1. SNOMED CT Family of Languages Dr Linda Bird, IHTSDO Implementation Specialist

2. SNOMED CT Family of Languages We need a consistent ‘family of languages’ that supports SNOMED CT related activities, including: ▪Defining postcoordinated clinical meanings ▪Binding SNOMED CT to information models ▪Defining intensional reference sets ▪Querying SNOMED CT ▪Representing the SNOMED CT concept model

3. SNOMED CT Languages ▪Compositional Grammar ▪To define a SNOMED CT expression ▪Expression Constraint Language ▪To constrain the set of possible concepts or expressions ▪Query Language ▪To query over SNOMED CT content ▪Template Languages ▪To incorporate ‘slots’ to be filled at a later time

4. Compositional Grammar To express a clinical idea using a SNOMED CT expression ▪Expression: A structured combination of one or more concept identifiers used to express a clinical idea ▪Precoordinated expression: An expression containing a single concept identifier ▪Postcoordinated expression: An expression containing two or more concept identifiers ▪Use Cases: ▪Expressions in health records ▪Expressions in messages ▪Precoordinated concept definitions ▪Expression associations with LOINC

5. Compositional Grammar

8. ▪Examples: ▪24136001 |hip joint structure|: 272741003 |laterality| = 7771000 |left| ▪397956004 |prosthetic arthroplasty of the hip|: 363704007 |procedure site| = (24136001 |hip joint structure|: 272741003 |laterality| = 7771000 |left|) ▪111115 |amoxicillin capsule|: {127489000 |has active ingredient| = 96068000 |amoxicillin trihydrate|, 111115 |has reference basis of strength| = 372687004 |amoxicillin| 111115 |strength magnitude equal to| = #500, 111115 |strength unit| = 258684004 |mg|} 111115 |trade name| = “AMOXIL” ▪<<< 73211009 |diabetes mellitus|: 363698007 |finding site| = 113331007 |endocrine system|

9. Compositional Grammar ▪Specification and Implementation Guide ▪Introduction ▪Use Cases ▪Requirements ▪Logical Model ▪Syntax Specification ▪Examples ▪Implementation Considerations ▪Appendix A: Concept Definition & Expression Relationship Statements ▪Backwardly compatible with previous specification ▪Two significant enhancements ▪Concrete values ▪Definition status ▪Community Review closes 14 th November

10. Expression Constraint Language * To constrain the set of possible concepts or expressions ▪Expression Constraint: A computable rule that can be used to define a set of concepts or expressions ▪Use cases: ▪Constrain content of a particular data element in an EHR ▪Create a machine processable query over SNOMED CT concepts ▪Define an intensional reference set ▪Define a range constraint in the SNOMED CT concept model * Draft language available late 2014

11. Expression Constraint Language

14. To constrain the set of possible expressions ▪Examples: ▪^ 700043003 |problem list reference set| ▪<< 71388002 |procedure|: 363698007 |finding site| = << 80891009 |heart structure| ▪<19829001|disorder of lung| AND ! ^ 152725851000154106|cardiology reference set| ▪<< 404684003|clinical finding| : 116676008|associated morphology| = << 55641003|infarct| OR 42752001 |due to| = << 22298006|myocardial infarction| ▪< 373873005 |pharmaceutical / biologic product|: [3..*] 127489000 |has active ingredient| = < 105590001 |substance|

15. Expression Constraint Language Specification and Implementation Guide ▪Currently in review by Languages Advisory Group ▪Committee and community review will follow

16. Query Language * To query over SNOMED CT content ▪Use cases: ▪Querying SNOMED CT content ▪Defining intensional reference sets ▪Querying patient data ▪Binding SNOMED CT to ICD-11 linearizations ▪Filter Keywords: ▪version ▪effectiveTime ▪active ▪moduleId ▪definitionStatus (concept) ▪characteristicType (relationship) ▪member (reference set)  languageCode (description)  typeId (description)  term (description)  caseSignificanceId (description)  languageRefSet  preferredTerm  fullySpecifiedName  acceptableTerm * Draft language available late 2014

17. Query Language To query over SNOMED CT content ▪Examples: ▪<< 64572001 |disease| {{ term = “.* heart.*” }} ▪<< 64572001 |disease| {{ preferredTerm = “.* heart.*” }} ▪<< 64572001 |disease| {{ preferredTerm = “.* heart.*”, languageRefSet = 900000000000508004 |GB English| }} ▪<< 404684003 |clinical finding| {{ definitionStatus = 900000000000073002 |defined| }} ▪<< 138875005 |SNOMED CT concept| {{ version = http://snomed.info/sct/449081005/version/20140131 }} ▪^ 723916301000154101 |procedure frequency refset| {{ member.900000000000519001 |frequency| > #100 }}

18. Template Language * To incorporate slots to be filled at a later time ▪Use cases: ▪Defining reusable patterns for pre- or post-coordination ▪Defining information model constraints ▪Transforming between equivalent information models ▪Expression Template Examples: ▪[[ $diagnosis]]: 363698007 |finding site| = [[$bodySite]] ▪[[ << 64572001 |disease| ]]: 363698007 |finding site| = [[ < 91723000 |anatomical structure | ]] ▪Expression Constraint Template Example: ▪<< [[$procedure]] * Draft language available early 2015

19. Questions and Discussion