A Clinical Terminology Server at the University Hospital UZB, Brussels
Dr. Benny Van Bruwaene, M.D. Semantic Interoperability Committee
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14-9-2009
Coding clinical information
Billing MKG/RCM (diagnoses) RIZIV/INAMI (procedures)
Reason of encounter ICPC
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Epidemiology Clinical Pathways Kwaliteitsindicatoren Drug surveillance Studies
14-9-2009
Coding clinical information Solution
Summary/Problem list in the E.P.R. No abstraction needed
Terminology server Controlled Medical Vocabulary
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14-9-2009
Terminology server UZB
Controlled Medical Vocabulary Dutch terms
Snomed CT Ontology
Term Finder Syntactic (Fast Type) Semantic (Fast Code, NLP)
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Term Finder Syntactic
Semantic
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Term Finder Syntactic
Semantic
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Controlled Medical Dictionary Multiple coding systems Term
ICD MKG D
ICD ok
Snomed CT number
Snomed ok
diabetes mellitus type 1 met proteïnurie
25001|5851
diabetes mellitus type 1
25001
0
46635009
diabetes mellitus type 1, slecht gecontroleerd
25003
0
190371008
diabetes mellitus type 2 met microalbuminuria
25000|5851
0
401112005
brittle diabetes mellitus type 1
25003
0
11530004
diabetes mellitus type 2 met majeur defect in insulinesecretie
25000
0
73211009
0
diabetes mellitus type 2 met majeure insulineresistentie
25000
0
9859006
0
diabetes mellitus type 2 bij obesitas
25000|27800
0
81531005
diabetes mellitus type 2
25000
0
73211009
diabetes mellitus type 2 zonder obesitas
25000
0
359642000
diabetisch cataract
25050|36641
43959009
diabetische retinopathie
25050|36201
4855003
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401109007
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Controlled Medical Dictionary Multiple coding systems Term
ICD9-CM
Operating Room
RIZIV
multipele segmentale dikdarm resectie
4571
ECPARCOL
243062|731382
abdominale resectie caecum en terminaal ileum
4572|4593
REILECAE
243084|731382
abdominale resectie caecum en terminaal ileum met stomie
4572|4620|4610
REILECAE
243084|731382
laparoscopische resectie caecum en terminaal ileum
4572|4593
SOILECAE
243084|731382
laparoscopische resectie caecum en terminaal ileum met stomie
4572|4620|4610
SOILECAE
243084|731382
abdominale rechter hemicolectomie
4573
ECREHEMI
243062|731382
laparoscopische rechter hemicolectomie
4573
SOREHEMI
243062|731382
laparoscopische rechter hemicolectomie met stomie
4573|4620|4610
SOREHEMI
244064
abdominale resectie van het colon transversum
4574
ECPARCOL
243062|731382
abdominale resectie van het colon transversum met colostomie
4574|4610
ECCOLVEL
243084|731404
laparoscopische resectie van het colon transversum
4574
SOPARCOL
243062|731382
abdominale linker hemicolectomie
4575
ECLIHEMI
243062|731382
abdominale linker hemicolectomie met anastomose rectum
4575|4594
ECLIHEMI
243062|731382
abdominale linker hemicolectomie met colostomie
4575|4610
ECLIHEMI
243084|731404
laparoscopische linker hemicolectomie
4575
SOLIHEMI
243062|731382
laparoscopische linker hemicolectomie met anastomose rectum
4575|4594
SOLIHEMI
243062|731382
laparoscopische linker hemicolectomie met colostomie
4575|4610
SOLIHEMI
243084|731404
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Controlled Medical Dictionary Attributes Type of concept Term
Type
acute respiratoire acidose
problem.disorder
chronische respiratoire acidose
problem.disorder
respiratoire acidose
problem.disorder
respiratoire alkalose
problem.disorder
respiratoire infectie bij mucoviscidose
problem.disorder
pneumonie door respiratoir syncytium virus
problem.disorder
bilaterale pneumonie met respiratoire insufficiëntie (O2-druk<60 mm Hg)
problem.disorder
community acquired pneumonia (CAP) met respiratoire insufficiëntie (O2-druk<60 mm Hg)
problem.disorder
hospital acquired pneumonia (HAP) met respiratoire insufficiëntie (O2-druk<60 mm Hg)
problem.disorder
pneumonie met respiratoire insufficiëntie (O2-druk<60 mm Hg)
problem.disorder
acute respiratoire decompensatie (O2-druk<60 mm Hg) respiratoire decompensatie (O2-druk<60 mm Hg)
problem problem.disorder
acute respiratoire distress
problem.finding
respiratoire insufficientie (O2-druk<60 mm Hg)
problem.disorder
chronische respiratoire decompensatie (O2-druk<60 mm Hg)
problem
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Controlled Medical Dictionary Attributes – Chronic Snomed CT number
Term
Chronic
401112005 diabetes mellitus type II met microalbuminuria
1
359642000 diabetes mellitus type II zonder obesitas
1
46635009 diabetes mellitus type I 401109007 diabetes mellitus type I met proteïnurie 11530004 brittle diabetes mellitus type I
1 1 1
190371008 diabetes mellitus type I, slecht gecontroleerd 24927004 diabetes mellitus type II met keto-acidose 371055001 diabetes mellitus type I met keto-acidose 190329007 diabetes mellitus met hyperosmolair coma 26298008 diabetisch coma met keto-acidose
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Controlled Medical Dictionary Attributes – ICD code History
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Term
