Transcript Bombing Bombay?

Interoperability and the Power of
Sharing Concepts
Andrew S. Kanter, MD MPHa,b
a Millennium
b
Villages Project, Earth Institute, Columbia University, New York, USA
Department of Biomedical Informatics, Columbia University, New York, NY, USA
Agenda
Context for MVP and MGV-Net
Concepts in OpenMRS
Different Types of Terminologies
Sharing concepts: the good, the bad and the ugly
MVP Dictionary, OCC, Metadata sharing module
New initiatives
Millennium Villages Project
Partnership between the Earth Institute
Columbia University, UNDP, Millennium Promise
and national governments.
Primarily operates in 10 countries in 14 agroecological zones in Sub-Saharan Africa
Integrated development at $120 pc/y
Covers about 500,000 people
Each cluster of villages has around 40,000
people and 3-6 clinics
Millennium Villages
Koraro, Ethiopia
Timbuktu, Mali
Bonsaaso, Ghana
Ikaram, Nigeria
Dertu, Kenya
Pampaida, Nigeria
Sauri, Kenya
Mayange, Rwanda
Gumalira, Malawi
Potou, Senegal
Mwandama, Malawi
Mbola, Tanzania
Tiby, Mali
Ruhiira, Uganda
MGV-Net
Concepts vs. Free Text
DM, Diabetes, Diabetes Mellitus,
Diabetic, Dibetes => Same thing?
Diabetes Mellitus, Type I; Diabetes;
Type II Diabetes; MODY; Diabetic Coma
=> Different levels of specificity
Malaria, Paludisme, Falciparum Malariae
=> Different languages
Terminology About Terminology
Administrative- classification for
administration of health care (e.g., ICD, CPT®)
Reference- concept-based, controlled
terminology for complex organization and
aggregation of information
(e.g., SNOMED®CT, RxNorm™, LOINC)
Interface- terms or phrases which support
clinician entry of patient data into computer
systems (e.g., Problem (IT), “Concept
Names”)
Interoperability Requires…
Controlled Medical Terminology (CMT) or
Concept Dictionary
Standard codes and terms for semantic
interoperability (Reference Terms)
Hierarchical representation to address
different levels of specificity
Administrative codes for reporting and
reimbursement
The Good… Shared concepts allow:
Sharing of data collection tools (and
forms)
Sharing of reporting tools (and reports)
Sharing of applications and modules
Sharing of data for analysis,
surveillance and research
The Bad… Shared concepts require:
Good communication
Editorial control and governance
Similar modeling of questions and
answers
Some flexibility when designing forms
and tools.
The Ugly… Shared concepts may:
Require mapping of existing dictionaries
Produce duplicates of existing concepts
Force redesign and removal of
unnecessary variation in forms
Adds additional overhead when
importing forms and modules
Current Choices for Concept Sharing
Internal sharing of concept dictionary
Sharing of MVP’s concept dictionary and
mappings
OpenMRS Concept Collaborative
OpenMRS Meta Data Import/Export
Module
MVP Concept Dictionary
Contains most diseases, procedures and
medications (47,600 concepts)
Mapped to SNOMED CT, ICD-10,
RxNorm, (LOINC) and CVX codes.
Several Languages:
– 61,700 en − 851 fr − 28 rw
– 32,305 es − 212 sw − 9 pt
MVP Concept Dictionary cont.
Governance policy for requesting new
concepts and releases
Supported by Columbia University
SNOMED and ICD-10 x-maps from IMO
Currently in 1.4.x with ports to 1.6.x
OpenMRS Concept Collaborative
Centralized repository of concepts
Published by sites such as PIH, AMPATH
and MVP
Given unique OCC ID and mapped at
server level
Selecting concept retains metadata
from originator
OpenMRS Concept Collaborative cont.
Updates can be identified and pushed
out
Can pull subset of concepts based on
source or selection
Concepts ordered by frequency of use
Hosted by OpenMRS, busy Ben
OpenMRS Meta Data I/E Module
Work from Darius and Rafael in GSoC
Allows exporting of meta data tables or
portion of tables based on selections
Can be used for concepts and concept
subsets as well as forms/fields
Automatically handles dependencies
Works like old form import/export mod.
OpenMRS Meta Data I/E Module
Does not compare with existing
concepts (will add dupes)
Allows for different modeling of similar
concepts
Uses custom XML
Rafael will continue to work on it.
New Initiatives
Maternal Concept Lab
PIH-MVP concept
mappingwww.maternalconceptlab.com
Terminology Service Bureau Module
Continuing to add SNOMED coding
Forms and Report Library