Re: SV: [Troll] Terminology bindings ... again

[Jussara Macedo Rötzsch]

Heather,

As  you know Brazil has chosen to adopt SNOMED CT on a business case basis,
trying to create clinical models that make the better use of structures and
meaning.
Therefore my research group has dedicated to study detailed clinical models
and to deepen our knowledge of Snomed CT. We agree with GF that we have
four ways to do it and that depends  on the use cases.  As Mikael said
there’s no fix boundary between when you use pre or post coordinatinated
expressions, although context to me naturally is easier to be represented
in the structure ( templates).
TO leverage our knowledge os Snomed CT everyone in our team has taken the
Snomed CT Foundation Course. I think that many assumptions made here are
explained there.
BRAZIL has just joined Snomed CT International. We intend to propose  a
creation of a Worlgroup   focussed on DCMs, for the openEHR community, as
Thomas tried to do years ago.
I will be In London for the next Business meeting, and gladly would have a
meeting with others with the same objective.
Jussara Rötzsch

Em sáb, 24 de mar de 2018 às 04:42, Heather Leslie <
heather.les...@atomicainformatics.com> escreveu:

> Totally agreed, Silje. I think preordination for anatomical location is
> invaluable, but it’s the only use case that I have identified as one we
> absolutely can’t do without.
>
>
>
> But I would love the opportunity to really investigate this properly, and
> with others who understand SNOMED better than I. That will help with the
> boundary issue/semantically grey area.
>
>
>
> I’d prefer that we could use and reuse simpler, really high quality value
> sets from in multiple archetypes for different contexts eg a list of
> diagnoses in the Problem/diagnosis archetype as well as the Family History
> archetype. The archetype context is invaluable here. And the terminology
> community focussing on high value terms that would provide great impact.
>
>
>
> Regards
>
>
>
> Heather
>
>
>
>
>
> *From:* openEHR-technical  *On
> Behalf Of *Bakke, Silje Ljosland
> *Sent:* Friday, 23 March 2018 8:35 PM
>
>
> *To:* For openEHR technical discussions <
> openehr-technical@lists.openehr.org>
>
> *Subject:* RE: SV: [Troll] Terminology bindings ... again
>
>
>
> I read Thomas’ reply with great interest, and I generally agree that with
> a well thought out information model, the very detailed precoordinated
> expressions are redundant. At the same time I understand Mikael’s point of
> view too. BUT, what I’m often met with is that because these precoordinated
> expressions exist (like for example “lying blood pressure” and “sitting
> blood pressure”), we should use them INSTEAD OF using our clever
> information models (that we do have) for recording new data.
>
>
>
> In my opinion this is wrong because it doesn’t take into account that
> healthcare is unpredictable, and this makes recording more difficult for
> the clinician. How many different variations would you have to select from?
> Take the made up example “sitting systolic blood pressure with a medium
> cuff on the left upper arm”; this will be a lot of possible permutations,
> especially if you take into account all the different permutations where
> one or more variable isn’t relevant.
>
>
>
> So while I don’t think the existence of these precoordinated terms in
> itself is a problem, it’s a potential problem that people get a bit
> overzealous with them.
>
>
>
> Regards,
>
> *Silje*
>
>
>
> *From:* openEHR-technical  *On
> Behalf Of *Mikael Nyström
> *Sent:* Friday, March 23, 2018 10:06 AM
> *To:* For openEHR technical discussions <
> openehr-technical@lists.openehr.org>
> *Subject:* SV: SV: [Troll] Terminology bindings ... again
>
>
>
> Hi tom,
>
>
>
> I can agree with you that if SNOMED CT was created when all patients in
> the world already had all information in their health record recorded using
> cleverly built and structured information models (like archetypes,
> templates and similar), but that is not the case. Instead SNOMED CT also
> tries to help healthcare organizations to do something better also with
> their already recorded health record information, because that information
> to a large extent still belongs to living patients.
>
>
>
> It would be interesting to have your opinion about why it is a real
> problem with the “extra” pre-coordinated concepts in SNOMED CT in general
> and not only for the use case of creating archetypes or what would be
> nicest in theory.
>
>
>
>  Regards
>
>  Mikael
>
>
>
>
>
> *Från:* openEHR-technical [
> mailto:openehr-technical-boun...@lists.openehr.org
> ] *För *Thomas Beale
> *Skickat:* den 23 mars 2018 01:06
> *Till:* openehr-technical@lists.openehr.org
> *Ämne:* Re: SV: [Troll] Terminology bindings ... again
>
>
>
> I have made some attempts to study the problem in the past, not recently,
> so I 

Re: [Troll] Terminology bindings ... again

[GF]

Yes.

The simple rules that solve the Boundary Problem need some exceptions.
- anatomical structure
- possibly some aspects of devices

To investigate it properly is a possibility.
The problem I see is the How question.
For me there is only one solution and that is by analysing the problem and 
thinking about it.

