Terminology and Classification


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Mary-Ellen Wetherspoon
Senior Advisor – Clinical Coding
New Zealand Health Information Service
14 December 2007

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  • Terminology and Classification

    1. 1. Terminology and Classification Mary-Ellen Wetherspoon Senior Advisor – Clinical Coding New Zealand Health Information Service 14 December 2007
    2. 2. SNOMED CT ® Taking the mystery out of SNOMED CT ®
    3. 3. Is SNOMED CT ® better than ICD?
    4. 4. Which one is better?
    5. 5. ICD and SNOMED CT ® <ul><li>DIFFERENT: </li></ul><ul><ul><li>Entities </li></ul></ul><ul><ul><li>Capability </li></ul></ul><ul><ul><li>Uses </li></ul></ul>
    6. 6. Definition Basics <ul><li>Coding </li></ul><ul><li>Classifications </li></ul><ul><li>Terminology </li></ul>
    7. 7. Coding <ul><li>Simply assign a code value to a code meaning </li></ul><ul><li>ACUTE RENAL FAILURE </li></ul><ul><ul><li>SNOMED CT – 14669001 </li></ul></ul><ul><ul><li>ICD-10-AM – N17.9 </li></ul></ul>
    8. 8. Classifications <ul><li>Group together concepts for a specified purpose </li></ul><ul><li>K91.1 Postgastric surgery syndromes </li></ul><ul><ul><li>Syndrome : </li></ul></ul><ul><ul><ul><ul><li>dumping </li></ul></ul></ul></ul><ul><ul><ul><ul><li>postgastrectomy </li></ul></ul></ul></ul><ul><ul><ul><ul><li>postvagotomy </li></ul></ul></ul></ul>
    9. 9. ICD <ul><li>I nternational Statistical C lassification of D iseases and Health Related Problems </li></ul>
    10. 10. The Family
    11. 11. Features of Classification <ul><li>A single axial classification </li></ul><ul><ul><li>Viral pneumonia - infection or a respiratory disease? </li></ul></ul>
    12. 12. Respiratory Disease <ul><li>J = respiratory disease </li></ul><ul><li>J1 = influenza and pneumonia </li></ul><ul><li>J12 = viral pneumonia NEC </li></ul><ul><li>J12.0 = adenoviral pneumonia </li></ul>
    13. 13. But in some instances <ul><li>J10.1 = influenza with pneumonia (influenza virus identified) </li></ul><ul><li>B25.0† = cytomegaloviral pneumonitis (J17.1*) </li></ul><ul><li>P23.0 = congenital pneumonia due to viral agent </li></ul>
    15. 15. Other = not G25.0, not G25.1 Other = not G25.4 Other specified ‘something’ but not anything that is a member of G25.0, G25.1, G25.2, G25.3, G25.4, G25.5, G25.6 We don’t know what this is, but it should be a member here somewhere, but NOT in any other G25.x
    16. 16. How is it used <ul><li>Collection and reporting of basic health statistics </li></ul><ul><li>Quality database storage for accurate clinical and statistical data </li></ul><ul><li>Monitoring of public health </li></ul><ul><li>Model of designing reimbursement systems </li></ul><ul><li>Information can be used to improve clinical, financial and administrative performance </li></ul>
    17. 17. If it is built for everything it will be fit for nothing! <ul><li>Useful for analysis </li></ul><ul><li>Stable over time </li></ul><ul><li>Rules and Standards </li></ul><ul><li>Reasonably straight forward to implement </li></ul><ul><ul><li>Specialist skills </li></ul></ul><ul><li>Not able to be used in a patient record </li></ul><ul><li>Not elsewhere classified and Not otherwise specified </li></ul><ul><li>Not enough detail </li></ul>
    18. 18. Terminologies <ul><li>Reference features </li></ul><ul><ul><li>Inter-relate and define concepts </li></ul></ul><ul><li>Interface features </li></ul><ul><ul><li>Synonyms, search keys, subsets, etc to ease consistent entry and display </li></ul></ul>
    19. 19. SNOMED CT ® <ul><li>S ystematized NO menclature of MED icine </li></ul><ul><li>C linical T erms </li></ul>
    20. 20. SNOMED CT ® <ul><li>Clinical terminology </li></ul><ul><li>Consistent storage </li></ul><ul><li>Enabler of EHR </li></ul>
