1. FROM ONE NOMENCLATURES TO ANOTHER… Drs. Sven Van Laere

2. Content Table Actual state Definition of interoperability Mapping Mapping in practice

3. Actual state – Healthcare with too many standards ICPC-2 ICD LOINC – Different levels ICPC-2 used by GP ICDused forbilling LOINCused for laboratory results

4. Actual state – No continuity in healthcare 1 1 2 2 Referral 3 3 4 4 GP Hospital

5. Recap – In the medical history we evolved from free text (60-ies) to structured language Free text Codes Classifications Terminologies Nomenclatures de Lusignan

6. What should we do?

7. Definition Antonio Aguilar A state which exists between two application entities when, with regard to a specific task, one application entity can accept and understand data from the other and perform that task in an appropriate and satisfactory manner without the need for extra operator intervention. Interoperability

8. Definition Antonio Aguilar Interoperability in eHealth for whom? -healthcare companies e.g. vendors of clinical systems, administrative IT systems and medical devices -healthcare providers e.g. GPs, physicians, nurses, technicians, etc. -IT and administrative staff -health authorities and governments

9. Definition Antonio Aguilar Interoperability levels -functional and syntactic interoperability the ability of two or more systems to exchange information through functionality and defined message structures so that this information is human readable by the receivers e.g. HL7 v2, DICOM -semantic interoperability the ability for information shared by systems to be understood at the level of formally defined domain concepts so that the information is computer processable by the receiving systems e.g. HL7 v3 RIM, SNOMED CT

10. Mapping How to… Mapping A linkage between a concept from one standard to another standard based on the equivalence between the two concepts

11. Mapping How to… Mapping rules Consider the place in the hierarchy of a terminology standard Consider the semantics of a concept Consider the relationship with other concepts around a concept

12. Mapping How to… Manual mapping human knowledge of medical experts, linguists, terminology experts, … Semi-automatic mapping Computer algorithm identifies candidate mappings based on descriptions Human review of the automatic mapping

13. Variety of standards We know… The principles of mapping now But… How do we deal with the wide variety of standards (ICPC-2, ICD-10, LOINC, NANDA, SNOMED CT,…)

14. Variety of standards

15. What RT to choose? Choose most comprehensive SNOMED CT 310,000 concepts Support pre- and post-coordination Still under evaluation Assess-CT project http://www.assess-ct.eu/

16. MAPPING IN PRACTICE…

17. Refsets Reference set A set of references to SNOMED CT components Simple reference sets are used to distribute SNOMED CT subsets Reference sets may include additional information about referenced components – so they also have other uses

18. Types of refsets

19. Simple refset

22. Simple refset model

23. Broad range of use Language refset Attribute-value refset Association refset Ordered refset Mapping refsets – Simple mapping – complex mapping …

24. Language refset refsetId (SCTID) – Identifies the refset – Subtype of 900000000000506000 | Language type reference set | referencedComponentId(SCTID) – Referes to a description acceptabilityId – Indicates the acceptability of the description for use in the specified language, dialect or use case – Subtype of 900000000000511003 | Acceptability | 900000000000549004 | Acceptable | 900000000000548007 | Preferred |

25. Attribute-value refset Apply a value from a specified range to a component Can be used for many different purposes – For example, to indicate the reason for inactivation of a particular concept refsetId(SCTID) – Identifies the refset which names the purpose of the added values – Subtype of 900000000000480006 | Attribute value type reference set| referencedComponentId(SCTID) – Identifies the component to which the value is being applied valueId(SCTID) – The value represented by identifying a concept from a relevant hierarchy

26. Association refset Represents a set of unordered directed associations of a particular type between components Can be used for many different purposes – For example, to indicate an association between an inactive concept and an active concept that replaces it refsetId (SCTID) – Identifies the refset which names the nature of the association – Subtype of 900000000000521006 | Association type reference set | referencedComponentId (SCTID) – the source component of the association targetComponentId (SCTID): – the target component of the association

27. Ordered refset Priority ordering or ordered associations refsetId (SCTID) – Identifies the refset – Subtype of 447258008 | Ordered type reference set | referencedComponentId (SCTID) – Identifies the component that is included in the ordered list order (Integer) – the sort order – 1 represents the highest priority – Duplicate values are permitted linkedToId(SCTID) – the component that acts as a grouper or hierarchy node, collecting togethera subgroup from within the list

28. Mapping refset – single mapping Allows representation of simple maps between SNOMED CT concepts and codes in other code systems Usually only appropriate for “one-to-one” mappings refsetId(SCTID) – Identifies the refset – Subtype of 900000000000496009 | Simple map reference set | referencedComponentId(SCTID) – The concept being mapped mapTarget(String): – The code in the other code system

29. Mapping refset – complex/extended mapping Enables representation of maps where each concept may map to one or more codes in a target scheme The target code can be selected at run-time from a number of alternate codes using machine readable rules and/or human readable advice

30. Exercise We are going to make a subset, based on the SNOMED CT browser – http://browser.ihtsdotools.org/ http://browser.ihtsdotools.org/

31. Exercise Navigate in the browser and use the International edition

32. Exercise Lookup the following concepts: – Open fracture dislocation of knee joint – Open fracture of femoral condyle of femur – Open fracture of patella – Open fracture of tibial condyles What is the similar parent of these 4 concepts?

33. Open fracture dislocation of knee joint

34. Open fracture of femoral condyle of femur

35. Open fracture of patella

36. Open fracture of tibial condyles

37. Exercise Lookup the same concepts in the ICD-10 classification – http://www.icd10data.com/ICD10CM/Codes http://www.icd10data.com/ICD10CM/Codes Fill in the file with the found results In the mapping tab find at least one mapping