health Transition Authority Limited (NEHTA), a company set up by Federal, State and Territory Governments to develop better ways of electronically collecting and securely exchanging health information . “It’s no longer acceptable that it takes days for a GP to receive a discharge summary about one of her patients who’s been in hospital and when it comes it’s illegible, incomplete or open to interpretation. The same goes for communication in the other direction for referrals.
“But it’s not as simple as sending an email. Because the information needs to go into the hospital or the doctor’s records, it has to be automatically understood by the computer – and if every doctor and their computer use different terms to describe their diagnoses, tests, treatments and medicines, this can’t be done. Without all computers in the health care sector using a single clinical language, the promise of electronic health communication can’t be fulfilled on a national scale,” argues Dr Reinecke.
“So NEHTA is currently finalising negotiations on a heads of agreement to be a Charter member of a proposed new international body for a single global clinical language called SNOMED. Once a member, the advantages are many. It means that software developers will have a standard language they can use in their products – free. The computer of one health care practitioner will be able to easily interpret information sent from another practitioner. Significant progress will be made in reducing the estimated 20 percent of avoidable deaths in hospital – nearly 3000 deaths a year - due to communication problems or poor record keeping.
“NEHTA shall also extend SNOMED to suit the specific needs of the Australian health care environment and the practices of our health professionals.”
* The 38 ways to describe diabetes:
1. adult-onset diabetes
2. adult-onset diabetes mellitus
3. autoimmune diabetes
4. brittle diabetes
5. bronze diabetes
6. chemical diabetes
7. diabetes insipidus
8. diabetes intermittens
9. diabetes mellitus
10. diabetes mellitus type I
11. diabetes mellitus type II
12. gestational diabetes
13. growth-onset diabetes
14. IDDM
15. insulin-dependent diabetes
16. insulin-dependent diabetes mellitus
17. juvenile diabetes
18. juvenile-onset diabetes
19. ketoacidosis-prone diabetes
20. ketosis-prone diabetes
21. ketoacidosis-resistant diabetes
22. ketoacidosis-resistant diabetes mellitus
23. ketosis-resistant diabetes
24. ketosis-resistant diabetes mellitus
25. late-onset diabetes
26. latent diabetes
27. mature-onset diabetes
28. maturity-onset diabetes
29. maturity-onset diabetes of the young
30. nephrogenic diabetes insipidus
31. NIDDM
32. non-insulin-dependent diabetes
33. non-insulin-dependent diabetes mellitus
34. subclinical diabetes
35. sugar diabetes
36. steroid diabetes
37. type I diabetes
38. type II diabetes
The following are typical ways in which to prescribe the taking of a common, broad spectrum antibiotic called Amoxycillin, twice a day:
Amoxycillin Trihydrate 250mg, 250mg bd
Amoxycillin 250mg, 250mg bd
Amoxil 250 mg capsule, 1 capsule twice a day
Alphamox 250mg capsule, 250mg twice a day
Amohexal 250mg capsule, 1 twice per day
Cilamox 250mg capsule, 1 capsule bd
Moxacin 250mg capsule, 1 capsule twice a day