[Troll] Terminology bindings ... again

Pablo Pazos pablo.pazos at cabolabs.com
Tue Mar 13 14:00:33 EDT 2018

" but in some cases, *it is missing concepts*"

Shouldn't we contribute?

Is the same as openEHR, there are missing archetypes and we need the
community, users, clinical modelers and engineers to contribute.

LOINC also misses concepts, and when I asked them how can I contribute,
they sent me the process and some templates for requesting a new concept to
be added, pretty simple, formal and open!

IMO we can't expect perfection, is a bad strategy and a move towards
isolation. I think pragmatism is better and go with "this is the best we
can expect for". We are the ones that should push towards the ideal, but as
a guide not as a goal (getting a little philosophical here...).

The same idea applies to tooling, anyone can create tools to manage the
terminology better. In our own backyard we have tools that need
improvement, but we accept them because there is no better alternative.

On Tue, Mar 13, 2018 at 11:21 AM, Thomas Beale <thomas.beale at openehr.org>

> The killer move would be to do something I advocated for years
> unsuccessfully: *separate SNOMED technology from content *and allow them
> to be independently licensable and used. Here, technology means
> representation (RF2 for example), open source programming libraries for
> working with ref-sets, specs and implems for e..g the constraint language,
> URIs and so on.
> It should be possible for a country (the one I am most familiar with
> w.r.t. to terminology today is Brazil) to create an empty 'SNOMED
> container' of its own, and put its existing terminologies in there -
> typically procedure lists, drug codes, lab codes, devices & prosthesis
> codes, packages (chargeable coarse-grained packages like childbirth that
> you get on a health plan) and so on. There are usually < 20k or even 10k
> such codes for most countries (UK and US would an exception), not counting
> lab analyte codes (but even there, 2000 or so codes would take care of most
> results). But the common situation is that nearly every country has its own
> version of these things, and they are far smaller than SNOMED. Now,
> SNOMED's version of things is usually better for *some *of that content,
> but in some cases, *it is missing concepts*.
> The ability to easily create an empty SNOMED repo, fill it with national
> vocabularies, have it automatically generate non-clashing (i.e. with other
> countries, or the core) concept codes and mappings, and then serve it from
> a standard CTS2 (or other decent standard) terminology service would have
> revolutionised things in my view. This pathway has not been obviously
> available however, and has been a real blockage. The error was not
> understanding that the starting point for most countries isn't the
> international core, it's their own vocabularies.
> The second killer feature would have been to *make creating and managing
> ref-sets for data/form fields much easier*, based on a subsetting
> language that can be applied to the core, and tools that implement that.
> Ways are needed to make the local / legacy vocabularies that have been
> imported, to look like a regular ref-set.
> The third killer feature would have been to *make translation tools work *on
> the basis of legacy vocabulary and new ref-sets, not on the basis of the
> huge (but mostly unused) international core.
> I think IHTSDO's / SNOMED International's emphasis has historically been
> on curating the core content, and making/buying tools to do that (the
> IHTSDO workbench, a tool that comes with its own PhD course), rather than
> promulgating SNOMED technology and tooling to enable the mess of real world
> content in each country to be rehoused in a standard way, and incrementally
> joined up by mapping or other means to the core. I think the latter would
> have been more helpful.
> There is additionally an elephant in the room: *IHTSDO (now SNOMED
> International) has been tied to a single terminology - SNOMED CT*, but it
> would have been better to have had a terminology standards org that was
> independent of any particular terminology, and worked to create a truly
> terminology-independent technology ecosystem, along with technical means of
> connecting terminologies to each other, without particularly favouring any
> one of them. It's just a fact that the world has LOINC, ICDx, ICPC, ICF and
> hundreds of other terminologies that are not going anywhere. What would be
> useful would be to:
>    - classify them according to meta-model type - e.g. multi-hierarchy
>    (Snomed); single hierarchy (ICDx, ICPC, ... ); multi-axial (LOINC); units
>    (UCUM, ...), etc
>    - build / integrate technology for each major category - I would guess
>    < 10
>    - help the owning orgs slowly migrate their terminologies to the
>    appropriate representation and tools
>    - embark on an exercise to graft in appropriate upper level
>    ontology/ies, i.e. BFO2, RO, and related ontologies (this is where the <10
>    comes from by the way)
>    - specify standards for URIs, querying, ref-sets that *work across all
>    terminologies*, not just SNOMED CT
> A further program would look at integrating units (but not by the current
> method of importing to SNOMED, which is a complete error because of the
> different meta-models), drugs and substances (same story), lab result
> normal and other range data, and so on. None of this can be done without
> properly studying and developing the underlying ontologies, which are
> generally small, but subtle.
> I'll stop there for now. I suspect I have kicked the hornet's nest, but
> since Grahame kicked it first, and I can run faster than him, I feel oddly
> safe. Probably an illusion.
> - thomas
> On 13/03/2018 12:12, Grahame Grieve wrote:
>> I am get the impression that SNOMED CT is hard to implement, and
>> therefore wondered if we are at some kind of tipping point, like where
>> HL7v3 was a few years ago, and some bright spark came along, and now we
>> have FHIR that is gaining great traction in the health community due to the
>> ease at which it can be implemented.
> this is very true, and I wish that someone would stick their neck out and
> do this at scale with
> a community behind them. Many of the parameters for how it could be done
> are obvious around
> free and crowd-support etc. But the big problem is that there is no
> capacity for it to happen as a
> palace revolution; it must be a full civil war first.
> Grahame
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> --
> Thomas Beale
> Principal, Ars Semantica <http://www.arssemantica.com>
> Consultant, ABD Team, Intermountain Healthcare
> <https://intermountainhealthcare.org/>
> Management Board, Specifications Program Lead, openEHR Foundation
> <http://www.openehr.org>
> Chartered IT Professional Fellow, BCS, British Computer Society
> <http://www.bcs.org/category/6044>
> Health IT blog <http://wolandscat.net/> | Culture blog
> <http://wolandsothercat.net/>
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Ing. Pablo Pazos Gutiérrez
pablo.pazos at cabolabs.com
+598 99 043 145
skype: cabolabs
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