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Accessing SNOMED CT With FHIR Terminology Services

Expediting SNOMED CT implementation in New Zealand with FHIR Terminology Services.

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Accessing SNOMED CT With FHIR Terminology Services

  1. 1. FINDING WITH FHIR HL7NZ Standards Workshop– June27, 2016 Accessing SNOMED CT With FHIR Terminology Services PeterJordanMScLLBMCPD Vice-ChairHL7NewZealand
  2. 2. Page 2 • HL7 New Zealand The SNOMED CT Landscape in NZ • Comprehensive Terminology > 300,000 active concepts…each with multiple descriptions & relationships. • Endorsed by MoH for EHR clinical content coding at point of care. • Replacing Read Codes in primary care. • Numerous implementation options…  A code system – store information  An interface Terminology – capture & display  An indexing system - retrieve  A common terminology – meaningful communication & integration  A dictionary – query, analyse & report; link health records to knowledge resources • 2016 SNOMED CT Expo: Oct 27-28 Wellington
  3. 3. Page 3 • HL7 New Zealand The Problem • Terminology is HARD: very few – if any – existing systems do it well. • Consistency required for clinical safety and downstream uses (analytics, research, etc.). • Friendly & efficient UIs (controls or text + Natural Language Processing?) • HIE issues are common to ALL systems • Risks of individual implementation approach – Inconsistent implementations – e.g. pre or post coordination? – Version Lags if Facility/Vendor based deployment – Duplicate/Overlapping Reference Sets – Inconsistent Mapping to Read (NZ variations)
  4. 4. Page 4 • HL7 New Zealand Mitigation • Sector-wide implementation • National Release Centre – single source • National Reference Sets • Single set of NZ Read to SCT maps • Terminology Services • Common standards-based APIs
  5. 5. Page 5 • HL7 New Zealand Terminology Services • Repository of coded clinical concepts, descriptions & relationships plus tools for maintenance of vocabulary resources, but… • There’s a lot of complexity here: o Code Systems / Ref Sets / Value Sets / Bindings o Value Sets are complex (intensional, extensional, implicit) o Underlying terminology logic much more complex (expressions) • Most applications much simpler o List of codes and displays in some table structure o This is a known problem – in many countries
  6. 6. Page 6 • HL7 New Zealand Terminology Services API • Bridge the Gap: delegate all this complexity to specialist software • Provide a set of services that do what applications need • It becomes easy to write applications that do terminology well • FHIR – a framework well-suited to building these APIs.
  7. 7. Page 7 • HL7 New Zealand Application Needs • Give me a list of codes (filtered by term, super type, expression) • How do I display this code? • Is this code valid? • Translate this code to a different code system • Integrate terminology search into my application (including client-side caching)
  8. 8. Page 8 • HL7 New Zealand Application Needs API Gives • Give me a list of codes (filtered by term, super type, expression) • How do I display this code? • Is this code valid? • Translate this code to a different code system • Integrate terminology search into my application (including client-side caching) • $expand • $lookup • $validate-code • $translate • $closure
  9. 9. Page 9 • HL7 New Zealand FHIR Terminology Resources • Code System – defines a set of codes with meanings, e.g. URL, version, description, key properties, filters • Value Set – selects a set of codes from one, or more, Code Systems constructed from…  Inline code system or..  Set of codes defined in other code systems, e.g. SNOMED CT by listing the codes (extensional) and/or providing selection criteria (intensional)  Can be expanded – turned into a simple collection of enumerated codes & descriptions, ready to use for data entry or validation. • Concept Map – mappings between Code Systems
  10. 10. Page 10 • HL7 New Zealand Using SNOMED CT With FHIR Value Sets • Implicit Value Sets o defined as part of each request o provide a interface to distinct subsets o basis for $expansion operations [base]/ValueSet/$expand o URLs with base identifier ?identifier=http://snomed.info/sct/ 900000000000207008 /version/20160131 …plus a query portion defining scope… o All concepts in the edition/version /fhir_vs ...but maybe add a text filter! /fhir_vs&filter=midlife o All concepts subsumed by (descendants of) another concept /fhir_vs=isa/38341003 o All concepts in specified reference set /fhir_vs=refset/450970008
  11. 11. Page 11 • HL7 New Zealand NZ Implementation Example • Patients First Terminology Server http://its.patientsfirst.org.nz/RestService.svc/Terminz NB: Display preferred terms, rather than fully specified names.
  12. 12. Page 12 • HL7 New Zealand Questions and Comments? Next steps…beta testing! Test Page: http://itp.patientsfirst.org.nz/Home/Terminology Feedback to peter.jordan@patientsfirst.org.nz

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