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SNOMED CT – Distributed Content Management
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  1. SNOMED CT – Distributed Content Management Stefan Schulz Content Committee April 2, 2009

  2. Problem statement • SNOMED CT’s size: barrier for effective content management and redesign • Any action on SNOMED as a whole is a major undertaking • Only a small fraction of this material has ever been used • Concentration on quality-assured subset recommended Alan Rector (2008): Semantic Interoperability Deployment and Research Roadmap http://www.semantichealth.org/DELIVERABLES/SemanticHEALTH_D6_1.pdf

  3. SNOMED CT: Ontology + Vocabulary SNOMED – CT Ontology(concepts,relations) SNOMED CT SNOMED – CT Vocabulary (descriptions)

  4. SNOMED CT Ontology SNOMED – CT Ontology(concepts,relations) • entire esophagus• sarcoma • L-carnitine• Intensive care unit• Stenosis Natural primitives constituting the conceptual “atoms” of the domain. Basic Core (BC) SNOMED – CT Vocabulary (descriptions)

  5. SNOMED CT Ontology SNOMED – CT Ontology(concepts,relations) • esophagitis• esophageal neoplasm• entire left upper extremity• Severe asthma Natural primitives constituting the conceptual “atoms” of the domain. Basic Core (BC) Clinically relevant frequent concepts that are (could be) expressed by full definitions Extended Core (EC) SNOMED – CT Vocabulary (descriptions)

  6. SNOMED CT Ontology SNOMED – CT Ontology(concepts,relations) • prednisolone 50 mg tablet• L-Carnitine product• nurse – RAF• Georgia state• Leishmania donovani Natural primitives constituting the conceptual “atoms” of the domain. Basic Core (BC) Clinically relevant frequent concepts that are (could be) expressed by full definitions Extended Core (EC) Primitive Concepts for which a SNOMED CT independent, authoritative source exists Authoritative Concepts (AC) SNOMED – CT Vocabulary (descriptions)

  7. SNOMED CT Ontology SNOMED – CT Ontology(concepts,relations) • Abrasion AND/OR friction burn of ear with infection, • Injection of triamnicolone into nail bed, • Deep third degree burn of forehead AND/OR cheek with loss of body part Natural primitives constituting the conceptual “atoms” of the domain. Basic Core (BC) Clinically relevant frequent concepts that are (could be) expressed by full definitions Extended Core (EC) Primitive Concepts for which a SNOMED CT independent, authoritative source exists Authoritative Concepts (AC) Fully defined but idiosyncratic concepts Precoordinated Concepts (PC) SNOMED – CT Vocabulary (descriptions)

  8. SNOMED CT Ontology SNOMED – CT Ontology(concepts,relations) • implementation of planned interventions• Take at regular intervals. Complete the prescribed course unless otherwise directed• No antenatal care: not known pregnant• Previous known suicide attempt Natural primitives constituting the conceptual “atoms” of the domain. Basic Core (BC) Clinically relevant frequent concepts that are (could be) expressed by full definitions Extended Core (EC) Primitive Concepts for which a SNOMED CT independent, authoritative source exists Authoritative Concepts (AC) Fully defined but idiosyncratic concepts Precoordinated Concepts (PC) Concepts, fully defined or not, that describe a clinical situation, belief state or database entry Contextual Concepts (CC) SNOMED – CT Vocabulary (descriptions)

  9. SNOMED CT Ontology SNOMED – CT Ontology(concepts,relations) Natural primitives constituting the conceptual “atoms” of the domain. Basic Core (BC) Clinically relevant frequent concepts that are (could be) expressed by full definitions Extended Core (EC) Primitive Concepts for which a SNOMED CT independent, authoritative source exists  Authoritative Concepts (AC)  Fully defined but idiosyncratic concepts Precoordinated Concepts (PC) Concepts, fully defined or not, that describe a clinical situation, belief state or database entry  Contextual Concepts (CC) SNOMED – CT Vocabulary (descriptions)

  10. SNOMED CT: Ontology + Vocabulary SNOMED – CT Ontology(concepts,relations) SNOMED CT SNOMED – CT Vocabulary (descriptions)

  11. SNOMED CT: Vocabulary • ”malignant tumor of esophagus (disorder)” FSN: Unambiguous, largely self-explaining unique term (with hierarchy tag) FSN FullySpecified Name SNOMED – CT Vocabulary (descriptions)

  12. SNOMED CT: Vocabulary • ”malignant tumor of esophagus” PT: Unambiguous, largely self-explaining unique term (without hierarchy tag) FSN PT FullySpecified Name PreferredTerm SNOMED – CT Vocabulary (descriptions)

  13. SNOMED CT: Vocabulary • “esophageal carcinoma” FSN: Unambiguous, largely self-explaining unique term (with hierarchy tag) PT: Unambiguous, largely self-explaining unique term (without hierarchy tag) FSN PT RS RS: Carries the same meaning as the corresponding FSN or PT FullySpecified Name PreferredTerm RealSynonym SNOMED – CT Vocabulary (descriptions)

