UMLS SNOMED CT (KorMed RT)
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
EHR /, requirement
UMLS UMLS KCD4CM CPT ICNP LOINC Concept CUI EDI Relation
, EDI EAN, WHO-ATC, FDA-NDC, UMLS RxNORM, EuPharm-NFC
KST KST ICNP ICNP ICD-9-CM CDT CDT ICD-10 CPT CPT LOINC IST IST EDI EDI KCPT KCPT KCD-4-CM
Current stage Our Goal Next stage
(concept) (semantic class (generic concept) (term) (concept relationship) (semantic class relationship), (Term relationship) (property) (postcoordination)
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
(NLM) (vocabulary), Metathesaurus Semantic Network UMLS 135 Semantic Type, 54 Relationship SPECIALIST Lexicon (lexical items)
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
Synonymous terms cluster into a concept Preferred term Unique identifier (CUI) Adrenal gland diseases MeSH D000307 Adrenal disorder AOD 0000005418 Disorder of adrenal gland Read C15z. Diseases of the adrenal glands SNOMED DB-70000 C0001403 2004 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(>4.7m) SUI(String Unique Identifier) Atom Concept name in a given source(>5.4m) AUI(Atom Unique Identifier) Sample Records C0002871 ENG P L0002871 PF S0013742 Anemia 0 C0002871 ENG P L0002871 VP S0013787 Anemias 0 C0002871 ENG P L0002871 VC S0352787 ANEMIA 0 C0002871 ENG P L0002871 VC S0414880 anemia 0 2004 EHR Medinfo Tutorial T20 C0002871 ENG P L0002871 VO S0470197 Anemia, NOS 3
www.nlm.nih.gov/research/ulms/
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
Inflection() noun nucleus, nuclei verb cauterize, cauterizes, cauterized, cauterizing adjective red, redder, reddest Derivation() verb noun cauterize --- cauterization adjective noun red --- redness
Spelling variants oe/e oesophagus esophagus ae/e anaemia anemia ise/ize cauterise cauterize genitive mark Addison s disease Addison disease Addisons disease
Omissions Redundant Classifications Classification Errors Encephalitis Viruses Ambiguity Ex. Paronychia of toe Nonuniform Classification Ex. Prematurity
Subarachnoid
EMR
UMLS UMLS EMR Filter Matching With A Rule Matching Complete/partial matching Output (Auto Index Data)
on the both forearms, pruritic erythematous wheallike papules d: 2ds on the both forearms, pruritic erythematous wheallike papules d: 2ds on the C0238767^C0016536^C0033774^ C0332476^C0221232-like^C0332563^d: 2ds CUI Concept Semantic type C0238767 Both Spatial Concept C0033774 Pruritus Symptom and sign C0016536 C0332476 C0221232 C0332563 Forearm Erythematous Wheal Papule Body location or region Functional concept Symptom and sign Symptom and sign
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
SNOMED CT
SNOMED History SNOP(1965) SNOMED(1974) SNOMED II(1979) SNOMED III(1993) SNOMED RT(1999) new SNOMED CT(2002)
SNOMED CT Components Concepts Concept IDs Descriptions Hierarchies Relationships Attributes IS-A A relationships Attribute relationships
(Concepts) (Descriptions) Preferred Term Fully Specified Name Synonyms (Relationships) IS-A (Hierarchies) (Attribute) (post-coordination) granularity
(concept) (term) (preferred term, synonym) Non-Ambiguity: / IS-A : (attribute relation):
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 5 5 6 7 9 [EMPTY] 0 0 8 Item ID Partition ID Concept ID : 22298006 Fully specified name : Myocardial infarction (disorder) Preferred term : Myocardial infarction Synonym : Cardiac infarction Heart attack Infarction of heart Infarto de miocardio
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.
Attribute & Value
2000 College of American Pathologists
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)
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.
Coding Standards 14,, Single Reference Terminology 14 interoperability for the electronic health record EHR
+ domain, structure subset ),,., EDI
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
disease heart disease lung disease heart attack arrhythmia pneumonia
disease heart disease lung disease infectious disease heart attack arrhythmia pneumonia
,,, (Common Conceptual Model) (Domain Conceptual Model) instance
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
Term_Relationship Lexicon Consist of Concept Relationships Concept Domain Categorized by Semantic_Relationships SemanticClass
EHR
Model Service Process -> EHR contents Application Interface Model : Findings & Problems, Nursing, Drug -> Quality Control DB/Application -> Application Application
Term_Relationship Lexicon Consist of Concept Relationships Concept Domain A part of Semantic_Relationships SemanticClass 2006.6.30