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Julie M. Green, MS, DVM Julie M. Green, MS, DVM Veterinary Medical Informatics Veterinary Medical Informatics VMRCVM – Virginia Tech VMRCVM – Virginia Tech Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine The Changing Face of The Changing Face of Terminology Terminology How to Keep Up

The Changing Face of Terminology

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The Changing Face of Terminology. How to Keep Up. Why does terminology change?. Terminologies are incomplete Medicine covers a large body of knowledge Missing content is inevitable Veterinary content is low priority Errors are made Medicine evolves. Why does terminology change?. - PowerPoint PPT Presentation

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Page 1: The Changing Face of Terminology

Julie M. Green, MS, DVMJulie M. Green, MS, DVMVeterinary Medical InformaticsVeterinary Medical Informatics

VMRCVM – Virginia TechVMRCVM – Virginia Tech

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

The Changing Face of TerminologyThe Changing Face of Terminology

How to Keep Up

Page 2: The Changing Face of Terminology

Why does terminology change?Why does terminology change?

• Terminologies are incompleteMedicine covers a large body of knowledgeMissing content is inevitableVeterinary content is low priority

• Errors are made• Medicine evolves

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Page 3: The Changing Face of Terminology

Why does terminology change?Why does terminology change?

• Terminologies are incomplete

• Errors are made‘To Err Is Human’…to correct is inevitable

• Medicine evolves

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Page 4: The Changing Face of Terminology

Why does terminology change?Why does terminology change?

• Terminologies are incomplete• Errors are made

• Medicine evolvesMedical advancementsExpanding knowledgeReevaluation of current thinking

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Page 5: The Changing Face of Terminology

How does terminology change?How does terminology change?

• Minor changes

• Concept additions

• Concept retirements

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Page 6: The Changing Face of Terminology

How does terminology change?How does terminology change?

• Minor changesConsidered “minor” if changes do NOT

affect the meaning of the conceptEx. Spelling corrections

• Concept additions

• Concept retirements

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Page 7: The Changing Face of Terminology

How does terminology change?How does terminology change?

• Minor changes

• Concept additionsNew content, self-explanatory

• Concept retirements

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Page 8: The Changing Face of Terminology

How does terminology change?How does terminology change?

• Minor changes

• Concept additions

• Concept retirementsConcepts should NEVER be DELETEDMark content as retired or inactiveRelationships between retired content and

potential replacements

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Page 9: The Changing Face of Terminology

What does this mean?What does this mean?

Change is a comin’…

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Is your system ready?

Page 10: The Changing Face of Terminology

What does this mean?What does this mean?

• Depends on type of implementation– Direct implementation– Mapping or translation

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Page 11: The Changing Face of Terminology

Direct ImplementationDirect Implementation

Direct Implementation

• Use content in the interface

• Users directly interact with terminology

• Practicality requires subsets

• Must be kept “in synch” with changes

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

24448007 Bacterial infection due to Klebsiella pneumoniae

95325000 Subcutaneus nodule

73211009 Diabetes mellitus

Sample from a “Findings” Subset

Page 12: The Changing Face of Terminology

Direct ImplementationDirect Implementation

Minor changes

• Text changes

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

24448007 Bacterial infection due to Klebsiella pneumoniae

95325000 Subcutaneus nodule

73211009 Diabetes mellitus

Sample “Findings” Subset

CorrectSubcutaneus

Page 13: The Changing Face of Terminology

Direct ImplementationDirect Implementation

Minor changes

• Text changes

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

24448007 Bacterial infection due to Klebsiella pneumoniae

95325000 Subcutaneus nodule

73211009 Diabetes mellitus

Sample “Findings” Subset

Componentid Changetype ReleaseDate

95325000 2 20090131

SCT_componenthistory table row

CorrectSubcutaneus

Page 14: The Changing Face of Terminology

Direct ImplementationDirect Implementation

Minor changes• Text changes

– Replace text of term used

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

24448007 Bacterial infection due to Klebsiella pneumoniae

95325000 Subcutaneous nodule

73211009 Diabetes mellitus

Sample “Findings” Subset

Componentid Changetype ReleaseDate

95325000 2 20090131

SCT_componenthistory table row

Page 15: The Changing Face of Terminology

Direct ImplementationDirect Implementation

Additions (to subsets)

