Hi Philippe,
I think that you have missed that SNOMED CT is created for multiple use cases.
Your use case that you describe as "a modern approach" is a good use case that
I like. In that use case SNOMED CT can be used in the way you describe using
SNOMED CT's concepts a little higher up in the hierarchies together with SNOMED
CT Compositional Grammar and SNOMED CT's concept model.
Another use case, that many implementers consider is important but you don't
seem to care about, is the ability to handle legacy data to be able to keep a
life-long health record. Most people alive today where born when simple health
records that only used simple coding where in massive use. (When that era
started and (potentially) ended is up to the reader to decide...) To cater for
information that are more of legacy information, SNOMED CT also has concepts
that can represent that kind of information. But SNOMED CT also has a machinery
to transform between the different representations. Your example "fracture of
the left ankle" is not possible to express using a single concept from SNOMED
CT, but if it had been possible it had been possible to automatically transform
that concept to the expression below, which seems like to be what you argue for
in your "modern approach" use case.
64572001 | Disease (disorder) | :
{ 363698007 |Finding site| =
{33696004 |Bone structure of ankle (body structure)| : 272741003
|Laterality| = 7771000 |Left (qualifier value)|},
116676008 |Associated morphology| = 72704001 |Fracture (morphologic
abnormality)|
}
I therefore find your arguments against SNOMED CT equally relevant as arguments
of the type
"SNOMED CT is useless, because it contains the concepts 285336007 | Background
radiation (physical force) |, 60638008 | Planetary surface craft, device
(physical object) | and 242250006 | Crash landing of spacecraft (event) | and I
don't need that kind of concepts at my clinic."
because the simple solution is to not use what you don't need.
Regards
Mikael
-----Ursprungligt meddelande-----
Från: openEHR-technical [mailto:[email protected]]
För Philippe Ameline
Skickat: den 15 mars 2018 16:18
Till: [email protected]
Ämne: Re: [Troll] Terminology bindings ... again
Le 15/03/2018 à 00:34, Mikael Nyström a écrit :
> Hi Philippe
>
> It seems like you are making a big deal of that SNOMED CT is an ancient
> product, but I would like to see your explicit arguments about that instead
> of only negative generalizations. From my point of view it is quite modern
> with an OWL based ontology with additional features for terminology and
> versioning, which basically is what SNOMED CT are.
>
> Regards
> Mikael
Hi Mikael,
The question will always remain "what component do you need at a given
technological moment?"
If what you want to do is what has been done since 1980, that's to say fill
forms inside a care place and exchange it with other care places, I guess that
Snomed CT is the proper component.
Since it was born a coding system, you can create complicated meta-concepts in
a single code (of course, it means you will have to find your own subset inside
an always expanding universe, but ease comes with a price) and it is very
convenient to fill the good old set of attribute–value pairs.
On the contrary, if you estimate that a modern approach would be to tell and
organize a patient's journey, you have to exhibit more modern structures
because in order to "tell something", you need not only a terminology (say a
vocabulary) but also a grammar. A proper grammar (at least the one I use) can
be a "dependency grammar" in the form of a graph or trees.
Now that you can tell elaborated things using a vocabulary (the
ontology) and a grammar (the graph of trees), the "agglutinating"
structure of Snomed rapidly sucks. Because now that "fracture of the left
ankle" can be expressed as the branch "fracture" "located at" "left ankle",
there is no longer a need for the hundred of thousand (and
counting) "codes" that where convenient for ancient systems but are now a
genuine problem.
Do you imagine a natural language that would be so massively agglutinating that
it would contain words like "FractureOfTheLeftAnkleThatWasTreatedButStillHurts"?
I guess that, due to a terrible learning curve, the children would speak at six
;-)
To sum it up, Snomed is probably convenient for application with a structure
schema that can only handle a coding system (hey, it also comes with a semantic
network) but is not fit as a formal language vocabulary.
Best,
Philippe
_______________________________________________
openEHR-technical mailing list
[email protected]
http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.openehr.org
_______________________________________________
openEHR-technical mailing list
[email protected]
http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.openehr.org
