ICD-11 FC and SNOMED CT Finding Ontologies
ICD 11 FC and SNOMED CT – finding as
Ontologies of Clinical Situations
Stefan Schulz
Model according to SemanticHealthNet
Clinical
Disposition
Clinical
Structure
Clinical
Process
Clinical
Condition
Patient
EHR
Clinical
Situation
Clinical
Diagnosis
isAbout
Situation
includes
Condition
isA
not includes
Condition
A clinical situation with X is a phase of a patient's life in which a condition of the type X is
wholly present
A clinical situation without X is a phase of a patient's life that does not include any condition
of the type X at any time
Conjunction Example (ICD11 draft)
Situation
Situation
Situation
isA
isA
Example (ICD11 draft)
clinical disposition ?
clinical process?
clinical structure?
clinical structure?
Situation
Situation
Situation
Situation
isA
isA
isA
Situations in SNOMED CT
•
Many Is-a links in the SNOMED finding hierarchy only
plausible for situations
(Tetralogy of Fallot example), cf.
eHealth 2012 paper
•
Very difficult to draw a line between conditions and
situations, cf. AMIA 2012 paper
•
Caveat: Bipartition in existing SNOMED situation
hierarchy (con
text
model):
–
Situations proper (e.g.
Has a red eye
)
–
Information entities (e.g.
Suspected sarcoma
)
•
See MEDINFO 2012 submission on the SNOMED CT
context model
Open issues (II)
•
Consensus in both communities
•
Action to "officially" declare SNOMED CT
findings/disorders as
Clinical situations
•
"Situation" in FSNs and text definitions
•
What about disjointness of ICD categories?
–
Tricuspid stenosis
and
Mitral stenosis
are disjoint
conditions
–
Situation
with Tricuspid stenosis
and
Situation
with Mitral stenosis
are not disjoint
(only very few situations are really disjoint, e.g. pregnancy
and prostate cancer)
–
Axiomatization of "Clinical Situation": JAMIA paper
under review
Open issues (II)
•
Exclusions:
•
Many ICD class that carry (or inherit) exclusions
•
Classes with exclusions are managed in the
foundational component
•
Classes with exclusions do normally not exactly
map to SNOMED CT concepts
–
e.g. icd:Acute pericarditis excludes rheumatic p.
–
icd:Acutepericarditis equivalentTo
sct:AcutePericarditis and not RheumaticPericarditis
e
e
e
e
e
e
e
e
e
e
e
e
e
e
e
e
ICD linearizations and FC
only ICD linearizations (residuals)
e
ICD classes that carry exclusions
only FC (common parents of "e")
SNOMED CT
ICD "heading"
common ontology concepts
Exclusions and common ontology
Schematic representations and models by Stefan Schulz illustrate the integration of ICD-11 FC and SNOMED CT for clinical situations, conditions, and diagnoses. The relationship between clinical situations, conditions, dispositions, structures, and processes is defined, with examples from ICD-11 drafts and insights into SNOMED CT hierarchies.
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Presentation Transcript
ICD 11 FC and SNOMED CT finding as Ontologies of Clinical Situations Stefan Schulz
Model according to SemanticHealthNet includes Condition isAbout Situation Clinical Diagnosis Clinical Situation Clinical Condition not includes Condition isA Clinical Disposition Clinical Structure Clinical Process EHR Patient A clinical situation with X is a phase of a patient's life in which a condition of the type X is wholly present A clinical situation without X is a phase of a patient's life that does not include any condition of the type X at any time
Conjunction Example (ICD11 draft) Situation Situation isA isA Situation
Example (ICD11 draft) clinical disposition ? clinical process? clinical structure? clinical structure? Situation isA Situation isA Situation isA Situation
Situations in SNOMED CT Many Is-a links in the SNOMED finding hierarchy only plausible for situations (Tetralogy of Fallot example), cf. eHealth 2012 paper Very difficult to draw a line between conditions and situations, cf. AMIA 2012 paper Caveat: Bipartition in existing SNOMED situation hierarchy (context model): Situations proper (e.g. Has a red eye) Information entities (e.g. Suspected sarcoma) See MEDINFO 2012 submission on the SNOMED CT context model
Open issues (II) Consensus in both communities Action to "officially" declare SNOMED CT findings/disorders as Clinical situations "Situation" in FSNs and text definitions What about disjointness of ICD categories? Tricuspid stenosis and Mitral stenosis are disjoint conditions Situation with Tricuspid stenosis and Situation with Mitral stenosis are not disjoint (only very few situations are really disjoint, e.g. pregnancy and prostate cancer) Axiomatization of "Clinical Situation": JAMIA paper under review
Open issues (II) Exclusions: Many ICD class that carry (or inherit) exclusions Classes with exclusions are managed in the foundational component Classes with exclusions do normally not exactly map to SNOMED CT concepts e.g. icd:Acute pericarditis excludes rheumatic p. icd:Acutepericarditis equivalentTo sct:AcutePericarditis and not RheumaticPericarditis
Exclusions and common ontology e e e e e e e e e e e e e e e e ICD linearizations and FC only FC (common parents of "e") ICD "heading" common ontology concepts e only ICD linearizations (residuals) ICD classes that carry exclusions SNOMED CT
