Hi Tom,
As with all kinds of standards and content that you can use, you need to
investigate and select the ones that are most appropriate for your use case.
That apply when selecting between openEHR, EN 13606, HL7 version 2, HL7 version
3 and also when selecting which openEHR archetypes or SNOMED CT concepts to use.
When selecting how to represent the use cases when the information is from a
situation with explicit context you need to investigate which alternatives you
have and which of the possible alternative that are the best alternative. If
the EHR system you use only can represent some codes and some free text, using
concepts to explicitly state everything in the situation using a single coded
concept is probably the only possible alternative. For these use cases the
situation hierarchy in SNOMED CT are really useful. However, if the EHR system
you use can represent a rich information model (which starts to be more and
more common) then it is in many cases better to use the information model to
represent the situations and use "pure" finding and procedure concepts in the
information model. I can't see that the possibility to satisfy different use
cases is a bad thing!
The possibility to use the "Refinability" feature with the qualifier values was
deprecated when the Release Format 1 was deprecated and that deprecation is
very well documented. (See for example Technical Implementation Guide section
9.2.1.)
The record artefact hierarchy is a hierarchy that try to model how the records
that are in use in different healthcare systems relate to each other and that
is dependent on both national legislation and local policy. It would therefore
be impossible to include a complete record artefact hierarchy for all
healthcare systems in the international release of SNOMED CT. However I believe
that it is at least better to include a skeleton where it is easier to add new
kinds of record artefacts on a national or local level than not provide
anything at all. (I agree that it would be better if concepts like 271531001 |
British Association for Adoption and Fostering B1/2 - adoption: birth history
(record artifact) |had been excluded. But for these concepts it is very easy to
understand when to use and when to not use the concepts.)
I therefore believe that 'in line with my current use case', 'close to my
current use case', and 'needs local extension to fit my current use case' is
closer to the implementation reality than your labelling 'in use', 'not really
in use' and 'outdated'. Your statement that some hierarchies (the situation
hierarchy?) would be semi-deprecated just because they don't fit openEHR's
archetype design principles also seems quite malicious as long as there are
other EHR systems and standards on the market. If some kind of life cycle
statement was included they probably need to be on a use case level and not on
a general level.
However, when it comes to the use case you refer to below I hope that the
implementers use the available help for selecting the appropriate content from
SNOMED CT. There are quite extensive documentation that describe the content
(including the Editorial Guide) they can use. IHTSDO (which is SNOMED CT's
equivalent to openEHR Foundation) also have connected National Release Centers
in all member countries that can guide implementations. I also expect that at
least some of the implementers have taken at least one of the courses IHTSDO
provide about SNOMED CT's content. IHTSDO's support function (including their
implementation specialists and customer relation leads) could also help in
cross-country implementations. I therefore doesn't see all the problems you see
Tom!
(BTW: I would really like if openEHR set up national release centers and
provide free on-line training courses in the same way as IHTSDO do. I think
that would increase the use and usefulness of openEHR.)
Regards
Mikael
From: openEHR-technical [mailto:[email protected]] On
Behalf Of Thomas Beale
Sent: den 30 april 2016 12:35
To:
[email protected]<mailto:[email protected]>
Subject: Re: SNOMED
Mikael
Ok, I take your point in one sense, but how are we to know what is 'in use',
'not really in use', 'outdated', ....? More importantly, how would a national
programme signal to its user base which hierarchies are deprecated,
semi-deprecated, needing work - don't use), or something similar? What happens
if two national programmes have different ideas about using the same
hierarchies, e.g. Sweden and Denmark. How would GP systems in CPH / southern
Sweden deal with different policies on use / non-use of say the Qualifiers
hierarchy?
What should an application do if it receives a code string containing terms
from the Qualifiers hierarchy, but the user orgs have been told to 'avoid the
Qualifiers hierarchy'?
The record hierarchy just doesn't belong in SNOMED CT. IAO / OBI maybe.
I would have much less of a problem if the 'use status' of these hierarchies
was clearer, but as far as I can see, it is not - there is no lifecycle state
(other than for properly obsoleted terms)...
- thomas
On 29/04/2016 20:20, Mikael Nyström wrote:
Hi Tom,
Most of the concepts in the situation hierarchy had probably been added because
they have been useful in EHR systems without advanced information models and
without the possibility to post-coordinate and they are probably still in
SNOMED CT because some of these EHR systems are still in use. However, if you
have the possibility to use better EHR systems there are no need to use these
concepts. I therefore doesn't see any real problem with them.
The concepts in the qualifier value hierarchy are no longer in use to the same
extent as they were when SNOMED CT was new 2002 and will probably be cleaned up
in the future.
I agree that the Record artefact hierarchy could be more useful, but I guess
that this hierarchy to a quite large extent needs to be filled with content on
the national level, because a quite large part of the administrative concepts
are country dependant.
However, I believe these kinds of complains about the content in SNOMED CT are
less useful. It is more like complains about openEHR because there are some
outdated or draft archetypes of lesser usefulness in the CKM. This kind of
content is always possible to ignore to use. Much more useful complains would
be complains about lack of content or incorrect modelled content in areas that
are central for the healthcare system. These kinds of complains can improve the
content and make SNOMED CT easier and better to use. Please submit them in the
SNOMED CT International Request Submission (SIRS) System at the address
https://sirs.nlm.nih.gov/ .
Regards
Mikael
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