Alberta Health Services Capital Health Palliative Care Program Clinical Vocabulary Pilot Project

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Alberta Health ServicesCapital Health Palliative
Care ProgramClinical Vocabulary Pilot Project

• Project Update
• Friday April 24, 2009
• Dennis Lee Francis Lau

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Presentation Outline

• AHW Project Overview
• What is SNOMED CT and Why?
• Encoding Methodology and Results
• Next Steps
• QAs

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Project Overview

• Objective
• 1-yr pilot to design, implement and evaluate a
  standards-based palliative care information
  system (PCIS)
• Project Phases
• Build palliative SNOMED CT terminology set
• Enhance current PCIS with SCT
• Implement enhanced PCIS for 10-week trial use
• Evaluate SCT-encoded, enhanced PCIS
• Write-up lessons, year-2 plan

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Presentation Outline

• AHW Project Overview
• What is SNOMED CT and Why?
• Encoding Methodology and Results
• Next Steps
• QAs

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Musen paper2 - Medical Informatics Searching for
Underlying Components
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Coronary artery disease Arterioclerotic heart
disease Atherosclerotic heart disease Coronary
sclerosis
synonyms
128238001Chronic heart disease equivalent to
56265001Heart disease 263502005Clinical
course 90734009Chronic
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Presentation Outline

• Project Overview
• What is SNOMED CT and Why?
• Encoding Methodology and Results
• Next Steps
• QAs

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SNOMED CT Encoding Methodology
INTERFACE TERMINOLOGY
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Inputs

• Regional Palliative Care Program (RPCP) Database
• Data Elements
• Gender
• Diagnosis
• Problem at Refer
• Coded Values
• Gender Male
• Diagnosis Head neck
• Problem Dyspnea
• Free Text Values
• Diagnosis Esophageal ca
• Problem Complain of fatigue

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Data Cleaning Process
Splitting Terms Into Atomic Concepts
Filtering Unmappable Data Types
Correcting Spelling Mistakes
Extending Acronyms Abbreviations
Inferring Clinical Condition
Candidate Term
Interface Terminology
Ca (l) lung (small cell) June 2003
Filter off June 2003
Ca ? carcinoma l ? left
Small cell carcinoma of left lung
Ca (l) lung (small cell) June 2003, Bran, Bone
mets
Bran
Bran ? Brain
metastasis
Brain metastasis
Bone mets
mets ? metastasis
Bone metastasis

• ltobservation classCode"OBS" moodCode"EVN"gt
• ltcode code"ASSERTION" codeSystem"2.16.840.1.1138
  83.5.4"/gt
• ltvalue codeSystem"2.16.840.1.113883.6.96"
  codeSystemName"SNOMED CT" code"254632001"
  displayName"Small cell carcinoma of lung
  (disorder)" /gt
• lteffectiveTime value"200306"/gt
• lt/observationgt

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Encoding Process
Pre- Coordinated Concept
YES
YES
Match Found?
Lexical Matching (Batch Mode)
Post- Coordinated Expression
Concept Active?
Search Historical Relationships
Concept Active?
YES
NO
NO
NO
YES
YES
Lexical Matching (Manual Mode)
Match Found?
Post- Coordination
Match Found?
Unencodeable
NO
NO
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Encoding Examples

• Pre-coordination (Ovarian cancer)
• 363443007Malignant tumor of ovary (disorder)
• Refinement (Cancer of right ovary)
• 363443007Malignant tumor of ovary (disorder)
• 363698007Finding site (attribute)
• 20837000Structure of right ovary (body
  structure)
• Qualification (Recurrent ovarian cancer)
• 363443007Malignant tumor of ovary (disorder)
• 263502005Clinical course (attribute)
• 255227004Recurrent (qualifier value)

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Outputs

• Encoded Terms
• SNOMED CT Reference Sets
• Interface Terminology Set
• Unencoded Terms
• SNOMED CT Extension Set
• Unencodeable Term Set

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Encoding Summary Statistics
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More Encoding Examples
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Presentation Outline

• Project Overview
• What is SNOMED CT and Why?
• Encoding Methodology and Results
• Next Steps
• QAs

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Next Steps

• 10-week trial - ongoing
• Evaluation
• Lessons learned
• Year-2 Plan

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Presentation Outline

• Project Overview
• What is SNOMED CT and Why?
• Encoding Methodology and Results
• Next Steps
• QAs