making standard terminology work in clinical...
TRANSCRIPT
![Page 1: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/1.jpg)
1
Making Standard Terminology Work InClinical Guidelines
Robert McClure1, James Campbell2,Julie Glasgow3, Mark Nyman4
1Apelon, Inc., Ridgefield, CT ; 2University of Nebraska Medical Center, Omaha, NE; 3GE Healthcare Integrated IT Solutions, Seattle, WA; 4Mayo Clinic, Rochester, MN
![Page 2: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/2.jpg)
2
Introductions
• Who are we?• Who we think you are…
– Training and experience: • Clinical understanding• Management of electronic information
– Interest• Prepare to implement clinical guidelines• Understand how terminology standards are
used in guidelines
![Page 3: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/3.jpg)
3
Objectives
• Gain general understanding of CDSS and standard terminologies
• Understand use of standard terminologies in CDSS
• Learn to manage challenges that arise in mapping local concepts to a CDSS
![Page 4: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/4.jpg)
4
Agenda
• Session Overview (McClure) – Intro – Guidelines overview – SAGE overview – Standard Terminologies
• What and why important• Guideline Abstraction (Glasgow)
– SAGE process– Identifying concepts in the guideline
• Making terminology work locally (Nyman) – Mapping – Issues to grapple with
• Wrap-up – Questions (McClure)
![Page 5: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/5.jpg)
5
What are Guidelines?• Guideline(n): a cord or rope to aid passage over a
difficult point (Merriam-Webster)• Systematic statements of evidence-based policy
rules or principles to assist clinicians and patients make decisions on healthcare alternatives
• Characteristics– May be developed by government agencies at any level,
institutions, professional societies, governing boards, or by convening expert panels.
– May be in narrative, outline, flowchart or tabular forms– Need to be formalized to provide computerized clinical
decision support at point of care
![Page 6: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/6.jpg)
6
Why Study Guidelines?President’s Information Technology Advisory Committee (2001)“Transforming Health Care through Information Technology”Findings…:• The U.S. lacks a broadly disseminated and accepted national
vision for information technology in health care• The introduction of integrated decision-support systems that can
proactively foster best practices and reduce errors requires enhanced information-technology methods and tools
Recommendations…: • Expand the range and granularity of routinely captured data• Standardize terminology • Develop guidelines based on evidences and best practices• Implement guidelines so that they are usable effectively at the
point of care, including embedded decision support that is continually updated as new evidence accumulates
![Page 7: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/7.jpg)
7
• Collaborative research and development project to develop a standards-based technology to enable encoding and dissemination of guidelines in executable format.
• Infrastructure will employ informatics standards including Protégé open source workbench, HL7 RIM, SNOMED CT and LOINC, and deployment technology to support encoding and dissemination of guidelines across vendor platforms and throughout the spectrum of care
• Guideline deployment technology will present guideline content to clinicians through active, patient-specific recommendationssurfaced through functions of the local clinical information system, and integrated into the care workflow
SAGE is partially supported under a grant from the U.S. Department of Commerce, National Institute of Standards and Technology, Advanced Technology Program, Cooperative Agreement Number 70NANB1H3049.
SAGE Project Overview
![Page 8: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/8.jpg)
8
Why Terminology Standards
• Interoperability– Common representation of meaning
• Robust terminology model
– Common coding– Interlingua
• Translate once
– Shared framework for collaborative improvement of the terminology
• Decision support needs all of this
![Page 9: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/9.jpg)
9
Selected NCVHS Terminology Standards
• SNOMED CT– CAP, soon International SDO
• LOINC– Regenstrief Institute
• ICD-9-CM– WHO/NCHS
• CPT– AMA
• NDC, RxNorm, NDF-RT, …
![Page 10: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/10.jpg)
10
SNOMED CT ®
• Under development by the College of American Pathologists since the 1960’s
• Provides a disambiguated, polyhierarchical representation of over 450,000 medical concepts, with approximately 1 million descriptions
• Under licensing agreement with the NLM• Crossmaps to other commonly-used
terminologies are built in• Presently the most complete formal medical
ontology in existence
![Page 11: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/11.jpg)
11
• Synonyms & homonyms– By assigning a unique numeric code to each
medical concept, SNOMED CT formalizes clinical terminology.
• Subsumption– By representing the complete set of relationships
among medical concepts, SNOMED CT automates classification logic.
