mapping local terminology to SNOMED-CT for ehr in Hong Kong SNOMED CT Implementation Showcase October 2013
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1 mapping local terminology to SNOMED-CT for ehr in Hong Kong SNOMED CT Implementation Showcase October 2013
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3 Edward Tam (person) Edward Tam Health Informatics Analyst ehr Information Standards Office Mail : edwardtam@ha.org.hk Phone :
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7 electronic Health Record (ehr) sharing system project by Hong Kong SAR government territory-wide health record sharing platform both public & private health care providers live-run expected at end of 2014 need an information standard for data consistency
8 Hong Kong Clinical Terminology Table (HKCTT) information standard for ehr sharing system based on Hospital Authority Clinical Vocabulary (HACVT) accumulated diagnosis & procedure concepts how to link with SNOMED-CT for interoperability?
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10 ideal for ehr use: comprehensive collection of concepts varied levels of granularity
11 efficient concept searching during info capture synonyms multi-hierarchy relationships definition with attributes
12 easy customisation post-coordination easy extension of terminology, while preserving semantic hierarchy good for information retrieval and data analysis
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14 HACVT HKCTT during the last two decades, accumulated: 55M diagnosis entries 20M procedure entries to ensure backward compatibility
15 SNOMED CT to enable use of SNOMED-CT by health care providers for capturing clinical records and transmitting to ehr to enable use of SNOMED-CT for analysis of ehr records
16 HKCTT vs SNOMED CT direct implementation of SNOMED-CT? mapping HKCTT to SNOMED-CT?
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18 directly implement SNOMED-CT : HA HA HA HA HA HA HACVT ehr SNOMED-CT ehr GPs GPs SCT Analysis
19 directly implement SNOMED-CT : need to change working practice & culture!! need data conversion for existing data!!
20 map HKCTT to SNOMED-CT : To: WHO ehr ICD10 ehr HA HA HA HA HA HA HACVT ehr HKCTT SNOMED-CT GPs ehr ehr GPs SCT Analysis
21 map HKCTT to SNOMED-CT : preserve working practice & culture preserve existing data, need no data conversion allowing data capture & analysis using SNOMED-CT best of both worlds
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23 basic mapping concepts source target relationships degree of equivalence cardinality of the map
24 degree of equivalence exact match / equivalent match approximate match no match 1 Exact match No match
25 cardinality of the map one to one one to many many to one many to many
26 mapping principles purpose rules and guidelines standards-based authoritative support validation map maintenance organization in charge update with source and targets
27 mapping steps develop business case / define use case develop rules plan pilot phase develop full content periodic testing, final QA testing communicate with source / target owners validation
28 validation understandable, reproducible, usable map understood by user without manual map developed by process straightforward and reproducible no matter who or what to perform the mapping map usable for use case external validation conducted by entity not involved with development or financial or political interest
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30 mapping proceeded in phases: exact matching post-coordination verification to ensure quality
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32 exact matching compare descriptive meanings between concepts in HKCTT and SNOMED-CT ignore word form differences like spelling & grammar
33 exact matching reviewers with clinical knowledge background double-checked by second reviewer (HA 7453) Deafness of one ear = (SCT ) Unilateral deafness?
34 exact matching 46% (18600) concepts exact matched
35 exact matched (46%)
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41 exact match verification the NORM program from the Lexical Tools from the Unified Medical Language System (UMLS) perform normalization on exact matched concept pairs (HKCTT concept & SNOMED-CT concept) compare the two normalized lexical forms, if the same, the concept pair is exact matched
42 exact match verification NORM (HA 15217) Macrodactylia (finger) (SCT ) macrodactylia of fingers no punctuations Macrodactylia finger macrodactylia of fingers no stop words Macrodactylia finger macrodactylia fingers no upper case macrodactylia finger macrodactylia fingers no plurals macrodactylia finger macrodactylia finger result = SAME macrodactylia finger macrodactylia finger
43 exact match verification out of concepts pairs exact matched, 55% (10100) have same normalized lexical forms
44 exact matched & verified
45 exact matched but failed lexical verification: (HA 13806) Lumbar vertebral disease (HA 3494) Pigmented mole (HA 6130) Plexopathy (HA 15325) Breast ectopic (HA 37863) Hypoglossal pain (HA 8296) Hypotension (SCT ) Disorder of lumbar spine (SCT ) Melanocytic nevus (SCT ) Nerve plexus disorder (SCT ) Accessory breast (SCT ) Hypoglossal neuralgia (SCT ) Low blood pressure
46 exact matched but failed lexical verification: (HA 31631) Ultrasonogram of kidney (HA 33095) Control of haemorrhage in pharynx (HA 24692) Gastrectomy, partial (HA 23917) Chest tapping (HA 27315) Elbow fusion (HA 27879) Excision of Extra Finger (SCT ) Echography of kidney (SCT ) Hemostasis of pharynx (SCT ) Subtotal gastrectomy (SCT ) Thoracentesis (SCT ) Arthrodesis of elbow (SCT ) Removal of supernumerary finger
47 submission to IHTSDO concepts with no exact match (SNOMED-CT) submit to International Health Terminology Standards Development Organisation (IHTSDO) for addition to the SNOMED-CT international core release
48 submission to IHTSDO 12% (4800) concepts submitted to IHTSDO 3% (1100) concepts added to SNOMED-CT core becomes exact match
49 submitted & exact matched (3%)
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51 priority concept groups concepts in low usage / no usage concepts with special status (inactive, etc)
52 priority concept groups 16% (6600) concepts to lower priority mapping plan
53 to low priority (16%)
54 post-coordination concepts with no exact match (SNOMED-CT) represent the concept using SNOMED-CT concepts follow SNOMED-CT editorial guidelines
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56 post-coordination mapping patterns found common patterns among post-co mappings
57 post-coordination mild cystitis is a cystitis (disorder) severity mild (qualifier value) severe aplastic anaemia is a severity aplastic anemia (disorder) severe (severity modifier) (qualifier value)
58 post-coordination mapping patterns mild Dx moderate Dx severe Dx is a = Dx severity = mild (qualifier value) is a = Dx severity = moderate (severity modifier) (qualifier value) is a = Dx severity = severe (severity modifier) (qualifier value)
59 post-coordination acute alcoholic psychosis is a clinical course alcohol-induced psychosis (disorder) sudden onset and/or short duration (qualifier value) chronic adjustment disorder is a clinical course adjustment disorder (disorder) chronic (qualifier value)
60 post-coordination mapping patterns acute Dx is a = Dx clinical course = sudden onset AND/OR short duration (qualifier value) chronic Dx is a = Dx clinical course = chronic (qualifier value)
61 post-coordination open trigeminal rhizotomy is a access trigeminal rhizotomy (procedure) open approach - access (qualifier value) percutaneous cardiopulmonary bypass is a access cardiopulmonary bypass operation (procedure) percutaneous approach - access (qualifier value)
62 post-coordination mapping patterns open Px closed Px percutaneous px is a = Px access = open approach - access (qualifier value) is a = Px access = closed approach - access (qualifier value) is a = px access = percutaneous approach - access (qualifier value)
63 post-coordination transurethral resection of bladder is a surgical approach resection of lesion of bladder (procedure) transurethral approach (qualifier value)
64 post-coordination mapping patterns trans-xxx Px is a = Px surgical approach = trans-xxx
65 post-coordination post infarct dementia is a after dementia (disorder) cerebral infarction (disorder) aseptic meningitis, post-operative is a after aseptic meningitis (disorder) surgical procedure (procedure)
66 post-coordination mapping patterns Dx1, post-dx2 Dx, post-px is a = Dx1 after = Dx2 is a = Dx after = Px (procedure)
67 post-coordination history of disorders of nervous system and sense organs is a associated finding history of - disorder (situation) nervous system and sense organ diseases (disorder) family history of digestive disorder is a associated finding family history of disorder (situation) disorder of digestive system (disorder)
68 post-coordination mapping patterns history of Dx family history of Dx is a = history of - disorder (situation) associated finding = Dx (disorder) is a = family history of disorder (situation) associated finding = Dx (disorder)
69 post-coordination mapping patterns found 90+ post-coordination mapping patterns review & refine, referencing existing SCT core concepts re-apply the patterns to post-co similar HKCTT concepts to maintain mapping quality & consistency to improve mapping efficiency
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71 mapping team discussion meetings mapping team members bi-weekly discussion meetings to review mapping rules & practices to review post-coordination patterns
72 post-coordination 26% (10400) concepts mapped by post-coordination
73 post-co ed (26%)
74 post-coordination verification 5% (500 / 10400) sample of post-co mappings 90 post-co mapping patterns verification by overseas experts
75 post-coordination verification 56% (280 / 500) mappings 60% (54 / 90) mapping patterns expert agrees with HA, or expert advice is taken re-apply verified patterns to post-co similar concepts
76 post-co ed & verified
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78 mapping results 46% (18600) concepts exact matched 55% (10100) mappings verified (NORM from Lexical Tools) 3% (1100) concepts submitted & added to SNOMED-CT 26% (10400) concepts mapped by post-coordination 56% (280 / 500) mappings verified (overseas expert) 16% (6600) concepts to lower priority
79 in progress (8%) post-co ed (26%) post-co ed & verified to low priority (16%) exact matched & verified exact matched (46%) submitted & exact matched (3%)
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81 the mapping approach preserves working practice and culture preserves existing data, avoiding data conversion
82 the mapping approach enables ehr records to be captured, transmitted, stored, searched, retrieved, analysed using SNOMED-CT enriches HKCTT with semantic definitions & relationship hierarchies, enabling semantic & hierarchical analysis of ehr records in future
83 the bonus uncovers problem concepts accumulated but hidden inside the vocabulary table, including duplicated, ambiguous & inconsistent concepts provides easy & efficient method for cleansing
84 lessons learnt follow standards use tools to speed up seek authority to fix root problems use priority to adjust progress track patterns, review & re-apply to similar tasks hold discussion meetings to align practices seek expert advices and do external verifications
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87 Dr N T Cheung Mr John Mok Ms Vicky Fung Mr P C Ho Ms Maggie Lau Ms Karen Szeto Mr William Ho Ms Austen Wong Mr Wilson Yu Mr Eric Ho Ms H H Tsui Ms Ellen Chan Mr Andy Wai Ms Karen Li Ms Cherry Yip Mr Patrick Chu Ms Gladys Yip
88 Thank you!
Briefing on ehr Content Hong Kong Clinical Terminology Table (HKCTT) By Maggie LAU Health Informatician, ehriso
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