julie m. green, ms, dvm veterinary medical informatics vmrcvm – virginia tech veterinary medical...
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Julie M. Green, MS, DVMJulie M. Green, MS, DVMVeterinary Medical InformaticsVeterinary Medical Informatics
VMRCVM – Virginia TechVMRCVM – Virginia Tech
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
The Changing Face of TerminologyThe Changing Face of Terminology
How to Keep Up
Why does terminology change?Why does terminology change?
• Terminologies are incompleteMedicine covers a large body of knowledgeMissing content is inevitableVeterinary content is low priority
• Errors are made• Medicine evolves
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
Why does terminology change?Why does terminology change?
• Terminologies are incomplete
• Errors are made‘To Err Is Human’…to correct is inevitable
• Medicine evolves
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
Why does terminology change?Why does terminology change?
• Terminologies are incomplete• Errors are made
• Medicine evolvesMedical advancementsExpanding knowledgeReevaluation of current thinking
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
How does terminology change?How does terminology change?
• Minor changes
• Concept additions
• Concept retirements
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
How does terminology change?How does terminology change?
• Minor changesConsidered “minor” if changes do NOT
affect the meaning of the conceptEx. Spelling corrections
• Concept additions
• Concept retirements
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
How does terminology change?How does terminology change?
• Minor changes
• Concept additionsNew content, self-explanatory
• Concept retirements
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
How does terminology change?How does terminology change?
• Minor changes
• Concept additions
• Concept retirementsConcepts should NEVER be DELETEDMark content as retired or inactiveRelationships between retired content and
potential replacements
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
What does this mean?What does this mean?
Change is a comin’…
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
Is your system ready?
What does this mean?What does this mean?
• Depends on type of implementation– Direct implementation– Mapping or translation
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
Direct ImplementationDirect Implementation
Direct Implementation
• Use content in the interface
• Users directly interact with terminology
• Practicality requires subsets
• Must be kept “in synch” with changes
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
24448007 Bacterial infection due to Klebsiella pneumoniae
95325000 Subcutaneus nodule
73211009 Diabetes mellitus
Sample from a “Findings” Subset
Direct ImplementationDirect Implementation
Minor changes
• Text changes
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
24448007 Bacterial infection due to Klebsiella pneumoniae
95325000 Subcutaneus nodule
73211009 Diabetes mellitus
Sample “Findings” Subset
CorrectSubcutaneus
Direct ImplementationDirect Implementation
Minor changes
• Text changes
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
24448007 Bacterial infection due to Klebsiella pneumoniae
95325000 Subcutaneus nodule
73211009 Diabetes mellitus
Sample “Findings” Subset
Componentid Changetype ReleaseDate
95325000 2 20090131
SCT_componenthistory table row
CorrectSubcutaneus
Direct ImplementationDirect Implementation
Minor changes• Text changes
– Replace text of term used
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
24448007 Bacterial infection due to Klebsiella pneumoniae
95325000 Subcutaneous nodule
73211009 Diabetes mellitus
Sample “Findings” Subset
Componentid Changetype ReleaseDate
95325000 2 20090131
SCT_componenthistory table row
Direct ImplementationDirect Implementation
Additions (to subsets)
• User need drives additions to subsets– System should accept new content requests– Centralized content requests desirable
• Experts should decide appropriateness• Central authority can then submit request to
SNOMED
– Temporary code for storage until concept is added to SNOMED
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
Direct ImplementationDirect Implementation
Additions (to SNOMED)
• New terms become available in the standard
• Review based on– User requests– Subject Matter Expertise
• Choose additions based on review
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
Direct ImplementationDirect Implementation
