bt clinical computing
TRANSCRIPT
BT Clinical Computing
Snomed CT Interface Dr Benny Van Bruwaene, Dr Thierry Klein
Snomed CT Interface
• Parser Text -> Snomed CT (BT-Knowliah)
• Structured Snomed CT Interface (BT-SBIM-Indizen)
Autocompletion
Context sensitive protocols (BT-SBIM)
• Multipurpose Code Convertor (BT)
• Terminology Management System (BT-Indizen)
• Snomed CT Repository & Patient Summary (BT-Knowliah)
Continuityof Care
Snomed CT Patient Summary
Clinical and Medication
Reconciliation
Decision support
Personal HealthRecord
Transparent Medical Coding
Snomed CT-guidedtext interface
Parsing text to Snomed CT
Rule-basedmultipurpose code
conversion
Snomed CT Big Data
Medical Data Intelligence
Clinical Trials
Benchmarking
MeaningfulUse
Problem list (active and past diagnoses)
Allergy list
Support e-prescription medication
Drug drug interaction
Evidence Basedorder-entry
(RX/lab/consultation)
Sumehr/CCD
communication
Webapplication BT Snomed CT InterfaceWeb Services Electronic Medical Record
Webapp Report - Codes
6
Webapp Form
7
8
Webapp List (Patient Summary)
9
Natural Language ParserText to Snomed CT
Parsing Text Snomed CT• Strenght
Batch: Retrospective (studies big data)
Webservice On Line
No operational change HCP
Automatic coding & Translation
o UREG, Registries, Clinical trials, ….
Patient Summary, Medical history
• Weakness
Garbage in -> Garbage out
Coverage Snomed CT dictionary
Parsing Text Snomed CT
Parsing Text Snomed CTClinical Findings - Laboratory
Parsing Text Snomed CTObservable entities
Parsing Text Snomed CTMedication
Term analysis & Update SCT Dictionary• Parse sample of reports
• Termanalysis
• Annotate to Snomed CT
Number of Tokens used
Number of unique Tokens
Number of Tokens used%
Number of unique Tokens%
Total 12.626 2.608 100,0% 100,0%
Coded before annotation 7.487 1.111 59,3% 42,6%
Annotation 1.301 81 10,3% 3,1%
Coded after annotation 8.788 1.192 69,6% 45,7%
Example 50 reports
Snomed CT Interface• Autocompletion
• Context sensitive protocolling
Snomed CT Interface• Strenght
Fast data entry
Complete, Correct, Non ambiguous
Coded
• Weakness
New interface for Health care Professional
Autocompletion Smartphone like
• As you type
• Abbreviations
• Parts of words
• Browse
Autocompletion
• As you type
• Abbreviations
• Parts of words
• Browse
Autocompletion
• As you type
• Abbreviations
• Parts of words
• Browse
Autocompletion
• As you type
• Abbreviations
• Parts of words
• Browse
Snomed CT InterfaceAutolearning
Snomed CT InterfaceAutolearning
Context sensitive pick lists• Target code (ICD, …)
• Protocolling
Target Code drivenHorizontal : all users
Target Code (RIZIV-INAMI) –guided
Target Code (ICD) – guided
Report PCS and RIZIV-INAMI compliant
Multipurpose Code Conversion
Context Sensitive RefsetsFast protocolling
413226009 | Esophagitis grade II | , 39839004 | diaphragmatic hernia |
Operation protocoleIntervention: Arthroplastie prothétique de la hanche <Mc>gauche;droite;bilatéral</Mc>
Indication:
Protocole:
Type de prothèse
Voie d'abord:
Composants de la prothèse
Luxation complète <Mc>appuyée;non appuyée</Mc>
Subluxation
Dysplasie de la hanche
Dysplasie cotyloïdienne luxante
Anomalie d'ouverture de l'angle cervico-obturateur (coxa valga)
Antéversion exagérée du col
Antétorsion du fémur
Coxa vara congénitale avec excès de couverture du cotyle
Coxa vara acquise de la maladie de Paget
Séquelle d'épiphysiolyse
Intervention:Arthroplastie prothétique de la hanche gauche.Indication:Coxarthrose secondaire gauche. Luxation complète non appuyée.
