슬라이드 1

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2 UMLS SNOMED CT (KorMed RT)

4 EHR ICD-9-CM CPT EDI UMLS ICD-9-CM CPT EDI UMLS ICNP UMLS ICNP UMLS ICD-10 KCD-4-CM KCPT UMLS ICD-10 KCD-4-CM KCPT UMLS LOINC KCPT EDI UMLS LOINC KCPT EDI UMLS UMLS UMLS IST KST EDI IST KST EDI CDT ICD-10 KCD-4-CM KCPT UMLS CDT ICD-10 KCD-4-CM KCPT UMLS EDI UMLS EDI UMLS

5 EHR /, requirement

6 UMLS UMLS KCD4CM CPT ICNP LOINC Concept CUI EDI Relation

7 , EDI EAN, WHO-ATC, FDA-NDC, UMLS RxNORM, EuPharm-NFC

8 KST KST ICNP ICNP ICD-9-CM CDT CDT ICD-10 CPT CPT LOINC IST IST EDI EDI KCPT KCPT KCD-4-CM

9 Current stage Our Goal Next stage

10 (concept) (semantic class (generic concept) (term) (concept relationship) (semantic class relationship), (Term relationship) (property) (postcoordination)

21 NLM 1986 to facilitate the retrieval and integration of machine-readable biomedical information from disparate sources 130,,,,,, 15 The UMLS is not itself a standard; cross-referenced collection of standards and other data and knowledge sources

22 (NLM) (vocabulary), Metathesaurus Semantic Network UMLS 135 Semantic Type, 54 Relationship SPECIALIST Lexicon (lexical items)

23 Synonyms : different terms Addisonian syndrome Bronzed disease Addison melanoderma Asthenia pigmentosa Primary adrenal deficiency Primary adrenal insufficiency Primary adrenocortical insufficiency Chronic adrenocortical insufficiency Contexts : different hierarchies eponym symptoms clinical variants 2004 Medinfo Tutorial T20

24 Synonymous terms cluster into a concept Preferred term Unique identifier (CUI) Adrenal gland diseases MeSH D Adrenal disorder AOD Disorder of adrenal gland Read C15z. Diseases of the adrenal glands SNOMED DB C Medinfo Tutorial T20

Concept Set of synonymous concept names(1.2m) CUI(Concept Unique Identifier) Term Set of normalized names(>4.1m) LUI(Term Unique Identifier) String Distinct concept name(>4.

25 Concept Set of synonymous concept names(1.2m) CUI(Concept Unique Identifier) Term Set of normalized names(>4.1m) LUI(Term Unique Identifier) String Distinct concept name(>4.7m) SUI(String Unique Identifier) Atom Concept name in a given source(>5.4m) AUI(Atom Unique Identifier) Sample Records C ENG P L PF S Anemia 0 C ENG P L VP S Anemias 0 C ENG P L VC S ANEMIA 0 C ENG P L VC S anemia EHR Medinfo Tutorial T20 C ENG P L VO S Anemia, NOS 3

29 Natural language processing system lexical Contents English lexicon Many words from the biomedical domain 200,000+ lexical items treat ; treats ; treated ; treating Lexical tool, word order Used by the lexical tools

30 Inflection() noun nucleus, nuclei verb cauterize, cauterizes, cauterized, cauterizing adjective red, redder, reddest Derivation() verb noun cauterize --- cauterization adjective noun red --- redness

31 Spelling variants oe/e oesophagus esophagus ae/e anaemia anemia ise/ize cauterise cauterize genitive mark Addison s disease Addison disease Addisons disease

32 Omissions Redundant Classifications Classification Errors Encephalitis Viruses Ambiguity Ex. Paronychia of toe Nonuniform Classification Ex. Prematurity

35 Subarachnoid

37 EMR

39 UMLS UMLS EMR Filter Matching With A Rule Matching Complete/partial matching Output (Auto Index Data)

40 on the both forearms, pruritic erythematous wheallike papules d: 2ds on the both forearms, pruritic erythematous wheallike papules d: 2ds on the C ^C ^C ^ C ^C like^C ^d: 2ds CUI Concept Semantic type C Both Spatial Concept C Pruritus Symptom and sign C C C C Forearm Erythematous Wheal Papule Body location or region Functional concept Symptom and sign Symptom and sign

42 Component subcomponent terms Chief Complaint Physical examination Data type Input Box Input Box Review of System General fever Check Box Chill Check Box Head & Neck Headache Check Box dizzness mental Check Box List Box Value Yes, No Yes, No Yes, No Yes, No,,,, Alert Stuper Drowsy Semi-coma Coma Remark

