Making openEHR Terminology binding practice Jussara Rötzsch Adapted from Ian McNicoll
Terminology binding patterns• Direct node‐binding – e.g. ‘Urine color’ node • Node name e.g.. “Urine color” – Automatically has unique internal term ‘at0007’ – Can be ‘run‐time’ coded by external term – Can be ‘run‐time’ mapped to an external term • Node value e.g.. ‘Red, yellow, purple’ – Unique term provided by Internal value set ‘at0009’ – External term mapped to term from Internal value set – External term used as the value
Direct‐binding issues• Incomplete terminology / translation coverage – e.g.. SNOMED – 50‐70% for histopathology• Effort – Requires very good terminology skills • Can be challenging to choose correct bindings – Some concepts require post‐coordination to capture correctly – Is it worth trying to achieve complete node binding?
Direct‐binding guidance• Concentrate on current requirements – Archetypes and templates ‘fix’ the semantics • Initial efforts guided by actual requirements • More bindings can be added later as requirements evolve – Node bindings • Use internal value sets. Consider leaving ‘open to allow for local variation. • Add External terminology bindings where required and available
Termset‐binding issues• Very little at Archetype‐level – Scope of the termset binding is often too broad to be meaningful at implementation • E.g. ‘All procedures’ in ACTION.procedure archetype – Very few examples of sensible termset‐bindings in international archetypes – Much more applicable at national level • esp. National terminologies
Termset‐binding guidance• Almost all at Template‐level – Layered constraint approach • All procedures – Orthopedic procedures » Knee specialist procedures – But generally have to provide option to override the constraint for unusual clinical situations • e.g.. Non‐orthopedic procedure carried out in Orthopedic department.
Termset‐binding guidance• Microsoft / NHS Common User Interface (CUI) – Layered constraint with ‘termset filters – ‘Get‐out clause’ where constraint is too tight
Example: “Family history” Term bound to node Name ? 371534008 |Summary report (record artifact) ? 422735006 |Summary clinical document (record artifact) Termset-bound to node Value: (Is_a genetic relation) 444148008 | Person in family of subjectTerm bound to node Name:408732007 | Subject Term bound to node internal Value set:relationship context [at0004|Not known] =365873007|Gender unknown (finding)(attribute) [at0004|Not known] =UNK|Gender unknown [at0005|Male] = SNOMEDCT::248153007 | Male (finding) [at0005|Male] = KITH-SEX::M| Male [at0006|Female] = 248152002 | Female(finding) [at0006|Female] = KITH-SEX::F | FemaleTerm bound to node Name:184100006 | Patient sex(observable entity OR Termset-bound to node Value: (??????) 429019009 | Finding related to biological sex
Assessed risk : Family history No matches found in SNOMED CT