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Servicios Terminológicos


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Servicios Terminológicos para el (re)uso efectivo de la Información Clínica - Dra. Jussara Macedo

Servicios Terminológicos para el (re)uso efectivo de la Información Clínica - Dra. Jussara Macedo

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  • 1. Terminology Service Jussara Rötzsch Based on: Ian McNicoll Christopher Chute
  • 2. What do we need? Messaging An EHR that is • Independent of implementation technology • Independent of clinical system developer • Enables access to multiple clinical Query applications • Designed for longevity and re-use TerminologyContent Specifications Information Models
  • 3. The Problem• Terminology systems vary considerably in both content  and structure. – NDF‐RT – RxNorm – SNOMED‐CT – ICD‐9 and ICD‐10 – CPT – etc• Requirements of terminology vary widely• Implementation decisions of terminology vary widely• Storage formats may differ (relational database, XML,  ...) © 2002‐2009, Health Level  March, 2009 3 Seven, Inc.
  • 4. Real world use of SNOMED CT• Clinicians – Need to be able to find the term that they need easily – Need to use SNOMED terms correctly – good subsets  are safe – Transparent to the end user• Applications – Need to be able to deploy SNOMED and use it reliably  in their apps – Need to be able to query reliably1.4
  • 5. Common Terminology Services (CTS)• Purpose is to specify a common Application  Programming Interface (API) to access  terminological content• Client software doesn’t have to know about  specific terminology data structures and/or  how to access them• Server software can plug and play with many  clients © 2002‐2009, Health Level March, 2009 5 Seven, Inc.
  • 6. Common Terminology Services API• Allows Client Software to be developed  Independently from Service Server Software• Allows Terminology Plug‐and‐Play• Allows Client Plug‐and‐Play• Defines a “Functional Contract” © 2002‐2009, Health Level March, 2009 6 Seven, Inc.
  • 7. CTS API ... Application Interface CTS Service Data © 2002‐2009, Health Level March, 2009 7 Seven, Inc.
  • 8. CTS API HL7Application Vocab Find codes having “*myelitis” Browser Interface CTS HL7 Terminology Service Server Select * from VOC_concept_designation WHERE text like ‘%myelitis’ MS Access Data Tables © 2002‐2009, Health Level March, 2009 8 Seven, Inc.
  • 9. CTS API – Different Client, Same Service IHCApplication Picklist Find codes having “*icillin” Tool Interface CTS HL7 Terminology Service Server Select * from VOC_concept_designation WHERE text like ‘%icillin’ MS Access Data Tables © 2002‐2009, Health Level March, 2009 9 Seven, Inc.
  • 10. CTS API – Different Server, Same Client IHC Application Picklist Find codes having “*icillin” Tool Interface CTS APELON DTS Select * from conc_repr Service WHERE text like ‘%icillin’ AND ... SNOMED Oracle Data CT Tables © 2002‐2009, Health Level March, 2009 10 Seven, Inc.
  • 11. CTS API – Distributed Services IHCApplication Picklist Find codes having “*icillin” Tool Interface CTS <msg><soap....><filter=“*icillin”...</msg> Service Web Data Internet Service Portal © 2002‐2009, Health Level March, 2009 11 Seven, Inc.
  • 12. Common Terminology Services Message Processing Message Processing Application Message Processing Application Application Message API Vocabulary API Vocabulary Vocabulary Vocabulary © 2002‐2009, Health Level March, 2009 12 Seven, Inc.
  • 13. OpenEHR (Ocean)Terminology Server Use cases Maintenance Multiple Languages & subsets
  • 14. Terminology Server • Stores named queries • Caches complex queries • Caches saved between sessions Ocean Terminology Server UKEnglish SNOMED-CT extension
  • 15. ProcessUser determines which part(s) of SNOMED‐CT  hierarchy is of interest (including which  subsets)Can choose to: – Include a node – Exclude a node (pass through) – Exclude a node and all the children of a node  (exclude) – Include the node for navigation only – Hoist the children to be peers of the parent
  • 16. Blood groups – raw views
  • 17. Blood Groups simple list (all terms) • Choose all relevant blood groups • Hoist all nodes to be peer with parents This gives a flat list of terms
  • 18. ABO Blood Groups 3‐layer tree • The hierarchy of ABO blood groupsNavigate Select
  • 19. Terminology Query language• <?xml version="1.0" encoding="utf‐8" ?> Start at ABO• <ots:query  blood group• xmlns:ots=""• name="BloodTypev2"• language="en‐us"   Set root to• terminology="Snomed"  • cacheMode="Permanent"> Navigate• <childNodes>• <concept conceptId="112143006"• operation="Navigate"> Iterate down the• <childNodes> IS_A relationship• <relatedConcept operation="Navigate"• relationship="116680003">• <childNodes>• <relatedConcept operation="Select"• relationship="116680003">• </relatedConcept>• </childNodes>• </relatedConcept>• </childNodes>• </concept> Make all nodes• </childNodes>• </ots:query> with an IS_A relationship selectable
  • 20. ABO Blood Groups 3‐layer tree restructured PlaceholderPlaceholder Select Navigate
  • 21. ABO Blood Groups 3‐layer tree restructured  code• <?xml version="1.0" encoding="utf‐8" ?>• <ots:query • xmlns:ots="" Navigate• name="BloodTypev2"• language="en‐us"  • terminology="Snomed"  • cacheMode="Permanent">• <childNodes>• <placeHolder text="Blood Types">• <childNodes>• <concept conceptId="112143006"• operation="Passthrough"> Select• <childNodes>• <relatedConcept operation="Navigate"• relationship="116680003">• Placeholder <childNodes>• <placeHolder text="Rh subtypes">• <childNodes>• <relatedConcept operation="Select"• relationship="116680003">• <constraints>• Placeholder <lexicalConstraints>• <lexicalConstraint matchRule="MustMatch">• <searchString>*Rh*</searchString>• </lexicalConstraint>• </lexicalConstraints>• </constraints>• </relatedConcept>
  • 22. OTS Features• Terminology support – Support for multiple terminology • linking concepts by relationships (hierarchies) • property based – Support for terminologies in their native structures – Access to terminologies in any database technology• Queries – Queries may be pre‐defined and made available to all users – Queries based on queries – Provide a high‐level mechanism for identifying concepts relevant  to local requirements
  • 23. OTS Features• Query language – XML based – terminology‐independent – allows selection or navigation around relevant concepts depending on the  situation. – powerful expressive capabilities across trees, multiple links and iterative structures• Visual interface – hierarchical navigation – rapid text searches – visual specification of queries• Computer Interfaces – Global Web Service interface accessible to all – Class library available for local .NET usage
  • 24. Q&