Current Affiliation: Staff Scientist, Lister Hill National Center for Biomedical Communications, National Library of Medicine, National Institutes of Health
Education: MD, University of Hong Kong
MSc, University of Sunderland, UK
MA in Biomedical Informatics, Columbia University, New York, NY
Fellow of the Royal College of Surgeons of Edinburgh, and Fellow of the Hong Kong Academy of Medicine
How I describe my work to those outside the field …
I work in the field of biomedical terminology. The goal of medical terminology is to represent medical data and information in a way that computers can understand, process and share. We can make healthcare better and safer through the use of very smart systems and give clinicians advice and decision support. The prerequisite is that we have high quality information in our electronic health record (EHR) that is represented in a clear and unambiguous way which computers can understand, analyse, manipulate and act upon.
Years of experience …
About 16 years. It was after I finished my first master’s degree that I really got involved in informatics.
Since my high school days I have always been interested in computer science and computers. In those days personal computers had not yet been invented. I still remember my first computer program was written on a programmable calculator manufactured by Texas Instruments.
After I graduated from medical school I trained to become a surgeon and I took a Master’s degree program in computer science from the University of Sunderland in the UK as part of a distance learning program. Then I started looking around to see how I could apply this knowledge.
At that time, particularly in Hong Kong, very few physicians had an in-depth knowledge of IT or computer systems and that was a big obstacle, because my hospital had started to computerize the medical record system. The system developers did not understand what clinicians really wanted or needed and the clinicians did not know how to communicate their requirements to the technical people. I was one of the few people who could actually speak to both groups.
That turned out to be a big help in moving things forward and avoiding pitfalls.
After that I was drawn more and more to informatics projects, so much so that I decided I had to make a choice. I knew I couldn’t do both surgery and informatics equally well because my time was limited. So, after long thought, and after 15 years of surgery, I took the leap and became a full time medical informatics specialist.
I was given the task of overseeing the development of the clinical information systems in over 40 public hospitals and institutions in Hong Kong, serving a population of almost 7 million people. I left Hong Kong in 2001 and immigrated to New Zealand and then 1 year later I came to the US to pursue another Master’s degree at Columbia University and have been in the U.S. ever since.
What are your ambitions? At the end of your career, what do you hope to have accomplished?
I would be very happy if I could contribute to improving the quality and also the value of medical data in the electronic health record through the use of medical terminologies. To do that there are significant obstacles to overcome. First, people have to understand the importance of terminologies in facilitating data interpretability and information sharing. The ‘meaningful use’ incentive is an important step in this direction by mandating the use of standard terminologies for various data elements in the EHR. Also important is to remove the barriers for people to use terminologies. Even now, many clinicians still find terminologies difficult to use and think that terminologies will severely restrict what they can say. The usual complaint is that they are forced to choose from a list of very strange terms that have very little resemblance to the words or expressions that they normally use in clinical medicine.
These impressions very often originate from using ICD codes directly to capture clinical information. ICD is a statistical classification rather than a clinical terminology. Many ICD names are not clinically-oriented, and they often do not contain enough clinical details to support patient care. So to deal with all that we need a better terminology. Now we have SNOMED CT (Systematized Nomenclature of Medicine Clinical Terms) which is a very comprehensive terminology designed primarily for clinical care. SNOMED CT has been designated as the terminology for clinical problems and procedures in stage 2 of the meaningful use program. However, choosing the right terminology is just the start. It’s still a lot of work to make sure that terminologies are implemented and used in the way they are intended, otherwise we will not be able to reap the benefits.
Who or what are your key sources in the informatics field?
The JAMIA journal and the annual conference are my main source of information, knowledge, and inspiration … and also my colleagues at NLM. I am very lucky to have the chance to work with people who are real experts in the field of terminologies, such as Betsy Humphreys, Clement McDonald and James Cimino.
What are your hobbies? What do you do for fun?
I enjoy camping. I was first introduced to camping 4 or 5 years ago after I moved to the U.S. and have been camping ever since. Here we are very lucky to have campgrounds at the national or local parks. These are wonderful places and they are well-maintained. I recommend them to everybody I meet who loves the outdoors. I also do some Chinese calligraphy. I’ve been doing it for a long time, and I find it very calming and very relaxing, almost like meditation. I’m also learning Tai Chi and a style of Chinese Martial Arts called Wing Chun. Bruce Lee was a master of Wing Chun, based on which he created his own style of Kung Fu
Articles that spotlight my research interests …
These are 3 projects that I am currently leading. The first is a map between SNOMED and ICD 10 CM. ICD codes are needed for administrative purposes, like reimbursement, public health statistics and so on. So in creating a map between SNOMED and the ICD 10 cm, I’m providing a means of re-using clinical data encoded in a clinical terminology to generate administrative codes. ICD 10 CM is not in use now, but will be required in 2014 to replace ICD 9 CM which has been in use for over 30 years. That will be a big change. We’ve already published a map of over 15,000 SNOMED concepts.
The next project is Clinical Observations Recording and Encoding or CORE Problem List Subset of SNOMED CT. To make it easier to implement SNOMED CT in the EHR, I’ve collected big data sets from 8 large-scale health care institutions, like Kaiser Permanente, Mayo Clinic, Veterans Health Administration, and one from Hong Kong. From there I found the most commonly used SNOMED CT terms.
The last one is called RxTerms. The RxTerms project started with a practical need for an easy way to capture medication information for NLM’s Personal Health Record. RxTerms is an interface terminology that will allow people to enter medical information easily and efficiently, and link the information to RxNorm codes.
AMIA is important to me because …
AMIA is my professional home and brings me news, information, and inspiration. AMIA also represents our profession very ably. It has a strong voice in public health policy issues and also fights for recognition of our field.
I am involved with AMIA …
I’ve been an AMIA member for over 10 years and I’ve attended many AMIA annual and spring conferences and I have presented my research at many of these meetings I’ve also presented in AMIA Webinars and I’m constantly monitoring several mailing lists, where I find some very interesting topics being discussed.
It may surprise people to know …
I think of myself as a global citizen. I’ve lived in Hong Kong, United Kingdom, New Zealand, and Japan before moving to the U.S., and I speak 5 languages: Cantonese, Mandarin, English, Japanese and French. I love to travel, learn foreign languages and experience different cultures. I think the world is getting smaller and we are much more connected now. If we open our eyes and our heart, we can appreciate how similar we all are in our pursuit of health, happiness, love and peace.