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  1. ACC going from READ codes to SNOMED CT

    09 November 2018 - 11:54 AM

    SNOMED CT (Systematized Nomenclature of Medicine -- Clinical Terms) is a standardized, multilingual vocabulary of clinical terminology that is used by physicians and other health care providers for the electronic exchange of clinical health information.

    SNOMED CT provides the core general terminology for electronic health records. SNOMED CT comprehensive coverage includes: clinical findings, symptoms, diagnoses, procedures, body structures, organisms and other etiologies, substances, pharmaceuticals, devices and specimens.

    Mapping from a Clinical Terminology to a Classification
    by Margo Imel, RHIT, MBA, SNOMED International, and James R. Campbell, MD, University of Nebraska Medical Center

    The paper discusses mapping and the relationships of SNOMED CT® to a statistical and administrative classification system such as ICD-9-CM. It explores the purpose and differences encountered in creating a mapping and provides a brief overview of SNOMED® and its evolution.

    The Terminology- SNOMED CT®, an Evolving Clinical Reference Terminology
    SNOMED® is the Systemized Nomenclature of Medicine. It is a controlled medical terminology (CMT). At its simplest, a SNOMED is a coded vocabulary of medical concepts and expressions used in healthcare. It is designed to provide the terminology needed to code the entire medical record. Controlled means that the content of the terminology is validated with careful quality assurance procedures in place to ensure that the terminology is structurally sound, biomedically accurate and consistent with current practice. SNOMED is a work of the College of American Pathologists (CAP), a medical specialty organization of Board-certified pathologists. Oversight of the "content" is provided by a multi-disciplinary editorial board with broad representation from clinical practice and academia.

    What is a Clinical Reference Terminology?
    A reference terminology is defined as "a set of concepts and relationships that provide a common reference point for comparisons and aggregation of data about the entire health care process, recorded by multiple different individuals, systems or institutions."

    A reference terminology is an ontology of concepts and the relationships linking them. An ontology is a collection of terms, similar to a dictionary or glossary, that is organized by meaning rather than alphabetically. A reference terminology can allow the concepts to be defined in a formal and computer-processable way. For example, hierarchical relationships can be defined using the "is a" link to identify which concepts are included within broader concepts. Along with other relationships, a network of meaning is created that is useful for computer representation and processing that allows a computer to answer basic questions such as: "Is angina pectoris a type of heart disease?"

    By creating computable definitions, a reference terminology supports reproducible transmission of patient data between information systems. It supports consistent and understandable coding of clinical concepts and so is a central feature for the function of computerized patient records.

    Origins of SNOMED CT
    Introduced in 1965, the Systematized Nomenclature of Pathology (SNOP) was the precursor to SNOMED. SNOP consisted of logically organized codes for the key terms that describe the pathology case:

    • Topography - The part of the body from which the specimen came
    • Morphology - The pathologic change documented in the report
    • Procedure - The method by which the specimen was obtained
    In the mid-1970s, work began to expand the coded vocabulary beyond pathology and develop a terminology that would encompass the entire medical record. The first edition of the Systematized Nomenclature of Medicine (SNOMED) was published in 1977 and was soon followed by SNOMED II in 1980. This work was refined with another release, in 1993, of SNOMED International, which was updated annually through 1998. Work continued with the release of SNOMED RT version 1.0 in January 2001 and SNOMED RT 1.1 in July of 2001.

    Is SNOMED only for pathology applications? While one of SNOMED CT's precursors focused mainly upon pathology, today's SNOMED CT has a broad scope that encompasses all of healthcare. SNOMED CT is the merger of SNOMED RT and the United Kingdom's CTV 3 terminology, formerly known as the Read codes. SNOMED CT's 19 hierarchies provide coverage in diseases, findings, procedures, body structures, pharmacy products and other health care concepts.

    The hierarchical nature of SNOMED CT enables recording and documentation of clinical data at the appropriate level of detail that can later be analyzed from other perspectives and groupings.

