BT Clinical Computing

BT Clinical Computing

Snomed CT Interface Dr Benny Van Bruwaene, Dr Thierry Klein

Snomed CT Interface

• Parser Text -> Snomed CT (BT-Knowliah)

• Structured Snomed CT Interface (BT-SBIM-Indizen)

Autocompletion

Context sensitive protocols (BT-SBIM)

• Multipurpose Code Convertor (BT)

• Terminology Management System (BT-Indizen)

• Snomed CT Repository & Patient Summary (BT-Knowliah)

Continuityof Care

Snomed CT Patient Summary

Clinical and Medication

Reconciliation

Decision support

Personal HealthRecord

Transparent Medical Coding

Snomed CT-guidedtext interface

Parsing text to Snomed CT

Rule-basedmultipurpose code

conversion

Snomed CT Big Data

Medical Data Intelligence

Clinical Trials

Benchmarking

MeaningfulUse

Problem list (active and past diagnoses)

Allergy list

Support e-prescription medication

Drug drug interaction

Evidence Basedorder-entry

(RX/lab/consultation)

Sumehr/CCD

communication

Webapplication BT Snomed CT InterfaceWeb Services Electronic Medical Record

Webapp Report - Codes

6

Webapp Form

7

8

Webapp List (Patient Summary)

9

Natural Language ParserText to Snomed CT

Parsing Text Snomed CT• Strenght

Batch: Retrospective (studies big data)

Webservice On Line

No operational change HCP

Automatic coding & Translation

o UREG, Registries, Clinical trials, ….

Patient Summary, Medical history

• Weakness

Garbage in -> Garbage out

Coverage Snomed CT dictionary

Parsing Text Snomed CT

Parsing Text Snomed CTClinical Findings - Laboratory

Parsing Text Snomed CTObservable entities

Parsing Text Snomed CTMedication

Term analysis & Update SCT Dictionary• Parse sample of reports

• Termanalysis

• Annotate to Snomed CT

Number of Tokens used

Number of unique Tokens

Number of Tokens used%

Number of unique Tokens%

Total 12.626 2.608 100,0% 100,0%

Coded before annotation 7.487 1.111 59,3% 42,6%

Annotation 1.301 81 10,3% 3,1%

Coded after annotation 8.788 1.192 69,6% 45,7%

Example 50 reports

Snomed CT Interface• Autocompletion

• Context sensitive protocolling

Snomed CT Interface• Strenght

Fast data entry

Complete, Correct, Non ambiguous

Coded

• Weakness

New interface for Health care Professional

Autocompletion Smartphone like

• As you type

• Abbreviations

• Parts of words

• Browse

Autocompletion

• As you type

• Abbreviations

• Parts of words

• Browse

Autocompletion

• As you type

• Abbreviations

• Parts of words

• Browse

Autocompletion

• As you type

• Abbreviations

• Parts of words

• Browse

Snomed CT InterfaceAutolearning

Snomed CT InterfaceAutolearning

Context sensitive pick lists• Target code (ICD, …)

• Protocolling

Target Code drivenHorizontal : all users

Target Code (RIZIV-INAMI) –guided

Target Code (ICD) – guided

Report PCS and RIZIV-INAMI compliant

Multipurpose Code Conversion

Context Sensitive RefsetsFast protocolling

413226009 | Esophagitis grade II | , 39839004 | diaphragmatic hernia |

Operation protocoleIntervention: Arthroplastie prothétique de la hanche <Mc>gauche;droite;bilatéral</Mc>

Indication:

Protocole:

Type de prothèse

Voie d'abord:

Composants de la prothèse

Luxation complète <Mc>appuyée;non appuyée</Mc>

Subluxation

Dysplasie de la hanche

Dysplasie cotyloïdienne luxante

Anomalie d'ouverture de l'angle cervico-obturateur (coxa valga)

Antéversion exagérée du col

Antétorsion du fémur

Coxa vara congénitale avec excès de couverture du cotyle

Coxa vara acquise de la maladie de Paget

Séquelle d'épiphysiolyse

Intervention:Arthroplastie prothétique de la hanche gauche.Indication:Coxarthrose secondaire gauche. Luxation complète non appuyée.

