MTJ: What is the current focus of your company's business? SNOMED Terminology Solutions (STS), a division of the College of American Pathologists (CAP), is the world’s leading resource for achieving interoperability through the use of clinical standards, and is recognized worldwide for its foremost expertise in SNOMED Clinical Terms (SNOMED CT).

Donnelly: CAP STS® focuses on consulting, education and other services related to SNOMED CT, its predecessor versions (SNOMED RT, SNOMED 3.5), and other terminologies where SNOMED is often used collaboratively. The CAP STS consulting and education team includes clinicians and technical consultants recognized worldwide for their unequaled level of SNOMED expertise. CAP STS’ education and consulting services assist the global healthcare community to achieve interoperability through the standardization of data in electronic health applications and systems.

MTJ: How has this focus changed in the last 2 years?

Donnelly: To understand the dramatic business change CAP STS experienced in 2007, an overview of the forty year history is helpful. SNOMED’s earliest version dates to the late 1960s when a group of visionary pathologists recognized the value in encoding pathology data to facilitate the ability to track patient cases and share data. Over the next thirty years, the SNOMED database content continued to expand alongside the pathology user base. By the early 1990s, the CAP published a two-inch thick book of SNOMED codes and terminology implemented and in use in over 30 countries.

A few years later, CAP leadership recognized that SNOMED had the ability to bring value well beyond the practice of pathology, and made the strategic decision to invest in that future. Over the next decade, a series of collaborations, with organizations such as Kaiser Permanente and the UK’s National Health Service, resulted in the development of SNOMED CT®, a hierarchical, relational database with over 300,000 unique health care concepts and semantic relationships. This greatly enhanced the ability of the global health care community to enable the reliability and consistency of data retrieval.

Global recognition of SNOMED CT’s potential soon followed. Already in use nationally in the UK, the U.S. National Library of Medicine furthered SNOMED’s adoption when, in 2003, it executed an agreement for its use throughout the U.S.

But the most dramatic development was yet to come. As other countries started to express interest in following the UK and U.S. lead in using SNOMED CT, the CAP recognized the long-term strategy to achieve global adoption also required an international organizational approach to support it. The International Health Standards Terminology Development Organisation (IHTSDO®) was formed on April 5, 2007, with a founding membership of nine countries (U.S., UK, Canada, Australia, New Zealand, Denmark, Sweden, The Netherlands, and Lithuania), all intent on achieving global adoption of SNOMED CT. Upon formation of the IHTSDO, the CAP transferred all SNOMED CT intellectual property rights to the IHTSDO.

With the formation of the IHTSDO, CAP’s SNOMED International division progressed from owner and developer of SNOMED CT to the IHTSDO’s support organization. In this role, CAP STS continues to develop and maintain SNOMED CT under the governance of the IHTSDO. In addition, we recognized the growing worldwide need for knowledge and assistance in the use of SNOMED CT. In order to leverage this new opportunity, business objectives of the division were redefined and launched CAP STS as the premier expert in SNOMED CT educational and consulting resources.

A year later, CAP STS has increased our staff by over 50 percent as we continue to bring on recognized industry experts in SNOMED, terminology infrastructure, and IT support. We have greatly expanded our educational offerings with more focused topics, targeting multiple levels of expertise in a variety of media, and with new offerings slated in the near future. We are exploring collaborative opportunities that will enable us to couple our consulting expertise with complimentary tools and systems. We also continue to develop and maintain the SNOMED CT database itself as the support organization to the IHTSDO.

MTJ: What are your current initiatives?

Donnelly: In addition to expanding our consulting and education service and serving as the support organization for the IHTSDO, we keep a high-level presence at the important standards and policy setting initiatives such as HL7, IHE, and HITSP, and the IHTSDO working groups. We are in the process of expanding our educational program offerings, which will include Web-based, self-service options that will appeal to the global market. We also recognize the need for varying levels of education to fit needs ranging from the novice to the expert SNOMED user, and those of special interest groups. As a result, we expect to add a number of new programs to address these unique audiences.

We continually listen to the needs of our customers to identify new opportunities that fit our strategic direction. We envision that our consulting offerings will expand as a result. As our customer forge down the path of integration, with SNOMED as the backbone of the standardization effort, we anticipate these initiatives will easily expand to include other terminologies, legacy data, and systems integrations. We will explore these, either as unique CAP STS product offerings, or potentially in collaboration with other parties.

MTJ: How has your market segment changed over the last year?