    The integration of a clinical terminology such as SNOMED CT into computer-based patient records provides a comprehensive and functional terminology for clinical care. SNOMED CT can be utilized to index, store and retrieve patient information for clinical purposes. SNOMED CT helps ensure comparability of data records between multiple practitioners, across diverse platforms and computer systems.

    What is a Classification System?
    A classification system has been defined as: A systematic arrangement into classes or groups based on perceived common characteristics; a means of giving order to a group of disconnected facts. The groups or classes may have similar or like characteristics or may even be synonymous.

    The Classification ICD-9-CM
    International Classification of Disease, Ninth Revision (ICD-9) was originally designed to classify patient morbidity and mortality for reporting. The clinical modifications provided a way to classify morbidity data for indexing of medical records, medical case reviews, and ambulatory and other medical care programs, as well as for basic health statistics, resulting in International Classifications of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). ICD-9-CM codes are commonly used for reporting, analysis, and payment of healthcare services.

    ICD-9-CM employs multiple axes of classifications. Within individual chapters different axes are used in classifying different diseases. ICD-9-CM codes classify diseases or conditions that are similar which may or may not be synonymous. An example in which both diseases are both included in ICD-9-CM code 789.0x is:

    • Abdominal pain
    • Infantile colic

    ICD-9-CM maybe described as a "closed" classification which means that each actual patient diagnosis is "bundled" into only one of the broad categories provided by the classification scheme.

    Why Create a Map between SNOMED and ICD?

    The purpose of mapping is to provide a link between one terminology and another in order to:

    • use data collected for one purpose for another purpose
    • retain the value of data when migrating to newer database formats and schemas
    • avoid entering data multiple times with the risk of driving up cost and errors

    A map there is, therefore, created with a specific purpose in mind and must be refined for particular use cases and users in diverse settings.

    Since classifications such as ICD-9-CM are widely used in health care for administrative purposes, SNOMED International provides mapping resources that allow a linking from SNOMED clinical concepts to codes used in other schemas and for other purposes. As an example, the purpose of the cross mapping to ICD-9-CM is to support the process of deriving an ICD-9 CM code from patient data.

    While SNOMED provides an ICD-9-CM mapping, each enterprise needs to review the content to ensure consistency with local policies and practices before integrating into the enterprise's processes and tools.

    Coding involves the use of clinician documentation and other clinical data contained in a particular patient health record as the source for determining the appropriate code assignment within a terminology, classification, or other controlled vocabulary. Coding conventions and guidelines are applied in determining code assignment.

    Mapping is linking terminology content between two schemes. Unlike coding, it is not specific to a particular patient encounter. Coding selections may sometime depend upon the context of the patient record; context is not available for each patient when a mapping is developed.

    Each mapping from source to target should have a purpose. The mapping begins with the development of heuristics and guidelines that support the use case or the purpose of the mapping, respecting the conventions of the source and target to preserve the granularity and flexibility of both.

    Computer programs may use mapping files to translate codes and help automate the process. Full automation that takes into account the coding rules (e.g., such as disease during pregnancy) remains an elusive goal that requires knowledge-based software and some kind of human review.

    So the good news is that ACC are adopting an information system that forces adherence to criteria thus avoiding individual staff members rationalising what they believed to be the problem based entirely upon their own intuition, common sense, critical reasoning and suchlike that has nothing whatsoever to do with the legislated criteria.
  2. Happy days

    07 November 2018 - 10:12 AM


    This needs no explanation, and is a fun read, no matter your gender.

    What do you expect from such simple creatures? Your last name stays put. The garage is all yours. Wedding plans take care of themselves. Chocolate is just another snack. You can never be pregnant. You can wear a white T-shirt to a water park. You can wear NO shirt to a water park.

    Car mechanics tell you the truth. The world is your urinal. You never have to drive to another gas station restroom because this one is just too icky. You don't have to stop and think of which way to turn a nut on a bolt. Wrinkles add character.

    Wedding dress - $5,000. Tux rental - $100. People never stare at your chest when you're talking to them. New shoes don't cut, blister, or mangle your feet. One mood all the time. Phone conversations are over in 30 seconds flat.

