The new ERA-EDTA PRDs UK Renal SNOMED CT subset TheProject Keith Simpson UKRR Advisor keith.simpson@nhs.net Thanks to ERA-EDTA Registry: Kitty Jager Managing Dir and members of the Coding and Terminology Group (UK members Charlie Thomson, Venkat Raman) UKRR: Afzal Chaudhry, Ron Cullen NHS TC Yong Gao, Denise Downs, Ian Arrowsmith, Ed Cheetham:
PRD Headings ERA-EDTA PRD ERA-EDTA Primary Renal Diagnosis (PRD) terms Histology Clinical history Family history Clinical Exam Biochemistry Immunology Urine analysis Imaging Gene test Other criteria & notes SNOMED CT concept identifier for focus concept SNOMED CT fully specified name SNOMED CT expression constraint Mapping to old PRD code Mapping to old PRD term Online Mendelian Inheritance in Man - link ICD10 code ICD10 rubric.
. ERA-EDTA Primary Renal Diagnosis
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The diagnosis The term we use = the PRD The evidence <> a definition (yet) Notes Because we don t have a definition.
The diagnosis The term we use = the PRD The evidence <> a definition (yet) Notes Because we don t have a definition.
PRD SNOMED id Concept mapping of the meaning.
PRD SNOMED id Concept mapping of the meaning.
. Why map to SNOMED?
SNOMED CT Provides Extensive and well supported list of terms current language translation, literature links eg BMJ, Map of Medicine decision support, queries using multiple domain hierarchies, secondary functions eg research, hospital management
SNOMED CT Provides Extensive and well supported list of terms current language translation, literature links eg BMJ, Map of Medicine decision support, queries using multiple domain hierarchies, secondary functions eg research, hospital management Will soon be the only terminology supported by the NHS in the UK
One concept, many names Some of the descriptions associated with ConceptID 22298006: Fully Specified Name: Preferred term: Synonym: Synonym: Synonym: Myocardial infarction (disorder) DescriptionID 751689013 Myocardial infarction DescriptionID 37436014 Cardiac infarction DescriptionID 37442013 Heart attack DescriptionID 37443015 Infarction of heart DescriptionID 37441018 Includes foreign language and local terms.
Conveys meaning not just a label relationships and attributes like: Is a kidney disease Is a.
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UK Renal SNOMED CT subset
UK Renal SNOMED CT subset Includes: most of the existing renal terms about 1100 and the new ERA EDTA PRDs Managed by: UK Renal Terminology Committee (RIXG & RA) working with the NHS Terminology Centre Purpose: Patient records, Registries, RADAR, RDGs, research, TheProject.
Renal IT suppliers keen to implement meeting in Bristol 19 Sept 2012
TheProject
Renal Units TheProject Labs.
Labs Renal Units TheProject RPV UKRR SRR NHSBT RaDaR BAPN Other National data.
hard to manage wasteful summarised data can t be recovered many different file formats perpetuates errors inflexible some unknown >> bias eg RRT start date & unit lost in transfer
Labs Renal Units TheProject RPV UKRR Patient sees~all their data Warehouse SRR NHSBT Other National data RPV type data transfer, at least daily RaDaR?10-20 gps BAPN.
Labs Renal Units TheProject RPV UKRR Patient sees~all their data Warehouse SRR NHSBT RaDaR?10-20 gps BAPN Other National data.
Labs Renal Units TheProject RPV Patient moves renal unit UKRR Warehouse SRR NHSBT RaDaR?10-20 gps BAPN Other National data.
Labs Renal Units TheProject RPV Patient moves renal unit Warehouse UKRR SRR All potential participants and renal IT suppliers have agreed in principle NHSBT RaDaR?10-20 gps BAPN Other National data.
Summary The new ERA-EDTA PRDs UK Renal SNOMED CT subset TheProject
ICD 10 Hierarchy A bacterial infections B other infections C malignancies D benign neoplasms E endocrine G CNS N renal
ICD 10 Hierarchy A bacterial infections incl meningiococcal meningitis B other infections incl H. influenza C malignancies and sarcoid D benign neoplasms E endocrine G CNS incl H. influenzae meningitis and Systemic atrophy of CNS in myxoedema N renal
ICD 10 Nephrotic N040 Nephrotic syndrome, minor glomerular abnormality N041 Nephrotic syndrome, focal and segmental glomerular lesions N042 Nephrotic syndrome, diffuse membranous glomerulonephritis N043 Diffuse mesangial proliferative glomerulonephritis N044 Diffuse endocapillary proliferative glomerulonephritis N045 Diffuse mesangiocapillary glomerulonephritis N046 Nephrotic syndrome, dense deposit disease N047 Nepthrotic syndrome, diffuse crescentic glomerulonephritis N048 Nephrotic syndrome, other N049 Nepthrotic syndrome, unspecified
N04 ICD 10 Nephrotic N040 Nephrotic syndrome, minor glomerular abnormality N041 Nephrotic syndrome, focal and segmental glomerular lesions N042 Nephrotic syndrome, diffuse membranous glomerulonephritis N043 Diffuse mesangial proliferative glomerulonephritis N044 Diffuse endocapillary proliferative glomerulonephritis N045 Diffuse mesangiocapillary glomerulonephritis N046 Nephrotic syndrome, dense deposit disease N047 Nepthrotic syndrome, diffuse crescentic glomerulonephritis N048 Nephrotic syndrome, other N049 Nepthrotic syndrome, unspecified
ICD10 Terms including renal one example per letter A985 Haemorrhagic fever with renal syndrome C65X Malignant neoplasm of renal pelvis D301 Benign neoplasm of renal pelvis E112 Non-insulin-dependent diabetes mellitus with renal comps I120 Hypertensive renal disease with renal failure K767 Hepatorenal syndrome M8312/3 Renal cell carcinoma (C64) N170 Acute renal failure with tubular necrosis O904 Postpartum acute renal failure P960 Congenital renal failure Q600 Renal agenesis, unilateral R392 Extrarenal uraemia S354 Injury of renal blood vessels Z992 Dependence on renal dialysis
ICD10 which language? N200 N140 P960 Calculus of kidney Analgesic nephropathy Congenital renal failure
ICD10 which language? N119 N159 Chronic tubulo-interstitial nephritis, unspecified Renal tubulo-interstitial disease, unspecified
TheProject For discussion: How a UK renal data warehouse be organised and managed security data and clinical governance management coalition anonymisation/named data encryption data transfer -?XML Schema HL7 data validation?practical on anonymous data, where to do flexibility allow new fields = data items to be added by user Include meta data
TheProject Granular data Include fields for meta data date time relative time (pre dose, post dialysis ) sample if not obvious (venous, arterial blood, venous side of dialyser ) result unit of measurement (eg Hb g/l, g/dl, mmol/l) reference range assay method (eg PTH)
TheProject Granular data Diagnoses and procedures Store at highest level required by initiator Aggregate later where required Use SNOMED CT terms & codes (UK Renal Terminology Committee)
TheProject Derived data: store raw data where possible/ practical derive results eg BMI, URR
TheProject Involves Patients Renal units Registries (UKRR & SRR) Renal Association RPV RaDar Groups already keen to join Renal IT industries Data Governance NHS, DoH, ISD
TheProject Can we develop a project that better supports what we do: Care for patients Quality improvementunits could devolve some QI to the registries prompts (Tx list), trends (infections) Run the services Research basic and epidemiology Teach & learn