• User need drives additions to subsets– System should accept new content requests– Centralized content requests desirable

• Experts should decide appropriateness• Central authority can then submit request to

SNOMED

– Temporary code for storage until concept is added to SNOMED

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Page 16: The Changing Face of Terminology

Direct ImplementationDirect Implementation

Additions (to SNOMED)

• New terms become available in the standard

• Review based on– User requests– Subject Matter Expertise

• Choose additions based on review

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Page 17: The Changing Face of Terminology

Direct ImplementationDirect Implementation

Additions

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

24448007 Bacterial infection due to Klebsiella pneumoniae

95325000 Subcutaneus nodule

73211009 Diabetes mellitus

Tempcode Elbow arthritis

Sample “Findings” Subset

User requested:Elbow arthritis

(added to subset)

Page 18: The Changing Face of Terminology

Direct ImplementationDirect Implementation

Additions

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Sample “Findings” Subset

Componentid Changetype ReleaseDate

439656005 0 20090131

SCT_componenthistory table row

New term added:(to SNOMED)

Elbow arthritis

24448007 Bacterial infection due to Klebsiella pneumoniae

95325000 Subcutaneus nodule

73211009 Diabetes mellitus

Tempcode Elbow arthritis

Page 19: The Changing Face of Terminology

Direct ImplementationDirect Implementation

Additions• If temporary “placeholder” codes were created in the

subset, these need to be updated with new SCTID

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

24448007 Bacterial infection due to Klebsiella pneumoniae

95325000 Subcutaneus nodule

73211009 Diabetes mellitus

439656005 Arthritis of elbow

Sample “Findings” Subset

Componentid Changetype ReleaseDate

439656005 0 20090131

SCT_componenthistory table row

Page 20: The Changing Face of Terminology

Direct ImplementationDirect Implementation

Retirements

• Retirement = inactivate term in standard– Ambiguous, Duplicate, Knowledge changed

• Must be replaced in subsets

• Record of “referrals” must be kept– Used for legacy data retrieval/analysis

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Page 21: The Changing Face of Terminology

Direct ImplementationDirect Implementation

Retirements

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

24448007 Bacterial infection due to Klebsiella pneumoniae

95325000 Subcutaneus nodule

73211009 Diabetes mellitus

439656005 Arthritis of elbow (disorder)

Sample “Findings” Subset

Componentid Changetype ReleaseDate Status

24448007 1 20090131 2

SCT_componenthistory table row

Retired as duplicate

Page 22: The Changing Face of Terminology

Direct ImplementationDirect Implementation

Retirements

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

24448007 Bacterial infection due to Klebsiella pneumoniae

95325000 Subcutaneus nodule

73211009 Diabetes mellitus

439656005 Arthritis of elbow (disorder)

Sample “Findings” Subset

Componentid Changetype ReleaseDate Status

24448007 1 20090131 2

SCT_componenthistory table row

Retired as duplicate

Page 23: The Changing Face of Terminology

relationshipid Conceptid1 Relationshiptype conceptid2 Characteristictype

3544879021 24448007 168666000(Same As)

186435004 2

Direct ImplementationDirect Implementation

Retirements

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

24448007 Bacterial infection due to Klebsiella pneumoniae

95325000 Subcutaneus nodule

73211009 Diabetes mellitus

439656005 Arthritis of elbow (disorder)

Sample “Findings” Subset

SCT_relationships table row

Replace with186435004

Friedlander’s bacillus infection

Page 24: The Changing Face of Terminology

relationshipid Conceptid1 Relationshiptype conceptid2 Characteristictype

3544879021 24448007 168666000(Same As)

186435004 2

Direct ImplementationDirect Implementation

Retirements

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

186435004 Friedlander’s bacillus infection

95325000 Subcutaneus nodule

73211009 Diabetes mellitus

439656005 Arthritis of elbow (disorder)

Sample “Findings” Subset

SCT_relationships table row

Replace with186435004

Friedlander’s bacillus infection

Page 25: The Changing Face of Terminology

relationshipid Conceptid1 Relationshiptype conceptid2 Characteristictype

3544879021 24448007 168666000(Same As)