    21. 21. What it is <ul><li>Ontology </li></ul><ul><li>Self defining knowledge model </li></ul><ul><li>Empirical </li></ul><ul><li>Poly-hierarchical </li></ul><ul><li>Highly faceted </li></ul><ul><li>Flexible </li></ul><ul><li>Agile </li></ul>
    22. 22. What it isn’t <ul><li>Dictionary </li></ul><ul><li>Lists of terms, codes </li></ul><ul><li>Reference tables </li></ul><ul><li>Classification system </li></ul><ul><li>Software </li></ul><ul><li>Information system </li></ul><ul><li>Simple </li></ul>
    23. 23. Concepts <ul><li>A unit of meaning </li></ul><ul><li>Distinct </li></ul><ul><li>Unambiguous </li></ul><ul><li>Unique numeric identifier </li></ul><ul><li>Unique name </li></ul><ul><li>Descriptions </li></ul>
    24. 24. Descriptions <ul><li>Each concept has: </li></ul><ul><li>Fully Specified Name (FSN) </li></ul><ul><li>Preferred Term </li></ul><ul><li>Concepts may have: </li></ul><ul><li>One or more synonyms </li></ul>
    25. 25. Hierarchies <ul><li>19 Upper level hierarchies </li></ul><ul><li>Sub-hierarchies </li></ul>
    26. 26. Relationships <ul><li>Is_A relationships link concepts within a hierarchy </li></ul><ul><li>Attribute relationships link concepts between other hierarchies </li></ul>
    27. 27. How it works <ul><li>Concepts organised into hierarchies </li></ul><ul><li>Descriptions or synonyms express clinical concepts </li></ul><ul><li>Semantic relationships enable robust, reliable and consistent data retrieval </li></ul><ul><li>Cross mapping </li></ul>
    28. 28. Concept Definitions <ul><li>SNOMED CT ® defines ‘viral pneumonia’ as follows: </li></ul>viral pneumonia is a viral respiratory infection is a infective pneumonia causative agent virus associated morphology inflammation associated morphology consolidation finding site lung structure
    29. 29. SNOMED CT ® – Viral Pneumonia <ul><li>The ‘is a’ relationships represent a hierarchy of subtypes </li></ul>Viral pneumonia Viral respiratory infection Infective pneumonia viral pneumonia is a viral respiratory infection is a infective pneumonia causative agent virus associated morphology inflammation associated morphology consolidation finding site lung structure
    30. 30. Concept Id 75570004 Viral pneumonia Viral respiratory infection Respiratory tract infection SNOMED CT® Concept Infection by site Infectious disease Disorder of respiratory system Respiratory finding Viral infection by site Viral disease Infective pneumonia Infectious disease of lung Disorder of lung Disorder of lower respiratory system Lung finding Lower respiratory tract finding Lower respiratory tract infection Pneumonia Pneumonitis Inflammatory disorder of lower respiratory tract Inflammatory disorder of the respiratory tract Inflammatory disorder of the respiratory system Lung consolidation Finding by site Finding of trunk structure Finding of body region Finding of region of thorax Viscus structure finding Clinical finding Disorder by body site Disorder of body system Disorder of thorax Disorder of trunk Disorder of body cavity Disease Inflammation of specific body systems Inflammation of specific body structures or tissue Inflammation of specific body organs Inflammatory disorder causative agent virus G associated morphology inflammation associated morphology consolidation finding site lung structure
    31. 31. How is this used <ul><li>Supports effective selective retrieval for decision support and research </li></ul><ul><li>Viral Pneumonia – </li></ul><ul><ul><li>All viral diseases </li></ul></ul><ul><ul><li>All infectious diseases </li></ul></ul><ul><ul><li>All respiratory disorders </li></ul></ul><ul><ul><li>All inflammatory disorders </li></ul></ul><ul><li>All these are true and common to someone who has viral pneumonia </li></ul>
    32. 32. Other Uses <ul><li>Facilitate E – data collection at the point of care </li></ul><ul><li>Detailed capture of specific clinical information </li></ul><ul><li>Synergy between different sites and providers </li></ul>
