Re: [Gnumed-devel] About systems of codification

[Jim Busser]

On 2011-09-28, at 12:53 AM, richard terry wrote:

> Some departments have 
> coding on their discharge forms (paper).
> 
> So a mess.
> 
> I think eventually SnoMed will rule here.

I agree. ICD9 for example has only

        MALIGNANT NEOPLASM OF THE TRACHEA, BRONCHUS AND LUNG

so no way to granularly identify in any reproducible way various Ca of the lung.

SNOMED will be much better. As someone pointed out off list, the problem with 
free text is that coding would have to be done as an extra step, if not right 
away, then later (i.e. never).

Had a suitable coding been available from the start, there could (in many 
cases) have been *no need* for the free text. I must tell you that I have a lot 
of patients in whim I would much rather and more quickly input

        401 (for essential hypertension)
        250 (for diabetes mellitus)

and let the code populate the text of the list, unless I provided text of my 
own. As soon as anyone would have SNOMED, I think they will want the flow to be:

- input a term selected from SNOMED
- only if the desired term is unavailable (or the selected term in some way 
inadequate) -- then and only then input some free text
- what the user would see is:

and then, for display of the existing problem list:

- if a SNOMED term had been inputted, display that term
- if free text had been entered, show that appended to the SNOMED term (unless 
no SNOMED term had been entered, in which case display only the free text

The traditional and current approach (even in GNUmed) is *first* to input free 
text, and then (optionally) to code it. Once I would have SNOMED I would want 
the fields reversed and would want to flow (input) multiple past history items 
through a single widget like the one below -- see screenshot.

I may be wrong, but predict Karsten will doubt the adequacy of SNOMED to 
replace free text. But maybe he will be open to the possibility that it could 
warrant to be the primary entry, with text as the optional supporting field?

A colleague who turns out to have worked a lot with SNOMED (and is in fact on a 
Canadian committee) told me today:

"It was interesting that in the Infoway project that recommended SNOMED for 
clinical use that 20 or so clinicians seemed hostile towards SNOMED but as each 
subsequent meeting happened people were more and more in favour of SNOMED. In 
the end there was no question that SNOMED should be the terminology of choice 
for clinical purposes."

-- Jim

SNOMED project excerpts (dragged).pdf
Description: Adobe PDF document