Coxarthrose primaire de la hanche

Coxarthrose secondaire:

Coxarthrite

Luxation de hanche traumatique

Fracture du col fémoral

Fracture du cotyle

Nécrose de la tête fémorale

Déscellement d'une prothèse existante:

Fracture du col fémoral

Spoedregistratie UREG

Reden spoed:Verkeersongeval. Chauffeur moto. Aanrijding met camion.…….

Reden spoed: 

Anamnèse 

Klinisch onderzoek 

Medische voorgeschienis 

Familiale antecedenten 

Aanvullende onderzoeken 

Behandeling op spoed: 

Evolutie: 

Behandeling bij ontslag:

Verkeersongeval:

Val

Arbeidsongeval<_>

Sportongeval<_>

Intoxicatie<_>

Zelfmoordpoging

Agressie

Intrafamiliaal geweld

Automutilatie<_>

Verwaarlozing<_>

Intoxicatie door <_>

Overdosis verdovende middelen<_>

Bevalling

In context van lopende behandeling<_>

Chauffeur

Passagier

Voetganger aangereden door

Fietsongeval

auto

camion

moto

brommer

fiets

voetganger

autobus

tram

trein

boot

paard

Aanrijding met

Val<_>

auto

camion

moto

brommer

fiets

voetganger

autobus

tram

trein

boot

paard

At Admission

Allergie geneesmiddelen: Geneesmiddel: aspirineManifestatie: Angio-oedeemErnst: ernstigTijdstip: 2013Evidentie: Anamnese betrouwbaar.

Allergie

Allergie geneesmiddelen

Intolerantie geneesmiddelen

Allergie voedingsmiddelen

Intolerantie voedingsmiddelen

Allergie insectenbeet

Atopie

Allergisch contacteczeem

Familiale geschiedenis van allergie aan <_> Reactie: _ Lid van de familie: <_>

Geneesmiddel:

Manifestatie:

Ernst: <Mc>llicht;matig;ernstig;levensbedreigend</Mc>

Tijdstip: <_>

Plaats: <_>

Evidentie <Mc>zeker;waarschijnlijk;mogelijk;waarschijnlijk afwezig;uitgesloten</Mc>

<_>

penicilline

iodium

aspirine

Anaphylactische shock<_>

Angio-oedeem<_>

Urticaria<_>

Auto-immun hepatitis

Anamnese<_>

Test in vitro<_>

Provocatietest: <_>

Context Sensitive RefsetsPrescription Clinical pathways

retrosternale pijn

Context Sensitive Refsets

• Flow chart guided

Fast, complete, correct

Structured (coded) -> Dispatch XML, Code conversion

• Context sensitive

Data driven!

o Diagnosis – Procedure - Study

User / Department

Terminology Management• Terminology

• Cross maps

• Refsets

Terminology Management SystemTerminologies & Cross maps

Terminology Management SystemTerminologies & Cross maps

Interactive - Collaborative• BT Clinical Computing

Software

Coding experts

Statistics of Use

• Participating hospitals (Local Use, Bottom Up)

You see what you get

o Snomed CT , English

o Secondary codes (ICD, RIZIV-INAMI, …)

Correction Loop

o Add, Correct

• National Release Centre, IHTSDO (International, Top down)

Snomed CT -> 1 Preferred Term

Cross maps & Rules

Multipurpose Code ConvertorSnomed CT to ICD-10

Hospital data (ICD)

• BT Snomed CT Interface

Import or Copy / Paste (part of) text

‘Submit’

Questions – Answers

Codes ICD

• Export to Hospital Data System (HDS)

BT Snomed Interface <> HDSystem


Code Conversion PCS

Code Conversion PCS


UREG Text –> Codes

Export report -> Code convertor

48

Snomed CTTo Patient Summary

Medical Report -> Patient Summary

Medical Report -> Patient SummarySnomed CT coded annotation

Texte Snomed CT

[Monsieur X] 184095009 | patient first name | = 'Monsieur', 371484003 |

patient name | = ‘X’

