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

2. 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

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

4. 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

5. 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

6. 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

7. 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).

8. 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 this 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

9. 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

10. Post-coordination 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. Pasteurella pneumonia + has course = acute

11. 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).

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

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

14. Display Concept “definition”

15. SELECT ConceptID2 FROM RelationshipsTable WHERE ConceptID1 = (TargetConceptID) AND RelationshipsType =116680003; TargetConceptID (Gather IsA parents) SELECT ConceptID2, RelationshipType, RelationshipsGroup FROM RelationshipsTable WHERE ConceptID1 = (TargetConceptID) AND CharacteristicType = 0 AND NOT RelationshipsType =116680003 (Gather non isa Children) (Output) ISA relationships always defining 116680003 = “ISA” Group by RelationshipsGroup CharacteristicType =0 is defining “List” a SNOMED “definition”

17. Recursion for gathering all descendants of a concept. Build subsets breeds, species all disorders all cardiovascular disorders etc. Query for concept and all its specializations everything that “ISA” respiratory disease. ConceptID SELECT Distinct ConceptID1 FROM RelationshipsTable WHERE RelationshipsType =116680003 AND ConceptID2 IN (NewChildlist); SET NewChildList = ConceptID APPEND returns from query to s SET NewChildList = Returns from query Output Childlist Returns? – Yes No Variations on this query:

18. 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