1. SNOMED CT Search & Data Entry
Fadi El-Turk
Anne Randorff Højen

2. Who are we? Anne Randorff Fadi El Turk M.Sc., PhD
Aalborg University, Denmark
Member of I&I Since 2012
2013/2014 SIA Scheme participant
Fadi El Turk
B.Sc. M.Sc.
Research Consultant at Cerner
2013/2014 SIA Scheme participant
Previously worked at BMJ Group

3. Agenda Welcome and introduction
Why search and data entry is important (Anne)
Examples of Search and Data Entry techniques (Fadi and Anne)

4. Why is Search and data entry techniques important?

5. Why are search and data entry techniques important?
- SNOMED CT is comprehensive and complex

6. The expectation: It is a prerequisite that:
SNOMED CT can support
Semantic interoperability
Improved efficiency of clinical care
Effective clinical documentation
Advanced data analysis
Automated decision support
Etc.
It is a prerequisite that:
SNOMED CT coded data is sharable
and comparable
Search and data entry capabilities are intuitive,
effective and efficient

7. The Problem:
Different strategies  different results Different results  coding variability Interrater variability  reduced ability to…
Semantic interoperability
Improved efficiency of clinical care
Effective clinical documentation
Advanced data analysis
Automated decision support
Etc.

8. Examples of browser differences
[Rogers, Jeremy, and Olivier Bodenreider. "SNOMED CT: Browsing the Browsers." KR-MED ]
Examples of browser differences

9. ‘low back pain’

10. ‘pain lower back’

11. The Problem:
Different strategies  different results Different results  coding variability Interrater variability  reduced ability to…
Semantic interoperability
Improved efficiency of clinical care
Effective clinical documentation
Advanced data analysis
Automated decision support
Etc.

12. CONSISTENT CONCEPT SELECTION
A CHALLENGE IN SNOMED CT IMPLEMENTATION
Configuration of EHR

13. CONSISTENT CONCEPT SELECTION
A CHALLENGE IN SNOMED CT IMPLEMENTATION
Attention must be focused on the consistent application of SNOMED CT.
Concept selection needs clear and extensive rules.
Necessary to know the content and structure of SNOMED CT.
Tooling is important, e.g. more sophisticated browsers.
Configuration of EHR
CHIANG, Michael F., et al. Reliability of SNOMED-CT coding by three physicians using two terminology browsers. In: AMIA Annual Symposium Proceedings. American Medical Informatics Association, p. 131.
ANDREWS, James E.; RICHESSON, Rachel L.; KRISCHER, Jeffrey. Variation of SNOMED CT coding of clinical research concepts among coding experts. Journal of the American Medical Informatics Association, 2007, 14.4:
VIKSTRÖM, Anna, et al. Mapping the categories of the Swedish primary health care version of ICD-10 to SNOMED CT concepts: Rule development and intercoder reliability in a mapping trial. BMC Medical Informatics and Decision Making, 2007, 7.1: 1-9.

14. The Problem:
Different strategies  different results Different results  coding variability Interrater variability  reduced ability to…

15. Reduced ability to... Semantic interoperability
Improved efficiency of clinical care
Effective clinical documentation
Advanced data analysis
Automated decision support
Etc.

16. The new IHTSDO ‘Search and Data entry Guide’
Provides recommendations on Search and Data Entry Techniques
Developed as part of the ‘SNOMED CT Implementation Advisor Scheme 2013’
Reviewed by the I&I committee
Currently under final review by the Head of Implementation and Education
To be published by the end of April

17. Target Audience of the guide
Implementers of
search and data entry functionality
End users of search and data entry ? !

