1. Veterinary Adaptation of SNOMED-CT ® We don’t have to eat the whole elephant!

2. Practical veterinary terminology? "In theory, there is no difference between theory and practice. But in practice, there is." - Yogi Berra

3. SNOMED – the elephant January 2009 release of SNOMED-CT® 300,520 concepts 782,367 descriptions 1,407,442 object – attribute – value triples SNOMED-CT® is a terminology. It’s designed and distributed to be a functional terminology NOT an HIS-ready system for recording any particular information.

4. SNOMED It’s too… Big Complicated Expensive Yes but… We can make it smaller (sort of), and use small pieces (for most purposes). Use it in simple and straightforward ways But nothing, it’s expensive. Not the license fees, the cost of making it work.

5. SNOMED – what do we want? We want to see only the concepts we want and only when we want to see them ALL of SNOMED is obviously too much MUCH content is not needed in vet med Concepts we don’t need Descriptions we don’t want to see SNOMED not mature enough to automate Some missing veterinary content Extension mechanism, VTSL namespace

6. What DON’T we want? More witty than usual (finding) 247983000 Denies alcohol abuse (finding) 413968004 pT3 and/or N1 (III): Tumor involves one or both ovaries with microscopically confirmed peritoneal metastasis outside the pelvis (including liver capsule metastasis) and/or regional lymph node metastasis (TNM category and FIGO stage) (ovary) (finding) (397497003)

7. Veterinary sub-setting approaches Start with SNOMED then remove content that is NOT of interest. Someone has to decide what’s “not of interest” Someone familiar with SNOMED Someone with domain knowledge This requires decision on: –each of 300,520 contents –each of 782,367 descriptions OR start with veterinary list(s), find it (map it) in SNOMED, remove the rest by subtraction.

8. SNOMED extension mechanism What? Concepts that are not part of IHTSDO (core) release Extension concepts are placed correctly in the “isa” hierarchy and defined according to SNOMED-CT style guidelines Extension concepts are identified with a valid SCTID (legal name space)

9. SNOMED veterinary extension Why? Expedite content addition SNOMED has limited veterinary expertise –We end up waiting for X update cycles. Important content needed between release dates –Content that supports animal disease outbreaks –e.g. Melamine intoxication

10. SNOMED veterinary extension But wait, SNOMED’s already too big… Small number of veterinary concepts missing NOW. We may need concepts that are not “appropriate” for core.

11. Start with SNOMED- 1500 SNOMED concepts - VTSL extension- SNOMED core

12. not to scale - small animal concept Identify Small Animal Subset (AAHA) - SNOMED core- VTSL extension

13. Associate with hierarchy - small animal concept - non small animal concept not to scale - VTSL extension- hierarchy concept (core or extension)

14. Small animal Subset + Adaptation hierarchy not to scale - small animal concept- hierarchy concept (core or extension)- VTSL extension

15. Small Animal Navigation Subset (unnecessary hierarchy nodes removed) not to scale - small animal concept- hierarchy concept (core or extension)- VTSL extension

16. Small animal Subset This is done to scale.= 1500 SNOMED concepts = specialty vocabularies (not in current version)

17. Interoperability with other lists Small animal list can be a useful part of “mixed animal” system Small animal list would integrate (could be used to query) a more granular specialty (e.g., cardiologist) list. Vendors benefit if a single maintenance structure / distribution pathway is in place.

18. Small Animal Subset + Adaptation hierarchy not to scale - small animal concept- Adaptation hierarchy- VTSL extension

19. Equine subset (AAEP) + Adaptation hierarchy - equine subset - adaptation hierarchy - VTSL extension

20. Zoological subset (ZIMS/ISIS) + Adaptation hierarchy - zoological subset- adaptation hierarchy - VTSL extension

21. Combine subsets (VTSL) + Adaptation hierarchy - all subsets - equine AND zoo subsets - zoo subset- small animal AND zoo subsets - VTSL extension - adaptation hierarchy

22. How do we get this done? We find the money. We obtain a very large grant from a philanthropic organization. We can convince a federal agency that veterinary medical terminology “is in their portfolio.” Form a consortium using modest contributions We leverage a variation of “commons-based peer production”.

23. Commons-based peer production Bankler 2002 Open participation in development of open- source information resources Wikipedia Many “commons-based” efforts produce very high quality products Linux Perl

24. VTSL-facilitated commons-based peer production VTSL has developed methods to manage multiple (simultaneous) subsets. VTSL has developed internet-based methods to facilitate “mapping” and review of content. VTSL has developed web-services to distribute content.

25. Why VTSL-facilitated? Somebody needs to collate efforts of individual expert groups. Veterinary peers who are also terminologists can guide the project. Tools are functional and being refined. Do you know anyone else who wants to take terminology this seriously?

26. What’s been or being done? SubsetSponsor Common animal namesFDA, USDA/VS, USGS VS TaxonomyUSDA/VS BreedsUSDA/NAHLN SpeciesUSDA/NAHLN Specimen typesUSDA/NAHLN Small animal findings subsetAAHA Pharmaceutical IndicationsFDACVM (SPL) Various zoologic subsetsISIS (ZIMS) Wildlife health findings subsetUSGS/DOD Various HL7 subsetsUSDA/NAHLN Various LOINC subsetsUSDA/NAHLN Various NCI subsetsFDACVM (SPL) Veterinary proprietary drugs/biologicalsSNOMED core