• Expressiveness– By defining rules for combining concepts into
“expressions”, many clinical ideas can be encoded
Why do we need SNOMED CT?
![Page 12: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/12.jpg)
12
SNOMED CT StructureTermsConcepts
Relationships
![Page 13: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/13.jpg)
13
SNOMED CT StructureTermsConcepts
Relationships
![Page 14: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/14.jpg)
14
SNOMED CT StructureTermsConcepts
Relationships
![Page 15: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/15.jpg)
15
SNOMED CT StructureTermsConcepts
Relationships
![Page 16: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/16.jpg)
16
SNOMED CT StructureTermsConcepts
Relationships 4855003
![Page 17: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/17.jpg)
17
SNOMED CT StructureTermsConcepts
Relationships 4855003
![Page 18: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/18.jpg)
18
SNOMED CT StructureTermsConcepts
Relationships 4855003 Diabetic retinopathy
![Page 19: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/19.jpg)
19
SNOMED CT StructureTermsConcepts
Relationships 4855003 Diabetic retinopathy
29555009
![Page 20: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/20.jpg)
20
SNOMED CT StructureTermsConcepts
Relationships 4855003 Diabetic retinopathy
29555009
![Page 21: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/21.jpg)
21
SNOMED CT StructureTermsConcepts
Relationships 4855003 Diabetic retinopathy
29555009 Retinal disorder
![Page 22: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/22.jpg)
22
SNOMED CT StructureTermsConcepts
Relationships 4855003 Diabetic retinopathy
29555009 Retinal disorder
Is-A
![Page 23: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/23.jpg)
23
SNOMED CT StructureTermsConcepts
Relationships 4855003 Diabetic retinopathy
29555009 Retinal disorder
Is-A
![Page 24: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/24.jpg)
24
SNOMED CT StructureTermsConcepts
Relationships 4855003 Diabetic retinopathy
29555009 Retinal disorder
Is-A
![Page 25: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/25.jpg)
25
SNOMED CT StructureTermsConcepts
Relationships 4855003 Diabetic retinopathy
29555009 Retinal disorder
Is-A
Due-to
![Page 26: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/26.jpg)
26
SNOMED CT StructureTermsConcepts
Relationships 4855003 Diabetic retinopathy
29555009 Retinal disorder
Is-A
Due-to
![Page 27: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/27.jpg)
27
SNOMED CT StructureTermsConcepts
Relationships 4855003 Diabetic retinopathy
29555009 Retinal disorder
73211009
Is-A
Due-to
![Page 28: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/28.jpg)
28
SNOMED CT StructureTermsConcepts
Relationships 4855003 Diabetic retinopathy
29555009 Retinal disorder
73211009
Is-A
Due-to
![Page 29: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/29.jpg)
29
SNOMED CT StructureTermsConcepts
Relationships 4855003 Diabetic retinopathy
29555009 Retinal disorder
73211009 Diabetes mellitus
Is-A
Due-to
![Page 30: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/30.jpg)
30
SNOMED CT StructureTermsConcepts
Relationships 4855003 Diabetic retinopathy
29555009 Retinal disorder
73211009 Diabetes mellitus
Is-A
Due-to
![Page 31: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/31.jpg)
31
The Inheritance HierarchyConcepts are arranged in a tree hierarchy
Medication
Antibiotic Anti-HTN
Penicillin Quinolone
Ampicillin Methicillin
Beta-blocker Diuretic
Atenolol Betaxolol Metoprolol
. . .
is ais a
![Page 32: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/32.jpg)
32
The Inheritance HierarchyConcepts are arranged in a tree hierarchy
Medication
Antibiotic Anti-HTN
Penicillin Quinolone
Ampicillin Methicillin
Beta-blocker Diuretic
Atenolol Betaxolol Metoprolol
. . .
is ais a
![Page 33: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/33.jpg)
33
The Inheritance HierarchyConcepts are arranged in a tree hierarchy
Medication
Antibiotic Anti-HTN
Penicillin Quinolone
Ampicillin Methicillin
Beta-blocker Diuretic
Atenolol Betaxolol Metoprolol
. . .
is ais a
![Page 34: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/34.jpg)
34
The Inheritance HierarchyConcepts are arranged in a tree hierarchy
Medication
Antibiotic Anti-HTN
Penicillin Quinolone
Ampicillin Methicillin
Beta-blocker Diuretic
Atenolol Betaxolol Metoprolol
. . .