Additions
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
24448007 Bacterial infection due to Klebsiella pneumoniae
95325000 Subcutaneus nodule
73211009 Diabetes mellitus
Tempcode Elbow arthritis
Sample “Findings” Subset
User requested:Elbow arthritis
(added to subset)
Direct ImplementationDirect Implementation
Additions
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
Sample “Findings” Subset
Componentid Changetype ReleaseDate
439656005 0 20090131
SCT_componenthistory table row
New term added:(to SNOMED)
Elbow arthritis
24448007 Bacterial infection due to Klebsiella pneumoniae
95325000 Subcutaneus nodule
73211009 Diabetes mellitus
Tempcode Elbow arthritis
Direct ImplementationDirect Implementation
Additions• If temporary “placeholder” codes were created in the
subset, these need to be updated with new SCTID
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
24448007 Bacterial infection due to Klebsiella pneumoniae
95325000 Subcutaneus nodule
73211009 Diabetes mellitus
439656005 Arthritis of elbow
Sample “Findings” Subset
Componentid Changetype ReleaseDate
439656005 0 20090131
SCT_componenthistory table row
Direct ImplementationDirect Implementation
Retirements
• Retirement = inactivate term in standard– Ambiguous, Duplicate, Knowledge changed
• Must be replaced in subsets
• Record of “referrals” must be kept– Used for legacy data retrieval/analysis
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
Direct ImplementationDirect Implementation
Retirements
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
24448007 Bacterial infection due to Klebsiella pneumoniae
95325000 Subcutaneus nodule
73211009 Diabetes mellitus
439656005 Arthritis of elbow (disorder)
Sample “Findings” Subset
Componentid Changetype ReleaseDate Status
24448007 1 20090131 2
SCT_componenthistory table row
Retired as duplicate
Direct ImplementationDirect Implementation
Retirements
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
24448007 Bacterial infection due to Klebsiella pneumoniae
95325000 Subcutaneus nodule
73211009 Diabetes mellitus
439656005 Arthritis of elbow (disorder)
Sample “Findings” Subset
Componentid Changetype ReleaseDate Status
24448007 1 20090131 2
SCT_componenthistory table row
Retired as duplicate
relationshipid Conceptid1 Relationshiptype conceptid2 Characteristictype
3544879021 24448007 168666000(Same As)
186435004 2
Direct ImplementationDirect Implementation
Retirements
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
24448007 Bacterial infection due to Klebsiella pneumoniae
95325000 Subcutaneus nodule
73211009 Diabetes mellitus
439656005 Arthritis of elbow (disorder)
Sample “Findings” Subset
SCT_relationships table row
Replace with186435004
Friedlander’s bacillus infection
relationshipid Conceptid1 Relationshiptype conceptid2 Characteristictype
3544879021 24448007 168666000(Same As)
186435004 2
Direct ImplementationDirect Implementation
Retirements
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
186435004 Friedlander’s bacillus infection
95325000 Subcutaneus nodule
73211009 Diabetes mellitus
439656005 Arthritis of elbow (disorder)
Sample “Findings” Subset
SCT_relationships table row
Replace with186435004
Friedlander’s bacillus infection
relationshipid Conceptid1 Relationshiptype conceptid2 Characteristictype
3544879021 24448007 168666000(Same As)
186435004 2
Direct ImplementationDirect Implementation
Retirements
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
Previous Subset Concept Replacement Concept
24448007(Bacterial infection due to Klebsiella pneumoniae)
186435004(Friedlander’s bacillus infection)
Subset Replacement History
SCT_relationships table row
Keep Local History
Of Replacements
MappingMapping
• Proprietary interface lists– Familiar “pick lists”
• Interface lists are “transformed” in the background
• Users “insulated” from standard terminology
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
CODE Pick List Term SCTID [Provided for demo only, not stored]
KLEB Klebsiella infection
24448007 Bacterial infection due to Klebsiella pneumoniae
NODS Nodule, SQ 95325000 Subcutaneus nodule
DIBM Diabetes mellitus 73211009 Diabetes mellitus
Sample Mapping table
MappingMapping
When changes occur…• Mappings must be reviewed and updated• As users create new local terms, maps must
be created• If mappings are used to drive queries,
retirement history must be utilized.
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
MappingMapping
Minor changes
• Text changes only affect the standard terminology
• Mapping is still accurate.
