A Clinical Terminology Server at the University Hospital UZB, Brussels. Dr. Benny Van Bruwaene, M.D. Semantic Interoperability Committee

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1 A Clinical Terminology Server at the University Hospital UZB, Brussels Dr. Benny Van Bruwaene, M.D. Semantic Interoperability Committee

2 Coding clinical information Billing MKG/RCM (diagnoses) RIZIV/INAMI (procedures) Reason of encounter ICPC Epidemiology Clinical Pathways Kwaliteitsindicatoren Drug surveillance Studies

3 Coding clinical information Solution Summary/Problem list in the E.P.R. No abstraction needed Terminology server Controlled Medical Vocabulary

4 Terminology server UZB Controlled Medical Vocabulary Dutch terms Snomed CT Ontology Term Finder Syntactic (Fast Type) Semantic (Fast Code, NLP)

5 Term Finder Syntactic Semantic

6 Term Finder Syntactic Semantic

7 Controlled Medical Dictionary Multiple coding systems Term ICD MKG D ICD ok Snomed CT number diabetes mellitus type 1 met proteïnurie diabetes mellitus type diabetes mellitus type 1, slecht gecontroleerd diabetes mellitus type 2 met microalbuminuria brittle diabetes mellitus type diabetes mellitus type 2 met majeur defect in insulinesecretie diabetes mellitus type 2 met majeure insulineresistentie diabetes mellitus type 2 bij obesitas diabetes mellitus type diabetes mellitus type 2 zonder obesitas Snomed ok diabetisch cataract diabetische retinopathie

8 Controlled Medical Dictionary Multiple coding systems Term ICD9-CM Operating Room RIZIV multipele segmentale dikdarm resectie 4571 ECPARCOL abdominale resectie caecum en terminaal ileum REILECAE abdominale resectie caecum en terminaal ileum met stomie REILECAE laparoscopische resectie caecum en terminaal ileum SOILECAE laparoscopische resectie caecum en terminaal ileum met stomie SOILECAE abdominale rechter hemicolectomie 4573 ECREHEMI laparoscopische rechter hemicolectomie 4573 SOREHEMI laparoscopische rechter hemicolectomie met stomie SOREHEMI abdominale resectie van het colon transversum 4574 ECPARCOL abdominale resectie van het colon transversum met colostomie ECCOLVEL laparoscopische resectie van het colon transversum 4574 SOPARCOL abdominale linker hemicolectomie 4575 ECLIHEMI abdominale linker hemicolectomie met anastomose rectum ECLIHEMI abdominale linker hemicolectomie met colostomie ECLIHEMI laparoscopische linker hemicolectomie 4575 SOLIHEMI laparoscopische linker hemicolectomie met anastomose rectum SOLIHEMI laparoscopische linker hemicolectomie met colostomie SOLIHEMI

9 Controlled Medical Dictionary Attributes Type of concept acute respiratoire acidose chronische respiratoire acidose respiratoire acidose respiratoire alkalose respiratoire infectie bij mucoviscidose pneumonie door respiratoir syncytium virus Term Type problem.disorder problem.disorder problem.disorder problem.disorder problem.disorder problem.disorder bilaterale pneumonie met respiratoire insufficiëntie (O2-druk<60 mm Hg) community acquired pneumonia (CAP) met respiratoire insufficiëntie (O2-druk<60 mm Hg) hospital acquired pneumonia (HAP) met respiratoire insufficiëntie (O2-druk<60 mm Hg) pneumonie met respiratoire insufficiëntie (O2-druk<60 mm Hg) acute respiratoire decompensatie (O2-druk<60 mm Hg) respiratoire decompensatie (O2-druk<60 mm Hg) acute respiratoire distress respiratoire insufficientie (O2-druk<60 mm Hg) chronische respiratoire decompensatie (O2-druk<60 mm Hg) problem.disorder problem.disorder problem.disorder problem.disorder problem problem.disorder problem.finding problem.disorder problem

10 Controlled Medical Dictionary Attributes Chronic Snomed CT number Term diabetes mellitus type II met microalbuminuria diabetes mellitus type II zonder obesitas diabetes mellitus type I diabetes mellitus type I met proteïnurie brittle diabetes mellitus type I diabetes mellitus type I, slecht gecontroleerd diabetes mellitus type II met keto-acidose diabetes mellitus type I met keto-acidose diabetes mellitus met hyperosmolair coma diabetisch coma met keto-acidose Chronic