    33. 33. One without the other <ul><li>Terminology and Classification are fundamentally different </li></ul><ul><li>Not designed to compete </li></ul><ul><li>Duality = completeness </li></ul>
    34. 34. An example <ul><li>20-Jul-07: 21522001 | abdominal pain | 19:30) 268941000 | O/E - abdo. pain on palpation | Diagnosis 196652006 | acute duodenal ulcer | </li></ul><ul><li>21:45) 8765009 | haematemesis | </li></ul><ul><li>21-Jul-07 : 79922009 | epigastric pain | 01:10) 246112005 | severity | = 24484000 | severe | </li></ul><ul><li>Radiology 17204006 | pneumoperitoneum | Diagnosis 88968005 | duodenal ulcer with perforation | </li></ul><ul><li>ICD-10-AM </li></ul><ul><ul><li>K26.2 Duodenal ulcer, acute with both haemorrhage & perforation </li></ul></ul>
    35. 35. Needing SNOMED CT ® <ul><li>It will be legible </li></ul><ul><li>Encourages more detail </li></ul><ul><li>Decrease duplication </li></ul><ul><li>Less ambiguous </li></ul><ul><li>More communicable </li></ul><ul><li>Consistency leads to better sharing of information </li></ul><ul><li>Improved granularity for research purposes </li></ul>
    36. 36. Mapping <ul><li>Make SNOMED CT ® more like ICD? </li></ul><ul><li>Make ICD more like SNOMED CT ® ? </li></ul><ul><li>Either approach will corrupt the purpose and power of both! </li></ul>
    37. 37. Challenges <ul><li>Interchangeable </li></ul><ul><ul><li>Scope, domain, different use cases </li></ul></ul><ul><li>A continuum </li></ul><ul><ul><li>Logic, structures, relationships differ, not just a measure of granularity </li></ul></ul><ul><li>Seamlessly interoperable </li></ul><ul><ul><li>Words may be common, but context, hierarchical structures and logic alter meaning </li></ul></ul><ul><li>Stand alone </li></ul><ul><ul><li>Needs some form of middle tier services and support </li></ul></ul>
    38. 38. SNOMED CT ® to ICD-10-AM <ul><li>No use case for Australian purposes yet specified </li></ul><ul><li>Epidemiology? Reimbursement? Semi-automated? Guide for Coders? </li></ul><ul><li>Feasibility studies – results expose difficulties not yet solutions </li></ul><ul><li>Share some common ground with US approach </li></ul>
    39. 39. What is needed <ul><li>Formal, well specified use cases </li></ul><ul><li>Agreed proven and standard mapping methods </li></ul><ul><li>SNOMED education </li></ul><ul><li>Terminology and classification knowledge </li></ul><ul><li>International convergence and co operation </li></ul><ul><li>Tools, infrastructure, time </li></ul><ul><li>Governance </li></ul>
    40. 40. Harmonisation <ul><li>Work is underway between the IHSTDO and WHO to develop a SNOMED CT ® to ICD-10 map </li></ul>
    41. 41. Differences <ul><li>SNOMED CT ® </li></ul><ul><li>Inheritance </li></ul><ul><li>IS-A </li></ul><ul><li>Definitions </li></ul><ul><li>Multi-counting </li></ul><ul><li>Relationships </li></ul><ul><li>No nominals </li></ul><ul><li>Unable to aggregate for statistics </li></ul><ul><li>ICD </li></ul><ul><li>Nominals </li></ul><ul><li>NOT </li></ul><ul><li>Mutual exclusivity </li></ul><ul><li>No clinical definitions </li></ul><ul><li>Clinical face validity </li></ul><ul><li>Statistical utility and conventions </li></ul>
    42. 42. ICD 11 <ul><li>Clinical currency, update and enhance </li></ul><ul><li>Provide more specificity </li></ul><ul><li>Remove ambiguity </li></ul><ul><li>Make rules and conventions more explicit </li></ul><ul><li>Improve index, include greater specificity </li></ul>
    43. 43. Future Prospects <ul><li>Mapping between SNOMED CT ® and ICD will improve both, WITHOUT wholesale structural change or replication of either instrument </li></ul>
    44. 44. Thanks to <ul><li>NZHIS colleagues </li></ul><ul><li>NCCH terminology project team especially Donna Truran, Margaret Campbell, Patricia Saad and Kerry Innes </li></ul><ul><li>International colleagues for public availability of their knowledge and materials </li></ul>