Ingredients that we could take in consideration are notions like:
- Models in the Interoperability Stack must be autonomous and orthogonal
- The Models we need in the Stack
- Closed world assumption of Archetypes versus Open world assumption of the 
ontology behind SNOMED
- Requirements for data exposed to users via statistics, screens, forms, and 
documents
- Requirements for data stored, retrieved from databases
- Requirements for data to be interpreted by clinical reasoners
- Modelling methods

Gerard   Freriks
+31 620347088
  gf...@luna.nl

Kattensingel  20
2801 CA Gouda
the Netherlands

> On 24 Mar 2018, at 08:41, Heather Leslie 
>  wrote:
> 
> Totally agreed, Silje. I think preordination for anatomical location is 
> invaluable, but it’s the only use case that I have identified as one we 
> absolutely can’t do without.
> 
> But I would love the opportunity to really investigate this properly, and 
> with others who understand SNOMED better than I. That will help with the 
> boundary issue/semantically grey area.
> 
> I’d prefer that we could use and reuse simpler, really high quality value 
> sets from in multiple archetypes for different contexts eg a list of 
> diagnoses in the Problem/diagnosis archetype as well as the Family History 
> archetype. The archetype context is invaluable here. And the terminology 
> community focussing on high value terms that would provide great impact.
> 
> Regards
> 
> Heather
> 



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RE: SV: [Troll] Terminology bindings ... again

[Heather Leslie]

Totally agreed, Silje. I think preordination for anatomical location is 
invaluable, but it's the only use case that I have identified as one we 
absolutely can't do without.

But I would love the opportunity to really investigate this properly, and with 
others who understand SNOMED better than I. That will help with the boundary 
issue/semantically grey area.

I'd prefer that we could use and reuse simpler, really high quality value sets 
from in multiple archetypes for different contexts eg a list of diagnoses in 
the Problem/diagnosis archetype as well as the Family History archetype. The 
archetype context is invaluable here. And the terminology community focussing 
on high value terms that would provide great impact.

Regards

Heather


From: openEHR-technical  On Behalf 
Of Bakke, Silje Ljosland
Sent: Friday, 23 March 2018 8:35 PM
To: For openEHR technical discussions 
Subject: RE: SV: [Troll] Terminology bindings ... again

I read Thomas' reply with great interest, and I generally agree that with a 
well thought out information model, the very detailed precoordinated 
expressions are redundant. At the same time I understand Mikael's point of view 
too. BUT, what I'm often met with is that because these precoordinated 
expressions exist (like for example "lying blood pressure" and "sitting blood 
pressure"), we should use them INSTEAD OF using our clever information models 
(that we do have) for recording new data.

In my opinion this is wrong because it doesn't take into account that 
healthcare is unpredictable, and this makes recording more difficult for the 
clinician. How many different variations would you have to select from? Take 
the made up example "sitting systolic blood pressure with a medium cuff on the 
left upper arm"; this will be a lot of possible permutations, especially if you 
take into account all the different permutations where one or more variable 
isn't relevant.

So while I don't think the existence of these precoordinated terms in itself is 
a problem, it's a potential problem that people get a bit overzealous with them.

Regards,
Silje

From: openEHR-technical 
>
 On Behalf Of Mikael Nyström
Sent: Friday, March 23, 2018 10:06 AM
To: For openEHR technical discussions 
>
Subject: SV: SV: [Troll] Terminology bindings ... again

Hi tom,

I can agree with you that if SNOMED CT was created when all patients in the 
world already had all information in their health record recorded using 
cleverly built and structured information models (like archetypes, templates 
and similar), but that is not the case. Instead SNOMED CT also tries to help 
healthcare organizations to do something better also with their already 
recorded health record information, because that information to a large extent 
still belongs to living patients.

It would be interesting to have your opinion about why it is a real problem 
with the "extra" pre-coordinated concepts in SNOMED CT in general and not only 
for the use case of creating archetypes or what would be nicest in theory.

 Regards
 Mikael


Från: openEHR-technical [mailto:openehr-technical-boun...@lists.openehr.org] 
För Thomas Beale
Skickat: den 23 mars 2018 01:06
Till: 
openehr-technical@lists.openehr.org
Ämne: Re: SV: [Troll] Terminology bindings ... again


I have made some attempts to study the problem in the past, not recently, so I 
don't know how much the content has changed in the last 5 years. Two points 
come to mind:


1. the problem of a profusion of pre-coordinated and post-coordinatable 
concepts during a lexically-based choosing process (which is often just on a 
subset).
 this can be simulated by the lexical search in any of the Snomed search 
engines, as shown in the screen shots below. Now, the returned list is just a 
bag of lexical matches, not a hierarchy. But - it is clear from just the size 
of the list that it would take time to even find the right one - usually there 
are several matches, e.g. 'blood pressure (obs entity)', 'systemic blood 
pressure', 'systolic blood pressure', 'sitting blood pressure', 'stable blood 
pressure' and many more.

I would contend (and have for years) that things like 'sitting blood pressure', 
'stable blood pressure', and 'blood pressure unrecordable' are just wrong as 
atomic concepts, each with a separate argument as to why. I won't go into any 
of them now. Let's assume instead that the lexical search was done on a subset, 
and that only observables and findings (why are there two?) show up, and that 
the user clicks through 'blood pressure (observable entity)', ignoring the 30 
or more other concepts. Then the result is a part of the