Does mapping to SNOMED CT improve precision of subjective clinical evaluations ?
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Does mapping to SNOMED CT improve precision of subjective
clinical evaluations?
SHI2010 presentationKirstine Rosenbeck Gøeg & Anne Randorff Rasmussen
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INTRODUCTION
Semantic of clinical documentation
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Ambiguous documentation
“Impairment of vision”
Worsening of something chronic
First diagnose
Impairment causing change of occupation
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A problem?
• Interview 2009 “Vi har nogle begreber som vi har brugt i årevis, eksempelvis tilladelig blødning..... nogen der siger, at det er 100ml, mens andre siger at det er det i hvert fald ikke. Så der opdager vi, at vi ikke har den samme opfattelse. Så der må vi blive enige om at tilladelig blødning er under 100ml, hvis moren ellers har det godt, blodtrykket holder og hun ikke besvimer. Der var så meget mere, der skulle knyttes til sådan et begreb....”
• Rector 1999 “Common usage may differ from the expectations of information retrieval, e.g. it may seem odd to say that ‘The fingernail is a part of the arm’, but it would be an error not to retrieve ‘evulsion of nail’ under ‘trauma to upper extremity’.”
Interview 2009: http://projekter.aau.dk/projekter/files/17651356/speciale-rapportTilUdskrift.pdfRector 1999: Why is terminology so hard? Method Inform Med 1999; 38: 239–52
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A problem?
• Increasingly possible to– Exchanging information to
perform shared care– Use data for statistical
purposes
• Characterised by– No input validation– Most likely to stay in one
organisation and being used only for patient treatment purposes
Semantic precision!
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METHOD
Mapping subjective evaluations to SNOMED CT
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Method• Two cases
– Tolerable bleeding/ Tilladelig blødning
– Eating too little/ Småtspisende
• Charaterised by– Real life examples of clinical
evaluations– From spring 2009– Expressed difficulties in
mapping from paper documentation to electronic documentation
• Three approaches to improve precision using SNOMED CT– Mapping to existing pre-
coordinated SNOMED CT terms consisting of a finding and a qualifier. Map the evaluation as is, without interpretation.
– Mapping by analysing the clinical situation/context in which the evaluation is obtained.
– Mapping by nesting the subjective evaluation with the rationale behind the evaluation.
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RESULTS
SNOMED CT mappings
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Existing pre-coordinated terms
Hemorrhage
Actute Massive Subacute ChronicDiffuse
Bleeding(finding)Associated morphology
Finding of vaginal bleeding
Normal menstual Fresh Scanty Moderate Profuse Abnormal
Bleeding(finding)
Finding of quantity of eating
Binging Excessive Fasting Overeating
Finding of eating pattern
Picky eater Greediness
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Adding the context of the finding
Finding: Tolerable bleeding
Context: During labour
Maternal blood loos within normal
limits
SNOMED CTmapping
Finding: Eating too little
Context: Screening, some time duration
Inadequate dietary caloric intake,
continual
Inadequate dietary caloric intake,
continual
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Nesting observation and evaluation
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DISCUSSION
Choosing between mappings
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Discussion
• A study with only two clinical expressions – pros and cons
• Choosing between the three approaches?– Mapping directly is not recommended based on
the results of this study – Considering the clinical situation and
consequences of different mappings– Asking clinical experts
• Can levels of precision be pre-specified?
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• Correspondence:Kirstine Hjære RosenbeckPhD Fellow, Aalborg UniversityDepartment of Health Science and Technology
E-mail: [email protected]:+45 9940 8835