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glossary-ref

Gloss
tSNOMED
CT
itself is only a part of the solution to addressing the requirements for effective electronic clinical records. A terminology on its own "does" nothing unless it is implemented as part of an application and used. Implementation of glossary-ref
Gloss
tSNOMED
CT
requires software applications that exploit its features to meet the real and perceived needs of users.

The "users" of

glossary-ref
Gloss
tSNOMED
CT
include:
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...

As illustrated by , users experience

glossary-ref
Gloss
tSNOMED
CT
through application software which delivers services to access and apply glossary-ref
Gloss
tSNOMED
CT
. The ways in which applications apply the features of glossary-ref
Gloss
tSNOMED
CT
to address user requirements determine the extent to which the potential benefits are realized .

The following sections summarize some of the types of implementation that may be needed to meet different requirements. Some types of application do not need to support or use all

glossary-ref
Gloss
tSNOMED
CT
features. However, there are some overarching requirements for consistency between implementation used within a given organization, country or region. Even where requirements are limited, care should be taken to ensure that glossary-ref
Gloss
tSNOMED
CT
enabled
applications
are aligned with good practice and with agreed policies applicable to the situations in which they are used.

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Figure 1. Relationship between users application software and SNOMED

Caption figure
Relationship between users application software and SNOMED CT

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Implementation Types - Clinical records

A

glossary-ref
Gloss
tSNOMED
CT
enabled clinical record application uses glossary-ref
Gloss
tSNOMED
CT
expressions
to represent clinical information in the records of individual patients.

Clinical record applications include specialized departmental systems, organization -wide systems and systems that integrate multiple systems to deliver a distributed

glossary-ref
Gloss
telectronic
health
record
or a collection of widely accessible summary records.

A

glossary-ref
Gloss
tSNOMED
CT
enabled clinical record application needs to provide glossary-ref
Gloss
trecord
services
including entry, storage, retrieval and communication of glossary-ref
Gloss
tSNOMED
CT
expressions
. These glossary-ref
Gloss
trecord
services
depend on glossary-ref
Gloss
tterminology
services
including the ability to search for glossary-ref
Gloss
tconcepts
and to interpret stored glossary-ref
Gloss
tSNOMED
CT
expressions
.

A wide range of types of information can be represented at different levels of detail using

glossary-ref
Gloss
tSNOMED
CT
expressions
. The types of information and level of detail that are used may vary depending on user requirement or may be limited by the design of the application. Differences in the required level of expressivity influence the range of glossary-ref
Gloss
trecord
services
that need to be supported.

The way that

glossary-ref
Gloss
tSNOMED
CT
expressions
are represented within a record structure affects the range of services that are required to deliver the potential benefits of implementation. The value of the rich expressivity of glossary-ref
Gloss
tSNOMED
CT
may be enhanced or diminished by the way the record structure relates glossary-ref
Gloss
tSNOMED
CT
expressions
to surrounding contextual information. For example, if a record structure permits similar or related information to be recorded in several ways a query to retrieve that information will need to consider all these possibilities. Retrieval is simpler if similar information is recorded in a consistent way - irrespective of the way it was entered. This issues are discussed in detail in the Record Services Guide .

...

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Implementation Types - Knowledge representation

A

glossary-ref
Gloss
tSNOMED
CT
enabled knowledge representation uses glossary-ref
Gloss
tSNOMED
CT
expressions
to represent or tag resources that represent clinical knowledge. Examples of resources that can be glossary-ref
Gloss
tSNOMED
CT
enabled include electronic reference books, clinical guidelines, care pathways, decision support protocols and requirements for analysis and audit.

There are various ways in which

glossary-ref
Gloss
tSNOMED
CT
expressions
can be used in a knowledge resource. These can be divided into two broad categories:

  • Use of glossary-ref
    Gloss
    tSNOMED
    CT
    expressions
    as an integral part of a structured representation of knowledge:
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    • For example, a decision support rule that tests for the existence of a record of a particular type of finding represented using a glossary-ref
      Gloss
      tSNOMED
      CT
      expression
      .
  • Use of glossary-ref
    Gloss
    tSNOMED
    CT
    expressions
    to tag or index a knowledge resource:
    Anchor
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    _60abe27b-702a-459f-993e-41ff2c5d2a71__f
    • For example, a reference book in which textual glossary-ref
      Gloss
      tdescriptions
      of indications, contraindications and side effects of particular treatments are tagged with glossary-ref
      Gloss
      tSNOMED
      CT
      expression
      that can be used to allow context-sensitive retrieval of relevant information.

There are two distinct but interrelated aspects to

glossary-ref
Gloss
tSNOMED
CT
knowledge representation.