History
PTCA van meerdere coronaire vaten in één enkele operatietijd
V4582
PTCA van meerdere coronaire vaten met plaatsing drug eluting stent
V4582
PTCA van meerdere coronaire vaten met plaatsing non-drug eluting stent
V4582
aortocoronaire bypass van 1 kransslagader
V4581
Term
History
maligne slokdarmneoplasma
V1003
primair maligne slokdarmneoplasma
V1003
recidief van maligne slokdarmneoplasma
V1003
spinocellulair slokdarmcarcinoom
V1003
maligne neoplasma van de cardia
V1004
maligne neoplasma van de cardio-oesofageale overgang
V1004
primair maligne neoplasma van de cardia
V1004
14-9-2009
Controlled Medical Dictionary Coding guidelines Term
Comment
acute respiratoire acidose chronische respiratoire acidose respiratoire acidose respiratoire alkalose respiratoire infectie bij mucoviscidose
code pneumonie coderen als HD
pneumonie door respiratoir syncytium virus bilaterale pneumonie met respiratoire insufficiëntie (O2-druk<60 mm Hg) community acquired pneumonia (CAP) met respiratoire insufficiëntie (O2-druk<60 mm Hg) hospital acquired pneumonia (HAP) met respiratoire insufficiëntie (O2-druk<60 mm Hg) pneumonie met respiratoire insufficiëntie (O2-druk<60 mm Hg) acute respiratoire decompensatie (O2-druk<60 mm Hg) respiratoire decompensatie (O2-druk<60 mm Hg) acute respiratoire distress respiratoire insufficientie (O2-druk<60 mm Hg) chronische respiratoire decompensatie (O2-druk<60 mm Hg)
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Terminologieserver
Fast entry Few characters Abbreviations
Precise Standardised terminology (foreign doctors!)
Coding Automatic Multiple codes Coding comments for coding personnel
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Attributes -> Artificial Intelligence
14-9-2009
Snomed CT Cross maps ICD-9-CM
and ICD-10 cross maps
(semi-)automatic updating ICD-version Compatibility with external expert systems
clinical pathways, drug surveillance
Multiple data sets for studies, statistics
compatibility historical trends
UMLS
cross map -> MESH
Literature search 14
14-9-2009
Snomed CT Granularity Expert
system
Translation
Case Report Forms clinical trials Medical summary in English, French, Spanish for foreign patients Term 15
search more specific 14-9-2009
Granularity Study 2004
N=252
ICD-9-CM
SNOMED CT
Used term more specific than Code
52%
11%
Code dependent on context
6%
2%
Used term = Code
42%
86%
Snomed CT Ontology Relationships Grouping
Artificial intelligence Statistics
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14-9-2009
Snomed CT Ontology
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Snomed CT Weaknesses No
ICD-9-CM cross maps for Procedures
Only
85 % exact match
Irrelevant/Invalid
concepts
Vague, ambiguous Synonyms, overlapping Attributes
Not normalised Incomplete French? 19
14-9-2009
Building Controlled Medical Dictionary Practical strategy
Selection of used ICD-codes in last 5 years
Crossmap: used ICD-codes -> Snomed Concepts
Translation of Snomed Concepts available in a Dutch ICD-index (dr. J.L. Mommaerts, MD)
Validation by clinicians coding personnel
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14-9-2009
Building Controlled Medical Dictionary
Relevant terms 15.000
12.500 diagnoses 2.500 procedures
No synonyms
Full control Choice of terms
Clinically relevant, Actual Unambiguous
Fast addition new terms
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14-9-2009
Use Medical Dictionary No synonyms
Necessity of semantic Term finder Updating Term finder
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14-9-2009
Term Finder
Language & Computing, Belgium
Syntactic
(alphabetical)
Semantic
Natural Language Processor
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14-9-2009
Term Finder Optimalisation Speed Syntactic
Semantic
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14-9-2009
Term Finder Syntactic Position
independent
Acu myoc <-> Myoc acu Typing
errors
Impact <-> Inpakt Elimination
type fonts (),-.
ST-Elevation <-> ST Elevation Ranking
Concordance
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Terminology server Syntactic
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Terminology server Syntactic
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14-9-2009
Term Finder Semantic String/term typed by doctor/nurse
Dutch Natural Language Processor
Snomed/ICD concepts
Connected Dutch terms CMV
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Term search ‘Cleft lip' ICD-based
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Term search ‘Cleft lip' Snomed
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Term Finder Semantic ICD-based
More sensitive (broad) Procedures Snomed-based
More specific (narrow) Procedures to be Snomed-coded
Actual choice: ICD
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Term Finder Semantic No synonyms Low set up cost Maintenance
necessary in CMV
High probability Learning CMV Didactic Ergonomic
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to find term
ranking for fast selection/entry
14-9-2009
A Clinical Terminology Server at the University Hospital UZB, Brussels
Dr. Benny Van Bruwaene, M.D. Demo
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14-9-2009