    A five-day vacation requires only one small suitcase. You can open all your own jars. You get extra credit for the slightest act of thoughtfulness. If someone forgets to invite you, he or she can still be your friend. Your underwear is $8.95 for a three-pack. Two pairs of shoes are more than enough.


    You almost never have strap problems in public. You are unable to see wrinkles in your clothes Everything on your face stays its original color. The same hairstyle lasts for years, maybe decades. You only have to shave your face and neck.

    You can play with toys all your life. One wallet and one pair of shoes - one color for all seasons. You can wear shorts no matter how your legs look. You can 'do' your nails with a pocket knife.

    You have freedom of choice concerning growing a mustache. You can do Christmas shopping for 25 relatives on December 24 in 25 minutes.

    No wonder men are happier!


    · If Laura, Kate and Sarah go outfor lunch, they will call each other Laura, Kate and Sarah

    · If Mike, Dave and John go out, they will affectionately refer to each other as Fat Boy, Bubba and Wildman.


    · When the bill arrives, Mike, Dave and John will each throw in $20, even though it's only for $32.50. None of them will have anything smaller and none will actually admit they want change back.

    • When the girls get their bill, out come the pocket calculators.


    · A man will pay $2 for a $1 item he needs.

    · A woman will pay $1 for a $2 item that she doesn't need but it's on sale.


    · A man has six items in his bathroom: toothbrush and toothpaste, shaving cream, razor, a bar of soap, and a towel.

    · The average number of items in the typical woman's bathroom is 337. A man would not be able to identify more than 20 of these items.


    · A woman has the last word in any argument.

    · Anything a man says after that is the beginning of a new argument.


    · A woman worries about the future until she gets a husband.

    · A man never worries about the future until he gets a wife.


    · A woman marries a man expecting he will change, but he doesn't.

    · A man marries a woman expecting that she won't change, but she does.


    · A woman will dress up to go shopping, water the plants, empty the trash, answer the phone, read a book, and get the mail.

    · A man will dress up for weddings and funerals.
  3. Pre-current legislation complaints

    02 November 2018 - 11:56 AM

    Does anyone know the correct protocols and expectation for the pre-current legislation complaints procedure.
    I had complained to the ACC that they failed to make disclosure of the information they relied upon to cancel my claim. This complaint continued from October 1997 up until the present without ACC providing me with an answer.
    I also requested a copy of my file which was not forthcoming until after a review hearing.
    The reviewer adjourned a review hearing because I had not received any information that the ACC relied upon for the decision being reviewed. He did not reconvene the review hearing and then after three months went on to make a decision not to disturb the ACC decision Thus depriving me of any form of review hearing.

    I note by the ACC notes that their investigation Continued on until August 2001, after the start of the current legislation. As the ACC had not resolve the complaint prior to the current legislation does it mean that the complaint ship's to the current legislation criteria and protocols?

    As a matter of interest I note that the complaints investigation officer advise the ACC that they would need to rescinded their decision if they don't provide me with the information relied upon for the decision.
    Almost 20 years later the ACC acknowledged to a judge in the High Court that they never had any information for the purposes of the decision to cancel the claim. That explains why the ACC never is rendered any information to me and failed to provide either the criminal or the civil courts any information describing a single work task activity to any material time thus preventing any possibility that I could challenge their claim that they possessed information. Quite clearly they had conspired to pervert the course of justice from the beginning. I think I ought to have my complaint addressed and answered one way or the other whether it be under the previous legislation or current legislation. I'm seeking an apology.
  4. Legislated criteria for ACC decision-making information

    29 October 2018 - 05:25 PM

    For a long time I have been meaning to address this observable pattern of behaviour whereby people are making reference to what they call information when they really mean false information.

    The ACC legislation requires the ACC to base all decisions on authorised and qualified information that is fit for its purpose. However we do frequently see ACC soliciting information from those who are not qualified to give up such as members of the public, therapists, in-house doctors and even the decision makers themselves. This pattern of behaviour follows right through to the ACC generating a situation whereby reviewers and judges are being asked to generate information which is far from the criteria of legislation.