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    Applying glossary-ref
    Gloss
    tSNOMED
    CT
    expressions
    to the resource:
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    • The form of representation to be used must be specified in a way that takes account of the ways in which the resource is to be used and accessed.
    • The knowledge authoring environment must allow the specified representation to be applied consistently. This requires use of glossary-ref
      Gloss
      tTerminology
      services
      that allow searching and selection of glossary-ref
      Gloss
      tconcepts
      . Depending on the level of detail required, there may also be a requirement to support the construction of glossary-ref
      Gloss
      tpostcoordinated
      expressions
      .
  • Enabling appropriate access to and use of the resource:
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    • The types of access required depend on the intended functionality.
    • The most basic level of functionality involves using glossary-ref
      Gloss
      tSNOMED
      CT
      expressions
      as a glossary-ref
      Gloss
      tconcept
      -based index. By taking account of the subtype
      Glossary ref
      SNOMED CT
      Glossary ref
      Gloss
      Spacetrue
      tSNOMED CT
      Gloss
      tsubtype hierarchy
      and defining glossary-ref
      Gloss
      trelationships
      , a glossary-ref
      Gloss
      tconcept
      -based index can provide more relevant results than a simple
      Specref
      RefTypefield
      tterm
      based search.
    • More sophisticated uses such as clinical decision support require glossary-ref
      Gloss
      tSNOMED
      CT
      expressions
      in the knowledge resource to be used to generate queries that can be applied to information stored in an glossary-ref
      Gloss
      telectronic
      health
      record
      .
    • The provider of a glossary-ref
      Gloss
      tSNOMED
      CT
      enabled knowledge resource may provide a specification that allows software developed by other organizations to interrogate it and provide the required level of functionality. Alternatively, the knowledge authoring organization may also develop and provide software that delivers the intended functionality.

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Implementation Types - Aggregation and analysis

glossary-ref

Gloss
tSNOMED
CT
enabled aggregation and analysis systems use glossary-ref
Gloss
tSNOMED
CT
to enable effective aggregation and analysis of information derived from clinical record systems. glossary-ref

Gloss
tSNOMED
CT
enables consistent processable representation of clinical information. As well as presenting opportunities for analysis of information within an individual clinical record system, this can be used to support analysis of a broader substrate of aggregated data.

There are two types of approach that be employed to enable analysis of aggregate data.

  • A glossary-ref
    Gloss
    tSNOMED
    CT
    enabled data warehouse:
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    • The content and structure of data required from individual glossary-ref
      Gloss
      tClinical
      Information
      Systems
      is specified. The specified structure must include details of the required representation of data including glossary-ref
      Gloss
      tSNOMED
      CT
      expressions
      .
    • The required data is extracted and uploaded to a database designed for the purpose of large scale analysis. Usually the extract and upload will need to be repeated or updated at specified intervals.
    • The central database is structured to optimize common types of queries taking account of the glossary-ref
      Gloss
      tSNOMED
      CT
      expressions
      and the glossary-ref
      Gloss
      trelationships
      between referenced glossary-ref
      Gloss
      tconcepts
      asserted in glossary-ref
      Gloss
      tSNOMED
      CT
      content.
    • A
      Specref
      RefTypefield
      tquery
      interface is provided to allow common types of question to be expressed against the central database.
    • Queries are run taking account of the glossary-ref
      Gloss
      trelationships
      between glossary-ref
      Gloss
      tconcepts
      to provide comprehensive and accurate results ( minimizing the risks of false negatives or false positives).
    • The results of queries are presented where relevant using glossary-ref
      Gloss
      tSNOMED
      CT
      expressions
      as processable labels to enable further analysis.
  • A common
    Specref
    RefTypefield
    tquery
    specification supported by clinical record systems:
    Anchor
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    • A common glossary-ref
      Gloss
      treference
      information
      model
      including glossary-ref
      Gloss
      tSNOMED
      CT
      expressions
      is specified. This is used as a common glossary-ref
      Gloss
      tmodel
      of
      meaning
      against which queries are evaluated.
    • Each clinical record system provider implements this common glossary-ref
      Gloss
      tmodel
      of
      meaning
      as a view of the information stored in their glossary-ref
      Gloss
      telectronic
      health
      record
      .
    • A
      Specref
      RefTypefield
      tquery
      interface is provided to allow common types of question to be expressed against the common glossary-ref
      Gloss
      tmodel
      of
      meaning
      .
    • Queries are distributed and run on individual systems and the results are returned to a central system for aggregate reporting.
    • The results of queries are presented where relevant using glossary-ref
      Gloss
      tSNOMED
      CT
      expressions
      as processable labels to enable further analysis.

In practice, there is significant overlap between these two approaches. A data warehouse approach can benefit from a common approach to specifying the information extraction requirements. This allows changes to the specification without re-engineering the contributing clinical record systems. A common

Specref
RefTypefield
tquery
specification approach requires a central element to manage distribution of queries and aggregation of results.

Irrespective of the approach taken,

glossary-ref
Gloss
tSNOMED
CT
enabled aggregation and analysis is most effective where the representation of information in the contributing clinical record systems is consistent with a common view. However, it is possible to aggregate information from diverse systems if the limits imposed by differences are understood. It is even possible for a glossary-ref
Gloss
tSNOMED
CT
aggregation and analysis system to be applied information that was not originally encoded using glossary-ref
Gloss
tSNOMED
CT
. An extraction and aggregation interface that includes mapping from another coding system may produce information of adequate quality and consistency for many purposes. Data derived by tagging textual records using glossary-ref
Gloss
tnatural
language
processing
may also meet requirements that are not safety-critical.

