2021-09-20 - OBSERVABLE Meeting

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Daniel Karlsson 

James R. Campbell

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• Scale/score Observables for anesthesia and clinical medicine
• The Anesthesia CRG has submitted a paper to the EAG describing some of the problems of SNOMED in relation to modeling of assessment scales (see Modelling of Assessment Scales in SNOMED CT.docx)
• See attached presentation for discussion this date: "Clinical Scale Scores20210301"
• Deliverables: 

  1) Anesthesia CRG will proceed with proposing FSN/PT for ASA scale scores as qualifier, including definitions of each value, and proceed with obtaining permission from ASA for publication

• 2) Anesthesia CRG will proceed with proposing FSN/PT for Mallampati scale scores as qualifiers, including definitions of each value, and proceed with obtaining permission from authoritative source for publication

• More complicated use case of Glasgow Coma Scale was discussed briefly to prepare for detailed discussion next meeting.

• Deliverable:  3) Meeting attendees to consider special use case of supporting calculations for Glasgow Coma Scale Total Score from three Ordinal component scores for discussion next meeting

2021-04-19:

Assessment scale hierarchy requirements https://docs.google.com/presentation/d/1b_vmIY7IFjfYuaXd6H-c5GxijEyaFj75wbvreZ4_fkA/edit?usp=sharing

Andrew Norton provided background to the use cases provided by the Anesthesia CRG.

A requirement to represent the scale points of the assessment scales when they correspond to findings, but question is who is responsible for the association between clinical findings in general and scale points. 

There are two use cases which are slightly different: (1) the requirement to be able to use SNOMED CT to encode contents of the EHR and then use that to "populate" assessment scale components, and (2) the requirement to be able to store and communicate results of application of the assessment scales per se using SNOMED CT concepts. Moving from (1) (i.e. a SNOMED CT encoded EHR) to (2) (SNOMED CT encoded assessment scale representation) is non-trivial. There is a discrepancy between the recording of clinical findings (more granular) and the recording of values for assessment instruments (discrete buckets). The challenge is matching the clinical findings to the appropriate value in the assessment. This is not (necessarily) something that is handled within SNOMED. However, assessment scales are also sometimes used as the primary documentation.

2021-05-17:

Some example existing scale observables were discussed in relation to the subsumption expected from any work done to define scale observables. E.g. the Apgar component observables are not subsumed by any observables related to heart rate, respiration, skin color etc. To contrast, pain score observables are subsumed by other pain observables. The group agreed that being able to group scale observables by what the scales assess is a desireable feature of any solution.

2021-06-21:

James R. Campbell made a presentation at the Anesthesia CRG call about representing assessment scale observables. A key missing piece is the representation of scale points (ordinals) beyond their scale value (e.g. 1, 2, 3, ... for GCS) to include the actual clinical meaning. For GCS, neurologists' input will be sought. Experimentation with the CRG include more complex scales will help produce a decision paper for the EAG.

2021-08-02:

Slides

Scale observables could, when they correspond to e.g. physiological or otherwise established observations, be represented as <base observable> : | Technique | = <the assessment scale>, | Scale type | = | Ordinal|. See example in slides.

IP issues might prohibit the representation of some assessment scale components: Proprietary Names and Works

2021-08-16:

There's been a meeting of the Clinical Reference Group leads about assessment scales and SNOMED CT. A more general discussion about the requirements for assessment scale content is planned for a new meeting September 8. Andrew Norton will present the work done in the Anesthesia CRG with Observables and Findings. Will discuss this presentation with James R. Campbell and Daniel Karlsson.

The preferred representation of scale values/points/ordinals was discussed. Currently some concepts for scale values for some assessment scales, or parts thereof, exist in SNOMED CT, e.g. <<386557006 | Glasgow coma scale finding (finding) | but only for the total score, not its components. 

Parameters (previously "Settables")

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The issue of representation of target observables has been raised again in a Jira ticket.

The question the group needs to answer is whether targets and observables need to be seperated or to be kept apart. In practice, is there a requirement to query for both observables and "settings" alternatively is there a risk in having targets and observations mixed up?

One solution would be to (minimally) add a primitive parent "setting observable" (or just "setting") to all targets, settings, parameters, etc. in the current observables hierarchy.

2020-09-21:

Suzanne Santamaria shared with the nutrition group, will share with Jim Case

2020-11-16:

Release of content postponed to July 2021.

2020-12-14:

If time permits, go through comments from Jim Case.

See this page

2021-02-08:

"Parameter" is a better name for the super concept of all observables determined by decision.

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A review of existing Editorial Guide for Observables is due. Some pages seem dated. Comments to pages are done in a Google Doc here. https://docs.google.com/document/d/1dfDd-K4hP425O_7poTA8roZ_fkAKQj0l458LGob1FBM/edit?usp=sharing

• Sarah Harry terming guidelines needs updating
• Many pages seem dated, e.g. Relationship between Observable Entities and NPU codes, Representing LOINC Terms with the SNOMED CT Observable Entity Model, Test Observable Entity Naming Conventions
• Wording of guidelines could be lighter on the jargon
• Examples from existing Observables as well as from the LOINC tech preview could be added
• Process for approval of changes discussed

2020-12-14:

Templates for quality and process observables.

Particularly, the boundary between quality and process observables might need discussion (presentation). There is (at least) a potential for inconsistencies unless there are clear guidance on when to use quality and process patterns respectively as there 

Sarah Harry what about e.g. clotting time?

2021-01-18:

Comments from SNOMED staff to the EG Google Doc was discussed. Comments were added to the document. "PG agreement" as a comment in the document indicates that the project group agreed to the comment above.

2021-06-21:

Changes made in the document

2021-08-02:

Changes made and accepted by the project group. Some examples to be added concerning Inheres in and Direct site.

• Daniel Karlssonadd 1-2 examples with Inheres in and Direct site

Daniel Karlsson