The Changing Face of Terminology

1. The Changing Face of Terminology How to Keep Up Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

2. Why does terminology change? • Terminologies are incomplete • Medicine covers a large body of knowledge • Missing content is inevitable • Veterinary content is low priority • Errors are made • Medicine evolves Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

3. 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

4. Why does terminology change? • Terminologies are incomplete • Errors are made • Medicine evolves • Medical advancements • Expanding knowledge • Reevaluation of current thinking Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

5. How does terminology change? • Minor changes • Concept additions • Concept retirements Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

6. How does terminology change? • Minor changes • Considered “minor” if changes do NOT affect the meaning of the concept • Ex. Spelling corrections • Concept additions • Concept retirements Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

7. How does terminology change? • Minor changes • Concept additions • New content, self-explanatory • Concept retirements Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

8. How does terminology change? • Minor changes • Concept additions • Concept retirements • Concepts should NEVER be DELETED • Mark content as retired or inactive • Relationships between retired content and potential replacements Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

9. What does this mean? Is your system ready? Change is a comin’… Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

10. What does this mean? • Depends on type of implementation • Direct implementation • Mapping or translation Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

11. Direct Implementation Sample from a “Findings” Subset 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

12. Direct Implementation Correct Subcutaneus Sample “Findings” Subset Minor changes • Text changes Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

13. Direct Implementation Correct Subcutaneus SCT_componenthistory table row Sample “Findings” Subset Minor changes • Text changes Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

14. Direct Implementation SCT_componenthistory table row Sample “Findings” Subset Minor changes • Text changes • Replace text of term used Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

15. Direct 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

16. Direct 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

17. Direct Implementation User requested: Elbow arthritis (added to subset) Sample “Findings” Subset Additions Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

18. Direct Implementation New term added: (to SNOMED) Elbow arthritis SCT_componenthistory table row Sample “Findings” Subset Additions Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

19. Direct Implementation SCT_componenthistory table row Sample “Findings” Subset 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

20. Direct 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

21. Direct Implementation Retired as duplicate SCT_componenthistory table row Sample “Findings” Subset Retirements Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

22. Direct Implementation Retired as duplicate SCT_componenthistory table row Sample “Findings” Subset Retirements Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

23. Direct Implementation Replace with 186435004 Friedlander’s bacillus infection SCT_relationships table row Sample “Findings” Subset Retirements Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

24. Direct Implementation Replace with 186435004 Friedlander’s bacillus infection SCT_relationships table row Sample “Findings” Subset Retirements Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

25. Direct Implementation Keep Local History Of Replacements SCT_relationships table row Subset Replacement History Retirements Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

26. Mapping Sample Mapping table • 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

27. Mapping 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

28. Mapping Correct Subcutaneus Sample Mapping table Minor changes • Text changes only affect the standard terminology • Mapping is still accurate. Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

29. Mapping User requested: Elbow arthritis Sample Mapping table Additions Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

30. Mapping New term added: Elbow arthritis SCT_componenthistory table row Sample Mapping table Additions Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

31. Mapping New mapping: Elbow arthritis SCT_componenthistory table row Sample Mapping table Additions Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

32. Mapping Retired as duplicate SCT_componenthistory table row Sample Mapping table Retirements Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

33. Mapping Replace with 186435004 Friedlander’s bacillus infection SCT_relationships table row Sample Mapping table Retirements Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

34. Mapping Keep Local History Of Replacements SCT_relationships table row Mapping Replacement History Retirements Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

35. Legacy…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

36. Legacy…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

37. Legacy…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

38. Legacy…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

39. Legacy…Querying…Reporting Step 1: Determine all diagnosis codes that “fit the bill”. Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

40. Legacy…Querying…Reporting Was a replacement Step 1: Determine all diagnosis codes that “fit the bill”. Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

41. Legacy…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

42. Legacy…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

43. Legacy…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

44. Legacy…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

45. Legacy…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

46. Legacy…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

47. Legacy…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

48. Legacy…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

49. Legacy…Querying…Reporting Was an addition 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

50. Legacy…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