Mapping of Terminology Standards, a Way for Interoperability (Position Paper)
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Standards in medicine are essential to enable communication between healthcare providers. These standards can be used either for exchanging information, or for coding and documenting the health status of a patient. In this position paper we focus on the latter, namely terminology standards. However, the multidisciplinary field of medicine makes use of many different standards. We propose to invest in an interoperable electronic health record (EHR) that can be understood by all different levels of health care providers independent of the kind of terminology standard they use. To make this record interoperable, we suggest mapping standards in order to make uniform communication possible. We suggest using mappings between a reference terminology (RT) and other terminology standards. By using this approach we limit the number of mappings that have to be provided. The Systematized Nomenclature of Medicine, Clinical Terms (SNOMED CT) can be used as a RT, because of its extensive character and the preserved semantics towards other terminology standards. Moreover, a lot of mappings from SNOMED CT to other standards are already defined previously.
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Mapping of Terminology Standards, a Way for Interoperability (Position Paper)
- 1. 18-09-2015 pag. 1 Mapping of Terminology Standards, a Way for Interoperability Position Paper Sven Van Laere, Frank Verbeke, Frederik Questier, Ronald Buyl, Marc Nyssen 18 Sept 2015 @ ICTRS, EHST 2015 – Rhodes, Greece
- 5. 22-9-2015 pag. 5 Explanation Mapping of Terminology Standards, a Way for Interoperability Position Paper Mapping of Terminology Standards, a Way for Interoperability Position Paper Mapping of Terminology Standards, a Way for Interoperability Position Paper Mapping of Terminology Standards, a Way for Interoperability Position Paper
- 6. 22-9-2015 pag. 6 Position Paper • Position paper • Present an arguable opinion about an issue • eHealth, knowledge sharing, … • State an opinion without the need to present validated results • Short report and discussion of ideas • Facts • Situations • Methods • Procedures • Results of scientific research
- 7. 22-9-2015 pag. 7 Terminology standards • Standards in medical practice – Exchange of information COMMUNICATION STANDARDS – Documenting and coding of data TERMINOLOGY STANDARDS
- 8. 22-9-2015 pag. 8 Interoperability • Interoperability Antonio Aguilar A state which exists between two application entities when, with regard to a specific task, one application entity can accept and understand data from the other and perform that task in an appropriate and satisfactory manner without the need for extra operator intervention.
- 9. 22-9-2015 pag. 9 Interoperability • Interoperability in eHealth Antonio Aguilar for whom? - healthcare companies e.g. vendors of clinical systems, administrative IT systems and medical devices - healthcare providers e.g. GPs, physicians, nurses, technicians, etc. - IT and administrative staff - health authorities and governments
- 10. 22-9-2015 pag. 10 Interoperability • Interoperability levels Antonio Aguilar - functional and syntactic interoperability the ability of two or more systems to exchange information through functionality and defined message structures so that this information is human readable by the receivers e.g. HL7 v2, DICOM - semantic interoperability the ability for information shared by systems to be understood at the level of formally defined domain concepts so that the information is computer processable by the receiving systems e.g. HL7 v3 RIM, SNOMED CT
- 11. 22-9-2015 pag. 11 Terminology standards • Interoperability levels Antonio Aguilar - functional and syntactic interoperability the ability of two or more systems to exchange information through functionality and defined message structures so that this information is human readable by the receivers e.g. HL7 v2, DICOM - semantic interoperability * the ability for information shared by systems to be understood at the level of formally defined domain concepts so that the information is computer processable by the receiving systems e.g. HL7 v3 RIM, SNOMED CT
- 12. 22-9-2015 pag. 12 Motivation • Motivation –Healthcare with too many standards • ICPC-2 • ICD • LOINC –Different levels • ICPC-2 used by GP • ICD used for billing • LOINC used for laboratory results
- 13. 22-9-2015 pag. 13 Motivation • Motivation –In the medical history we evolved from free text (60-ies) to structured language • Free text • Codes • Classifications • Terminologies • Nomenclatures de Lusignan
- 14. 22-9-2015 pag. 14 Motivation • Motivation –No continuity in healthcare 1 2 Referral 3 4 GP Hospital
- 15. 22-9-2015 pag. 15 Start to invest in putting a bridge between different terminologies
- 16. 22-9-2015 pag. 16 Mapping • How to… • Mapping A linkage between a concept from one standard to another standard based on the equivalence between the two concepts
- 17. 22-9-2015 pag. 17 Mapping • How to… • Mapping rules • Consider the place in the hierarchy of a terminology standard • Consider the semantics of a concept • Consider the relationship with other concepts around a concept
- 18. 22-9-2015 pag. 18 Mapping • How to… • Manual mapping human knowledge of medical experts, linguists, terminology experts, … • Semi-automatic mapping • Computer algorithm identifies candidate mappings based on descriptions • Human review of the automatic mapping
- 19. 22-9-2015 pag. 19 Variety of standards • We know… • The principles of mapping now • But… • How do we deal with the wide variety of standards (ICPC-2, ICD-10, LOINC, NANDA, SNOMED CT,…)
- 20. 22-9-2015 pag. 20 Variety of standards 𝑁 ∙ (𝑁 − 1) 2 𝑁
- 21. 22-9-2015 pag. 21 What RT to choose? • Choose most comprehensive • SNOMED CT • 310,000 concepts • Support pre- and post-coordination • Still under evaluation • Assess-CT project http://www.assess-ct.eu/
- 22. 22-9-2015 pag. 22 What RT to choose? • Another option • UMLS • However some semantic differences…
- 23. 22-9-2015 pag. 23 What RT to choose? •Another option •UMLS semantic problems compared to SNOMED CT • Substance/product • Aspirin (substance) • Aspirin (product) • Morphologic abnormality / clinical finding • Glomus tumor (morphologic abnormality) • Glomus tumor (disorder) • … https://www.nlm.nih.gov/research/umls/Snomed/ snomed_represented.html
- 24. 22-9-2015 pag. 24 New ideas • Is this idea of mapping new? NO • Then what is new? • The idea of using one single reference terminology • The idea that we should start mapping to one single reference terminology • Reference terminologies can lead to (semantic) interoperability between care providers • … leading to CDS eventually
- 25. 22-9-2015 pag. 25 Message to take home •Start contributing to mappings •Start using a reference terminology •Don’t wait until another starts
- 26. 22-9-2015 pag. 26 References • Aguilar, A. 2005. Semantic Interoperability in the Context of e-Health. In CDH Seminar ’05, Galway, Ireland. • ASSESS-CT. 2015. ASSESS CT - Assessing SNOMED CT for Large Scale eHealth Deployments in the EU. Available from: http://www.assess-ct.eu • de Lusignan, S. 2005. Codes, classifications, terminologies and nomenclatures: definition, development and application in practice. Informatics in Primary Care, 13(1), 65-70. • IHTSDO. 2014. Mapping to SNOMED CT. Discussion and Guidance on Mapping Based Solutions Design for Migration or Transformation. Available from: https://csfe.aceworkspace.net/sf/go/doc10065