is ais a
![Page 35: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/35.jpg)
35
The Inheritance HierarchyConcepts are arranged in a tree hierarchy
Medication
Antibiotic Anti-HTN
Penicillin Quinolone
Ampicillin Methicillin
Beta-blocker Diuretic
Atenolol Betaxolol Metoprolol
. . .
is ais a
Antibiotic subsumes Penicillin and Methicillin
![Page 36: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/36.jpg)
36
Polyhierarchical structureA concept may have more than one parent in the
hierarchy
operation on gall bladder
laparoscopic cholecystectomy
laparoscopic procedure
procedure on abdomen
cholecystectomy
procedure
procedure by device
procedure by site
is a
is a
![Page 37: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/37.jpg)
37
Polyhierarchical structureA concept may have more than one parent in the
hierarchy
operation on gall bladder
laparoscopic cholecystectomy
laparoscopic procedure
procedure on abdomen
cholecystectomy
procedure
procedure by device
procedure by site
is a
is a
![Page 38: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/38.jpg)
38
Polyhierarchical structureA concept may have more than one parent in the
hierarchy
operation on gall bladder
laparoscopic cholecystectomy
laparoscopic procedure
procedure on abdomen
cholecystectomy
procedure
procedure by device
procedure by site
is a
is a
![Page 39: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/39.jpg)
39
Suprarenal Artery Embolus297143008
orOcclusion of Artery 2929001
Associated Morphology 116676008Embolus 55584005
Finding Site 363698007
Suprarenal Artery 89500000
Pre- and Post-Coordination
![Page 40: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/40.jpg)
40
Suprarenal Artery Embolus297143008
orOcclusion of Artery 2929001
Associated Morphology 116676008Embolus 55584005
Finding Site 363698007
Suprarenal Artery 89500000
Pre-Coordinated
Pre- and Post-Coordination
![Page 41: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/41.jpg)
41
Suprarenal Artery Embolus297143008
orOcclusion of Artery 2929001
Associated Morphology 116676008Embolus 55584005
Finding Site 363698007
Suprarenal Artery 89500000
Pre-Coordinated
Pre- and Post-Coordination
![Page 42: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/42.jpg)
42
Suprarenal Artery Embolus297143008
orOcclusion of Artery 2929001
Associated Morphology 116676008Embolus 55584005
Finding Site 363698007
Suprarenal Artery 89500000
Pre-Coordinated
Post-Coordinated
Pre- and Post-Coordination
![Page 43: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/43.jpg)
43
CDSS Vocabulary Services
Effective use of SNOMED vocabulary by the CDSS requires that these functions (at a minimum) be supported by the query/vocabulary management software:
1) Retrieve information about a single concept2) Determine if concept A is a “child” of concept B3) Query for a set of concepts, such as those defined
for use in clinical systemsa) “All the concepts that represent an immunocompromised
host””
![Page 44: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/44.jpg)
44
Guideline Abstraction
Julie Glasgow, MD
![Page 45: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/45.jpg)
45
SAGE Guideline Encoding Process
1. AssembleSource
Guidelines
2. EnvisionClinical
Scenarios
3. FormalizeGuideline
Logic
4. DefineGuidelineConcepts
5. FormalizeVocabularyInventory
6. Specify Information Queries
7. EncodeGuideline
Knowledgebase
GuidelineInstallation
and Execution
![Page 46: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/46.jpg)
46
SAGE Guideline Encoding Process
1. AssembleSource
Guidelines
2. EnvisionClinical
Scenarios
3. FormalizeGuideline
Logic
4. DefineGuidelineConcepts
5. FormalizeVocabularyInventory
6. Specify Information Queries
7. EncodeGuideline
Knowledgebase
GuidelineInstallation
and Execution
![Page 47: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/47.jpg)
47
SAGE Guideline Encoding Process
1. AssembleSource
Guidelines
2. EnvisionClinical
Scenarios
3. FormalizeGuideline
Logic
4. DefineGuidelineConcepts
5. FormalizeVocabularyInventory
