In an interview for the BRC, we feature the work of Leilei Zhu, who oversees clinical data standards at UCLH.
Leilei is a nationally recognised leader in working with clinical data and is based at the Clinical Research and Informatics Unit (CRIU) – part of the BRC at UCLH.
She led the UCLH roll out of the structured and standardised clinical vocabulary SNOMED CT in Epic, the electronic health record system used at UCLH. SNOMED gives clinical IT systems a single shared language, which makes exchanging information between systems easier, safer and more accurate.
UCLH was the first English-speaking site in the world to implement SNOMED CT throughout the Epic system. Leilei led work to standardise clinical vocabulary around diagnoses, which is now being introduced at all other sites in the UK which use Epic. This will affect up to 20 million people in the UK by 2025.
Leilei spoke to us about her role, the importance of capturing high-quality data, and more.
Can you tell us about your role?
I am responsible for clinical data standards at UCLH. My role is to work with clinicians, system designers and electronic health record systems such as Epic to ensure that data is recorded and stored in a standardised format. These data will be used in research, and everyday clinical care.
How does SNOMED CT benefit clinicians and patients?
Sites that use SNOMED can share data seamlessly – because SNOMED ensures that all data captured by different hospitals or healthcare facilities is recorded in the same clinical ‘language’.
And this means that it is easier for healthcare teams to see information collected about a patient at a different hospital or facility. This saves time for clinicians and helps to streamline treatment.
In the past, a diagnosis or treatment might have been recorded by two different hospitals in different ways. At UCLH for example, we had our own proprietary way of recording patient information, and this was different to what other hospitals did. So if you wanted to bring together data from UCLH with data from another hospital, you would have to do a lot of resource-intensive work with the data to make sure that different datasets were compatible. With SNOMED CT, this manual work is no longer necessary.
The term for this is ‘interoperability’ – meaning different systems can ‘speak to’ each other.
Our EHR system at UCLH is also providing us some insight on how people who work in data will need to work in the future.
We have to spend a lot of time and manpower converting clinical data into standard codes which are used in reporting. These codes relate to various national and international coding systems used around the world to record diagnoses, treatments, and other elements of care.
SNOMED CT can potentially remove the need to do this work, which in simple terms is called ‘mapping’. SNOMED automatically generates such codes, so this ‘mapping’ is, in theory, no longer needed However, this also means that patient data, when it is inputted into an EHR, must be complete and gap free. Unfortunately, this is not the case at present. This is not a problem local to UCLH, but a widespread issue in EHR systems.
How does SNOMED CT help in research?
With SNOMED CT, we can take part in research internationally more easily – again because data from different hospital sites can be used more easily together. And if clinicians have data beyond the local level at their fingertips to support their research, they can conduct more robust research.
It means you can draw stronger conclusions because you can base conclusions on larger quantities of data. That is powerful.
What should hospitals be focused on in terms of clinical data going forward?
If we consider the electronic health record system as a house, data standards would be the water pipe. All data, including high-quality data, must be standardised. My message to any organisation to embrace digital health is when introducing and configuring an electronic health record system, it is vital to agree the data standards right throughout the system from the very beginning. These data standards are one of the building blocks of your data infrastructure. Without these data standards, the quality of clinical data will be compromised, which will defeat its purpose to support better patient care either operationally or through research
I would also like to take this opportunity to encourage everyone working in data to explore how we can all work together towards the creation of the high quality, gap free patient data. This is actually very exciting, as by doing this we will all contribute to direct patient care, which is the highest agenda in NHS.