Coxarthrose primaire de la hanche
Coxarthrose secondaire:
Coxarthrite
Luxation de hanche traumatique
Fracture du col fémoral
Fracture du cotyle
Nécrose de la tête fémorale
Déscellement d'une prothèse existante:
Fracture du col fémoral
Spoedregistratie UREG
Reden spoed:Verkeersongeval. Chauffeur moto. Aanrijding met camion.…….
Reden spoed:<Br>
Anamnèse<Br>
Klinisch onderzoek<Br>
Medische voorgeschienis<Br>
Familiale antecedenten<Br>
Aanvullende onderzoeken<Br>
Behandeling op spoed:<Br>
Evolutie:<Br>
Behandeling bij ontslag:
Verkeersongeval:
Val
Arbeidsongeval<_>
Sportongeval<_>
Intoxicatie<_>
Zelfmoordpoging
Agressie
Intrafamiliaal geweld
Automutilatie<_>
Verwaarlozing<_>
Intoxicatie door <_>
Overdosis verdovende middelen<_>
Bevalling
In context van lopende behandeling<_>
Chauffeur
Passagier
Voetganger aangereden door
Fietsongeval
auto
camion
moto
brommer
fiets
voetganger
autobus
tram
trein
boot
paard
Aanrijding met
Val<_>
auto
camion
moto
brommer
fiets
voetganger
autobus
tram
trein
boot
paard
At Admission
Allergie geneesmiddelen: Geneesmiddel: aspirineManifestatie: Angio-oedeemErnst: ernstigTijdstip: 2013Evidentie: Anamnese betrouwbaar.
Allergie
Allergie geneesmiddelen
Intolerantie geneesmiddelen
Allergie voedingsmiddelen
Intolerantie voedingsmiddelen
Allergie insectenbeet
Atopie
Allergisch contacteczeem
Familiale geschiedenis van allergie aan <_> Reactie: _ Lid van de familie: <_>
Geneesmiddel:
Manifestatie:
Ernst: <Mc>llicht;matig;ernstig;levensbedreigend</Mc>
Tijdstip: <_>
Plaats: <_>
Evidentie <Mc>zeker;waarschijnlijk;mogelijk;waarschijnlijk afwezig;uitgesloten</Mc>
<_>
penicilline
iodium
aspirine
Anaphylactische shock<_>
Angio-oedeem<_>
Urticaria<_>
Auto-immun hepatitis
Anamnese<_>
Test in vitro<_>
Provocatietest: <_>
Context Sensitive RefsetsPrescription Clinical pathways
retrosternale pijn
Context Sensitive Refsets
• Flow chart guided
Fast, complete, correct
Structured (coded) -> Dispatch XML, Code conversion
• Context sensitive
Data driven!