  14. SNOMED CT: Vocabulary • “foot” (body part vs. length unit),• “fundus” for “uterine fundus”• “appendectomy” for „open appendectomy“ FSN: Unambiguous, largely self-explaining unique term (with hierarchy tag) PT: Unambiguous, largely self-explaining unique term (without hierarchy tag) FSN PT RS NS RS: Carries the same meaning as the corresponding FSN or PT FullySpecified Name PreferredTerm RealSynonym NearSynonym NS: term with a broader meaning, but in many contexts used as synonym to the related FSN SNOMED – CT Vocabulary (descriptions)

  15. SNOMED CT: Vocabulary • “Intertrigo (disorder) - Superficial dermatitis on opposed skin surfaces” FSN: Unambiguous, largely self-explaining unique term (with hierarchy tag) PT: Unambiguous, largely self-explaining unique term (without hierarchy tag) FSN PT TD RS NS RS: Carries the same meaning as the corresponding FSN or PT FullySpecified Name PreferredTerm RealSynonym NearSynonym TextDefinition NS: term with a broader meaning, but in many contexts used as synonym to the related FSN TD: Glossary-like definition that refines the description given by the Fully Specified Name. SNOMED – CT Vocabulary (descriptions)

  16. SNOMED CT: Vocabulary FSN: Unambiguous, largely self-explaining unique term (with hierarchy tag) PT: Unambiguous, largely self-explaining unique term (without hierarchy tag) FSN PT TD RS NS RS: Carries the same meaning as the corresponding FSN or PT FullySpecified Name PreferredTerm RealSynonym NearSynonym TextDefinition NS: term with a broader meaning, but in many contexts used as synonym to the related FSN TD: Glossary-like definition that refines the description given by the Fully Specified Name. SNOMED – CT Vocabulary (descriptions)

  17. SNOMED CT: Vocabulary * Ontology SNOMED Ontology(concepts,relations) BC: Natural primitives constituting the conceptual “atoms” of the domain. EC: Clinically relevant frequent concepts that are (could be) expressed by full definitions AC: Primitive Concepts for which a SNOMED CT independent, authoritative source exists PC: Fully defined but idiosyncratic concepts CC: Concepts, fully defined or not, that describe a clinical situation, belief state or database entry FSN: Unambiguous, largely self-explaining unique term (with hierarchy tag) PT: Unambiguous, largely self-explaining unique term (without hierarchy tag) RS: Carries the same meaning as the corresponding FSN or PT NS: term with a broader meaning, but in many contexts used as synonym to the related FSN TD: Glossary-like definition that refines the description given by the Fully Specified Name. SNOMED – CT Vocabulary (descriptions)

  18. SNOMED CT: Language Dimension SNOMED Ontology(concepts,relations) BC: Natural primitives constituting the conceptual “atoms” of the domain. EC: Clinically relevant frequent concepts that are (could be) expressed by full definitions AC: Primitive Concepts for which a SNOMED CT independent, authoritative source exists PC: Fully defined but idiosyncratic concepts CC: Concepts, fully defined or not, that describe a clinical situation, belief state or database entry FSN: Unambiguous, largely self-explaining unique term (with hierarchy tag) PT: Unambiguous, largely self-explaining unique term (without hierarchy tag) RS: Carries the same meaning as the corresponding FSN or PT NS: term with a broader meaning, but in many contexts used as synonym to the related FSN TD: Glossary-like definition that refines the description given by the Fully Specified Name. SNOMED – CT Vocabulary (descriptions)

  19. Stakeholders and Roles IHTSDO National Release Centers Affiliates User Groups Other SDOs • SNOMED CT • Ontology • Terms maintainproposeassure quality audit propose translate

  20. Possible Distributed Management SNOMED CT Concepts SNOMED CT descriptions BC EC AC PC CC FSN PT RS TD NS IHTSDO fully main-tain fully main-tain define sources, manage IDs audit quality assess-ment audit quality assess-ment fully main- tain (english) fully main- tain (english) fully main- tain (english) fully main-tain audit (english) National Release Centers quality assess-ment quality assess-ment translate propose maintain propose maintain main- tain(other) main- tain(others) main- tain (others) translate (?) audit(others) External authoritative sources provide names, meaning, and IDs User groups propose maintain propose maintain propose maintain … • Consequences: • “outsourcing” of many pre-coordinated concepts and synonyms: under the • responsibility of user groups. • IHTSDO’s role: audit and quality assurance. • IHTSDO mostly concentrates on BC and EC • Use of IDs from external namespaces

  21. Example 1 • Now: • user proposes a new concept C • IHTSDO processes request • IHTSDO finds concept definition • IHTSDO includes C into new SNOMED release • Future • user proposes a new concept C • user uploads to common repository • users discuss suitable definition • IHTSDO approves FSN and formal definition • IHTSDO decides whether to leave in repository or include in terminology

  22. Example 2 • Now: • National Release Center translates concept C • Future • user proposes a translation to concept C • user uploads proposal to common repository • users discuss • National Release Center approves translation

  23. Open issues • tooling • management of identifiers, namespaces etc. • intellectual property issues • workflows • quality control • referential integrity • …