Alberta Health Services Capital Health Palliative Care Program

Alberta Health Services Capital Health Palliative Care Program Clinical Vocabulary Pilot Project Update Friday April 24, 2009 Dennis Lee & Francis Lau 1

Presentation Outline p AHW Project Overview p What is SNOMED CT and Why? p Encoding Methodology and Results p Next Steps p Q&A’s 2

Project Overview p Objective: n 1 -yr pilot to design, implement and evaluate a standards-based palliative care information system (PCIS) p Project Phases: n Build palliative SNOMED CT terminology set n Enhance current PCIS with SCT n Implement enhanced PCIS for 10 -week trial use n Evaluate SCT-encoded, enhanced PCIS n Write-up lessons, year-2 plan 3

Presentation Outline p AHW Project Overview p What is SNOMED CT and Why? p Encoding Methodology and Results p Next Steps p Q&A’s 4

Musen paper 2 - Medical Informatics: Searching for Underlying Components 5 5

Presentation Outline p Project Overview p What is SNOMED CT and Why? p Encoding Methodology and Results p Next Steps p Q&A’s 7

Splitting Terms Data Elements Filtering Data Type Spelling Corrections Relational Database Coded Values Acronyms & Abbreviations Inferring Clinical Conditions INTERFACE TERMINOLOGY SNOMED CT Encoding Methodology Lexical Matching Historical Relationships SNOMED CT Reference Sets Encoded Terms Interface Terminology Set Precoordination Postcoordination Free Text Values SNOMED CT Extension Set Unencoded Terms Unencodeable Terms Set INPUTS DATA CLEANING PROCESS ENCODING PROCESS OUTPUTS 8

Inputs p Regional Palliative Care Program (RPCP) Database n Data Elements p. Gender p. Diagnosis p. Problem at Refer n Coded Values p. Gender: Male p. Diagnosis: Head & neck p. Problem: Dyspnea n Free Text Values p. Diagnosis: Esophageal ca p. Problem: Complain of fatigue 9

Data Cleaning Process Candidate Term Ca (l) lung (small cell) June 2003, Bran, Bone mets Splitting Terms Into Atomic Concepts Filtering Unmappable Data Types Ca (l) lung (small cell) June 2003 Filter off “June 2003” Bran Bone mets Correcting Spelling Mistakes Extending Acronyms & Abbreviations Inferring Clinical Condition “Ca” “carcinoma”; “l” “left” “Bran” “Brain” Small cell carcinoma of left lung “metastasis” “mets” “metastasis” Interface Terminology Brain metastasis Bone metastasis <observation class. Code="OBS" mood. Code="EVN"> <code="ASSERTION" code. System="2. 16. 840. 1. 113883. 5. 4"/> <value code. System="2. 16. 840. 1. 113883. 6. 96" code. System. Name="SNOMED CT" code="254632001" display. Name="Small cell carcinoma of lung (disorder)" /> <effective. Time value="200306"/> </observation> 10

Encoding Process Pre. Coordinated Concept YES Lexical Matching (Batch Mode) Match Found? NO Lexical Matching (Manual Mode) YES Concept Active? YES NO NO Post. Coordinated Expression Concept Active? NO YES Match Found? Search Historical Relationships Post. Coordination YES Match Found? NO Unencodeable 11

Outputs p Encoded Terms n SNOMED CT Reference Sets n Interface Terminology Set p Unencoded Terms n SNOMED CT Extension Set n Unencodeable Term Set 13

Encoding Summary Statistics No Encoding 1. Pre-coordination 2. Post-coordination 3. Ambiguous 4. Unique Synonyms Total 1, 471 3, 181 48, 101 468 691 1, 373 4 4 5 Requires post-coordination 664 957 5. Requires verification 340 3, 632 6. Incorrect syntax or encoding 121 155 250 7. Unencoded 3, 368 3, 954 8. Unencodeable 148 497 6, 584 8, 551 58, 769 Total 14

More Encoding Examples SCT Concepts SCT Descriptions Local Cleaned Terms 267036007|Dyspnea (finding)| Breathlessness Dyspnea Shortness of breath SOB – Shortness of breath Dysnpea (951) SOB dysnpea (1) Short of breath (8) Shortness of breath (329) SOB (7) 13645005|Chronic obstructive lung disease (disorder)| CAFL – Chronic airflow limitation CAO – Chronic airflow obstruction Chronic airflow limitation Chronic airflow obstruction Chronic airway disease Chronic airway obstruction Chronic obstructive airway disease Chronic obstructive lung disease COPD –Chronic obstructive pulmonary disease Chronic obstructive airway disease (1) Chronic obstructive lung disease (1) Chronic obstructive pulmonary disease (1) COPD (200) Obstructive lung disease (11) 129891007|Caregiver role strain (finding)| Care giver role strain Caregiver Caregiver burn out (3) exhausted (3) exhaustion (15) stress (72) stressed (3) 15