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
CODE Pick List Term SCTID
KLEB Klebsiella infection
24448007 Bacterial infection due to Klebsiella pneumoniae
NODS Nodule, SQ 95325000 Subcutaneus nodule
DIBM Diabetes mellitus 73211009 Diabetes mellitus
Sample Mapping tableCorrect
Subcutaneus
MappingMapping
Additions
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
User requested:Elbow arthritis
CODE Pick List Term SCTID
KLEB Klebsiella infection
24448007 Bacterial infection due to Klebsiella pneumoniae
NODS Nodule, SQ 95325000 Subcutaneous nodule
DIBM Diabetes mellitus 73211009 Diabetes mellitus
ARTE Arthritis, Elbow
Sample Mapping table
MappingMapping
Additions
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
CODE Pick List Term SCTID
KLEB Klebsiella infection
24448007 Bacterial infection due to Klebsiella pneumoniae
NODS Nodule, SQ 95325000 Subcutaneous nodule
DIBM Diabetes mellitus 73211009 Diabetes mellitus
ARTE Arthritis, Elbow
Sample Mapping table
Componentid Changetype ReleaseDate
439656005 0 20090131
SCT_componenthistory table row
New term added:Elbow arthritis
MappingMapping
Additions
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
CODE Pick List Term SCTID
KLEB Klebsiella infection
24448007 Bacterial infection due to Klebsiella pneumoniae
NODS Nodule, SQ 95325000 Subcutaneous nodule
DIBM Diabetes mellitus 73211009 Diabetes mellitus
ARTE Arthritis, Elbow 439656005 Arthritis of elbow (disorder)
Sample Mapping table
Componentid Changetype ReleaseDate
439656005 0 20090131
SCT_componenthistory table row
New mapping:Elbow arthritis
Componentid Changetype ReleaseDate Status
24448007 1 20090131 2
MappingMapping
Retirements
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
CODE Pick List Term SCTID
KLEB Klebsiella infection
24448007 Bacterial infection due to Klebsiella pneumoniae
NODS Nodule, SQ 95325000 Subcutaneous nodule
DIBM Diabetes mellitus 73211009 Diabetes mellitus
ARTE Arthritis, Elbow 439656005 Arthritis of elbow (disorder)
Sample Mapping table
SCT_componenthistory table row
Retired as duplicate
MappingMapping
Retirements
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
CODE Pick List Term SCTID
KLEB Klebsiella infection
186435004 Friedlander’s bacillus infection
NODS Nodule, SQ 95325000 Subcutaneous nodule
DIBM Diabetes mellitus 73211009 Diabetes mellitus
ARTE Arthritis, Elbow 439656005 Arthritis of elbow (disorder)
Sample Mapping table
relationshipid Conceptid1 Relationshiptype conceptid2 Characteristictype
3544879021 24448007 168666000(Same As)
186435004 2
SCT_relationships table row
Replace with186435004
Friedlander’s bacillus infection
relationshipid Conceptid1 Relationshiptype conceptid2 Characteristictype
3544879021 24448007 168666000(Same As)
186435004 2
MappingMapping
Retirements
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
Previous Mapping Concept Replacement Concept
24448007(Bacterial infection due to Klebsiella pneumoniae)
186435004(Friedlander’s bacillus infection)
Mapping Replacement History
SCT_relationships table row
Keep Local History
Of Replacements
Legacy…Querying…ReportingLegacy…Querying…Reporting
• Assumption: standard terminology is the basis for queries– Relationships in terminology used to
determine what codes to search for
• Ex: Retrieve all cases of Enterobacter infections (Enterobacteriaceae)
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
Legacy…Querying…ReportingLegacy…Querying…Reporting
Retrieve all cases of Enterobacter infections (Enterobacteriaceae)
Step 1: Determine all diagnosis codes that “fit the bill”.
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
Legacy…Querying…ReportingLegacy…Querying…Reporting
Step 1: Determine all diagnosis codes that “fit the bill”.
• Is there a single code that is equivalent to your criteria?– Infection due to Enterobacteriaceae
(disorder) [128945009]
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
Legacy…Querying…ReportingLegacy…Querying…Reporting
Step 1: Determine all diagnosis codes that “fit the bill”.
• What about cases that are coded with specific bacteria? – Descendents of
Infection due to Enterobacteriaceae (disorder) [128945009]
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
Legacy…Querying…ReportingLegacy…Querying…Reporting
Step 1: Determine all diagnosis codes that “fit the bill”.
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
128945009 Infection due to Enterobacteriaceae (disorder)
300985007 Coliform septicemia (disorder)
186435004 Friedlander's bacillus infection (disorder)
71057007 Infection due to Escherichia coli (disorder)
302231008 Salmonella infection (disorder)
… * Sample of 5 displayed out of 135 descendents
Legacy…Querying…ReportingLegacy…Querying…Reporting
Step 1: Determine all diagnosis codes that “fit the bill”.
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
128945009 Infection due to Enterobacteriaceae (disorder)
300985007 Coliform septicemia (disorder)
186435004 Friedlander's bacillus infection (disorder)
71057007 Infection due to Escherichia coli (disorder)
302231008 Salmonella infection (disorder)
… * Sample of 5 displayed out of 135 descendents
Was areplacement
Legacy…Querying…ReportingLegacy…Querying…Reporting
Retrieve all cases of Enterobacter infections (Enterobacteriaceae)
Step 1: Determine all diagnosis codes that “fit the bill”.
Step 2: Determine all LEGACY codes that “fit the bill”.
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
Legacy…Querying…ReportingLegacy…Querying…Reporting
Step 2: Determine all LEGACY codes that “fit the bill”.
• Query your current list of diagnosis codes for those with replacement history in your system.