18. Search vs. data entry

19. Search use cases Learning about the structure of the terminology
Creating reference sets (e.g. to represent subsets of terms and concepts)
Creating templates and protocols for data entry
Creating queries to retrieve data
Reviewing terminology content
Data entry

20. Search guidance Search by words and Identifiers Constrain searches
Extend searches
Improve search speed
Optimize display of search results

21. Data entry guidance SNOMED CT and structured records
Requirements for entry and display of SNOMED CT
Constraining data entry
Entering refinements for postcoordinated expressions

22. Examples of search techniques

23. Search by words and Identifiers

24. Search by words
String searches must be user configurable to support searches, such as searching for:
words any order
phrase match
identical term

25. Search by identifiers – Searching for cold (1)

26. Search by identifiers – Searching for cold (2)

27. Search by identifiers – Searching for cold (3)

28. Search by identifiers - by Concept ID

29. Search by identifiers - by Description ID

30. Constrain searches

31. Constrain search and data entry by hierarchy
Constrain searches by supertype ancestors (e.g. Disorder) 1 2
Recommended as a user configurable option for most use cases

32. Constrain search and data entry by hierarchy

33. Constrain search and data entry by reference sets
Language ref sets to avoid uncommon or foreign terms
Simple ref sets to simplify or encourage selection of concepts or used in a particular country, organization, or specialty
Context ref sets to specify or order the valid Concepts for entry in a particular field

34. Constrain search and data entry by reference sets

35. Anne  Fadi

36. Constrain search by status
Constrain searches by Concept and Description status
Constraining by active Concepts is recommended for data entry use cases
There are a few use cases where a user may legitimately wish to search Inactive Concepts and Descriptions (e.g. creating queries for diagnoses for retrospective research).

37. Constrain searches to avoid multiple hits on the same concept

38. Extend Searches

39. Extend searches – Use Word Equivalents (1)
In healthcare, there are many words with equivalent meanings
Synonyms provide alternative phrases referring to the concept
Synonyms are not created automatically for every possible combination of words with an equivalent meaning
‘Renal calculus’ is a synonym of ‘kidney stone’
Search for ‘kidney stone fragmentation’  ‘Percutaneous nephrostomy with
fragmentation of kidney stone’ result
Search for ‘renal stone fragmentation’  no results.

40. Extend searches – Use Word Equivalents (2)
One way of addressing this problem is to maintain a table of Word Equivalents 1 2

41. Extend searches: by post-coordinated searching (1)
When typing text for a search, the user is unlikely to know if their intended entry can be represented by a single Concept or requires a post-coordinated expression involving additional Concepts or qualifiers.
Where searches fail to find a pre-coordinated match, expansion of the search to support appropriate or commonly used qualifiers is likely to enhance usability.

42. Extend searches: by post-coordinated searching (2)1

43. Improving Search speeds

44. Enable real time searching
Improve search speeds
Enable real time searching
Show an indication of estimated number of matches before starting a search
Allow slow searches to be paused or cancelled
Optimize indexing
Of course you need to index content in order to speed up searches so it is the best way to optimise the way searches are indexed.

45. OPTIMISING THE DISPLAY OF SEARCH RESULTS

46. Order Search Results Rationally (1)
Order shortest matching results first

47. Order Search Results Rationally (2)
Order preferred term matches before synonyms

48. Order Search Results Rationally (3)
Order user preferred language matches first in multilingual environments

49. Order Search Results Rationally (5)
Display search results with most frequently used descriptions listed first 1 2

50. Distinguish identical descriptions of different concepts1 2

51. Rationalize search results by subsumption checking
Before
After

52. Display navigation results effectively (1)
Using the subtype hierarchy
Not designed for data entry

53. Display navigation results effectively (2)
Using the navigation hierarchy (hand-crafted)
Navigation hierarchies can be used to drive some types of structured data entry
Navigation hierarchies can order data in sensible ways by priority, or by some readily understood convention (e.g. cranial nerve order).

54. Discussion

55. The impact of efficient search capabilities
Semantic interoperability
Improved efficiency of clinical care
Effective clinical documentation
Advanced data analysis
Automated decision support
Etc.

56. Thank you for your attention
Questions?
Contact IHTSDO:
Web site:
Anne Randorff Højen:
Fadi El Turk: