1. Concepts & the Concept Dictionary
Regional East African Centre for Health Informatics
(REACH-INFORMATICS)
Lauren Stanisic
July 2012
REACH-INFORMATICS, July 2012

2. Outline and Goals for Today
Understand the concept dictionary, and how to develop and use concepts
Basic understanding of concept dictionary and concepts
Understanding how to define and use concepts
Proposing new concepts
Building a Form Key
REACH-INFORMATICS, July 2012

3. Any questions, before we begin?
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4. REACH-INFORMATICS, July 2012
Understanding Concepts and the Concept Dictionary
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5. REACH-INFORMATICS, July 2012
What is a Concept?
Basic data elements collected through a medical record system
Includes the questions and answers contained in an electronic medical record form
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6. What is a Concept?, cont’d
Can be a question or answer
A variable
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7. Example: What is a Concept?
What is the patient’s blood type?(concept id 300)
A+ (concept id 690)
B+ (concept id 694)
AB+ (concept id 1230)
O+ (concept id 699)
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8. Example: What is a Concept?
What is the patient’s height? (5090)
_________ inches
What is the patient marital status? (1054)
Married (5555)
Divorced (1058)
Never Marries (1057)
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9. Example: What is a Concept?
Date of Return Visit (5096) ____/ ____/ ______
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10. What is the Concept Dictionary?
Stores all the concepts and their definitions
Like a usual dictionary, except contains only the concepts used in the medical record system
Includes medical tests, procedures, drugs, results, symptoms, diagnoses, etc.
May also include socioeconomic information, such food, education, nutrition, income, etc.
Where you define the name and details for any observations or data collected
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11. REACH-INFORMATICS, July 2012
ACTIVITY
What questions do you have on Concepts and the Concept Dictionary?
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12. REACH-INFORMATICS, July 2012
ACTIVITY
- Can someone volunteer to describe what a concept is, in their own words? - Can someone volunteer to describe what a concept dictionary is, in their own words?
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13. REACH-INFORMATICS, July 2012
ACTIVITY
Everyone brainstorm 2 examples of concepts that would appear in Concept Dictionary, which have not yet been mentioned.
Request volunteers to share their ideas
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14. REACH-INFORMATICS, July 2012
In practice: You are given a medical record paper form, and are told made an electronic form. Where do you start?
Need to provide the concepts for the questions and answers on that form so that the form may be created electronically
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15. REACH-INFORMATICS, July 2012
Start by…
Determining which concepts in the Concept Dictionary match the questions and answers on that form
The first step is to check to see if you already have concepts in your dictionary to “map”, or assign, to the questions and answers on this paper form. You must search the dictionary in order to do this.
By “mapping” these two items, you connect a data element on the paper form to a data element in OpenMRS.
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16. Searching the Dictionary
In OpenMRS, search the dictionary by entering keywords into the search box.
Tips:
Check the dictionary to see if concepts already exist
Check for synonyms and abbreviations
Check different spellings
Create new concepts in the dictionary if not existing
Avoid duplicating concepts!!!!!
Talk about issue of duplicate concepts, etc.
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17. Searching the Dictionary, cont’d
Steps:
Click on the “Dictionary” option in the navigation pane (top of home page)
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18. Searching the Dictionary, cont’d
Enter the term in search box, and view responses below
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19. Searching the Dictionary, cont’d
Put your cursor over the desired option, and click to select it. The option will highlight.
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20. Searching the Dictionary, cont’d
Click on the item to read it’s description and determine if it meets your needs.
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21. Searching the Dictionary, cont’d
If the item you found meets your needs, “map” that item to the content on your form
If there is no existing item to meet your needs, create a new concept
To “map” a concept id with a question/answer on a paper form means you are saying that these two items are one in the same. That way, when the electronic form is created, you will use that concept id to represent that particular content in the form’s programming.
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22. REACH-INFORMATICS, July 2012
Understanding How to Design and Use Concepts
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23. Creating and Using Concepts
In OpenMRS, all concepts must have the following defined:
Name
Class
Datatype
Description
Concept Id
Name=The most basic label for a concept; each concept has one, and only one primary concept name
Class=Classification of the concept, details how a concept will be represented (ex: a question, an answer to a question, etc.)
Datatype=Defines the type of data that will be collected (ex: numeric, coded, text)
Description=Provides a full description of the concept’s meaning
Concept Id= An automatically generated ID number. Each concept has a unique ID number.
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24. Creating and Using Concepts, cont’d
Some concepts might also have the following:
Synonym
Short name
Coded Answers (only for a coded question)
Synonym=Any label or nickname that refers to a concept, such as acronyms and abbreviations
Short name=A shortened version of the primary name
Coded Answers (only for a coded question)
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25. Concept View in OpenMRS
The concept’s id can be found both on the concept page as well as in the web link.
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26. REACH-INFORMATICS, July 2012
Concept Primary Name
The basic label for the concept
Only has one, and it must be unique
No abbreviations or acronyms
Should be the word(s) used most often by those who will access the records
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27. REACH-INFORMATICS, July 2012
Concept Synonym
Nickname, abbreviations, and acronyms
Informal or local names
Examples: ARVs for antiretroviral
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28. Example: Primary Name & Synonym
Primary Name = Antiretroviral Drugs
Synonym = ARVS
Primary Name = Tuberculosis Skin Test, Qualitative
Synonym = TB Skin Test, Qual
Good to use conventions, such as qualitative and quantitative (qual and quant)
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29. REACH-INFORMATICS, July 2012
Concept Classes
Question
Test
Drug
Diagnosis
Symptom
Symptom/Finding
Anatomy
Class is useful to narrow down the scope of the information.
Question: a query with open-ended or coded responses
Test: Lab tests or physical exams
Drug: medication
Diagnosis: defined medical conclusion
Symptom: any sign of a possible conclusion
Symptom/Finding: any sign or indication, not specifically linked to one conclusion
Anatomy: body part
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30. Concept Classes, cont’d
Lab Set
Med Set
Convenience (Conv) Set
Misc
Lab Set: A group of several test concepts
Med Set: A group of several medications
Conv Set: A group of several questions
Misc: Used for a coded answer
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31. REACH-INFORMATICS, July 2012
Concept Datatypes
Numeric
Coded
Text
Date
Time
Datetime
Boolean
N/A
Numeric=Any data represented numerically, with the ability to classify units (ex: Height in CM)
Coded=Allows only those responses which have been predetermined/defined
Text=Open-ended responses (filled in)
N/A=The standard datatype for any non-query. Does not store information; it itself is what will be stored.
Date=Structured day, month, year
Time=Structured time response
Datetime=Structured response including b oth the date and the time
Boolean=Yes/No(True/False)
 Best practice with OpenMRS is to NOT use a boolean datatype, but rather created a coded Yes/No response question
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32. REACH-INFORMATICS, July 2012
ACTIVITY
Describe the concept class and data type you would use for the following items:
What is the patient’s weight (kg)?
Ibuprofin
Diabetes
Cough
Does the patient know his/her HIV status?
False
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33. REACH-INFORMATICS, July 2012
ACTIVITY
What concepts are needed for the following question? Specify their name, synonym, class and datatype.
Question:
What referrals did the patient receive?
TB Clinic
HIV Clinic
Mental Health
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34. REACH-INFORMATICS, July 2012
ACTIVITY
What concepts are needed for the following question? Specify their name, synonym, class and datatype. Question: What is the patient’s height (cm)? Answer: _______
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35. REACH-INFORMATICS, July 2012
ACTIVITY
What concepts are needed for the following question? Specify their name, synonym, class and datatype.
Question:
Date of encounter ____ /_____ /_____
(dd/ mm / yyyy)
On form design, be sure to choose the format for how the date will be displayed
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36. REACH-INFORMATICS, July 2012
Question Sets
A parent concept which stores child concept questions
Has N/A data type, because not a question
The child concepts are the questions which store data
Is a convenient way to store observations that are related to each other under one parent grouping
3 common types of question sets:
Conv Set: Convenience grouping of questions
Lab Set: Grouping of lab tests
Med Set: Grouping of medications
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37. REACH-INFORMATICS, July 2012
Proposing Concepts
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38. REACH-INFORMATICS, July 2012
Proposing Concepts
Performed when needed concepts do not yet exist in the dictionary
It is good to have a process that works for a group of people, not just one person
Ampath uses a simple and careful approach
Best practice for ampath, has worked for us. Proposed concept and review. Though there is a small % of concepts which need to be cleaned, but that is the reality of an implementation. Take home message: we take our time, to make sure we do it correctly. If this process is not taken seriously, there can be a lot of data issues. Take home message. REPEAT.
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39. Proposing Concepts, cont’d
Using an Excel Spreadsheet, outline the following items:
Question #
Display of item/text on the paper form
Proposed new concept’s:
Name
Description
Class
Datatype
Single or Multiple Answer (if coded question)
Coded Answers (if coded question)
Units (if numeric question)
Min/Max Values (if numeric question)
Any Other remarks
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40. Best Practice for Proposing Concepts
Be certain the concept doesn't already exist in the dictionary.
When searching the dictionary, use partial names to catch misspelled entries
Search for synonyms or local terms
Take home message: avoid, at all costs, duplicating a concept!!!!
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41. Best Practice for Proposing Concepts, cont’d
Be certain you completely understand the item being created
Do research and double check with the person requesting the concept that you have the correct specific definition.
Seek information from medical terminology authorities
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42. Best Practice for Proposing Concepts, cont’d
Make sure that you include a standardized representation of the concept, or follow any existing conventions in the dictionary.
For example, standard naming conventions.
Dictionary example: Qual/Quant
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43. REACH-INFORMATICS, July 2012
ACTIVITY
Propose concepts for the following question:
What side effects did the patient experience to his/her ARVS (tick all that apply)?
Rash
Swelling
Nausea
Vomit
Diarrhea
Hives
Debate about what classes to use, helps with larger dxnary to search
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44. REACH-INFORMATICS, July 2012
ACTIVITY
Propose concepts for the following question:
How many siblings does the patient have?
Answer: __________
See concept_id 5573
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45. REACH-INFORMATICS, July 2012
Building a Form Key
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46. REACH-INFORMATICS, July 2012
Building a Form Key
A Form Key is a way to visualize the elements on a form and the elements they will be “mapped” to in the system
Enter the concept IDs for the questions and responses on the form
Is a good tool to ensure that all needed items are available in the medical record system in order to collect the data
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47. Building a Form Key, cont’d
Steps:
For each field on the paper form, search the concept in the dictionary to locate an existing concept.
If a concept already exists, it is helpful to mark the concept ID on the paper form or keep a list of form questions IDs and corresponding concept IDs
If a concept does not exist, propose the concept on an excel spreadsheet before creating them in the concept dictionary.
This is ampath’s approach. Has been very helpful for our team members to work together. Standard conventions/key.
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48. Building a Form Key, cont’d
Ampath uses the following conventions:
Questions are in red font with yellow background
Sets are in red font with blue background
Responses are in red font
Drug concepts are in green font
Drug ids (only for formularies) are in purple font
Explain drug id
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49. Example: Building a Form Key
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50. REACH-INFORMATICS, July 2012
ACTIVITY
Use the REACH Sample Form. Search the concept dictionary and create a form key for this form.
Take appropriate actions when new concept(s) must be created.
Form is located in the shared drive
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51. RECAP: Outline and Goals for Today
Understand how to develop and use concepts and the concept dictionary
Basic understanding of concept dictionary and concepts
Understanding how to define and use concepts
Proposing new concepts
Building a Form Key
Did we accomplish our goals?
REACH-INFORMATICS, July 2012

52. Questions, Complaints, or Compliments?
Contact: Lauren Stanisic
REACH-INFORMATICS, July 2012