    Everybody from an ACC decision maker right through to Judges of the court are expressly forbidden by the legislation from generating information from their own understanding such as decisions based on their own "common sense". The situation generally comes about by way of ACC creating all kinds of balances of probability scenarios while avoiding obedience to the legislated criteria that limits the ACC to acquire information from an authorised qualified source.

    So we have information, misinformation and this information.

    For ACC purposes information is produced by a qualified independent source such as a medical specialist with qualification, experience and interest necessary to have any kind of the right to form an opinion or view point and/or diagnosis/prognosis.

    Misinformation is generated by a source of which the ACC has relied upon, such as a therapist, who does not meet the criteria. If the ACC staff member responsible for gathering information mistakenly asked the wrong person then that would be the production of misinformation. The reality with misinformation is that while there may have been an attempt to obtain Correct information there exists a danger, as perceived by legislation, that the information may be wrong. The result could be an honest mistake regardless as to whether the mistake goes the favour of the ACC or the claimant.

    Misinformation would be the ACC or Fairway websites providing the general public with the pattern of circumstances resulting in the general public joining up a bunch of dots to reach their own conclusions and then calling it commonsense knowledge. Likewise we notice that the ACC habitually make submissions to the courts whereby they leave the judge to reach their own conclusions about the facts in reliance upon it being an absence of information As opposed to submit into the court a series of exhibits which consists of actual information reaching the criteria described in legislation such as unauthorised information provider that has the necessary qualifications and experience to provide definitive information. We see this is where the ACC promotes so-called "common sense".

    Misinformation is not actually telling of a lie as what is submitted is neither true nor untrue. However it would be subject to further action if there was a deliberate plan afoot to mislead. As the value of entitlements frequently rise to hundreds of thousands of dollars the potential for criminal prosecution is extremely high but with the ACC being a multibillion-dollar Corporation hiding behind all manner of bureaucracy together with even providing claimants with false names in real terms it would be very difficult to secure a criminal prosecution against those who knowingly mislead and make decisions based on information they do not know to be true.

    Disinformation is a deliberate lie designed to deceive. For example should and ACC decision maker requiring information for decision withhold information from a suitably qualified and experienced information provider With the plan to provide only bias information in the ACCs favour then they are quite clearly conspiring to deceive with the result that More probably than not the assessor will be the one that generates a documented lie for them. Obviously when getting a third party to tell the lie they are doing so in a manner to distance themselves from personal liability as they cannot then make an honest decision. However once they are actually caught red handed doing this they had conspired to commit ACC fraud with the intention to deny the claimant entitlements. The way that they diminish the possibility of being prosecuted and incarcerated a third party within the ACC becomes the actual decision maker who theoretically would claim that they had absolutely no knowledge of any other information other than the information they received from the information generated by the official information provider.

    The ACC have a division separate from the ACC decision making process which claims that it has no knowledge of legislation nor criteria found within the legislation when seeking to prosecute ACC claimants. This division of the ACC settlements to the criminal court all manner of speculations and assumptions that have been dressed up to look like actual information by was the ACC would be lawfully entitled to make a decision on. They claim not to be providing misinformation or even disinformation on the basis that they are ignorant of the law and instead submit to the court what they considered to be "common sense" with the expectation that the judge likewise makes for the judges believed to be the same commonsense decision on the basis that the judge has relied on good faith that the ACC have provided to the court information that fits the legislated criteria.
  5. Capacity to work or earn? That is the question.

    26 October 2018 - 11:05 AM

    There seems to be considerable confusion with regards to the proper interpretation of the ACC legislation.

    All too often the ACC focus their attention on whether or not we are qualified, skilled and experienced to work without regard to having a capacity to earn.

    Is there a clear and definitive portion of legislation and case law that addresses this issue?

    What is the legislated criteria of the assessment procedure to provide information to the ACC?

    What is the decision that the legislation requires the ACC to make?