Re: Postcoordinated terminology expressions in openEHR

[Michael.Lawley]

I'm with Ian on this. The only use of post coordination is hard and requires 
complex tooling support that is way beyond any value you get.  I would say even 
laterality & other qualifiers should go in the information model and not in the 
terminology if you have the choice.

If you are instead talking about ECLs expression constraint language, then you 
might want to look at http://ontoserver.csiro.au/shrimp/ecl which provides a UI 
for constructing ECL expressions and evaluates them as well. It also has links 
to summary documentation and sample expressions.

Michael

Sent from my iPhone

On 20 Nov 2018, at 4:56 am, David Moner 
mailto:dam...@gmail.com>> wrote:

Hi, just for clarification, you have mixed are two different things:

- SNOMED CT postcoordinated expressions are structured combinations of one or 
more concepts to express a clinical idea. You use them to create new concepts 
not available in the SNOMED release. They are built using the SNOMED CT 
Compositional Grammar. In the archetypes they could be used for the semantic 
binding of the structure (at codes), or for data values in coded data 
typeshttps://confluence.ihtsdotools.org/display/SLPG/SNOMED+CT+Compositional+Grammar
https://confluence.ihtsdotools.org/display/SLPG/SNOMED+CT+Compositional+Grammar

- SNOMED CT Expression Constraint Language is an extension of the compositional 
grammar that allows building SNOMED CT subsets intensionally, i.e., by 
restriction or querying. This allows you to create a subset by defining an 
expresion. This can be used to constraint coded values (ac codes)
https://confluence.ihtsdotools.org/display/DOCECL/Expression+Constraint+Language+-+Specification+and+Guide

Now, if your question is about how to combine the modeling of archetypes and 
the modeling of SNOMED CT expressions, this paper could give you some hints. 
It's old, but still relevant. There are clear areas for modeling information as 
archetypes or with terminologies, but there is also a grey area where both 
solutions are applicable.

"Representing clinical information using SNOMED Clinical Terms with different 
structural information models", David Markwell, Laura Sato, Edward Cheetham
http://ceur-ws.org/Vol-410/Paper13.pdf

El lun., 19 nov. 2018 a las 14:21, Bakke, Silje Ljosland 
(mailto:silje.ljosland.ba...@nasjonalikt.no>>)
 escribió:
Hi everyone,

We’ve recently started an informal and practically oriented regular contact 
with the Norwegian SNOMED CT NRC. One of the things they were interested in 
discussing was how to use postcoordinated SNOMED CT (expression constraint 
language) expressions with openEHR, which I know nothing about. Does anyone 
have any knowledge about or experience with this?

Kind regards,
Silje Ljosland Bakke

Information Architect, RN
Coordinator, National Editorial Board for Archetypes
Nasjonal IKT HF, Norway
Tel. +47 40203298
Web: http://arketyper.no / Twitter: 
@arketyper_no

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Skype: davidmoner
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Re: Postcoordinated terminology expressions in openEHR

[David Moner]

Hi, just for clarification, you have mixed are two different things:

- SNOMED CT postcoordinated expressions are structured combinations of one
or more concepts to express a clinical idea. You use them to create new
concepts not available in the SNOMED release. They are built using the
SNOMED CT Compositional Grammar. In the archetypes they could be used for
the semantic binding of the structure (at codes), or for data values in
coded data types
https://confluence.ihtsdotools.org/display/SLPG/SNOMED+CT+Compositional+Grammar

- SNOMED CT Expression Constraint Language is an extension of the
compositional grammar that allows building SNOMED CT subsets intensionally,
i.e., by restriction or querying. This allows you to create a subset by
defining an expresion. This can be used to constraint coded values (ac
codes)
https://confluence.ihtsdotools.org/display/DOCECL/Expression+Constraint+Language+-+Specification+and+Guide

Now, if your question is about how to combine the modeling of archetypes
and the modeling of SNOMED CT expressions, this paper could give you some
hints. It's old, but still relevant. There are clear areas for modeling
information as archetypes or with terminologies, but there is also a grey
area where both solutions are applicable.

