Making openEHR

Terminology  binding practice

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Adapted from Ian McNicoll

Terminology binding patterns• Direct node‐binding

– e.g. ‘Urine color’

node• Node name

e.g.. “Urine color”

– Automatically has unique internal term ‘at0007’

– Can be ‘run‐time’

coded by external term

– Can be ‘run‐time’

mapped to an external term

• Node value

e.g.. ‘Red, yellow, purple’– Unique term provided by Internal value set ‘at0009’

– External term mapped to term from Internal value set 

– External term used as the value

Direct‐binding issues

• Incomplete terminology / translation coverage – e.g.. SNOMED

– 50‐70% for histopathology• Effort

– Requires very good terminology skills• Can be challenging to choose correct bindings

– Some concepts require post‐coordination to capture  correctly

– Is it worth trying to achieve complete node binding?

“BP 120/78, sitting, large cuff”Candidate SNOMED CT term bindings:

• Blood pressure finding - ... (finding) – 392570002• Sitting blood pressure - ... (observable entity) – 163035008• Blood pressure - ... (observable entity) – 75367002• Blood pressure taking - ... (procedure) – 46973005• Diastolic blood pressure - ... (observable entity) – 271650006• O/E - blood pressure reading - On examination - blood pressure

reading (finding) – 163020007• Blood pressure cuff - ..., device (physical object) – 70665002

Direct‐binding guidance

• Concentrate on current requirements– Archetypes and templates ‘fix’

the semantics

• Initial efforts guided by actual requirements

• More bindings can be added later as requirements 

evolve

– Node bindings• Use internal value sets. Consider leaving ‘open to allow 

for local variation.

• Add External terminology bindings where required and 

available

Termset‐binding issues

• Very little at Archetype‐level– Scope of the termset

binding is often too broad to 

be meaningful at implementation• E.g. ‘All procedures’

in ACTION.procedure

archetype

– Very few examples of sensible termset‐bindings in  international archetypes

– Much more applicable at national level• esp. National terminologies 

Termset‐binding guidance

• Almost all at Template‐level– Layered constraint approach

• All procedures– Orthopedic procedures

» Knee specialist procedures

– But generally have to provide option to override  the constraint for unusual clinical situations

• e.g.. Non‐orthopedic procedure carried out in  Orthopedic department.

• Microsoft / NHS Common User Interface  (CUI)

– Layered constraint with ‘termset

filters

– ‘Get‐out clause’

where constraint is too tight

Termset‐binding guidance

Example: “Family history”

Termset-bound to node Value: (Is_a genetic relation)444148008 | Person in family of subject

Termset-bound to node Value: (Is_a genetic relation)444148008 | Person in family of subject

Example: “Family history”

Term bound to node Name:184100006 | Patient sex (observable entity

Term bound to node Name:184100006 | Patient sex (observable entity

Term bound to node Name? 371534008 |Summary report (record artifact)? 422735006 |Summary clinical document (record artifact)

Term bound to node Name? 371534008 |Summary report (record artifact)? 422735006 |Summary clinical document (record artifact)

Term bound to node Name:408732007 | Subject relationship context (attribute)

Term bound to node Name:408732007 | Subject relationship context (attribute)

Term bound to node internal Value set:[at0004|Not known] =365873007|Gender unknown (finding)[at0004|Not known] =UNK|Gender unknown

[at0005|Male] = SNOMEDCT::248153007 | Male (finding)[at0005|Male] = KITH-SEX::M| Male

[at0006|Female] = 248152002 | Female(finding)[at0006|Female] = KITH-SEX::F | Female

Term bound to node internal Value set:[at0004|Not known] =365873007|Gender unknown (finding)[at0004|Not known] =UNK|Gender unknown

[at0005|Male] = SNOMEDCT::248153007 | Male (finding)[at0005|Male] = KITH-SEX::M| Male

[at0006|Female] = 248152002 | Female(finding)[at0006|Female] = KITH-SEX::F | Female

Termset-bound to node Value: (??????)429019009 | Finding related to biological sex

Termset-bound to node Value: (??????)429019009 | Finding related to biological sex

OR

Assessed risk : Family history

No matches found in

SNOMED CT

Local terminologies ‐

England

Local terminologies ‐

Scotland