6. Specify Information Queries
7. EncodeGuideline
Knowledgebase
GuidelineInstallation
and Execution
![Page 48: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/48.jpg)
48
SAGE Guideline Encoding Process
1. AssembleSource
Guidelines
2. EnvisionClinical
Scenarios
3. FormalizeGuideline
Logic
4. DefineGuidelineConcepts
5. FormalizeVocabularyInventory
6. Specify Information Queries
7. EncodeGuideline
Knowledgebase
GuidelineInstallation
and Execution
![Page 49: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/49.jpg)
49
SAGE Guideline Encoding Process
1. AssembleSource
Guidelines
2. EnvisionClinical
Scenarios
3. FormalizeGuideline
Logic
4. DefineGuidelineConcepts
5. FormalizeVocabularyInventory
6. Specify Information Queries
7. EncodeGuideline
Knowledgebase
GuidelineInstallation
and Execution
![Page 50: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/50.jpg)
50
SAGE Guideline Encoding Process
1. AssembleSource
Guidelines
2. EnvisionClinical
Scenarios
3. FormalizeGuideline
Logic
4. DefineGuidelineConcepts
5. FormalizeVocabularyInventory
6. Specify Information Queries
7. EncodeGuideline
Knowledgebase
GuidelineInstallation
and Execution
![Page 51: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/51.jpg)
51
SAGE Guideline Encoding Process
1. AssembleSource
Guidelines
2. EnvisionClinical
Scenarios
3. FormalizeGuideline
Logic
4. DefineGuidelineConcepts
5. FormalizeVocabularyInventory
6. Specify Information Queries
7. EncodeGuideline
Knowledgebase
GuidelineInstallation
and Execution
![Page 52: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/52.jpg)
52
SAGE Guideline Encoding Process
1. AssembleSource
Guidelines
2. EnvisionClinical
Scenarios
3. FormalizeGuideline
Logic
4. DefineGuidelineConcepts
5. FormalizeVocabularyInventory
6. Specify Information Queries
7. EncodeGuideline
Knowledgebase
GuidelineInstallation
and Execution
![Page 53: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/53.jpg)
53
SAGE Guideline Encoding Process
1. AssembleSource
Guidelines
2. EnvisionClinical
Scenarios
3. FormalizeGuideline
Logic
4. DefineGuidelineConcepts
5. FormalizeVocabularyInventory
6. Specify Information Queries
7. EncodeGuideline
Knowledgebase
GuidelineInstallation
and Execution
![Page 54: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/54.jpg)
54
CDC Adult Immunization Sub-guideline Schedule
![Page 55: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/55.jpg)
55
CDC Adult Immunization Sub-guideline Schedule
![Page 56: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/56.jpg)
56
Detail: US Adult Pneumococcal Guideline
![Page 57: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/57.jpg)
57
Detail: US Adult Pneumococcal Guideline
![Page 58: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/58.jpg)
58
Concepts in the Source Guideline• What is a chronic cardiovascular disease?• What defines diabetes mellitus?• What is functional or anatomic asplenia?• Who is an immunocompromised person?
![Page 59: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/59.jpg)
59
Concepts in the Source Guideline• What is a chronic cardiovascular disease?• What defines diabetes mellitus?• What is functional or anatomic asplenia?• Who is an immunocompromised person?
![Page 60: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/60.jpg)
60
Concepts in the Source Guideline• What is a chronic cardiovascular disease?• What defines diabetes mellitus?• What is functional or anatomic asplenia?• Who is an immunocompromised person?
![Page 61: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/61.jpg)
61
Concepts in the Source Guideline• What is a chronic cardiovascular disease?• What defines diabetes mellitus?• What is functional or anatomic asplenia?• Who is an immunocompromised person?
![Page 62: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/62.jpg)
62
Concepts in the Source Guideline• What is a chronic cardiovascular disease?• What defines diabetes mellitus?• What is functional or anatomic asplenia?• Who is an immunocompromised person?
