Managing SNOMED in your system 2 nd AAHA

Managing SNOMED in your system. 2 nd AAHA Software Vendors Summit – April 21, 2009

Nomenclature Tasks • Install nomenclature(s) • Subsets reduce SNOMED’s volume • Displaying preferred descriptions • System wide, even user specific • Requests from users for concept addition • Install Updates (ongoing and indefinitely) • Message processing • Data sharing only (multiple practices) • Query Interface for data retrieval

Distribution format • XML using SNOMED’s schema • Current version • Sample subset • Complete concept • Separate update distribution format can be developed.

Find and display descriptions (terms) • This task has not changed. • Descriptions retain the essence of AAHA Diagnostic terms • Index and search descriptions • “Select” records concept ID • Description ID is optional

Concept Addition • Users WILL discover concepts that are not present in the nomenclature • Licensed users can make requests to SNOMED directly • Channels have been established for “timely addition”. • Inadequate staff re: veterinary content

Concept Addition • When we (VTSL) receive a request for concept addition: • We confirm that the concept is really missing • Often there is a synonym present • Requested “description” can be added • We prepare a SNOMED-style definition for the concept and forward info to SNOMED. • Concepts are added to the nomenclature by a veterinarian on SNOMED staff

Managing concept requests • Veterinarian should be able to “request” additions without interfering with work flow. • Vendors should not need to hire terminologist(s). • Communications between veterinarian and terminologists should be automated. • Requires “placeholders” in medical records system. • Should be FULLY AUTOMATED (requires no Vendor participation in terminology give-and-take).

Managing concept requests • User can’t find the thing they want to say • One click to “let me just type it” • Save of veterinarians phrase sends (parse-able) message to VTSL webservice • VTSL replies with: • Please provide more information. What is thing you’re trying to say? (we need conversation ability) • Here’s your new description for existing concept OR • Here’s a new concept and description

Post-coordination (partial alternative to requests for new content) • What is post-coordination? • Create a new concept by adding specificity to and existing SNOMED concept. • Source has: • • “Acute pasteurella pneumonia” Target (SNOMED) has: • “pasteurella pneumonia” • Create: • Pasteurella pneumonia + has course = acute

Post-coordination Pasteurella pneumonia + has course = acute • Where do you put your new creation? • Extend the concepts table (1 new) • Identifier outside of SNOMED itself (namespace mechanism) • Extend the “relationships table” • An extension (not part of core) • Processed as if it is part of the original table.

Nomenclature Updates • New version of SNOMED scheduled for every 6 months. • Expect change rate to decline with time • We update our systems within 1 or two weeks of release. • VTSL creates content in extension. Updates can be AS NEEDED. • To date we’ve negotiated ONE update formalism. It is specialized to NAHLN (which needs subsets from additional nomenclatures).

Nomenclature Updates • Retired Concepts • Concept “referral” mechanism • • New Concepts Retired Descriptions New relationships

Queries • Query full copy of SNOMED • Queries based on description have highest yield. • Indexes • Query portion that has been recorded?

Display Concept “definition”

“List” a SNOMED “definition” Target. Concept. ID (Gather Is. A parents) ISA relationships always defining 116680003 = “ISA” SELECT Concept. ID 2 FROM Relationships. Table WHERE Concept. ID 1 = (Target. Concept. ID) AND Relationships. Type =116680003; (Gather non isa Children) Group by Relationships. Group Characteristic. Type =0 is defining SELECT Concept. ID 2, Relationship. Type, Relationships. Group FROM Relationships. Table WHERE Concept. ID 1 = (Target. Concept. ID) AND Characteristic. Type = 0 AND NOT Relationships. Type =116680003 (Output)

Recursion for gathering all descendants of a concept. Concept. ID SET New. Child. List = Concept. ID SELECT Distinct Concept. ID 1 FROM Relationships. Table WHERE Relationships. Type =116680003 AND Concept. ID 2 IN (New. Childlist); SET New. Child. List = Returns from query APPEND returns from query to s Returns? – Yes No Output Childlist Variations on this query: • Build subsets • breeds, species • all disorders • all cardiovascular disorders • etc. • Query for concept and all its specializations • everything that “ISA” respiratory disease.

Simple subtypes of epilepsy are all specializations of epilepsy • Benign focal epilepsy • Parietal lobe epilepsy Search for all concepts that are defined by the presence of seizures returns concepts that are seizure disorders but not epilepsies. • Benign focal epilepsy • Seizures due to metabolic disorder