A Clinical Terminology Server at the University Hospital UZB, Brussels Dr. Benny Van Bruwaene, M.D. Semantic Interoperability Committee 1 14-9-2009
Coding clinical information Billing MKG/RCM (diagnoses) RIZIV/INAMI (procedures) Reason of encounter ICPC Epidemiology Clinical Pathways Kwaliteitsindicatoren Drug surveillance Studies 2 14-9-2009
Coding clinical information Solution Summary/Problem list in the E.P.R. No abstraction needed Terminology server Controlled Medical Vocabulary 3 14-9-2009
Terminology server UZB Controlled Medical Vocabulary Dutch terms Snomed CT Ontology Term Finder Syntactic (Fast Type) Semantic (Fast Code, NLP) 4 14-9-2009
Term Finder Syntactic Semantic 5 14-9-2009
Term Finder Syntactic Semantic 6 14-9-2009
Controlled Medical Dictionary Multiple coding systems Term ICD MKG D ICD ok Snomed CT number diabetes mellitus type 1 met proteïnurie 25001 5851 401109007 diabetes mellitus type 1 25001 0 46635009 diabetes mellitus type 1, slecht gecontroleerd 25003 0 190371008 diabetes mellitus type 2 met microalbuminuria 25000 5851 0 401112005 brittle diabetes mellitus type 1 25003 0 11530004 diabetes mellitus type 2 met majeur defect in insulinesecretie 25000 0 73211009 0 diabetes mellitus type 2 met majeure insulineresistentie 25000 0 9859006 0 diabetes mellitus type 2 bij obesitas 25000 27800 0 81531005 diabetes mellitus type 2 25000 0 73211009 diabetes mellitus type 2 zonder obesitas 25000 0 359642000 Snomed ok diabetisch cataract 25050 36641 43959009 diabetische retinopathie 25050 36201 4855003 7 14-9-2009
Controlled Medical Dictionary Multiple coding systems Term ICD9-CM Operating Room RIZIV multipele segmentale dikdarm resectie 4571 ECPARCOL 243062 731382 abdominale resectie caecum en terminaal ileum 4572 4593 REILECAE 243084 731382 abdominale resectie caecum en terminaal ileum met stomie 4572 4620 4610 REILECAE 243084 731382 laparoscopische resectie caecum en terminaal ileum 4572 4593 SOILECAE 243084 731382 laparoscopische resectie caecum en terminaal ileum met stomie 4572 4620 4610 SOILECAE 243084 731382 abdominale rechter hemicolectomie 4573 ECREHEMI 243062 731382 laparoscopische rechter hemicolectomie 4573 SOREHEMI 243062 731382 laparoscopische rechter hemicolectomie met stomie 4573 4620 4610 SOREHEMI 244064 abdominale resectie van het colon transversum 4574 ECPARCOL 243062 731382 abdominale resectie van het colon transversum met colostomie 4574 4610 ECCOLVEL 243084 731404 laparoscopische resectie van het colon transversum 4574 SOPARCOL 243062 731382 abdominale linker hemicolectomie 4575 ECLIHEMI 243062 731382 abdominale linker hemicolectomie met anastomose rectum 4575 4594 ECLIHEMI 243062 731382 abdominale linker hemicolectomie met colostomie 4575 4610 ECLIHEMI 243084 731404 laparoscopische linker hemicolectomie 4575 SOLIHEMI 243062 731382 laparoscopische linker hemicolectomie met anastomose rectum 4575 4594 SOLIHEMI 243062 731382 laparoscopische linker hemicolectomie met colostomie 4575 4610 SOLIHEMI 243084 731404 8 14-9-2009
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 9 14-9-2009
Controlled Medical Dictionary Attributes Chronic Snomed CT number Term 401112005diabetes mellitus type II met microalbuminuria 1 359642000diabetes mellitus type II zonder obesitas 1 46635009diabetes mellitus type I 1 401109007diabetes mellitus type I met proteïnurie 1 11530004brittle diabetes mellitus type I 1 190371008diabetes mellitus type I, slecht gecontroleerd 24927004diabetes mellitus type II met keto-acidose 371055001diabetes mellitus type I met keto-acidose 190329007diabetes mellitus met hyperosmolair coma 26298008diabetisch coma met keto-acidose Chronic 10 14-9-2009
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 V1004 11 14-9-2009
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) 12 14-9-2009
Terminologieserver Fast entry Few characters Abbreviations Precise Standardised terminology (foreign doctors!) Coding Automatic Multiple codes Coding comments for coding personnel Attributes -> Artificial Intelligence 13 14-9-2009
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 14 14-9-2009
Snomed CT Granularity Expert system Translation Case Report Forms clinical trials Medical summary in English, French, Spanish for foreign patients Term search more specific 15 14-9-2009
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%
Snomed CT Ontology Relationships Grouping Artificial intelligence Statistics 17 14-9-2009
Snomed CT Ontology 18 14-9-2009
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? 19 14-9-2009
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 20 14-9-2009
Building Controlled Medical Dictionary Relevant terms 15.000 12.500 diagnoses 2.500 procedures No synonyms Full control Choice of terms Clinically relevant, Actual Unambiguous Fast addition new terms 21 14-9-2009
Use Medical Dictionary No synonyms Necessity of semantic Term finder Updating Term finder 22 14-9-2009
Term Finder Language & Computing, Belgium Syntactic (alphabetical) Semantic Natural Language Processor 23 14-9-2009
Term Finder Optimalisation Speed Syntactic Semantic 24 14-9-2009
Term Finder Syntactic Position independent Acu myoc <-> Myoc acu Typing errors Impact <-> Inpakt Elimination type fonts (),-. ST-Elevation <-> ST Elevation Ranking Concordance 25 14-9-2009
Terminology server Syntactic 26 14-9-2009
Terminology server Syntactic 27 14-9-2009
Term Finder Semantic String/term typed by doctor/nurse Dutch Natural Language Processor Snomed/ICD concepts Connected Dutch terms CMV 28 14-9-2009
Term search Cleft lip' ICD-based 29 14-9-2009
Term search Cleft lip' Snomed 30 14-9-2009
Term Finder Semantic ICD-based More sensitive (broad) Procedures Snomed-based More specific (narrow) Procedures to be Snomed-coded Actual choice: ICD 31 14-9-2009
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 32 14-9-2009
A Clinical Terminology Server at the University Hospital UZB, Brussels Dr. Benny Van Bruwaene, M.D. Demo 33 14-9-2009