Donnelly: In the past year, we have seen a significant expansion in our market segment. We are in the very early stages of adoption, but the IHTSDO’s formation ensures progress towards the worldwide adoption of standardized medical terminology. Over the last year, the nine member countries have been defining their initiatives to spur SNOMED adoption. Each member country has their own unique set of parameters defining its healthcare delivery, ranging from issues such as nationalized healthcare, country size, standards mandates, and how adoption will be financed. Entities in non-member countries adopting SNOMED have also expressed hopes their adoption will be the groundswell for their own national movement.

CAP STS continues to see a growing demand for more educational offerings in more formats. Online education is a huge growth area as SNOMED adoption truly is a global effort. Once new adopters receive education, they often return looking for assistance in their SNOMED implementation efforts. Areas of high interest include mapping legacy data and to other codesets. Subsetting of SNOMED in order to focus on terms for certain specialized use is also in great demand.

MTJ: What are the greatest challenges for your customers in adopting and implementing technology for your customers?

Donnelly: Certainly not unique to SNOMED, or even to health care terminology, time and resources are the two greatest challenges among our customers. Most health care providers are under tremendous economic pressure, and maintaining adequate staff to deliver patient care is a challenge in itself. So as much as they would all agree that standardized data exchange is an absolute must-have, the reality of getting there is daunting. Also, being in the early stages of adoption, many potential users would rather follow someone else’s success rather than be the trailblazer. It is also easy to underestimate the time and resources that a broad scale implementation will require. How are you helping your customers address these challenges? Describe your company's position in the industry with regard to the solutions you deliver.

MTJ: What do you believe to be the state of the industry in terms of growth, maturity, and availability of viable products to address the technology needs of the medical community? What advice would you offer to organizations attempting to implement any technology projects.

Donnelly: We are helping our customers address their challenges not only through providing our consulting and education services, but also by keeping a visible presence at the important global meetings addressing these technology issues, and by spreading the word of our customers’ success stories. We recognize that full adoption of the EHR, which includes the incorporation of standards, is in its earliest stages of adoption, and we are committed to providing the services that are needed to guarantee global success. For this reason, we have really focused our efforts on building the expert team that will help our customers successfully achieve their goal. We think we are unique in the industry in the level of expertise we provide. We also work with our customer to get their stories heard, whether it be via press release, white paper, or presentation at industry meetings. We know it is going to take a lot of effort from a lot of organizations working collaboratively to reach the global vision of interoperability. We are fully committed to seeing this happen.

As far as advice to organizations attempting to implement technology projects, CAP STS applauds your efforts. As you progress, recognize you are blazing a new path, and give yourself the time and resources to accomplish your goals. There will be challenges along the way, but there are experts out there who you can turn to for help, and we hope CAP STS will be one of those you consider.

SNOMED Clinical Terms (SNOMED CT) must continually evolve to meet the changing needs of its diverse customer base. Mr. Donnelly’s experience in long-range strategic planning for health care and technology companies gave him the necessary skills to launch a new business model for SNOMED CT that ultimately led to the creation of SNOMED Terminology Solutions (STS), a division of the College of American Pathologists (CAP). STS creates and supports products and services that support the use of SNOMED CT, namely education and consulting, and serves as the support organization to the International Health Terminology Standards Development Organisation (IHTSDO). In addition to the IHTSDO, STS customers include software vendors, health care organizations, clinical end-users, and government agencies.

Mr. Donnelly came to the CAP with a solid background in business management. His several management positions at Baxter International culminated with an appointment to serve as Vice President of Reengineering. Charged with restructuring domestic distribution and manufacturing for Baxter International, which manufactures and distributes medical devices and supplies, Mr. Donnelly combined, decentralized, outsourced, and ultimately reduced operating expenses by $30M.

From Baxter, Mr. Donnelly moved to Cardinal Health, Inc., a Fortune 25 integrated health care services company. As Regional Vice President and General Manager for Pharmaceutical Distribution in the Midwest region, he again consolidated, automated, converted operating systems, and generated significant increases in revenues and return on capital. As Chief Operating Officer and Board Member for Business Logic Corporation, a venture-backed software company that provided software and connectivity services to financial institutions, Mr. Donnelly managed daily operations as well as capital formation and sales initiatives. And as Vice President of Healthcare for Alliance Consulting, Inc., he advised healthcare companies on long-range planning, strategy, and major technology initiatives.

Mr. Donnelly is a recognized expert on the use of information technology and the critical importance of an accepted global standard for medical terminology.