2021-10-18 - OBSERVABLE Meeting @ the fall business meeting

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Daniel Karlsson

Daniel Karlsson

Daniel Karlsson 

James R. Campbell

Sarah Harry

X

• 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. 

2021-10-18:

Waiting for input from CRGs.

Daniel Karlsson

The OIMPG has been working since 2008 (in Birmingham) and since January 2017, the model has increasingly been implemented in the International SNOMED CT releases, still limited to certain domains.

Work has been done in different domains including vital signs, nutrition, cancer synoptic reports and given results of E2O project, laboratory medicine. Further needs have been identified for assessment scales, mental and behavioral health, as well as a number of yet undecided problems (e.g. risks, likelihoods, etc.). So, many of the problems are now within the different clinical domains rather than being about the peculiarities of the Observables model.

So where do we as a group (or any other stakeholders) want to see the project in the coming years, e.g.:

• Needs for Observables discussions will grow as we tackle the other 92 % of the hierarchy
• Project work is better managed in CRGs (with support)
• These topics X, Y, Z needs to be resolved before any update on the status of the OIMPG

Daniel Karlsson