"Representing clinical information using SNOMED Clinical Terms with
different structural information models", David Markwell, Laura Sato,
Edward Cheetham
http://ceur-ws.org/Vol-410/Paper13.pdf

El lun., 19 nov. 2018 a las 14:21, Bakke, Silje Ljosland (<
silje.ljosland.ba...@nasjonalikt.no>) escribió:

> Hi everyone,
>
>
>
> We’ve recently started an informal and practically oriented regular
> contact with the Norwegian SNOMED CT NRC. One of the things they were
> interested in discussing was how to use postcoordinated SNOMED CT
> (expression constraint language) expressions with openEHR, which I know
> nothing about. Does anyone have any knowledge about or experience with this?
>
>
>
> Kind regards,
> *Silje Ljosland Bakke*
>
>
>
> Information Architect, RN
>
> Coordinator, National Editorial Board for Archetypes
> Nasjonal IKT HF, Norway
>
> Tel. +47 40203298
>
> Web: http://arketyper.no / Twitter: @arketyper_no
> 
>
>
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> openEHR-technical mailing list
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>
> http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.openehr.org
>


-- 
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Web: http://www.linkedin.com/in/davidmoner
Twitter: @davidmoner
Skype: davidmoner
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Re: Postcoordinated terminology expressions in openEHR

[Ian McNicoll]

Yes agree laterality is another potentially high value case.

They should probably talk to the CIMI folks. Stan Huff has a good an idea
as anyone of both the potential and pitfalls of complex terminology
handling. I suspect that really held CIMI back at a critical moment but at
least they have a good understanding of te challenges.

In spite of decades of attempts, I don't know of any national program that
is using post-coordination to any extent.

Ian
Dr Ian McNicoll
mobile +44 (0)775 209 7859
office +44 (0)1536 414994
skype: ianmcnicoll
email: i...@freshehr.com
twitter: @ianmcnicoll


Co-Chair, openEHR Foundation ian.mcnic...@openehr.org
Director, freshEHR Clinical Informatics Ltd.
Director, HANDIHealth CIC
Hon. Senior Research Associate, CHIME, UCL


On Mon, 19 Nov 2018 at 15:38, Thomas Beale  wrote:

> I mostly agree with Ian, but with the small caveat that for very specific
> and well-known cases such as body laterality, you just *might consider*
> post-coordination on body site e.g.
>
>- 56459004 |foot structure| : 272741003 |laterality| = 7771000 |left|)
>
> However, even here, laterality often seems to be divided out in various
> ways depending on what you are talking about. E.g. anything to do with
> eyes, the whole exam is per-eye rather than each finding being marked as
> being on the 'eye, left' or 'eye, right'. In other places, 'left' and
> 'right' don't even have symmetrical meanings e.g. the heart (think
> left-branch bundle etc).
>
> Nevertheless, for those body sites where findings are reported as being on
> some X+left or right, I think we probably should consider post-coordination
> of the site and the laterality at some point. For everything else, it's a
> nice idea but forget it in data models.
>
> Where it could be used is via a *mapping formula *for multiple data
> points, e.g. in an archetype. The archetype data would be defined populated
> as a structure (as today), but a 'post-coordination formula' that indicates
> how to bind the values of particular coded elements together to obtain a
> Snomed expression could be used to generate such expressions from the data,
> for consumption by inference engines. This is the only place where they can
> be usefully computed with, in my opinion.
>
> Such a formula might look like this:
>
>- 47933007 |$pain_finding| : 363698007 |finding_site| = (
>$finding_site: 272741003 |laterality| =  $laterality)
>
> where $pain_finding, $finding_site and $laterality are bound to paths in
> the archetype.
>
> If the formula were evaluated, it might give this:
>
>- 22253000 |pain| : 363698007 |finding site| = ( 56459004 |foot
>structure| : 272741003 |laterality| = 7771000 |left| )
>
> With minor adjustments in the binding part of the ADL2 grammar, such
> formula bindings could be accommodated fairly easily I would think.
>
> Note: this is speculation, and has never been tried as far as I know. Even
> if it does, it's only for SNOMED, unless the SNOMED model of
> post-coordinated expressions is adopted by other terminologies...
>
> - thomas
>
> On 19/11/2018 13:32, Ian McNicoll wrote:
>
> Basically - don't!!
>
> The UK has been trying to do this for over 20 years without success. It is
> a terminologists dream but implementers nightmare.
>
> Make a start with high-value use cases e.g Allergy agent "Allergic to +
> causative agent" - so that you do not have to generate a new Snomed code
> for every potential allergen.
>
> Perhaps consider laterality. Beyond that, you risk delaying SNOMED CT
> implementation, as has happened in the UK.
>
> Post-coordination is like nuclear fusion - a damned good idea but tricky
> to do without blowing everything up.
>
> Ian
> Ian
> Dr Ian McNicoll
> mobile +44 (0)775 209 7859
> office +44 (0)1536 414994
> skype: ianmcnicoll
> email: i...@freshehr.com
> twitter: @ianmcnicoll
>
>
> Co-Chair, openEHR Foundation ian.mcnic...@openehr.org
> Director, freshEHR Clinical Informatics Ltd.
> Director, HANDIHealth CIC
> Hon. Senior Research Associate, CHIME, UCL
>
>
> On Mon, 19 Nov 2018 at 13:20, Bakke, Silje Ljosland <
> silje.ljosland.ba...@nasjonalikt.no> wrote:
>
>> Hi everyone,
>>
>>
>>
>> We’ve recently started an informal and practically oriented regular
>> contact with the Norwegian SNOMED CT NRC. One of the things they were
>> interested in discussing was how to use postcoordinated SNOMED CT
>> (expression constraint language) expressions with openEHR, which I know
>> nothing about. Does anyone have any knowledge about or experience with this?
>>
>>
>>
>> Kind regards,
>> *Silje Ljosland Bakke*
>>
>>
>>
>> Information Architect, RN
>>
>> Coordinator, National Editorial Board for Archetypes
>> Nasjonal IKT HF, Norway
>>
>> Tel. +47 40203298
>>
>> Web: http://arketyper.no / Twitter: @arketyper_no
>> 
>>
>>
>> ___
>> openEHR-technical mailing list
>> openEHR-technical@lists.openehr.org
>>
>> 

Re: Postcoordinated terminology expressions in openEHR

[Thomas Beale]

I mostly agree with Ian, but with the small caveat that for very 
specific and well-known cases such as body laterality, you just /might 
consider/ post-coordination on body site e.g.


 * 56459004 |foot structure| : 272741003 |laterality| = 7771000 |left|)

However, even here, laterality often seems to be divided out in various 
ways depending on what you are talking about. E.g. anything to do with 
eyes, the whole exam is per-eye rather than each finding being marked as 
being on the 'eye, left' or 'eye, right'. In other places, 'left' and 
'right' don't even have symmetrical meanings e.g. the heart (think 
left-branch bundle etc).


Nevertheless, for those body sites where findings are reported as being 
on some X+left or right, I think we probably should consider 
post-coordination of the site and the laterality at some point. For 
everything else, it's a nice idea but forget it in data models.


Where it could be used is via a /mapping formula /for multiple data 
points, e.g. in an archetype. The archetype data would be defined 
populated as a structure (as today), but a 'post-coordination formula' 
that indicates how to bind the values of particular coded elements 
together to obtain a Snomed expression could be used to generate such 
expressions from the data, for consumption by inference engines. This is 
the only place where they can be usefully computed with, in my opinion.


Such a formula might look like this:

 * 47933007 |$pain_finding| : 363698007 |finding_site| = (
   $finding_site: 272741003 |laterality| =  $laterality)

where $pain_finding, $finding_site and $laterality are bound to paths in 
the archetype.


If the formula were evaluated, it might give this:

 * 22253000 |pain| : 363698007 |finding site| = ( 56459004 |foot
   structure| : 272741003 |laterality| = 7771000 |left| )

With minor adjustments in the binding part of the ADL2 grammar, such 
formula bindings could be accommodated fairly easily I would think.