186435004 2

Direct ImplementationDirect Implementation

Retirements

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Previous Subset Concept Replacement Concept

24448007(Bacterial infection due to Klebsiella pneumoniae)

186435004(Friedlander’s bacillus infection)

Subset Replacement History

SCT_relationships table row

Keep Local History

Of Replacements

Page 26: The Changing Face of Terminology

MappingMapping

• Proprietary interface lists– Familiar “pick lists”

• Interface lists are “transformed” in the background

• Users “insulated” from standard terminology

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

CODE Pick List Term SCTID [Provided for demo only, not stored]

KLEB Klebsiella infection

24448007 Bacterial infection due to Klebsiella pneumoniae

NODS Nodule, SQ 95325000 Subcutaneus nodule

DIBM Diabetes mellitus 73211009 Diabetes mellitus

Sample Mapping table

Page 27: The Changing Face of Terminology

MappingMapping

When changes occur…• Mappings must be reviewed and updated• As users create new local terms, maps must

be created• If mappings are used to drive queries,

retirement history must be utilized.

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Page 28: The Changing Face of Terminology

MappingMapping

Minor changes

• Text changes only affect the standard terminology

• Mapping is still accurate.

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

CODE Pick List Term SCTID

KLEB Klebsiella infection

24448007 Bacterial infection due to Klebsiella pneumoniae

NODS Nodule, SQ 95325000 Subcutaneus nodule

DIBM Diabetes mellitus 73211009 Diabetes mellitus

Sample Mapping tableCorrect

Subcutaneus

Page 29: The Changing Face of Terminology

MappingMapping

Additions

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

User requested:Elbow arthritis

CODE Pick List Term SCTID

KLEB Klebsiella infection

24448007 Bacterial infection due to Klebsiella pneumoniae

NODS Nodule, SQ 95325000 Subcutaneous nodule

DIBM Diabetes mellitus 73211009 Diabetes mellitus

ARTE Arthritis, Elbow

Sample Mapping table

Page 30: The Changing Face of Terminology

MappingMapping

Additions

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

CODE Pick List Term SCTID

KLEB Klebsiella infection

24448007 Bacterial infection due to Klebsiella pneumoniae

NODS Nodule, SQ 95325000 Subcutaneous nodule

DIBM Diabetes mellitus 73211009 Diabetes mellitus

ARTE Arthritis, Elbow

Sample Mapping table

Componentid Changetype ReleaseDate

439656005 0 20090131

SCT_componenthistory table row

New term added:Elbow arthritis

Page 31: The Changing Face of Terminology

MappingMapping

Additions

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

CODE Pick List Term SCTID

KLEB Klebsiella infection

24448007 Bacterial infection due to Klebsiella pneumoniae

NODS Nodule, SQ 95325000 Subcutaneous nodule

DIBM Diabetes mellitus 73211009 Diabetes mellitus

ARTE Arthritis, Elbow 439656005 Arthritis of elbow (disorder)

Sample Mapping table

Componentid Changetype ReleaseDate

439656005 0 20090131

SCT_componenthistory table row

New mapping:Elbow arthritis

Page 32: The Changing Face of Terminology

Componentid Changetype ReleaseDate Status

24448007 1 20090131 2

MappingMapping

Retirements

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

CODE Pick List Term SCTID

KLEB Klebsiella infection

24448007 Bacterial infection due to Klebsiella pneumoniae

NODS Nodule, SQ 95325000 Subcutaneous nodule

DIBM Diabetes mellitus 73211009 Diabetes mellitus

ARTE Arthritis, Elbow 439656005 Arthritis of elbow (disorder)

Sample Mapping table

SCT_componenthistory table row

Retired as duplicate

Page 33: The Changing Face of Terminology

MappingMapping

Retirements

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

CODE Pick List Term SCTID

KLEB Klebsiella infection

186435004 Friedlander’s bacillus infection

NODS Nodule, SQ 95325000 Subcutaneous nodule

DIBM Diabetes mellitus 73211009 Diabetes mellitus

ARTE Arthritis, Elbow 439656005 Arthritis of elbow (disorder)

Sample Mapping table

relationshipid Conceptid1 Relationshiptype conceptid2 Characteristictype

3544879021 24448007 168666000(Same As)

186435004 2

SCT_relationships table row

Replace with186435004

Friedlander’s bacillus infection

Page 34: The Changing Face of Terminology

relationshipid Conceptid1 Relationshiptype conceptid2 Characteristictype

3544879021 24448007 168666000(Same As)

186435004 2

MappingMapping

Retirements

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Previous Mapping Concept Replacement Concept

24448007(Bacterial infection due to Klebsiella pneumoniae)

186435004(Friedlander’s bacillus infection)

Mapping Replacement History

SCT_relationships table row

Keep Local History

Of Replacements

Page 35: The Changing Face of Terminology

Legacy…Querying…ReportingLegacy…Querying…Reporting

• Assumption: standard terminology is the basis for queries– Relationships in terminology used to

determine what codes to search for

• Ex: Retrieve all cases of Enterobacter infections (Enterobacteriaceae)

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Page 36: The Changing Face of Terminology

Legacy…Querying…ReportingLegacy…Querying…Reporting

Retrieve all cases of Enterobacter infections (Enterobacteriaceae)

Step 1: Determine all diagnosis codes that “fit the bill”.

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Page 37: The Changing Face of Terminology

Legacy…Querying…ReportingLegacy…Querying…Reporting

Step 1: Determine all diagnosis codes that “fit the bill”.

• Is there a single code that is equivalent to your criteria?– Infection due to Enterobacteriaceae

(disorder) [128945009]

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Page 38: The Changing Face of Terminology

Legacy…Querying…ReportingLegacy…Querying…Reporting

Step 1: Determine all diagnosis codes that “fit the bill”.

• What about cases that are coded with specific bacteria? – Descendents of

Infection due to Enterobacteriaceae (disorder) [128945009]

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Page 39: The Changing Face of Terminology

Legacy…Querying…ReportingLegacy…Querying…Reporting

Step 1: Determine all diagnosis codes that “fit the bill”.

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

128945009 Infection due to Enterobacteriaceae (disorder)

300985007 Coliform septicemia (disorder)

186435004 Friedlander's bacillus infection (disorder)

71057007 Infection due to Escherichia coli (disorder)

302231008 Salmonella infection (disorder)

… * Sample of 5 displayed out of 135 descendents

Page 40: The Changing Face of Terminology

Legacy…Querying…ReportingLegacy…Querying…Reporting

Step 1: Determine all diagnosis codes that “fit the bill”.

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

128945009 Infection due to Enterobacteriaceae (disorder)

300985007 Coliform septicemia (disorder)

186435004 Friedlander's bacillus infection (disorder)

71057007 Infection due to Escherichia coli (disorder)

302231008 Salmonella infection (disorder)

… * Sample of 5 displayed out of 135 descendents

Was areplacement

Page 41: The Changing Face of Terminology

Legacy…Querying…ReportingLegacy…Querying…Reporting

Retrieve all cases of Enterobacter infections (Enterobacteriaceae)

Step 1: Determine all diagnosis codes that “fit the bill”.

Step 2: Determine all LEGACY codes that “fit the bill”.

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Page 42: The Changing Face of Terminology

Legacy…Querying…ReportingLegacy…Querying…Reporting

Step 2: Determine all LEGACY codes that “fit the bill”.

• Query your current list of diagnosis codes for those with replacement history in your system.

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

186435004 Friedlander's bacillus infection (disorder)

Previous Subset Concept Replacement Concept

24448007(Bacterial infection due to Klebsiella pneumoniae)

186435004(Friedlander’s bacillus infection)

Page 43: The Changing Face of Terminology

Legacy…Querying…ReportingLegacy…Querying…Reporting

Step 2: Determine all LEGACY codes that “fit the bill”.

• Add previous Concepts to the list of codes.

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

128945009 Infection due to Enterobacteriaceae (disorder)

300985007 Coliform septicemia (disorder)

186435004 Friedlander's bacillus infection (disorder)

71057007 Infection due to Escherichia coli (disorder)

302231008 Salmonella infection (disorder)

… * Sample of 5 displayed out of 135 descendents

24448007 Bacterial infection due to Klebsiella pneumoniae

Page 44: The Changing Face of Terminology

Legacy…Querying…ReportingLegacy…Querying…Reporting

Retrieve all cases of Enterobacter infections (Enterobacteriaceae)

Step 1: Determine all diagnosis codes that “fit the bill”.

Step 2: Determine all LEGACY codes that “fit the bill”.

Step 3: Query database for records stored using the codes found.

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Page 45: The Changing Face of Terminology

Legacy…Querying…ReportingLegacy…Querying…Reporting

• New content additions can also affect quality of querying.

• Ex: Retrieve cases diagnosed with Elbow arthritis

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Page 46: The Changing Face of Terminology

Legacy…Querying…ReportingLegacy…Querying…Reporting

Retrieve cases diagnosed with Elbow arthritis

Step 1: Determine all diagnosis codes that “fit the bill”.

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Page 47: The Changing Face of Terminology

Legacy…Querying…ReportingLegacy…Querying…Reporting

Step 1: Determine all diagnosis codes that “fit the bill”.

• Is there a single code that is equivalent to your criteria?– Arthritis of elbow (disorder) [439656005]

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Page 48: The Changing Face of Terminology

Legacy…Querying…ReportingLegacy…Querying…Reporting

Step 1: Determine all diagnosis codes that “fit the bill”.

• Arthritis of elbow (disorder) [439656005] and all descendents

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

439656005 Arthritis of elbow (disorder)

431263002 Bacterial arthritis of elbow (disorder)

201561002 Reactive arthropathy of elbow (disorder)

… * Sample of 3 displayed out of 12 descendents

Page 49: The Changing Face of Terminology

Legacy…Querying…ReportingLegacy…Querying…Reporting

Step 1: Determine all diagnosis codes that “fit the bill”.

• What about BEFORE the

addition?

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

439656005 Arthritis of elbow (disorder)

431263002 Bacterial arthritis of elbow (disorder)

201561002 Reactive arthropathy of elbow (disorder)

… * Sample of 3 displayed out of 12 descendents

Was anaddition

Page 50: The Changing Face of Terminology

Legacy…Querying…ReportingLegacy…Querying…Reporting

Step 1: Determine all diagnosis codes that “fit the bill”.

• Cases stored BEFORE the addition may have been coded in a different way.– Elbow joint inflamed?– Arthropathy of elbow?

• Epidemiologist/clinician should be aware – They decide what “other” codes to add (or

not)Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Page 51: The Changing Face of Terminology

Legacy…Querying…ReportingLegacy…Querying…Reporting

Retrieve cases diagnosed with Elbow arthritis

Step 1: Determine all diagnosis codes that “fit the bill”.

Step 2: Check for Additions, note the date, and consult Epidemiologist/clinician.

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Page 52: The Changing Face of Terminology

Legacy…Querying…ReportingLegacy…Querying…Reporting

Retrieve cases diagnosed with Elbow arthritis

Step 1: Determine all diagnosis codes.

Step 2: Check for Additions, note the date, and consult Epidemiologist/clinician.

Step 3: Determine all LEGACY codes.

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Page 53: The Changing Face of Terminology

Legacy…Querying…ReportingLegacy…Querying…Reporting

Retrieve cases diagnosed with Elbow arthritis

Step 1: Determine all diagnosis codes.

Step 2: Check for Additions, note the date, and consult Epidemiologist/clinician.

Step 3: Determine all LEGACY codes.

Step 4: Query database for records stored using the codes found.

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Page 54: The Changing Face of Terminology

Legacy…Querying…ReportingLegacy…Querying…Reporting

• Both implementations need HISTORY– Difference - where the final queries are run– Mapping

• determine applicable SNOMED concepts• query translation table to retrieve local codes• query records database to retrieve cases

– Direct Implementation• determine applicable SNOMED concepts• query records database to retrieve cases

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Page 55: The Changing Face of Terminology

Legacy…Querying…ReportingLegacy…Querying…Reporting

• Retirements– Need to have replacements stored

• Additions– Need to record date of addition

• Query/Reporting functions MUST account for changes made.

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine

Page 56: The Changing Face of Terminology

Changing TerminologyChanging Terminology

SUMMARY:

• Changes WILL happen

• Systems MUST be designed for terminology change

• History of changes are important to accurate retrieval and analysis

Veterinary Medical Informatics – Va-Md Regional College of Veterinary Medicine