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SNOMED CT's Condition / Situation approach related to OGMS
Stefan Schulz
Medical University of Graz (Austria)
ICBO 2013MontrealOGMS Meeting
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What are SNOMED CT findings and disorders – ontologically ?
Finding
Disorder
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Background
• Awareness of heterogeneity of the SNOMED CT hierarchies "finding", "disorder", "event":addressed by the IHTSDO SIG "Event – Condition – Episode" (ECE), after meeting with Barry Smith on October 2009
• Need for "common ontology" between future ICD 11 and SNOMED CT: joint advisory group IHTSDO + WHO
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Example
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From findings to conditions
• ECE, after discussion of OGMS (2009): Interpretation of SNOMED codes under "finding" (including "disorder") as "condition"
• Publication: Scalable representations of diseases in biomedical ontologies. Schulz S, Spackman K, James A, Cocos C, Boeker M. J Biomed Semantics. 2011
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"Clinical condition" (I)
• Current SNOMED finding classes are ambigous• Physicians (often) have no problem with this
ambiguity• 'Clinical condition' equivalentTo
'clinical disposition' or 'clinical structure' or 'clinical process'
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"Clinical condition" (II)
• Disambiguation according to needs:Allergic disposition vs. allergic reaction– Allergy and Disposition– Allergy and Process
• Allergy and inheresIn X classified as Disposition (ogms:Disease)
• Allergy and hasParticipant X classified as Process (ogms:Disease course)
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Problem not solved (I)
• Naming suggest clear commitment, which creates category conflicts between parents and children:
Blood vessel finding (finding)
Distention of blood vessel (finding)
Distention of vein (finding)
Varicose vein finding (finding)
Venous varices (disorder)
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Problem not solved (II)
Fracture ofUlna
Fracture ofRadius
Fracture ofRadius and Ulna
• Multiple parenthood difficult to interpret
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Is this True?
• FALSE, if X means “pathological condition”• TRUE, if X means
“situation with X” or “patient having X”
Fracture ofUlna
Fracture ofRadius
Fracture ofRadius and Ulna
subClassOf subClassOf
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Example 2
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Example 2
F
P
P
P
P
FF
P
F
P
P
Extension of “Situation with Pulmonic Valve Stenosis” includes extension of “Situation with Tetralogy of Fallot”: TRUE
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Two diverging interpretations of finding / disorder terms in SNOMED CT and ICD:
• They denote patient-borne Conditions such as body processes, states, dispositions, or (patho-) anatomical structures, which are reportable in the context of medical records
• They denote Clinical Situations, which are defined as phases of a patient’s life, during which he/she is bearer of (some combination of) pathological conditions.
• Only the situation interpretation is compatible with the current state of SNOMED CT (multiple taxonomies, "A with B" concepts, role groups)
• Low inter-modeller agreement when trying to partition SNOMED CT findings into conditions and situations (Stefan Schulz, Alan Rector, Jean-Marie Rodrigues, Kent Spackman. Competing Interpretations of Disorder Codes in SNOMED CT and ICD AMIA Annu Symp Proc. 2012; 2012: 819–827)
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Situations, conditions and role groups
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Situations, conditions and role groupsSituation
Situation Situation
SituationSituation
Situation
Situation Situation
hasCondition
hasCondition
hasCondition
hasCondition
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The Ontology of Clinical Situations
Andrade, Martínez-Costa, Spackman, Almeida, Schulz
Currently under review (Applied ontology)