Daily Archives: January 19, 2017

SNOMED CT

I’ve been looking at the subject of health information exchanges in this series. The exchange of information between different health information systems is facilitated by the development of standards. One international standard that has been developed is SNOMED CT. This NHS Digital video is a brief introduction to SNOMED CT which is scheduled to replace READ in primary care by April 2018.

Appendix A – Other Posts in the Series on Health Information Exchanges

Arizona Statewide Health Information Exchange

A History of The Health Information Exchange in Pennsylvania

The Arkansas Health Information Exchange – SHARE

The California Health Information Exchange – Cal Index

Health Information Exchanges

Health Information Exchanges and Chronic Conditions

HIPPA and Health Information Exchanges

Creating a Health Information Exchange in Arizona

Standardisation of Health Information Technology in New Zealand

Why Do We Need Electronic Record Systems to Talk to Each Other

Appendix B – Definition of Health Information Exchange

This is the definition of the Health Information Exchange that I use (Hersh et al, 2015)

Health information exchange (HIE), the electronic sharing of clinical information across the boundaries of health care organizations‘.

 

Index: There are indices for the TAWOP site here and here

Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link.

TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link.

Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk.

Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Conflicts of Interest: *For potential conflicts of interest please see the About section.

 

 

When is a Research Question Settled?

magnifyingglass.1

I was looking at the Corfu paper by Pitsavos and colleagues when it got me thinking about the bigger question of research goals. Research is about answering questions, learning more about the world and how things work. In healthcare research we expect research to produce an understanding of health and illness. We should also be able to apply this research to help improve lives.

So a very nice question to ask is ‘when is a research question settled?’. When is it unnecessary to do any more research in this area? Take the paper above for instance. The researchers looked at some of the variables related to coronary heart disease risk. The age of the participant at entry to the study was associated with a hazards ratio of 1.1 with a p value of less than 0.001 and a 95% confidence interval of 1.06-1.14. The hazards ratio for smoking was 1.79 (95% CI 1.15-2.77) with a p-value of 0.01. The hazards ratio for BMI was 1.05 with a p-value of 0.1 however. Since the arbitrary cut-off limit for significance is usually set at 5%, this would not be significant. Additionally the 95% confidence interval is 0.99-1.10 confirming that this association is less than straightforward.

For each of the questions above, we are talking about a population. Even when we talk very robustly about the results at a population level, we can then move to the individual level. Population level results become difficult to talk about at an individual level as there are many variables that predict outcome and which can vary considerably between people. So if we have extreme confidence in a research question at a population level, we can always move to a discussion of the individual to refine the questions we ask. This is one aspect of personalised medicine.

However my conclusion from reflecting on the paper and the question was that there must be a hierarchy of answers to research questions. When Kuhn talks about the end of scientific inquiry in one research area, this becomes a tool for other areas of science. For instance, we know that the first element of the periodic table is hydrogen. It doesn’t matter how much is invested into building research studies to investigate the identity of the first element of the periodic table – it’s already been done. The studies wouldn’t produce any new answers to that particular question.

So some questions have been answered. Do they pass into a realm of what we would describe as facts, axioms or theorems?

What prevents us from reaching the answers to other questions?

Index: There are indices for the TAWOP site here and here

Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link.

TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link.

Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk.

Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Conflicts of Interest: *For potential conflicts of interest please see the About section.