SNOMED CT

1
SNOMED CT Post-mapping Validation Methodology
for Nursing Vocabularies

• Der-Fa Lu,PhD RNDavid Eichmann, PhDDebra
  Konicek, MSN RN BC
• Mary Kanak, PhD(c) RN
• Connie Delaney, PhD RN FAAN FACMI

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Electronic Health Record

• National Health Information Initiatives in 2004.
• Goal 1 Inform clinical practice
• Goal 2 Interconnect clinicians
• Goal 3 -- Personalize care
• Goal 4 Improve population health

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Standardized Healthcare Languages

• Need for a normalized healthcare vocabulary.
• Across settings, applications, datasets.
• SNOMED CT, UMLS.

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Healthcare systems included

• ICD9-CM
• ICD-V2-Oncology
• LOINC
• Ophthalmology-related terms
• Systematized Nomenclature of Dentistry
• SM of Vet Med

• NANDA Taxonomy II
• Nursing Interventions Classification
• Nursing Outcomes Classification
• Peri-operative Nursing Data Set
• The Omaha System
• The Georgetown Home Health Care Classification

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SNOMED CT

• SNOMED Reference Terminology
• Clinical Terms Version 3
• 357,000 health care concepts957,000
  synonyms1.37 million semantic relationships

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Structures of SNOMED CT 18 Upper Level Concepts

• Clinical Finding
• Procedure
• Observable entity
• Body structure
• Organism
• Substance
• Pharmaceutical/biology product
• Specimen
• Physical object
• Physical force

• Events
• Environments/Geographical locations
• Social Context
• Context-dependent categories
• Staging and scales
• Attribute
• Qualifier value
• Special concept

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Healthcare systems included

• ICD9-CM
• ICD-V2-Oncology
• LOINC
• Ophthalmology-related terms
• Systematized Nomenclature of Dentistry
• SM of Vet Med

• NANDA Taxonomy II
• NIC
• NOC
• Perioperative Nursing Data Set
• The Omaha System
• The Georgetown Home Health Care Classification

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Purpose of the study

• To develop a methodology to validate the fitness
  of cross-mapping between SNOMED CT and other HC
  vocabularies
• Use a subset of Nursing Interventions
  Classification (NIC) for this pilot study.

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Different structures

• NIC

• SNOMED

Domain 1 (Physiological Basic) Class A (Act
Exe Mgt) Intervention (Body Mechanics
Promotion) Activity
Procedure Regimes therapies Therapy Rehabilitati
on therapy Physical rehab. trp pro. Sensorimotor
techniques Biomechanical trp activity Body
Mechanics Pro.
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Method Edit Distance

• A NIC structure

• B SNOMED CT

Regimes thp Eng con Physical reh
thp Exe thp Path distance 3
Act exe mgt Energy conservation Exe
thp Path distance 2
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Fitness of cross-mapping

• Level one exact fit.
• Level two moderate fit.
• Level three least fit.

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Sample Physiologic basic-Act. exe management

• Exercise therapy ambulation
• Exercise therapy balance
• Exercise therapy joint mobility
• Exercise therapy muscle control
• Energy management

• Body mechanics promotion
• Exercise promotion
• Exercise promotion strength training
• Exercise promotion stretching
• Teaching prescribed activity/exercise

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Examples of level 1

• NIC

• SNOMED CT

Movement therapy
Act. Exe Mgt
Exercise therapy balance
Exercise therapy ambulation
Exercise therapy ambulation
Exercise therapy balance
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Example of level 2

• NIC

• SNOMED CT

Procedure
Act. exe mgt.
Regimes therapies
Therapy
Energy cons.
Rehab therapy
Energy consv.
Exercise therapy
Physical reh. thp
Exer. Thp.
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Example of level 3

• NIC

• SNOMED CT

Procedure
Act. exe mgt
Regimes thp
Context-dep. proc
Body mech prom
Exe prom strength training
Body mech prom
Exe promstrength training
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Results of validating mapping of 10 NIC labels

• Level 1(exact fit) N4
• Level 2 (moderate fit) N1
• Level 3 (least fit) N5

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Discussion implications

• Capture of meaning and structure in mapping.
• Feedback to SNOMED CT and NIC.

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Future research

• Experiment difference sampling schemas.
• Expand to all SNOMED CT mappings of nursing
  vocabularies.
• Apply to other meta-thesauri, e.g., UMLS.
• Automate the search process.

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Questions comments

• der-fa-lu_at_uiowa.edu
• david-eichmann_at_uiowa.edu
• connie-delaney_at_uiowa.edu
• Thank you !