11 Controlled Medical Dictionary Attributes ICD code History Term PTCA van meerdere coronaire vaten in één enkele operatietijd PTCA van meerdere coronaire vaten met plaatsing drug eluting stent PTCA van meerdere coronaire vaten met plaatsing non-drug eluting stent aortocoronaire bypass van 1 kransslagader History V4582 V4582 V4582 V4581 Term maligne slokdarmneoplasma primair maligne slokdarmneoplasma recidief van maligne slokdarmneoplasma spinocellulair slokdarmcarcinoom maligne neoplasma van de cardia maligne neoplasma van de cardio-oesofageale overgang primair maligne neoplasma van de cardia History V1003 V1003 V1003 V1003 V1004 V1004 V

12 Controlled Medical Dictionary Coding guidelines acute respiratoire acidose chronische respiratoire acidose respiratoire acidose respiratoire alkalose respiratoire infectie bij mucoviscidose pneumonie door respiratoir syncytium virus Term Comment code pneumonie coderen als HD bilaterale pneumonie met respiratoire insufficiëntie (O2-druk<60 mm Hg) community acquired pneumonia (CAP) met respiratoire insufficiëntie (O2-druk<60 mm Hg) hospital acquired pneumonia (HAP) met respiratoire insufficiëntie (O2-druk<60 mm Hg) pneumonie met respiratoire insufficiëntie (O2-druk<60 mm Hg) acute respiratoire decompensatie (O2-druk<60 mm Hg) respiratoire decompensatie (O2-druk<60 mm Hg) acute respiratoire distress respiratoire insufficientie (O2-druk<60 mm Hg) chronische respiratoire decompensatie (O2-druk<60 mm Hg)

13 Terminologieserver Fast entry Few characters Abbreviations Precise Standardised terminology (foreign doctors!) Coding Automatic Multiple codes Coding comments for coding personnel Attributes -> Artificial Intelligence

14 Snomed CT Cross maps ICD-9-CM and ICD-10 cross maps (semi-)automatic updating ICD-version Compatibility with external expert systems clinical pathways, drug surveillance Multiple data sets for studies, statistics compatibility historical trends UMLS cross map -> MESH Literature search

15 Snomed CT Granularity Expert system Translation Case Report Forms clinical trials Medical summary in English, French, Spanish for foreign patients Term search more specific

16 Granularity Study 2004 N=252 ICD-9-CM SNOMED CT Used term more specific than Code Code dependent on context 52% 11% 6% 2% Used term = Code 42% 86%

17 Snomed CT Ontology Relationships Grouping Artificial intelligence Statistics

18 Snomed CT Ontology

19 Snomed CT Weaknesses No ICD-9-CM cross maps for Procedures Only 85 % exact match Irrelevant/Invalid concepts Vague, ambiguous Synonyms, overlapping Attributes Not normalised Incomplete French?

20 Building Controlled Medical Dictionary Practical strategy Selection of used ICD-codes in last 5 years Crossmap: used ICD-codes -> Snomed Concepts Translation of Snomed Concepts available in a Dutch ICD-index (dr. J.L. Mommaerts, MD) Validation by clinicians coding personnel

21 Building Controlled Medical Dictionary Relevant terms diagnoses procedures No synonyms Full control Choice of terms Clinically relevant, Actual Unambiguous Fast addition new terms

22 Use Medical Dictionary No synonyms Necessity of semantic Term finder Updating Term finder

23 Term Finder Language & Computing, Belgium Syntactic (alphabetical) Semantic Natural Language Processor

24 Term Finder Optimalisation Speed Syntactic Semantic

25 Term Finder Syntactic Position independent Acu myoc <-> Myoc acu Typing errors Impact <-> Inpakt Elimination type fonts (),-. ST-Elevation <-> ST Elevation Ranking Concordance

26 Terminology server Syntactic

27 Terminology server Syntactic

28 Term Finder Semantic String/term typed by doctor/nurse Dutch Natural Language Processor Snomed/ICD concepts Connected Dutch terms CMV

29 Term search Cleft lip' ICD-based

30 Term search Cleft lip' Snomed

31 Term Finder Semantic ICD-based More sensitive (broad) Procedures Snomed-based More specific (narrow) Procedures to be Snomed-coded Actual choice: ICD

32 Term Finder Semantic No synonyms necessary in CMV Low set up cost Maintenance High probability to find term Learning CMV Didactic Ergonomic ranking for fast selection/entry

33 A Clinical Terminology Server at the University Hospital UZB, Brussels Dr. Benny Van Bruwaene, M.D. Demo