Some thoughts on health and healthcare

Abstract In an acute hospital, Diagnosis-Related Groups (DRGs) and patient-based costing solve different, complementary problems. DRGs are a prospective payment and case-mix classification mechanism : they group inpatient episodes for reimbursement and resource allocation using coded diagnoses, procedures, severity, and other episode variables. Patient-based costing - especially Activity-Based Costing (ABC) and Time-Driven Activity-Based Costing (TDABC) - is an internal measurement method : it estimates the actual resources consumed by a given patient across the care cycle. The practical implication is that DRGs tell the hospital what it is likely to be paid, while patient-based costing tells the hospital what the case actually cost. An effective acute-hospital costing architecture therefore requires structured EHR data, reliable timestamps and event logs, linkage to HR/finance/supply systems, and a semantic layer that uses SNOMED CT and LOINC for point-of-care capture and WHO ICD-11 a...

Abstract The central implementation question is not whether SNOMED CT can improve coding at discharge, but whether it can become part of the care process itself. The answer is yes, but only under specific socio-technical conditions. SNOMED CT is most useful during admission when it is used as the semantic layer for working diagnoses, procedural events, pathway activation, clinical context, task orchestration, and real-time feedback , rather than as a retrospective abstraction exercise. Official SNOMED CT guidance explicitly frames the terminology as a means to “collect once and use many times,” and as an enabler of point-of-care analytics, decision support, and reporting that directly benefit clinicians and patients. In practice, this means that diagnoses and procedures must be recorded in small, workflow-specific SNOMED CT subsets; linked to timestamps, locations, and care states; and continuously reused for clinically relevant alerts, meaningful dashboards, and quality assurance (QA...

Abstract A defensible Belgian pathway to Major Diagnostic Categories (MDCs) and Diagnosis Related Groups (DRGs) based on WHO ICD-11 and WHO ICHI could be built as a three-layer architecture: SNOMED CT for point-of-care clinical semantics, WHO ICD-11 Mortality and Morbidity Statistics (MMS) and WHO International Classification of Health Interventions (ICHI) for classification of diagnoses and interventions, and a transparent national grouper that consumes standardized episode variables and produces reimbursement classes. That architecture should not assume the existence of an official global SNOMED CT→WHO ICD-11 or SNOMED CT→WHO ICHI reimbursement-grade map. WHO states that the outcome of WHO ICD-11/SNOMED CT mapping collaboration remains under discussion and is not guaranteed, while WHO’s ICD-11 licensing materials also state that mappings and crosswalks are not covered by the base WHO ICD-11 licence and may require separate written agreement. SNOMED International documents official ma...