Over the years HealthTerm has been recognised for its functionality – especially for its capability for handling translation processes of large code systems, e.g. SNOMED CT. HealthTerm has been used in all the major translations performed by countries after 2003 – among others Denmark, Sweden, Canada, Slovakia and Lithuania.
In 2010 HealthTerm was selected as the central terminology server in the EU Commission project epSOS. In this project, 23 countries were to exchange a “patient summary” and an e-prescription – that is, send a patient overview across country borders. This was due to the fact that as a EU citizen, you can now choose to receive your medical treatment in any of the 28 EU Member States. Therefore there is a need to be able to move patient data securely between countries. Besides the legal aspects in the exchange of patient data, it was necessary to develop a technical standard for the transfer of patient data. It also soon became clear that all information was in need of coding – no free text. Thereby it became possible to translate and/or map these codes, making it possible for the receiving country to easily understand the documents.
The epSOS project needed all of the modules in the HealthTerm toolbox. The Browser module handled an overview of all 27 different international code systems selected as the basis for the coding of the involved documents. The Subset module was used for selecting which part of a code system that could be used to express possible vaccines a patient has been given over time. The Translation module was used for translating all the different subsets selected for the many languages in the EU countries. The Mapping module was used to map two code systems. E.g. when Italy uses ICD-9 and Germany uses ICD-10. Last but not least, extension handling and the security modules were used to ensure that each country only could see its own data, but also had “view” rights to common data like international code systems and subsets.
In the epSOS project HealthTerm was used as a tool and as a Master. Master is the central place where data (terminologies) are created and maintained. Using HealthTerm as the central repository, semantic project groups was given an overview of whether all countries had translated and/or mapped all subsets, a status per country, outstanding tasks, etc.
HealthTerm was also used by the epSOS project to update the international code systems. New subset versions were created, which was translated and mapped by the individual countries. The epSOS project had from the start a liberal attitude to subsets, containing only the 5,000 most important diagnoses. This was agreed in order to make the initial effort for the individual countries manageable. This approach is sufficient for pilot project testing. However, the epSOS project was about to use real data, and therefore the existing subsets were inadequate and needed to be extended considerably with the accompanying translation and mapping tasks in many countries.
The epSOS project demonstrated HealthTerm’s unique capability in handling many code systems in many languages by many actors, who all had been given smaller tasks in this large semantic project. The epSOS project chose to distribute an extract from HealthTerm to the National Contact Points (NCPs), who then had a small local database in which all documents could be translated or mapped. This worked fine, but since all of this data nonetheless was collected via HealthTerm’s web services, the NCPs could now also use HealthTerm ‘live’. For this reason, HealthTerm was optimised for the handling of ‘live’ lookups. This means that the clinical applications no longer need to support the terminologies themselves, but can now utilise HealthTerm as a service – Terminology as a Service.
An instance of HealthTerm was also established into which all of the different code systems, as well as a large selection of subsets can be imported. Suppliers of clinical systems can now use a “cloud” (shared HealthTerm instance(s) hosted by CareCom) for lookups in the terminology and thus they do not need to develop and handle updates to code systems themselves. This also gives their customers an opportunity to influence the clinical content and even adapt this with professional tools.