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Terminology tools

glossary-ref

Gloss
tSNOMED
CT
enabled terminology tools provide access to glossary-ref
Gloss
tSNOMED
CT
content. On their own they are not practical end-user implementations but they enable the development and review of glossary-ref
Gloss
tSNOMED
CT
. They may also deliver services that can be used by end-user implementations.

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Implementation Types - Terminology browser

A

glossary-ref
Gloss
tSNOMED
CT
enabled glossary-ref
Gloss
tbrowser
allows the content and structure of glossary-ref
Gloss
tSNOMED
CT
to be explored and reviewed.

A typical

glossary-ref
Gloss
tSNOMED
CT
enabled glossary-ref
Gloss
tbrowser
can locate glossary-ref
Gloss
tconcepts
and glossary-ref
Gloss
tdescriptions
by glossary-ref
Gloss
tIdentifiers
and by searching the text of terms
Glossary ref
description
Gloss
Spacetrue
tdescription
Specref
RefTypefield
tterm
. Various views of located glossary-ref
Gloss
tconcepts
may be displayed including the set of related glossary-ref
Gloss
tdescriptions
, the hierarchical glossary-ref
Gloss
trelationships
and other defining glossary-ref
Gloss
trelationships
.

A terminology

glossary-ref
Gloss
tbrowser
may be:
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_41c29a69-0ca0-4e2f-ba35-136045cc4f02__7

  • A stand-alone tool.
  • Part of a more extensive implementation.
  • Accessible via an glossary-ref
    Gloss
    tApplication
    Programming
    Interface
    ( glossary-ref
    Gloss
    tAPI
    ):
    Anchor
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    _41c29a69-0ca0-4e2f-ba35-136045cc4f02__5
    • This may allow the glossary-ref
      Gloss
      tbrowser
      to be used by client applications to select glossary-ref
      Gloss
      tSNOMED
      CT
      expressions
      ;
    • It may be part of a glossary-ref
      Gloss
      tterminology
      server
      which provides a wider range of glossary-ref
      Gloss
      tTerminology
      services
      .

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Implementation Types - Terminology server

A

glossary-ref
Gloss
tSNOMED
CT
enabled
terminology
server
is a software application that provides programmatic access to glossary-ref
Gloss
tSNOMED
CT
components
. These services are made available through a documented glossary-ref
Gloss
tApplication
Programming
Interface
( glossary-ref
Gloss
tAPI
) which can be used by many different client applications.

A

glossary-ref
Gloss
tSNOMED
CT
enabled
terminology
server
must be able to import SNOMED CT release files and provide some or all of the services described in the Terminology Services Guide. All glossary-ref
Gloss
tterminology
servers
must support a basic minimum set of functions including Foundation Terminology Services and access to Reference sets and other metadata .

A

glossary-ref
Gloss
tterminology
server
may provide glossary-ref
Gloss
tuser
interface
services, such as a set of screen controls to support term selection. Alternatively, while the glossary-ref
Gloss
tAPI
should support searches, the glossary-ref
Gloss
tuser
interface
representation of the results of a search may be left to client applications. Where glossary-ref
Gloss
tuser
interface
controls are provided by the server, these controls may also be packaged in an integrated form as a glossary-ref
Gloss
tterminology
browser
.

A

glossary-ref
Gloss
tSNOMED
CT
enabled
terminology
server
may also provide services that support the use of other terminologies. In this case, it may conform to a standard specification such as glossary-ref
Gloss
tCommon
Terminology
Services
2
( glossary-ref
Gloss
tCTS2
).

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Implementation Types - Terminology development and maintenance tools

glossary-ref

Gloss
tSNOMED
CT
development and maintenance requires tools which are able to create and update glossary-ref
Gloss
tSNOMED
CT
content.

Development and maintenance tools may either be general purpose or may focus on specific requirements (e.g.

glossary-ref
Gloss
tReference
Sets
to support glossary-ref
Gloss
tlanguage
, glossary-ref
Gloss
tmapping
or development of glossary-ref
Gloss
tvalue
sets
).

The process of maintenance needs to track changes and manage conflicts between edits made by different authors. In the case of content development, the tools must also ensure that

glossary-ref
Gloss
tconcept
definitions conform to the glossary-ref
Gloss
tSNOMED
CT
Concept
Model
. At regular intervals the tools need to generate a consistent set of quality assured glossary-ref
Gloss
trelease
files
.

The

glossary-ref
Gloss
tIHTSDO
Workbench
is a set of software tools designed to support the development, maintenance, and use of glossary-ref
Gloss
tSNOMED
CT
. Its key role is to facilitate the maintenance of the glossary-ref
Gloss
tSNOMED
CT
International
Release
and the National glossary-ref
Gloss
tExtensions
developed by IHTSDO
Glossary ref
Gloss
tMembers
. However, the future scope of use may extend to other organizations and to health information systems around the world. The glossary-ref
Gloss
tWorkbench
is owned by the glossary-ref
Gloss
IHTSDO
tSNOMED International
and is available under an Open Source license agreement.