![Page 63: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/63.jpg)
63
“Functional or anatomic asplenia”
• Clinical Definition– Congenital
asplenia– Functional asplenia– Splenectomy– Asplenia syndrome– Hyposplenism– Sickle cell disease
• SNOMED CT Concept– 93030006– 38096003– 234319005 (Procedure)– 17604001– 23761004– 127040003 (Hemoglobin
S disease)
![Page 64: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/64.jpg)
64
“Functional or anatomic asplenia”
• Clinical Definition– Congenital
asplenia– Functional asplenia– Splenectomy– Asplenia syndrome– Hyposplenism– Sickle cell disease
• SNOMED CT Concept– 93030006– 38096003– 234319005 (Procedure)– 17604001– 23761004– 127040003 (Hemoglobin
S disease)
![Page 65: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/65.jpg)
65
Concepts in the Encoded Guideline:Protégé
![Page 66: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/66.jpg)
66
Concepts in the Encoded Guideline:Protégé
![Page 67: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/67.jpg)
67
Concepts in the Encoded Guideline:ProtégéContext Nodes organize and specifythe relationship to workflow. • What triggers the session• Who is involved• Where the session occurs
![Page 68: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/68.jpg)
68
Concepts in the Encoded Guideline:ProtégéContext Nodes organize and specifythe relationship to workflow. • What triggers the session• Who is involved• Where the session occurs
![Page 69: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/69.jpg)
69
Concepts in the Encoded Guideline:ProtégéContext Nodes organize and specifythe relationship to workflow. • What triggers the session• Who is involved• Where the session occurs
Decision Nodes provide support for making choices:•Specification of alternatives•Logic used to evaluate choices
![Page 70: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/70.jpg)
70
Concepts in the Encoded Guideline:ProtégéContext Nodes organize and specifythe relationship to workflow. • What triggers the session• Who is involved• Where the session occurs
Decision Nodes provide support for making choices:•Specification of alternatives•Logic used to evaluate choices
![Page 71: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/71.jpg)
71
Concepts in the Encoded Guideline:ProtégéContext Nodes organize and specifythe relationship to workflow. • What triggers the session• Who is involved• Where the session occurs
Decision Nodes provide support for making choices:•Specification of alternatives•Logic used to evaluate choices
![Page 72: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/72.jpg)
72
Concepts in the Encoded Guideline:ProtégéContext Nodes organize and specifythe relationship to workflow. • What triggers the session• Who is involved• Where the session occurs
Decision Nodes provide support for making choices:•Specification of alternatives•Logic used to evaluate choices
Action Nodes define activity to be accomplished by the CIS:•User interaction, query, messaging•Order sets•Appointments and referrals•Goal setting•Documentation and recording
![Page 73: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/73.jpg)
73
Concepts in the Encoded Guideline:ProtégéContext Nodes organize and specifythe relationship to workflow. • What triggers the session• Who is involved• Where the session occurs
Decision Nodes provide support for making choices:•Specification of alternatives•Logic used to evaluate choices
Action Nodes define activity to be accomplished by the CIS:•User interaction, query, messaging•Order sets•Appointments and referrals•Goal setting•Documentation and recording
![Page 74: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/74.jpg)
74
Adult Pneumococcal Vaccine Logic
![Page 75: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/75.jpg)
75
Adult Pneumococcal Vaccine Logic
![Page 76: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/76.jpg)
76
Functional or Anatomic Asplenia
![Page 77: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/77.jpg)
77
Functional or Anatomic Asplenia
![Page 78: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/78.jpg)
78
Functional Asplenia
![Page 79: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/79.jpg)
79
Functional Asplenia
![Page 80: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/80.jpg)
80
SAGE Protégé Tool for Vocab. Inventory
![Page 81: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/81.jpg)
81
SAGE Protégé Tool for Vocab. Inventory
![Page 82: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/82.jpg)
82
Guideline Concepts ↔ Patient Record• Concepts must be defined in order to find them in
the electronic patient record• There is variation in data representation across
EMRs– Concepts used– Structures to hold concepts– Usage customs
• A standard representation allows translation of concepts for inclusion in database queries
![Page 83: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/83.jpg)
83
Example: Possible Representations of a Patient’s Diabetes Mellitus• Entry on Problem List
– Diabetes Mellitus type II• Observation
– Lab Value of Fasting Glucose > 125 mg/dL or– Lab value for two-hour 75-g oral glucose
tolerance test > 200 mg/dL• Entry in Diagnoses & Procedures list
– Diabetes Mellitus type II
![Page 84: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/84.jpg)
84
Example: Possible Representations of a Patient’s Diabetes Mellitus• Entry on Problem List
– Diabetes Mellitus type II• Observation
– Lab Value of Fasting Glucose > 125 mg/dL or– Lab value for two-hour 75-g oral glucose
tolerance test > 200 mg/dL• Entry in Diagnoses & Procedures list
– Diabetes Mellitus type IIData engineers must map standard guideline concept
representations to local concepts and structures
![Page 85: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/85.jpg)
85
Making terminology work locally
Mark Nyman, MD
![Page 86: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/86.jpg)
86
1. AssembleSource
Guidelines
2. EnvisionClinical
Scenarios
3. FormalizeGuideline
Logic
4. DefineGuidelineConcepts
5. FormalizeVocabularyInventory
6. Specify Information
Queries
7. EncodeGuideline
Knowledgebase
GuidelineInstallation
and Execution
![Page 87: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/87.jpg)
87
1. AssembleSource
Guidelines
2. EnvisionClinical
Scenarios
3. FormalizeGuideline
Logic
4. DefineGuidelineConcepts
5. FormalizeVocabularyInventory
6. Specify Information
Queries
7. EncodeGuideline
Knowledgebase
GuidelineInstallation
and Execution
![Page 88: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/88.jpg)
88
SAGE Guideline Deployment System Execution Architecture
Encoded
Guideline
SAGE Execution
EngineClinical
Information System
VMR
Inter-face
Binding
Local Modifications
data
Event Listener
Event Notifications
Terminology Server
TerminologyFunctions
Data Query Service Calls
Action Service Calls
![Page 89: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/89.jpg)
89
Mapping
Decision Support System
Problems
Lab
Orders
Local Computer Information System
Problems
Lab
Orders
![Page 90: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/90.jpg)
90
Example:Mapping of Problems
Diabetes
![Page 91: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/91.jpg)
91
SNOMED: diabetes
![Page 92: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/92.jpg)
92
Local CIS
DM Coma2202581DM Type1 Hyperosmolarity2202578DM Type2 Hyperosmolarity2202577DM Type1 Ketoacidosis2202574DM Type2 Ketoacidosis2202573DM Ketoacidosis2202572DM Type1 Uncontrolled2202571DM Type2 Uncontrolled2202570DM Type12202569DM w/o Complications2202568DM Type22202567DM2202566
DM Type2 Retinopathy Prolif2202601DM Type2 Retinopathy Background2202600DM Type2 Retinopathy2202599DM Retinopathy Macular Edema2202598DM Retinopathy Background2202596DM Type2 Cataract2202594DM Retinopathy Proliferative2202593DM Retinopathy2202592DM Type1 Nephropathy Uncontrolled2202591DM Type2 Nephropathy Uncontrolled2202590DM Type1 Nephropathy2202589DM Type1 Nephrotic Syndrome2202588
![Page 93: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/93.jpg)
93
MAP
DM type 22202567Diabetes mellitus type 2
44054006
DM type 12202569Diabetes mellitus type 1
46635009DescriptionCIS #TermSNOMED #
![Page 94: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/94.jpg)
94
Example:Mapping of Lab Observations
Hgb A1c
![Page 95: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/95.jpg)
95
Retrieve Sub-guideline
![Page 96: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/96.jpg)
96
Retrieve Sub-guideline
![Page 97: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/97.jpg)
97
Retrieve Sub-guideline
![Page 98: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/98.jpg)
98
Mayo Lab Code for Hgb A1c
Kasson/in MICS82990Hemoglobin A1C, B 4548-4
New England/not in MICS124055Hemoglobin A1C, B 4548-4
Clinical Trials/not in MICS80947Hemoglobin A1C, B 4548-4
Central Clinical Lab/in MICS82080Hemoglobin A1C, B 4548-4
Performed/reportedUnit codeUnit code nameLOINC
![Page 99: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/99.jpg)
99
Mayo Lab Code for Hgb A1c
Kasson/in MICS82990Hemoglobin A1C, B 4548-4
New England/not in MICS124055Hemoglobin A1C, B 4548-4
Clinical Trials/not in MICS80947Hemoglobin A1C, B 4548-4
Central Clinical Lab/in MICS82080Hemoglobin A1C, B 4548-4
Performed/reportedUnit codeUnit code nameLOINC
![Page 100: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/100.jpg)
100
Mayo Lab Code for Hgb A1c
Kasson/in MICS82990Hemoglobin A1C, B 4548-4
New England/not in MICS124055Hemoglobin A1C, B 4548-4
Clinical Trials/not in MICS80947Hemoglobin A1C, B 4548-4
Central Clinical Lab/in MICS82080Hemoglobin A1C, B 4548-4
Performed/reportedUnit codeUnit code nameLOINC
![Page 101: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/101.jpg)
101
Mayo Lab Code for Hgb A1c
Kasson/in MICS82990Hemoglobin A1C, B 4548-4
New England/not in MICS124055Hemoglobin A1C, B 4548-4
Clinical Trials/not in MICS80947Hemoglobin A1C, B 4548-4
Central Clinical Lab/in MICS82080Hemoglobin A1C, B 4548-4
Performed/reportedUnit codeUnit code nameLOINC
![Page 102: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/102.jpg)
102
Mayo Lab Code for Hgb A1c
Kasson/in MICS82990Hemoglobin A1C, B 4548-4
New England/not in MICS124055Hemoglobin A1C, B 4548-4
Clinical Trials/not in MICS80947Hemoglobin A1C, B 4548-4
Central Clinical Lab/in MICS82080Hemoglobin A1C, B 4548-4
Performed/reportedUnit codeUnit code nameLOINC
![Page 103: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/103.jpg)
103
Mayo Lab Code for Hgb A1c
Kasson/in MICS82990Hemoglobin A1C, B 4548-4
New England/not in MICS124055Hemoglobin A1C, B 4548-4
Clinical Trials/not in MICS80947Hemoglobin A1C, B 4548-4
Central Clinical Lab/in MICS82080Hemoglobin A1C, B 4548-4
Performed/reportedUnit codeUnit code nameLOINC
![Page 104: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/104.jpg)
104
Mayo Lab Code for Hgb A1c
Kasson/in MICS82990Hemoglobin A1C, B 4548-4
New England/not in MICS124055Hemoglobin A1C, B 4548-4
Clinical Trials/not in MICS80947Hemoglobin A1C, B 4548-4
Central Clinical Lab/in MICS82080Hemoglobin A1C, B 4548-4
Performed/reportedUnit codeUnit code nameLOINC
![Page 105: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/105.jpg)
105
Translation Table
610567382990-ROCLIS
Hemoglobin A1C, B (Kasson)
610526782080-ROCLIS
Hemoglobin A1C, B (Rochester)
Hemoglobin A1C
LOINC:4548-4
observation
/mapping/toMayo Lab Code
/mapping/to/@label
/mapping/from/concept/@label
/mapping/from/concept
/mapping/@context
![Page 106: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/106.jpg)
106
Translation Table
611289915958-ROCLIS
Hemoglobin A1C, B
Hemoglobin A1C, calculated
LOINC:17855-8
observation
610567382990-ROCLIS
Hemoglobin A1C, B (Kasson)
610526782080-ROCLIS
Hemoglobin A1C, B (Rochester)
Hemoglobin A1C
LOINC:4548-4
observation
/mapping/toMayo Lab Code
/mapping/to/@label
/mapping/from/concept/@label
/mapping/from/concept
/mapping/@context
![Page 107: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/107.jpg)
107
Translation Table
611289915958-ROCLIS
Hemoglobin A1C, B
610567382990-ROCLIS
Hemoglobin A1C, B (Kasson)
610526782080-ROCLIS
Hemoglobin A1C, B (Rochester)
Hemoglobin A1C
LOINC:4548-4
observation
/mapping/toMayo Lab Code
/mapping/to/@label
/mapping/from/concept/@label
/mapping/from/concept
/mapping/@context
![Page 108: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/108.jpg)
108
Example:Mapping of Lab Orders
Hgb A1c
![Page 109: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/109.jpg)
109
Instance of Order
![Page 110: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/110.jpg)
110
Translation Table
XSERVI #82080-ROCLISO
Hemoglobin A1C,B
Hemoglobin A1C
LOINC:4548-4
order
/mapping/toMayo Lab Code
/mapping/to/@label
/mapping/from/concept/@label
/mapping/from/concept
/mapping/@context
![Page 111: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/111.jpg)
111
Mapping Challenges
• Mismatch in vocabularies• Mismatch of data representation• Absence of data elements in the CIS
![Page 112: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/112.jpg)
112
Potential Solutions• Mismatch in vocabularies
– Petition change in standard– Change local vocabulary
• Mismatch of data representation – Search the problem list
• Absence of data elements in the CIS– Query the user– Accept absence
![Page 113: Making Standard Terminology Work In Clinical Guidelinessage.wherever.org/references/docs/...Terminology.pdf · • Making terminology work locally (Nyman) – Mapping – Issues to](https://reader035.vdocuments.net/reader035/viewer/2022071214/6041e30557f1861ff37f7c38/html5/thumbnails/113.jpg)
113
Thanks for your attention..Questions?