Coderingenin een

HL7v3 RIM EPD

- 1 -

7 Brachmanoth 2008, kwart over 3 lokale tijd Utrecht

Ir. Yeb Havinga

�Waarom een standaard codering?

� Inleiding� Portavita Multidisciplinair EPD

� HL7 Observation

� SNOMED CT

Inhoud

- 2 -

�Drie elementen uit Diabetes dossier

�Gregoriaanse kalender � Vanaf 1582

� Next generation Juliaanse kalender

� Adoptie in europa van 1582 tot 1923

�Meten van tijd

Metrische systeem

Leer van geschiedenis

- 3 -

�Metrische systeem

�Gemeenschappelijke codes� handig voor samenwerken

� 22 mei 2008, 16:00 CET

�ASP based software voor chronic disease management� Antistolling, Diabetes, Stroke Service

� Binnenkort: Hartfalen en COPD

�Versie 1: HL7 v2 in XML database, tot 2003

Portavita Multidisciplinair EPD

- 4 -

�Versie 2: HL7 v3 RIM based relationele database

�Vanaf 2005 dossiers gecodeerd met SNOMED CT concepten� voorzover mogelijk.

�Concepten

�Relaties tussen concepten

� Link met HL7's CD (concept descriptor) data type snel gelegd

�De grootste: 370000 concepten, 1M relaties

SNOMED Clinical Terms

- 5 -

�De grootste: 370000 concepten, 1M relaties

�Description Logic

� Post coordination

� Code en value� Discussion: Structurally, many observations are name-value-pairs, where the Observation.code(inherited from Act) is the name and theObservation.value is the value of the property.

� Such a construct is also known as a "variable" (a named

SNOMED Clinical TermsHL7 Observation (text from ballot May’08)

- 6 -

� Such a construct is also known as a "variable" (a named feature that can assume a value); hence, the Observation class is always used to hold generic name-value-pairs or variables, even though the variable valuation may not be the result of an elaborate observation method. It may be a simple answer to a question or it may be an assertion or setting of a parameter.

�Hoe ziet het eruit in de website

�Welke code of value zien we in SNOMED

�Hoe is het geїmplementeerd?

Drie voorbeelden

- 7 -

Voorbeeld 1: Diagnose

- 8 -

Diagnoses in SNOMED CT

� Gevonden� 44054006|Diabetes mellitus type 2

� 46635009|Diabetes mellitus type 1

� 28453007|Maturity onset diabetes mellitus in young

� Niet gevonden

- 9 -

� LADA

� Speciaal geval: overig� 73211009|Diabetes mellitus

� In 2005:� Observation: code=INTDX (interim diagnosis), value 28453007

� In 2008:� Observation: code=ASSERTION, value= 28453007|Maturity onset diabetes mellitus in

MODY diagnose implementatie in EPD

- 10 -

28453007|Maturity onset diabetes mellitus in young:418775008|finding method|=???|cognitive process|

� Concern tracker

Disease

Clinical finding

Disorder of body system

Disorder by body site

Finding by site

Disorder of digestive system

Digestive system finding

Disorder of abdomen

General finding of abdomen

Finding of trunk structure

Finding of body region

Disorder of trunk Viscus structure finding Disorder of body cavity

- 11 -Maturity onset diabetes mellitus in young

Autosomal dominant hereditary disorder

Autosomal hereditary disorder

Hereditary disease

Digestive system hereditary disorder

Hereditary disorder by system

Hereditary disorder of endocrine system

Disorder of endocrine system

Diabetes mellitus associated with genetic

syndrome

Diabetes mellitus

Disorder of glucose metabolism

Disorder of carbohydrate metabolism

Metabolic disease

Disorder of endocrine pancreas

Disorder of pancreas

Finding of pancreas Abdominal organ findingDisorder of digestive

organ

Disorder of glucose regulation

�NHG richtlijn diabetes, jaarcontrole� “De huisarts informeert naar het welbevinden, ...

� SF-36 Gezondheidstoestand vragenlijst� 11 multiple choice vragen

�Vrije tekst veld

Voorbeeld 2: Welbevinden

- 12 -

�Vrije tekst veld

Welbevinden op scherm Portavita EPD

- 13 -

Welbevinden in SNOMED CT

� 365275006|General well being finding|

- 14 -

- 15 -

Welbevinden implementatie in EPD

� Uitstekend� Observation: code = 365275006, value = Uitstekend

� Goed� Observation: code = 365275006, value = Goed

� Redelijk

- 16 -

� Redelijk� Observation: code = 365275006, value = Redelijk

�Matig� Observation: code = 365275006, value = Matig

� Slecht� Observation: code = 365275006, value = Slecht

Voorbeeld 3: Zwangerschap

- 17 -

� Pregnancy finding:� 77386006|patient currently pregnant

� 60001007|not pregnant

� Finding of fertility:� 169449001|trying to conceive

Zwangerschap in SNOMED CT

- 18 -

- 19 -

- 20 -

� Zwanger� Observation: code = 77386006, value = Y

�Niet zwanger� Observation: code = 77386006, value = N

�Wens

Zwangerschap implementatie in EPD

- 21 -

�Wens� Observation: code = 169449001, value = Y

� Zwanger� Observation code=ASSERTION, value = 77386006|patient_currently_pregnant|

�Niet zwanger� Observation code=ASSERTION, value = 77386006|patient_currently_pregnant|, negationInd = Y

SNOMED HL7 impl. handleiding 1.4

- 22 -

77386006|patient_currently_pregnant|, negationInd = Y

� Observation code=ASSERTION, value = 24376009|situation with explicit context| :246090004|associated finding|= 77386006|patient_currently_pregnant|,408729009|finding context|= 410516002|known absent|

�Wens� Observation code=ASSERTION, value = 169449001|trying to conceive|

- 23 -

Toekomstplannen

� Uitbouwen Portavita Multidisciplinair EPD� COPD

� Hartfalen

� HL7 ondersteuning door database� HL7 datatypes (zoals CD), vertalingen met UMLS, SNOMED post-coordination, HL7 CTS API

- 24 -

SNOMED post-coordination, HL7 CTS API

� Portavita Medical Grid

� Doe mee� http://www.portavita.nl/bedrijf/vacature.html