2022-02-21 - OBSERVABLE Meeting

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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. 

2021-11-15:

Waiting for input from CRGs.

From Anesthesia: "...we would like to see the observables team produce a full set of terms using observable entities for one or two of the scales we have discussed such as GCS and SOFA so we could review suitability for clinical use."

2022-01-24:

Assessment scales for sleep apnea screening: STOP-BANG and Epworth Sleepiness screen.

The STOP-BANG score https://www.mdcalc.com/stop-bang-score-obstructive-sleep-apnea assesses the risk of Obstructive Sleep Apnea. Going back to previous discussions about representations of likelihood, risk and probability, it is proposed to represent these (and similar risk scores) using the following pattern/example:

363787002 |Observable entity (observable entity)|:
	370130000 |Property (attribute)| = xxxx |Risk|,
	719722006 |Has realization (attribute)| = 78275009 |Obstructive sleep apnea syndrome (disorder)|,
	272394005 |Technique (qualifier value)| = zzzz |STOP-BANG (assessment scale)|

Additional scores exist in SNOMED CT, 41 <<273249006 |Assessment scales| has the word "risk" in a description. 80943009 |Risk factor (observable entity)| (which is a misnomer) has 28 descendants.

James R. Campbell to model risk score concepts/sleep scale observables.

James R. Campbell

Presentation of two sleep scales (Epworth and STOP-BANG) with proposed Observables modeling.

Nashar Karim should attributes be grouped? Attributes are always self-grouped in the Observables model.

Nashar Karim scale type, should it be Ordinal or quantitative? This is following examples from the LOINC-expression work.

Piper Allyn Ranallo comparing to similar examples from the Mental and behavioral health domain, e.g. impulsivity assessment scales. Will prepare example for next time.

Agreement from the group concerning the proposed modeling.

Piper Allyn Ranallo to present impulsivity example at next meeting (March 21).

Daniel Karlsson to invite Elaine Wooler for discussion about processes and observables work

Daniel Karlsson

James R. Campbell

2022-02-21:

Presentation of Race and Gender assignment observables.

Alejandro Lopez Osornio in latin america this typically is not recorded, with few exceptions. 

Nashar Karim patient-reported, self-assigned, where is that seen in the modeling? It is represented through Interview technique.

Daniel Karlsson recording race is illegal in many european countries.

Daniel Karlsson

Next meeting is March 21 2022 20.00 UTC.

Agenda:

• Gender and race (assignment, identity) observables James R. Campbell
• Interpretation (ordinal scale) observables and ratios Nashar Karim