Note: this is speculation, and has never been tried as far as I know. 
Even if it does, it's only for SNOMED, unless the SNOMED model of 
post-coordinated expressions is adopted by other terminologies...


- thomas


On 19/11/2018 13:32, Ian McNicoll wrote:

Basically - don't!!

The UK has been trying to do this for over 20 years without success. 
It is a terminologists dream but implementers nightmare.


Make a start with high-value use cases e.g Allergy agent "Allergic 
to + causative agent" - so that you do not have to generate a new 
Snomed code for every potential allergen.


Perhaps consider laterality. Beyond that, you risk delaying SNOMED CT 
implementation, as has happened in the UK.


Post-coordination is like nuclear fusion - a damned good idea but 
tricky to do without blowing everything up.


Ian
Ian
Dr Ian McNicoll
mobile +44 (0)775 209 7859
office +44 (0)1536 414994
skype: ianmcnicoll
email: i...@freshehr.com 
twitter: @ianmcnicoll


Co-Chair, openEHR Foundation ian.mcnic...@openehr.org 


Director, freshEHR Clinical Informatics Ltd.
Director, HANDIHealth CIC
Hon. Senior Research Associate, CHIME, UCL


On Mon, 19 Nov 2018 at 13:20, Bakke, Silje Ljosland 
> wrote:


Hi everyone,

We’ve recently started an informal and practically oriented
regular contact with the Norwegian SNOMED CT NRC. One of the
things they were interested in discussing was how to use
postcoordinated SNOMED CT (expression constraint language)
expressions with openEHR, which I know nothing about. Does anyone
have any knowledge about or experience with this?

Kind regards,
*Silje Ljosland Bakke*

**

Information Architect, RN

Coordinator, National Editorial Board for Archetypes
Nasjonal IKT HF, Norway

Tel. +47 40203298

Web: http://arketyper.no / Twitter:
@arketyper_no 

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--
Thomas Beale
Principal, Ars Semantica 
Consultant, ABD Project, Intermountain Healthcare 

Management Board, Specifications Program Lead, openEHR Foundation 

Chartered IT Professional Fellow, BCS, British Computer Society 

Health IT blog  | Culture blog 
 | The Objective Stance 

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Re: Postcoordinated terminology expressions in openEHR

[Ian McNicoll]

Basically - don't!!

The UK has been trying to do this for over 20 years without success. It is
a terminologists dream but implementers nightmare.

Make a start with high-value use cases e.g Allergy agent "Allergic to +
causative agent" - so that you do not have to generate a new Snomed code
for every potential allergen.

Perhaps consider laterality. Beyond that, you risk delaying SNOMED CT
implementation, as has happened in the UK.

Post-coordination is like nuclear fusion - a damned good idea but tricky to
do without blowing everything up.

Ian
Ian
Dr Ian McNicoll
mobile +44 (0)775 209 7859
office +44 (0)1536 414994
skype: ianmcnicoll
email: i...@freshehr.com
twitter: @ianmcnicoll


Co-Chair, openEHR Foundation ian.mcnic...@openehr.org
Director, freshEHR Clinical Informatics Ltd.
Director, HANDIHealth CIC
Hon. Senior Research Associate, CHIME, UCL


On Mon, 19 Nov 2018 at 13:20, Bakke, Silje Ljosland <
silje.ljosland.ba...@nasjonalikt.no> wrote:

> Hi everyone,
>
>
>
> We’ve recently started an informal and practically oriented regular
> contact with the Norwegian SNOMED CT NRC. One of the things they were
> interested in discussing was how to use postcoordinated SNOMED CT
> (expression constraint language) expressions with openEHR, which I know
> nothing about. Does anyone have any knowledge about or experience with this?
>
>
>
> Kind regards,
> *Silje Ljosland Bakke*
>
>
>
> Information Architect, RN
>
> Coordinator, National Editorial Board for Archetypes
> Nasjonal IKT HF, Norway
>
> Tel. +47 40203298
>
> Web: http://arketyper.no / Twitter: @arketyper_no
> 
>
>
> ___
> openEHR-technical mailing list
> openEHR-technical@lists.openehr.org
>
> http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.openehr.org
>
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