âgé de 72 ans 424144002 | age | = '72'

a été hospitalisé service de gastro-entérologie du 20.03.2012 au 02.04.2012 puis du 27.04.2012 au 03.05.2012 pour

32485007 | hospital admission | , 309926000 | gastroenterology department | , 398201009 | start time | ='20/03/2012 ', 397898000 | stop time | = '02/04/2012' AND 398201009 | start time | ='27/04/2012 ', 397898000 | stop time | = '03/05/2012 '

altération de l'état général 285384003 | general health deterioration |

décompensation ascitique 59927004 | liver failure | , 47429007 | associated with | =

389026000 | ascites |

dyspnée. 267036007 | Dyspnea |

Antécédents personnels : 417662000 | past medical history |

- asthme 195967001 | Asthma |

'- HTA 38341003 | Hypertensive disorder |

- hépatite C avec cirrhose 50711007 | Viral hepatitis C | , 47429007 | associated with | = 19943007 | Cirrhosis of liver |

- bronchopneumonie 233604007 | Pneumonia |

Affection actuelle : 410665000 | reason for | , 32485007 | hospital admission |

porteur d'une cirrhose C 29679002 | carrier | , 19943007 | Cirrhosis of liver |

oedème important chronique des membres inférieurs102572006 | Edema of lower extremity |, 24484000 | severe | , 90734009 | Chronic |

dyspnée 267036007 | Dyspnea |

ballonnement abdominal 41931001 | Abdominal distension |

ponction d'ascite 89305009 | Abdominal paracentesis |, start date =’30/6/2012’

Le régime sans sel n'a pas été suivi car mal compris. 226164007 | very low salt diet | , 7058009 | Noncompliance with treatment |, 53314000 | inability to understand |, start date =’30/6/2012’

a pris 14 kgs en 2 mois. 8943002 | weight gain | , 248346009 | weight change | = 14 , 258683005 | kg | , 282363004 | denominators of time | = 2 , 258706009 | month |

Médication à domicile 394829006 | past medication |

Canrenol 100 mg : 2 x/jour 419615001 | potassium canrenoate | : 258666001 | Unit | = '100',

258684004 | mg |, 259083004 | times/day | = '2'

Indéral 10 mg : 1 x/jour372772003 | propranolol | : 258666001 | Unit | = '10',

258684004 | mg |, 259083004 | times/day | = '1'



Use Cases

• UREG registry

• Hospital Data ICD

• Operating Room & Registries

• Patient Summary

• Clinical Pathways

• Clinical Trials

• Clinical Research Open, big and real data

Thanks for your attention

Have you got any questions ?

Send your e-mail to [email protected]

Operating Room

• Extend Snomed dictionary

Parse Operation reports

Annotate missing Terms in function of Frequency

Use with Autocomplete & Parsing

• Link O.R. codes with Snomed procedures

Flow planning EPR -> O.R. -> Report / Coding

• Create Refsets

Fast protocolling

Coding ICD-10-BE, INAMI

Registry

Clinical Pathways

• Create Refsets

• Link Refsets with context

Clinical finding, Procedure, Medication, Clinical trial

User, specialty

Clinical Trials Clinical Research Organisations & Pharma

• Create Refset Study Inclusion – Exclusion criteria

Select eligible patients

Alert eligible patient in real time

Protocolling EPR

• Print Case Report Form in English

• Anonymise & Export & communicate Patient Summary

Clinical Research Open, big and real data

http://www.pharma.be/nl/focus/gezondheid-en-innovatie/100-klinische-studies/20-toekomstpact.html

• Dictionary

Add Terms used for Outcome variables

Parse reports department and Annotate missing Terms

Create Refsets for prospective registration

• Upload reports to BT Parser

Anonymize & Code to Snomed CT

• Update with national registry for life expectancy

• Transform Snomed CT to flat file (Excel)

BT Clinical Computing

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