o Diagnosis – Procedure - Study
User / Department
Terminology Management• Terminology
• Cross maps
• Refsets
Terminology Management SystemTerminologies & Cross maps
Terminology Management SystemTerminologies & Cross maps
Interactive - Collaborative• BT Clinical Computing
Software
Coding experts
Statistics of Use
• Participating hospitals (Local Use, Bottom Up)
You see what you get
o Snomed CT , English
o Secondary codes (ICD, RIZIV-INAMI, …)
Correction Loop
o Add, Correct
• National Release Centre, IHTSDO (International, Top down)
Snomed CT -> 1 Preferred Term
Cross maps & Rules
Multipurpose Code ConvertorSnomed CT to ICD-10
Hospital data (ICD)
• BT Snomed CT Interface
Import or Copy / Paste (part of) text
‘Submit’
Questions – Answers
Codes ICD
• Export to Hospital Data System (HDS)
BT Snomed Interface <> HDSystem
BT Snomed Interface <> HDSystem
Code Conversion PCS
Code Conversion PCS
BT Snomed Interface <> HDSystem
UREG Text –> Codes
Export report -> Code convertor
48
Snomed CTTo Patient Summary
Medical Report -> Patient Summary
Medical Report -> Patient SummarySnomed CT coded annotation
Texte Snomed CT
[Monsieur X] 184095009 | patient first name | = 'Monsieur', 371484003 |
patient name | = ‘X’
âgé de 72 ans 424144002 | age | = '72'
a été hospitalisé service de gastro-entérologie du 20.03.2012 au 02.04.2012 puis du 27.04.2012 au 03.05.2012 pour
32485007 | hospital admission | , 309926000 | gastroenterology department | , 398201009 | start time | ='20/03/2012 ', 397898000 | stop time | = '02/04/2012' AND 398201009 | start time | ='27/04/2012 ', 397898000 | stop time | = '03/05/2012 '
altération de l'état général 285384003 | general health deterioration |
décompensation ascitique 59927004 | liver failure | , 47429007 | associated with | =
389026000 | ascites |
dyspnée. 267036007 | Dyspnea |
Antécédents personnels : 417662000 | past medical history |
- asthme 195967001 | Asthma |
'- HTA 38341003 | Hypertensive disorder |
- hépatite C avec cirrhose 50711007 | Viral hepatitis C | , 47429007 | associated with | = 19943007 | Cirrhosis of liver |
- bronchopneumonie 233604007 | Pneumonia |
Affection actuelle : 410665000 | reason for | , 32485007 | hospital admission |
porteur d'une cirrhose C 29679002 | carrier | , 19943007 | Cirrhosis of liver |
oedème important chronique des membres inférieurs102572006 | Edema of lower extremity |, 24484000 | severe | , 90734009 | Chronic |
dyspnée 267036007 | Dyspnea |
ballonnement abdominal 41931001 | Abdominal distension |
ponction d'ascite 89305009 | Abdominal paracentesis |, start date =’30/6/2012’
Le régime sans sel n'a pas été suivi car mal compris. 226164007 | very low salt diet | , 7058009 | Noncompliance with treatment |, 53314000 | inability to understand |, start date =’30/6/2012’
a pris 14 kgs en 2 mois. 8943002 | weight gain | , 248346009 | weight change | = 14 , 258683005 | kg | , 282363004 | denominators of time | = 2 , 258706009 | month |
Médication à domicile 394829006 | past medication |
Canrenol 100 mg : 2 x/jour 419615001 | potassium canrenoate | : 258666001 | Unit | = '100',
258684004 | mg |, 259083004 | times/day | = '2'
Indéral 10 mg : 1 x/jour372772003 | propranolol | : 258666001 | Unit | = '10',
258684004 | mg |, 259083004 | times/day | = '1'
Medical Report -> Patient Summary
Medical Report -> Patient Summary
Use Cases
• UREG registry
• Hospital Data ICD
• Operating Room & Registries
• Patient Summary
• Clinical Pathways
• Clinical Trials
• Clinical Research Open, big and real data
Operating Room
• Extend Snomed dictionary
Parse Operation reports
Annotate missing Terms in function of Frequency
Use with Autocomplete & Parsing
• Link O.R. codes with Snomed procedures
Flow planning EPR -> O.R. -> Report / Coding
• Create Refsets
Fast protocolling
Coding ICD-10-BE, INAMI
Registry
Clinical Pathways
• Create Refsets
• Link Refsets with context
Clinical finding, Procedure, Medication, Clinical trial
User, specialty
Clinical Trials Clinical Research Organisations & Pharma
• Create Refset Study Inclusion – Exclusion criteria
Select eligible patients
Alert eligible patient in real time
Protocolling EPR
• Print Case Report Form in English
• Anonymise & Export & communicate Patient Summary
Clinical Research Open, big and real data
http://www.pharma.be/nl/focus/gezondheid-en-innovatie/100-klinische-studies/20-toekomstpact.html
• Dictionary
Add Terms used for Outcome variables
Parse reports department and Annotate missing Terms
Create Refsets for prospective registration
• Upload reports to BT Parser
Anonymize & Code to Snomed CT
• Update with national registry for life expectancy
• Transform Snomed CT to flat file (Excel)