Concept addition from conception to delivery

1
Concept addition from conception to delivery

• Or
• Why does it take so _at_ long?

2
You cant always get what you want

• Not all medical terms can or should be
  represented as is in SNOMED
• The terminology should not aid and abet the use
  of imprecise, inaccurate, or erroneous terms
• Not all nuances of medical circumstances can be
  captured and defined within the nomenclature
• Over-reliance on precoordination invites
  combinatorial explosion and limits expressivity

3
...but if you try sometimes, you can get what you
need

• The requirements of a controlled medical
  nomenclature restrict the addition of content
• My job is to determine what content can be added,
  and to add it in a form that does not introduce
  error or ambiguity to the nomenclature

4
Goals

• Avoid adding redundant or duplicate concepts to
  SNOMED
• Avoid adding ambiguous, obsolete, or incorrect
  terms as fully specified names
• Accurately define all new concepts

5
Preadmission questions

• Do we need this concept?
• What does the concept mean?
• In what context will the concept be used?
• Can the concept be defined in SNOMED?

6
Wheres Waldo?

• Does SNOMED already contains the concept,
  sometimes under another wording, or a usable
  equivalent?
• Ex request for Uroabdomen
• SNOMED already has an equivalent concept, Urine
  ascites, not found by searching for uroabdomen
• Adding Uroabdomen would create redundancy
• Request addition of Uroabdomen as synonym instead

7
Say what?

• In a controlled medical terminology, each concept
  must represent a single idea, and the concept
  FSN should clearly state that ideaBUT
• Human and veterinary medical language contains
  many terms whose meaning is not evident from the
  wording or which convey multiple meanings
• Downer cow
• White line disease
• Overeating disease

8
What this means

• Even accepted medical terms must often be
  translated, not transcribed, into SNOMED
• Just because the clinician said so does not
  mean SNOMED willor can--say so

9
Say what you mean

• If commonly accepted term is ambiguous, but
  conveys a commonly accepted meaning
• gt add concept
• gt give concept unambiguous FSN
• gt add common name as description

10
Example 1

• Sweeney
• neurogenic atrophy of shoulder muscles

11
Mean what you say

• If commonly used medical term conveys more than
  one meaning
• gt create separate concepts for each meaning
• gt give each concept unambiguous FSN
• gt assign commonly used term as synonym for
  each concept

12
Example 2

• Overeating disease
• Type C Enterotoxemia
• Type D Enterotoxemia
• Grain Overload

13
Saying 1 2 to mean 3

• If common term has complex meaning that can be
  best be captured by post-coordinating existing
  concepts
• gt Deny concept request
• gt Supply guidance to use of existing SNOMED
  concepts

14
Example 3

• Pigeon fever
• misleading namepigeons do not get or carry it
• variable presentation/- pectoral abscess
• Abscess of pectoral region 76035004
• Causative agent Corynebacterium
  pseudotuberculosis
• OR
• Infection due to Corynebacterium
  pseudotuberculosis

15
Saywhat did you mean?

• Requested term obscure, outdated, inherently
  vague or meaning is impossible to determine from
  information given
• seek clarification from requestor
• determine if concept warranted

16
Just the facts, maam

• When requesting a concept, you may be asked to
• Seek clarification from a clinician
• Supply background information
• Explain the concepts projected use
• Discuss whether existing SNOMED concept(s) can be
  used instead
• Accept a refusal ?

17

• Request Myelocytoma
• Problem Myelocytoma can refer to
• Multiple myeloma
• Chronic myelogenous leukemia
• A discrete tumor esp. of fowl, composed of
  myelocytes
• Need to know which meaning is intended

18

• Request Proliferative thrombovascular necrosis
• Problem References lacking
• Need to know
• --is this an accepted medical term?
• --what is the pathophysiology?
• --what is the etiology, if known?

19

• Request Delayed weaning
• Problem Context unclear
• Procedure or finding?
• If findingnecessarily abnormal?
• Need to know context, to determine hierarchy
  to which concept belongs

20

• Request Ringwomb
• Problem User requests new concept or guidance
  to appropriate existing concept
• Need to know exact nature of ringwomb to find
  if perfect match exists in SNOMED (yes).

21

• Request Chronic moist dermatitis
• Problem Concept irredeemably ambiguous
• Need to know how to break clinicians of using
  pseudodiagnoses!

22
And finally.

• Sliced, diced, buffed and polished concept
  submitted to SNOMED with suggested FSN, synonyms,
  and definitions
• CAP modeler reviews submissionmay reject, query,
  or accept concept
• If accepted, new concept is created and assigned
  codes in TDE
• New concept appears in next database release