My thoughts: - The picture is not wrong - It needs more detail: - Codes from codings systems are used in structures - Ontologies are the ‘best’ coding systems, derived classifications are ‘good’ as well - In structures codes are used in two ways: to give meaning to nodes in the structure, as And to give meaning to the data fields in the structure. -Since both codes and structures can give (i) meaning to concepts problems can occir (the Boundary Problem) Additional rules how to use the structure and codes used are needed: Rule 1: Only basic (primitive) codes from a coding systems are allowed. e.g. Code allowed for: 'Mamma tumor' but not a code for 'Mamma tumor not found’ Perhaps more rules are needed. In CIMI/HL7 there was/is and agreement to use LOINC codes to express the question and SNOMED to be used to provide the answer.
Gerard Freriks +31 620 34 70 88 +31 182 22 59 46 gf...@luna.nl Kattensingel 20 2801 CA Gouda the Netherlands > On 10 Oct 2019, at 11:29, Vebjørn Arntzen via openEHR-clinical > <openehr-clini...@lists.openehr.org> wrote: > > d. Although measures have been taken to implement international standards > such as the FHIR, for many years there will be a need to adhere to these > national information models. There is a trend towards increased international > standardization of information models and the use of terminologies as > information carriers. Important examples of frameworks that can be used in > Norway include Digital Imaging and Communication in Medicine (DICOM) (21), > Cross Enterprise Document Sharing (XDS) developed by Integrating the > Healthcare Enterprise (IHE), Fast Healthcare Interoperability Resources > (FHIR) developed by the organization Health Level Seven (HL7) and archetypes > developed by OpenEHR. The frameworks have different methods for terminology > binding, but what they have in common is that they look at the use of > standardized terminologies and the utilization of mutual experiences where > appropriate. This is a natural development of an ecosystem of information > exchange within health, driven by an international environment. A whole that > contains both coding systems, terminologies and information models is an > international trend. For example, IHE will use information models from HL7. > HL7 uses, among other things, SNOMED CT as proposed coding in its FHIR > information models and DICOM uses SNOMED CT directly which encodes several > places in its frameworks. Common to the organizations that drive the > development going forward is broad international participation, anchoring in > academia and with suppliers and / or authorities. There is an issue related > to the use of SNOMED CT as a bound terminology as it is licensed, and use > will therefore be tied to membership or require payment. SNOMED International > has previously allowed DICOM to use terms as part of a published standard. In > 2019, a larger amount of terms were released for use in the International > Patient Summary (discussed later). This is done to make it easier to use > SNOMED CT, even where there is a need for restrictive binding to terminology > in an information model. >
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