Diagnoses and Procedures Mapped to SNOMED CT®

1. Diagnoses and Procedures Mapped to SNOMED CT® Kathleen Ellis Veterinary Medical DataBases

2. Vocabularies • Some systems allow mapping concepts to pull-down lists & controlled vocabularies • Diagnoses • Fracture of Femur • Laminitis • Procedures • to charge screens (must be detailed to be able to be mapped) • Spay • Chemotherapy – Doxorubicin • Ultrasound Veterinary Medical DataBases 2011

3. Benefits • Time saver • Health information staff may spend time on other endeavors • Fewer staff need to be trained to use SNOMED CT to maintain the list • May increase consistency or accuracy because it is pre-coded • Data may be collected in real time • Clinician selects the diagnosis or procedure from the list • Simple queries may be done based on the pick list • More in-depth queries provided by VMDB Veterinary Medical DataBases 2011

4. Benefits of Collecting Procedural Data • Collecting procedural data along with the diagnoses may enhance query results • May present a more pared down list for the searcher to utilize • Lymphoma where treated with chemotherapy • Some queries are only performed on procedural data • Drug studies • Procedural data may be utilized for control studies • Normal examinations Veterinary Medical DataBases 2011

5. Mapping Only to Billing Information… • Does not allow for capturing diagnoses • Cushings • Urinary infections • Some procedures may not be able to be captured by billing information alone • Colic surgeries (too general) • Procedures are not performed at every patient encounter We would like to collect both diagnosis and procedural data to get a better picture of the patient Veterinary Medical DataBases 2011

6. How it works Veterinary Medical DataBases 2011

7. VMDB SNOMED CT® Master Diagnosis List • Developed with Missouri / Dr. Al Hahn • vmdb sample master listing SNOMED.xlsm • UVIS and Florida internal ID • Diagnoses text • UVIS standard code • SNOMED CT code* • SNOMED CT fully specified name Veterinary Medical DataBases 2011

8. Distribution of Master List • Diagnoses may not be changed, only retired or inactivated from the list • Diagnoses may be reworded by the institution as long as it does not change the meaning • Poisoning vs Toxicity • But not substituting benign tumor for a malignant tumor • A content expert should interpret the SNOMED mapping when a diagnoses wording is changed Veterinary Medical DataBases 2011

9. Requests to Add Codes • Request additions through VMDB • Should be unambiguous • So the clinician is absolutely sure of the meaning of the term(s)being chosen • Pannus • Cornea or third eyelid • Bloat • Rumen or non-ruminant • Desmitis Suspensory • Equine or non-equine Veterinary Medical DataBases 2011

10. Requests to Add Codes • Preference towards less detail • Fracture femur, rather than Fracture patellar surface femur • Synonyms • Preference is not to add synonyms or duplicate concepts • When concepts are revised, synonyms must also be revised • Duplicate concepts within a patient visit may skew the data (When data is submitted, duplicates should be purged) Veterinary Medical DataBases 2011

11. Maintenance of Mapped Lists • Periodically reviewed for needed updates • Retired codes • Rules changes Veterinary Medical DataBases 2011

12. Submitting Data to VMDB http://www.vmdb.org/Transmission_information/vmdb_transmission_file_guide.htm • Weed out duplicate entries within a visit • Mark a concept as a recheck • Mark a concept as suspect (optional) • Submit the concept code ID for Necropsy, Died and Euthanasia • Keep the sort order for post-coordinated concepts Veterinary Medical DataBases 2011

13. Submitting Data to VMDB • Resend cases that are updated within the record • Diagnoses/procedures added or deleted • Patient signalment revised • Visit information revised • Resend cases where the concept IDs are revised within the mapping (such as with a code being retired or in error) • Export records in chronologic order by admit or discharge date • If possible, do error checking before submission, • e.g., discharge date is not before admit date, DOB not after admit date, gender changes… Veterinary Medical DataBases 2011

14. Demo: Concept IDs used Internally in HIS • Diagnosis text added • Diagnosis mapped to SNOMED • Clinician chooses diagnosis • Mapped codes stored in medical records screen for quality assurance Veterinary Medical DataBases 2011

15. Using Mapped List Outside the HIS • Some institutions build their own tool outside of their HIS to link their diagnoses to the mapped list • Will work with institutions on a case by case basis Veterinary Medical DataBases 2011

16. XML exampletest xml data.txt <visits> <visit> <inst_id>13</inst_id> <trans_type>C</trans_type> <pat_no>039875</pat_no> <accession_num>20051293</accession_num> <species/> <breed>44696006</breed> <date_of_birth>19950920</date_of_birth> <gender>C</gender> <postal_code>60416</postal_code> <weight_value>30.9</weight_value> <weight_unit>lbs</weight_unit> <admit_dt>20051123:101953</admit_dt> <clinician>59</clinician> <discharge_dt>20051123:</discharge_dt> <discharge_disposition> 0</discharge_disposition> <snomed_group> <concept_id suspect="0" recheck="0" order="1">68566005</concept_id> <concept_id suspect="0" recheck="0" order="2">246075003</concept_id> <concept_id suspect="0" recheck="0" order="3">55547008</concept_id> <concept_id suspect="0" recheck="0" order="4">246075003</concept_id> <concept_id suspect="0" recheck="0" order="5">112283007</concept_id> </snomed_group> <snomed_group> <concept_id suspect="0" recheck="1" order="1">47270006</concept_id> </snomed_group> <snomed_group> <concept_id suspect="0" recheck="0" order="1">386584007</concept_id> </snomed_group> </visit> Veterinary Medical DataBases 2011

17. Acknowledgements • Hahn, Allen (University of Missouri) • Laskowski, Natalie (University of Illinois) • Siegel, Arthur (University of Illinois/VMDB) Veterinary Medical DataBases 2011