44 SNOMED CT

45 SNOMED History SNOP(1965) SNOMED(1974) SNOMED II(1979) SNOMED III(1993) SNOMED RT(1999) new SNOMED CT(2002)

46 SNOMED CT Components Concepts Concept IDs Descriptions Hierarchies Relationships Attributes IS-A A relationships Attribute relationships

47 (Concepts) (Descriptions) Preferred Term Fully Specified Name Synonyms (Relationships) IS-A (Hierarchies) (Attribute) (post-coordination) granularity

48 (concept) (term) (preferred term, synonym) Non-Ambiguity: / IS-A : (attribute relation):

49 SNOMED CT concepts have numeric identifiers called Concept IDs Concept IDs reveal no hierarchical or related information. Example : SNOMED CT Identifiers (SCTIDs) for Pneumonia Namespace ID Check digit [EMPTY] Item ID Partition ID Concept ID : Fully specified name : Myocardial infarction (disorder) Preferred term : Myocardial infarction Synonym : Cardiac infarction Heart attack Infarction of heart Infarto de miocardio

50 1. Is-A Relationship 2. Attribute relationships Part of the logical definition of the concept Pneumonia in SNOMED CT is : Pneumonia Concept Finding-site Attribute Lung structure Value of attribute - The example below shows the attribute relationships for the concept lumbar discitis. Lumbar discitis HAS FINDING-SITE Intervertebral disc structure Lumbar discitis HAS ASSOCIATED-MORPHOLOGY Inflammation In this example, Arthritis has two attributes : FINDING -SITE and ASSOCIATED-MORPHOLOGY.

51 Attribute & Value

53 2000 College of American Pathologists

54 Pre-coordinated concept bullous eruption of hand Post-coordinated concept X O Bullous(qualifier) + eruption(morphologic abnormality) + hand(body structure) Bullous eruption(disorder) + hand(body structure) Pre-coordinated concept delta beta Thalassemia beta Thalassemia Post-coordinated concept X X O delta Thalassemia(disorder) + Beta(organism) delta(qualifier) + Thalassemia(disorder) + beta(organism) delta(qualifier) + beta Thalassemia(disorder)

57 SNOMED CT is delivery setting-neutral, but requires more content in the Population Health and Community Health areas to be truly comprehensive. There is currently no French language version of SNOMED CT. Some French translation exists for SNOMED version 3.5, which represents some 40% of SNOMED CT. SNOMED CT is compliant with the affordability guideline, but the pcsg recommends a national license to reduce local adoption barriers. Migration costs are likely to be significant regardless of which terminology is selected. The pcsg noted that the cost of not moving forward to a standard terminology in support of the iehr would also be significant. Current content of SNOMED CT and the SNOMED international organization have limited Canadian influence. Canada should ensure that there is broad Canadian participation at all levels of the SNOMED organization as well as in future content maintenance and enhancement processes. No comprehensive reference terminology, such as SNOMED CT, is simplistic, but tools and software applications can reduce the complexity for clinicians. SNOMED CT does not offer support for local customization however, this is actually what Canada wants, so as to prevent local variation and resultant loss of standardization to SNOMED CT.

59 Coding Standards 14,, Single Reference Terminology 14 interoperability for the electronic health record EHR

61 + domain, structure subset ),,., EDI

62 Essential features Features Concept oriented Concept permanence Non-ambiguity Explicit version identifiers Comprehensive domain coverage Meaningless identifiers Multi-hierarchies Non-redundancy Concept,, concept concept version unique id Definition concept UI concept concept concept ( ) concept ( ) Desirable features Formal concept definitions Infrastructure/tools for collaborative terminology development Change sets Mappings to other terminologies concept definition,,, version,, mapping Supports for local, tool customization process

63 disease heart disease lung disease heart attack arrhythmia pneumonia

64 disease heart disease lung disease infectious disease heart attack arrhythmia pneumonia

65 ,,, (Common Conceptual Model) (Domain Conceptual Model) instance

66 Concept Concept Relationship Concept ID UMLS Source Domain Post-coordination Co-occurrence Concept Semantic Class Semantic Relationship UMLS Semantic type relationship Semantic Relationship Concept Domain Conceptual Framework Lexicon Lexicon Relationship UMLS SPECIALIST Lexicon/ Concept (atom), (, ), Lexicon Relationship

67 Term_Relationship Lexicon Consist of Concept Relationships Concept Domain Categorized by Semantic_Relationships SemanticClass

73 EHR

74 Model Service Process -> EHR contents Application Interface Model : Findings & Problems, Nursing, Drug -> Quality Control DB/Application -> Application Application

75 Term_Relationship Lexicon Consist of Concept Relationships Concept Domain A part of Semantic_Relationships SemanticClass

Rheu-suppl hwp

Rheu-suppl hwp Objective: This paper reviews the existing Korean medical and public health, and nursing academy articles on disease-specific and domain-specific quality of life, and provides recommendations for the universally