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
186435004 Friedlander's bacillus infection (disorder)
Previous Subset Concept Replacement Concept
24448007(Bacterial infection due to Klebsiella pneumoniae)
186435004(Friedlander’s bacillus infection)
Legacy…Querying…ReportingLegacy…Querying…Reporting
Step 2: Determine all LEGACY codes that “fit the bill”.
• Add previous Concepts to the list of codes.
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
128945009 Infection due to Enterobacteriaceae (disorder)
300985007 Coliform septicemia (disorder)
186435004 Friedlander's bacillus infection (disorder)
71057007 Infection due to Escherichia coli (disorder)
302231008 Salmonella infection (disorder)
… * Sample of 5 displayed out of 135 descendents
24448007 Bacterial infection due to Klebsiella pneumoniae
Legacy…Querying…ReportingLegacy…Querying…Reporting
Retrieve all cases of Enterobacter infections (Enterobacteriaceae)
Step 1: Determine all diagnosis codes that “fit the bill”.
Step 2: Determine all LEGACY codes that “fit the bill”.
Step 3: Query database for records stored using the codes found.
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
Legacy…Querying…ReportingLegacy…Querying…Reporting
• New content additions can also affect quality of querying.
• Ex: Retrieve cases diagnosed with Elbow arthritis
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
Legacy…Querying…ReportingLegacy…Querying…Reporting
Retrieve cases diagnosed with Elbow arthritis
Step 1: Determine all diagnosis codes that “fit the bill”.
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
Legacy…Querying…ReportingLegacy…Querying…Reporting
Step 1: Determine all diagnosis codes that “fit the bill”.
• Is there a single code that is equivalent to your criteria?– Arthritis of elbow (disorder) [439656005]
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
Legacy…Querying…ReportingLegacy…Querying…Reporting
Step 1: Determine all diagnosis codes that “fit the bill”.
• Arthritis of elbow (disorder) [439656005] and all descendents
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
439656005 Arthritis of elbow (disorder)
431263002 Bacterial arthritis of elbow (disorder)
201561002 Reactive arthropathy of elbow (disorder)
… * Sample of 3 displayed out of 12 descendents
Legacy…Querying…ReportingLegacy…Querying…Reporting
Step 1: Determine all diagnosis codes that “fit the bill”.
• What about BEFORE the
addition?
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
439656005 Arthritis of elbow (disorder)
431263002 Bacterial arthritis of elbow (disorder)
201561002 Reactive arthropathy of elbow (disorder)
… * Sample of 3 displayed out of 12 descendents
Was anaddition
Legacy…Querying…ReportingLegacy…Querying…Reporting
Step 1: Determine all diagnosis codes that “fit the bill”.
• Cases stored BEFORE the addition may have been coded in a different way.– Elbow joint inflamed?– Arthropathy of elbow?
• Epidemiologist/clinician should be aware – They decide what “other” codes to add (or
not)Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
Legacy…Querying…ReportingLegacy…Querying…Reporting
Retrieve cases diagnosed with Elbow arthritis
Step 1: Determine all diagnosis codes that “fit the bill”.
Step 2: Check for Additions, note the date, and consult Epidemiologist/clinician.
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
Legacy…Querying…ReportingLegacy…Querying…Reporting
Retrieve cases diagnosed with Elbow arthritis
Step 1: Determine all diagnosis codes.
Step 2: Check for Additions, note the date, and consult Epidemiologist/clinician.
Step 3: Determine all LEGACY codes.
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
Legacy…Querying…ReportingLegacy…Querying…Reporting
Retrieve cases diagnosed with Elbow arthritis
Step 1: Determine all diagnosis codes.
Step 2: Check for Additions, note the date, and consult Epidemiologist/clinician.
Step 3: Determine all LEGACY codes.
Step 4: Query database for records stored using the codes found.
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
Legacy…Querying…ReportingLegacy…Querying…Reporting
• Both implementations need HISTORY– Difference - where the final queries are run– Mapping
• determine applicable SNOMED concepts• query translation table to retrieve local codes• query records database to retrieve cases
– Direct Implementation• determine applicable SNOMED concepts• query records database to retrieve cases
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
Legacy…Querying…ReportingLegacy…Querying…Reporting
• Retirements– Need to have replacements stored
• Additions– Need to record date of addition
• Query/Reporting functions MUST account for changes made.
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine
Changing TerminologyChanging Terminology
SUMMARY:
• Changes WILL happen
• Systems MUST be designed for terminology change
• History of changes are important to accurate retrieval and analysis
Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine