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Kathleen Ellis

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Diagnoses and Procedures Mapped to SNOMED CT Kathleen Ellis Veterinary Medical DataBases Vocabularies Some systems allow mapping concepts to pull-down lists ... – PowerPoint PPT presentation

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Title: Kathleen Ellis


1
Diagnoses and Procedures Mapped to SNOMED CT
  • Kathleen Ellis
  • Veterinary Medical DataBases

2
Vocabularies
  • Some systems allow mapping concepts to pull-down
    lists controlled vocabularies
  • Diagnoses
  • Fracture of Femur
  • Laminitis
  • Procedures
  • to charge screens (must be detailed to be able
    to be mapped)
  • Spay
  • Chemotherapy Doxorubicin
  • Ultrasound

3
Benefits
  • Time saver
  • Health information staff may spend time on
    other endeavors
  • Fewer staff need to be trained to use SNOMED CT
    to maintain the list
  • May increase consistency or accuracy because it
    is pre-coded
  • Data may be collected in real time
  • Clinician selects the diagnosis or procedure from
    the list
  • Simple queries may be done based on the pick list
  • More in-depth queries provided by VMDB

4
Benefits of Collecting Procedural Data
  • Collecting procedural data along with the
    diagnoses may enhance query results
  • May present a more pared down list for the
    searcher to utilize
  • Lymphoma where treated with chemotherapy
  • Some queries are only performed on procedural
    data
  • Drug studies
  • Procedural data may be utilized for control
    studies
  • Normal examinations

5
Mapping Only to Billing Information
  • Does not allow for capturing diagnoses
  • Cushings
  • Urinary infections
  • Some procedures may not be able to be captured by
    billing information alone
  • Colic surgeries (too general)
  • Procedures are not performed at every patient
    encounter
  • We would like to collect both diagnosis and
    procedural data to get a better picture of the
    patient

6
How it works
7
VMDB SNOMED CT Master Diagnosis List
  • Developed with Missouri / Dr. Al Hahn
  • vmdb sample master listing SNOMED.xlsm
  • UVIS and Florida internal ID
  • Diagnoses text
  • UVIS standard code
  • SNOMED CT code
  • SNOMED CT fully specified name

8
Distribution of Master List
  • Diagnoses may not be changed, only retired or
    inactivated from the list
  • Diagnoses may be reworded by the institution as
    long as it does not change the meaning
  • Poisoning vs Toxicity
  • But not substituting benign tumor for a
    malignant tumor
  • A content expert should interpret the SNOMED
    mapping when a diagnoses wording is changed

9
Requests to Add Codes
  • Request additions through VMDB
  • Should be unambiguous
  • So the clinician is absolutely sure of the
    meaning of the term(s) being chosen
  • Pannus
  • Cornea or third eyelid
  • Bloat
  • Rumen or non-ruminant
  • Desmitis Suspensory
  • Equine or non-equine

10
Requests to Add Codes
  • Preference towards less detail
  • Fracture femur, rather than Fracture patellar
    surface femur
  • Synonyms
  • Preference is not to add synonyms or duplicate
    concepts
  • When concepts are revised, synonyms must also be
    revised
  • Duplicate concepts within a patient visit may
    skew the data
  • (When data is submitted, duplicates should be
    purged)

11
Maintenance of Mapped Lists
  • Periodically reviewed for needed updates
  • Retired codes
  • Rules changes

12
Submitting Data to VMDB
  • http//www.vmdb.org/Transmission_information/v
    mdb_transmission_file_guide.htm
  • Weed out duplicate entries within a visit
  • Mark a concept as a recheck
  • Mark a concept as suspect (optional)
  • Submit the concept code ID for Necropsy, Died and
    Euthanasia
  • Keep the sort order for post-coordinated concepts

13
Submitting Data to VMDB
  • Resend cases that are updated within the record
  • Diagnoses/procedures added or deleted
  • Patient signalment revised
  • Visit information revised
  • Resend cases where the concept IDs are revised
    within the mapping (such as with a code being
    retired or in error)
  • Export records in chronologic order by admit or
    discharge date
  • If possible, do error checking before submission,
  • e.g., discharge date is not before admit date,
    DOB not after admit date, gender changes

14
Demo Concept IDs used Internally in HIS
  • Diagnosis text added
  • Diagnosis mapped to SNOMED
  • Clinician chooses diagnosis
  • Mapped codes stored in medical records screen for
    quality assurance

15
Using Mapped List Outside the HIS
  • Some institutions build their own tool outside of
    their HIS to link their diagnoses to the mapped
    list
  • Will work with institutions on a case by case
    basis

16
XML exampletest xml data.txt
  • ltvisitsgt
  • ltvisitgt
  • ltinst_idgt13lt/inst_idgt
  • lttrans_typegtClt/trans_typegt
  • ltpat_nogt039875lt/pat_nogt
  • ltaccession_numgt20051293lt/accession_numgt
  • ltspecies/gt
  • ltbreedgt44696006lt/breedgt
  • ltdate_of_birthgt19950920lt/date_of_birthgt
  • ltgendergtClt/gendergt
  • ltpostal_codegt60416lt/postal_codegt
  • ltweight_valuegt30.9lt/weight_valuegt
  • ltweight_unitgtlbslt/weight_unitgt
  • ltadmit_dtgt20051123101953lt/admit_dtgt
  • ltcliniciangt59lt/cliniciangt
  • ltdischarge_dtgt20051123lt/discharge_dtgt
  • ltdischarge_dispositiongt 0lt/discharge_disposition
    gt
  • ltsnomed_groupgt
  • ltconcept_id suspect"0" recheck"0"
    order"1"gt68566005lt/concept_idgt

17
Acknowledgements
  • Hahn, Allen (University of Missouri)
  • Laskowski, Natalie (University of Illinois)
  • Siegel, Arthur (University of Illinois/VMDB)
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