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Experiences Mapping a Legacy Interface Terminology to SNOMED CT

Experiences Mapping a Legacy Interface Terminology to SNOMED CT. Geraldine Wade MD, MS S. Trent Rosenbloom MD, MPH. Overview. Description of project Process steps/methodology of mapping Resulting maps/semantic relationships Observations about SNOMED CT Conclusions/Implications.

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Experiences Mapping a Legacy Interface Terminology to SNOMED CT

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  1. Experiences Mapping a Legacy Interface Terminology to SNOMED CT Geraldine Wade MD, MS S. Trent Rosenbloom MD, MPH

  2. Overview Description of project Process steps/methodology of mapping Resulting maps/semantic relationships Observations about SNOMED CT Conclusions/Implications

  3. Description of Project Background/goals Mapping of entire data set from legacy clinical application 2002 concepts (source concepts) Historical application/current use

  4. Interface

  5. Interface

  6. Legacy Concepts

  7. Process Steps Establish Mapping Rules • Quality of semantic relationship • Post-coordination of complex legacy concepts

  8. Mapping rules Quality of map/semantic relationship Equal Related IS A No Match Post-coordination Use same Attribute/Value combinations for similar groupings

  9. Post-coordination options Example: “Venous hum auscultated” Auscultation (procedure) + Has focus (attribute) + venous hum (finding) Finding by auscultation (finding) + Associated with (attribute) + Venous hum (finding)

  10. Process Steps/ Methodology of Mapping • Grouping of Legacy Concepts • Searching for SNOMED CT targets • Recording of Maps • Iterative process to consensus

  11. 1. Grouping of Legacy Concepts Clinically Relevant Categories Keywords within concept strings (Auscultated, Elicited, Observed, History or Symptom, etc.) Domain expertise of terminologists diagnoses, procedures, devices Other “Follow up evaluation for” “Type of Clinical Encounter” “Patient Transferred From”

  12. Grouping of Legacy Concepts

  13. Grouping of Legacy Concepts

  14. Complex subgroup

  15. 2. Searching for Concepts • SNOMED CT (January 2005) • Tools used • Active, non-limited concept targets • Lexical/synonym matching

  16. 3. Recording of Maps • Spreadsheet • Used Fully Specified Name/ID • Quality of relationship • Attribute/value pairs/ID • Comments

  17. Spreadsheet Maps

  18. 4. Iterative process • Back and forth review by two terminologists (asynchronous) • Comment field with successive alternating responses • 1-3 iterations until all maps complete

  19. Iterative Process Example Recording of Comments

  20. Iterative Process Example Initial map Comments Remap

  21. Results

  22. Results Simple Map Example Source concept Target concept

  23. Results Complex Map Example Source concept Target concepts

  24. Results IS A MAPS Examples

  25. Results NO MAPS Examples

  26. Results Maps to both targets (one to many) Ebstein's anomaly of tricuspid valve (disorder) 204357006 Ebstein anomaly Ebstein's anomaly of common atrioventricular valve (disorder) 253443005 Left flank pain (finding) 162049009 Side flank pain Right flank pain (finding) 162050009

  27. Results Maps to either target (one to one) Disorder due to work-related activity accident (finding) 65339005 Injury related to work Accident while engaged in work-related activity (finding) 17542004

  28. Observations about SNOMED CT Inconsistencies

  29. Observations about SNOMED CT Redundancies Same preferred name for both concepts

  30. Observations about SNOMED CT Semantically dissimilar synonyms * No reference to RECTOCELE in Male

  31. Conclusions Mapping is tedious process Can be helped by applying process steps Overall good clinical concept representation in SNOMED CT May lead to new discoveries and continued refinement of standards

  32. Legacy interface terminologies challenges for mapping Likely: Not structured Single concepts or concept phrases Unable to use alignment Unlikely to have description logics (DLs)

  33. Legacy interface terminologies challenges for mapping Can offset by: Grouping of concepts Establish mapping rules for the relationship between source and target Apply similar attribute/value pairs to similar groupings for post-coordination Iterative process using mappers with clinical background

  34. Benefits of Iterative process Discriminating, peer-review Forum for validation, commentary Led to justification/revision of maps Led to new knowledge Discoveries about SNOMED CT Submissions for ongoing improvement of SNOMED CT

  35. Implications Clinical concepts that are standardized can have greater clinical utility - Decision support - Outcomes measurements - Patient Safety - Regulatory Requirements -Etc Be Interoperable with other applications and systems

  36. Future Consideration • Compare how many exact matches correspond with the frequency of clinically used terms in the actual application • May be that exact matches have the most immediate potential for integration

  37. Questions? Contact Us.. Geraldine Wade MD, MS gwade6@csc.com S. Trent Rosenbloom MD, MPH trent.rosenbloom@vanderbilt.edu

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