Bahmni PAT call on 17-May-2023 (SNOMED CT and Bahmni Integration)

Hi Andrew, Please find the first demo video of Recording Diagnosis & Viewing Reports in SNOMED CT with Bahmni here

Thank you! It was nice to see the demonstration. I wanted to point out a few things and ask some questions (if that is OK).

  1. When you show the CIEL concept for Malaria you point out that there are many maps from the concept (including to ICD-10, CIEL, ICPC, etc.) including SNOMED. There are also other relationships like sets and Q&A. How are those maintained for SNOMED-sourced concepts? How does a client get ICD-10 codes for their SNOMED diagnoses (almost certainly a requirement)?

  2. When searching for Asthma without SNOMED, the demo is misleading. CIEL has multiple Asthma concepts (less than SNOMED’s browser, but perhaps others). What were you searching? Why was there no fever concept?

  3. What happens when SNOMED does not have a concept. Try searching for “Sore throat”?

  4. When discussing descendants of a concept in the search, I was confused. If I search for ASTHMA and if there is a descendant of asthma that does not include the word “asthma” would it be returned? I don’t think users would want concepts that do not include the searched-for word to be included.

  5. When searching for synonyms, I would be careful about not showing the name they are actually matching (only showing the preferred term). You don’t know if the synonym is actually what the user was expecting and just assuming the preferred term is correct is dangerous. The user might not really know the preferred term, only the synonym, and you need to make sure they are selecting the correct term.

  6. When you add a term to the concept dictionary via the terminology server search, how do you know that the term does not already exist? Are you looking for SAME-AS SNOMED codes? What about the situations where SNOMED does not have SAME-AS coverage for the term I am looking for?

  7. When doing the SNOMED descendent report, would visits using CIEL concepts that have SAME-AS or NARROWER-THAN maps to SNOMED CT be included?

Thanks! Looking forward to part II.

Hi Andrew, Please find the second demo video of CDSS with Bahmni using SNOMED CT here

Thank you. It was very impressive! I would like to know more about the backend calculations in the CDSS and the particulars of the drug identification and calculations. SNOMED is not the preferred terminology for drug reference. CIEL has traditionally mapped to both SNOMED and RxNORM (and extension) but most CDSS does not use SNOMED for drugs. It would be good to consider how the CDSS engine is going to be maintained, and who is the authority. Wikipedia would not be an acceptable reference source for an expert system, but I get the general idea. It is powerful to see it in action! I would again ask that these functionalities also include concepts in the dictionary which are mapped to SNOMED and not only those sourced from the SNOMED server.

I would also like to point out that the hierarchy in SNOMED (and any other ontology) is built with a purpose. That purpose does not always overlap with the use case you need. Value sets are groups of codes/concepts that are intended to mean the same thing, or to identify a concept for a process like cohorting patients or triggering CDSS. Descendants of a single SNOMED code do not always meet this requirement. For example, there are SNOMED codes that imply that a patient has Diabetes that do not fall under the SNOMED disorder for Diabetes Mellitus. Previously, Sigmoidoscopy was a child of Colonoscopy (as the sigmoid is part of the colon). However, the CDSS rules for screening endoscopy are different whether the patient has only had a sigmoidoscopy versus a full colonoscopy so you don’t want the descendants of colonoscopy to all trigger the colonoscopy rule.

So, what I am saying is that CDSS rules need to consider the use of curated value sets for concepts and not just assume that single code hierarchical queries are sufficient.