Dra. Jussara Macedo

1. Making openEHR Terminology
binding practice
Jussara Rötzsch
Adapted from Ian McNicoll

2. 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

3. 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?

4. “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

5. 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

6. 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

7. 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.

8. Termset‐binding guidance
• Microsoft / NHS Common User Interface
(CUI)
– Layered constraint with ‘termset filters
– ‘Get‐out clause’ where constraint is too tight

9. Example: “Family history”

10. Example: “Family history”
Term bound to node Name
? 371534008 |Summary report (record artifact)
? 422735006 |Summary clinical document (record artifact)
Termset-bound to node Value: (Is_a genetic relation)
444148008 | Person in family of subject
Term bound to node Name:
408732007 | Subject Term bound to node internal Value set:
relationship context
[at0004|Not known] =365873007|Gender unknown (finding)
(attribute) [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 Name:
184100006 | Patient sex
(observable entity OR
Termset-bound to node Value: (??????)
429019009 | Finding related to biological sex

11. Assessed risk : Family history
No matches
found in
SNOMED CT

12. Local terminologies ‐ England

13. Local terminologies ‐ Scotland