Thomas, Thank you... this is getting clearer. I know that there are several hundred coded terms and answer lists relating to eyeglass and contact lens products already in LOINC, and there may well be some eyeglass terms in SNOMED CT. Many of these LOINC terms, however, have incomplete/ambiguous definitions or do not fully support business messages like eyeglass purchase orders and insurance claims. So it seems that a vision industry committee could start fresh by creating ontology models (UML) for "eyeglass" and "contact lens" products, from which archetypes can be defined with ADL.
It would only seem necessary to map these archetypes to LOINC and/or SNOMED CT if there were business applications already using those terminology systems... and we wanted the old LOINC-based systems to be interoperable with the new archetype-based systems... right? Finally, if a vision industry committee did successfully create 100 new archetypes to support doctors ordering eyeglasses from labs, would our committee be able to simply distribute the archetype-definition-list to the industry as one, big XML document? I guess, the other implied question is whether it would be necessary to set up one or more terminology servers... or could each lab management system and practice management system simply be shipped with a local copy of the current archetype list? ... with the ability to import newer versions (simple XML documents) later on? Thanks, -Chris At 01:35 AM 10/2/2003 +1000, Thomas Beale wrote: >Christopher Feahr wrote: > >>My understanding is that the US open-licence period for SNOMED CT begins >>Jan 1, 04. I have also been told that Centers for Medicare and Medicaid >>Services are planning a number of "demonstration projects" early in 2004, >>involving EHR systems and SNOMED CT terms. Therefore, I would agree with >>Ed and others who seem to be suggesting that we move forward with >>whatever steps are necessary to get SNOMED CT into production systems. >> >>In the context of a reasonably homogenous terminology space like the >>U.S., what would you see as the main problems with SNOMED that would have >>to be "fixed"? Pre-coordination issues have been mentioned along with >>some even more fundamental (??) issues that Thomas Beale suggests will >>take several years or possibly a decade to straighten out. Of course, >>from my point of view, my biggest problem will likely be scarcity of >>special vision care concepts/terms. >> >>So, what would we have to do exactly? And which standards organization >>would coordinate such a project... HL7? > >my feeling (with apologies to those who have been working for years in >terminology and I realise know the semantic space much better than I do) >is that a new process could emerge: > >a) some people develop some archetypes , e.g. American College of >Opthalmologists (not sure what the proper title is) >b) these archetypes will have local vocabulary which defines meanings for >exactly what terms need to mean in the exact context of the archetypes. >c) The mundane task of mappings to ICD or similar classifiers needed for >reimbursement and various population & efficiency studies is easy. This >will take care of the practical need for these codes. >d) mappings to ontologies are more challenging, and it may well be that >local archetype terms form "capsule vocabularies" that could be the basis >of change requests to developers of ontologies. Snomed is probably more in >this space than pure terminology, so it may be that we send change >requests of some kind to them, based on archetyps. >e) due to d), ontologies may change over time in such a way that more >direct mappings from archetypes become possible. > >- thomas beale > > >- >If you have any questions about using this list, >please send a message to d.lloyd at openehr.org Christopher J. Feahr, O.D. Optiserv Consulting (Vision Industry) http://Optiserv.com http://VisionDataStandard.org Office (707) 579-4984 Cell (707) 529-2268 - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
