Questions for Ian Arrowsmith, Chief Terminologist at Health and Social Care Information Centre (National Health Service, UK)
Ian has been involved in the use of clinical terminologies in electronic health records for over 13 years following his earlier career as a radiographer in the UK National Health Service. Ian was originally taken on as a terminologist in the project to create SNOMED Clinical Terms in 1999 and has worked in or around this field since that time. This period included several years as a Clinical Design Consultant in the Design Authority for the National programme for IT in the NHS – advising NHS colleagues, regulatory bodies and system suppliers in the delivery of what was the largest public sector procurement in the World. In this role Ian had responsibility for capture of health information requirements, specification, and high-level healthcare design to meet the needs of healthcare professionals and patient groups. This included elaboration and re-scoping of requirements and collaboration with regional teams and suppliers in system design. Ian was also the lead officer for ensuring terminology components of electronic applications were consistent and made the best use of available standards.
Since 2007, as Chief Terminologist in the NHS, Ian has managed a team of clinical terminologists in the maintenance and delivery of several terminologies including the Read codes, Diagnostic Imaging codes and the UK edition of SNOMED CT. Ian also played a part in the establishment and on-going governance of the International Healthcare Terminology Standards Development Organisation (IHTSDO) having been an active member of the Content Committee for 5 years, the Member Forum for 6 years and currently as a member of the Management Board. During recent years Ian has delivered educational sessions and workshops to colleagues in many countries including Canada, USA, Australia, Malaysia, Netherlands, Denmark, Sweden, Ireland, Norway and Singapore.
Jiayi Huang: You worked as a Radiographer for about quite a number of years. At which point did you realise the importance of terminology work in Health Care? Was it simply that you wanted a career change?
Ian Arrowsmith: I have had a long-standing interest in computing. We had a radiology information system in my hospital and we had coded data items for each procedure we did. Other than that it was a happy coincidence career change.
JH: You manage the clinical terminology team at the UK Terminology Centre (UKTC). Can you explain a bit about the structure of the team, and it role in the health care service in the UK? How many people are on the team and what are their backgrounds (are they trained terminologists)?
IA: All editing staff have a clinical background – doctors/nurses/pharmacists etc. though we do also have some associated staff who are not clinical. There are 10 clinical and 7 pharmacy terminologists. We provide the content necessary for electronic health records – both for clinical system users and system suppliers.
JH: One of the things I’ve noticed as a medical translation student is that not only can a single term be used in different ‘domains’ (i.e. medical specialisms), but that several terms can be used to denote one single concept. Is this a problem that you have encountered? In what ways does your team deal with the lack of standardisation of medical terminology?
IA: Alternative descriptions are available for concepts, each are linked to the same concept code so there should not be any misinterpretation. Each concept has a fully specified name that must be unambiguous.
JH: In your opinion, what is the biggest current challenge that the British National Health Service is facing in regards to terminology?
IA: Migrating the estate (the systems already adopted) from system supplier proprietary codes (every system supplier works with their customers to develop their very own set of terms and codes) and from legacy national code schemes (the old code schemes developed and managed nationally which are widely used but have significant deficiencies). It is a significant undertaking for suppliers to re-design their systems around a different terminology scheme.
JH: The NHS works with SNOMED CT (Systematized Nomenclature of Medicine–Clinical Terms). What is that?
JH: Do you think a standard medical terminology is achievable in the UK/ worldwide? Why or why not?
IA: It is eminently possible though there may not be comprehensive adoption as soon as we would like so that all benefits are realised. Also there are many data collections that are based on old or proprietary code schemes (see answer to question 4).
JH: What training does your team receive before they work in terminology at the UKTC?
IA: They have to have a clinical background and an aptitude for informatics and a degree or Masters. Most of the training is ‘on the job’ after they start. It takes a few years to ‘grow’ a terminologist.
JH: At the UKTC, how are terms extracted? How are they imported into the SNOMED CT?
IA: End users submit requests for change, terminologists add them to the database and assign the appropriate relationships – this is a largely manual process though much of the QA is automated. There are bespoke editing tools for the purpose.
JH: In your opinion, why do health care professionals need a standardised terminology? Does their need differ from those of laypeople’s need for standardised terminology?
IA: For effective communications between clinical professionals/organisations to support continuity of care. I don’t actually believe lay people’s needs are as different as sometimes portrayed.
JH: Could IATE be enriched in specific scientific domains with the contribution of specialists in terminology in the respective fields? By searching a few medical terms, what do you think of its resources and definitions/ contexts (be honest)?
IA: I’m sure that would be useful. SNOMED is authored in English so I imagine it would be very useful for countries where the main language is not English
JH: Are you aware of any translation issues in medical translation of terminology? Does the NHS deal with translated documents? How can translators translating from/into English deal with lack of standardisation of medical terms in your opinion?
IA: There is an issue around which term to translate – the IHTSDO has some guidance on translation. The following is extracted from the IHTSDO website:
The basic objective of any SNOMED CT translation is to provide accurate representations of SNOMED CT concepts in way that is understandable, usable, and safe. Translations must be concept-based, as term-to-term translations may yield literal expressions that are often meaningless. Instead, the translator analyzes each concept based on the position within the hierarchy, the descriptions, and relationships to other concepts before deciding on the most meaningful translation of a concept.
JH: Finally, what advice would you give to someone aspiring to work in medical terminology? What credentials should they ideally have?
IA: A logical brain, an eye for detail, the ability to understand difficult constructs and be able to work well with other like-minded individuals. Ideally a clinical background and a good understanding of how information is/can be used for the benefit of patients (and anybody else interested in analysing the data).
Jiayi Huang was born in Guangzhou China, and grew up in London. She did a BA in French and Contemporary Chinese at the University of Nottingham, where she spent her third year working at a training and rehabilitation centre for disabled people in France. She is currently studying an MSc in Scientific, Technical and Medical Translation with Translation Technology at Imperial College London. She studies part time, and also works as a French/ Chinese into English freelance translator. From May to September 2013, Jiayi is a trainee at the European Parliament’s Terminology Coordination Unit in Luxembourg, where her duties include researching drug-related term to be inserted into IATE and coordinating the trainees’ project in disability-related terminology.