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

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

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

4. 44 Presentation Outline  AHW Project Overview  What is SNOMED CT and Why?  Encoding Methodology and Results  Next Steps  Q&A’s

5. 5 5 Musen paper2 - Medical Informatics: Searching for Underlying Components

6. 6 6 Coronary artery disease Arterioclerotic heart disease Atherosclerotic heart disease Coronary sclerosis synonyms 128238001|Chronic heart disease| equivalent to 56265001|Heart disease|: 263502005|Clinical course| = 90734009|Chronic|

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

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

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

10. 10 Data Cleaning Process Splitting Terms Into Atomic Concepts Splitting Terms Into Atomic Concepts Filtering Unmappable Data Types Filtering Unmappable Data Types Correcting Spelling Mistakes Correcting Spelling Mistakes Extending Acronyms & Abbreviations Extending Acronyms & Abbreviations Inferring Clinical Condition Inferring Clinical Condition Ca (l) lung (small cell) June 2003, Bran, Bone mets Candidate Term Candidate Term Bran Bone mets “Bran”  “Brain” Ca (l) lung (small cell) June 2003 Filter off “June 2003” Filter off “June 2003” “mets”  “metastasis” “Ca”  “carcinoma”; “l”  “left” “Ca”  “carcinoma”; “l”  “left” “metastasis” Interface Terminology Interface Terminology Brain metastasis Bone metastasis Small cell carcinoma of left lung

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

12. 12 Encoding Examples  Pre-coordination (Ovarian cancer) 363443007|Malignant tumor of ovary (disorder)|  Refinement (Cancer of right ovary) 363443007|Malignant tumor of ovary (disorder)|: 363698007|Finding site (attribute)|= 20837000|Structure of right ovary (body structure)|  Qualification (Recurrent ovarian cancer) 363443007|Malignant tumor of ovary (disorder)|: 263502005|Clinical course (attribute)|= 255227004|Recurrent (qualifier value)|

13. 13 Outputs  Encoded Terms SNOMED CT Reference Sets Interface Terminology Set  Unencoded Terms SNOMED CT Extension Set Unencodeable Term Set

14. 14 Encoding Summary Statistics NoEncodingUniqueSynonymsTotal 1.Pre-coordination1,4713,18148,101 2.Post-coordination4686911,373 3.Ambiguous445 4.Requires post-coordination664 957 5.Requires verification340 3,632 6.Incorrect syntax or encoding121155250 7.Unencoded3,368 3,954 8.Unencodeable148 497 Total6,5848,55158,769

15. More Encoding Examples 15 SCT ConceptsSCT DescriptionsLocal Cleaned Terms 267036007|Dyspnea (finding)| Breathless 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 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 strainCaregiver burn out (3) Caregiver exhausted (3) Caregiver exhaustion (15) Caregiver stress (72) Caregiver stressed (3)

16. 16 Presentation Outline  Project Overview  What is SNOMED CT and Why?  Encoding Methodology and Results  Next Steps  Q&A’s

17. 17 Next Steps  10-week trial - ongoing  Evaluation  Lessons learned  Year-2 Plan

18. 18 Presentation Outline  Project Overview  What is SNOMED CT and Why?  Encoding Methodology and Results  Next Steps  Q&A’s