In response to letter to the editor: ‘Concerning SNOMED-CT content for public health case reports’
Year: 2010
Type: letter
Abstract: We are grateful for the careful review of our article by Wilcke et al.1 We would like to reaffirm our belief that SNOMED CT is an extremely useful terminology and the best current choice for the representation of clinical findings generally, and specifically for the representation of findings in public health case reports. The broad use of SNOMED CT will lead to the understanding of important modeling issues as well as improved SNOMED CT content. We appreciate the respondents' clarification that ‘porcine enteric adenomatosis’ is a species-independent disorder. However, the fact that we held this erroneous opinion is understandable. As ‘Porcine’ is in the name of the term, and without further explanation, the ‘true’ meaning is difficult to discern. The name of the term is ambiguous, if not outright misleading. This situation points to the underlying difficulty of making it easy for users to understand the meaning of concepts in reference terminologies. Great emphasis has been placed on the accuracy and internal consistency of reference terminologies, with less emphasis on what is needed to make the content easily understood by clinical users and researchers. Human readable definitions would be a big help. We agree with the respondents that, ‘Information regarding species, whether it be human or non-human can and should be identified by the information model, not the terminology.’ We are aware of the ongoing efforts to form a working relationship between creators of information models and terminology developers so that models and terminology can be created in unison, thereby removing ambiguity in data representation. We applaud and support these efforts. We absolutely agree that, ‘Balancing the needs of practical applications with the importance of the purity and accuracy of the terminology is a very difficult task….’ We would actually state that it is impossible. We would assert that hierarchies are created for a purpose. The purpose could be to support automated maintenance of the terminology, to create definitional relationships, or to allow appropriate inferences. If the different users of the terminology have different purposes, it is not always possible to meet all needs with a single hierarchy, no matter how much care is taken. Even with the clarifications offered by the respondents, the fact remains that the hierarchical relationships represented in SNOMED CT do not ideally support public health reporting use cases. The desired case roll-up behavior is not supported by the unmodified SNOMED CT hierarchies and concepts. While we asked for the development of a hierarchy that is exclusively for human conditions, a better statement of the need would have been the development of a hierarchy that is valid for public health inferencing about human disease. The problem is not with SNOMED CT per se. The root of the problem is that all purposes cannot be met by a single hierarchy. We need to support many purpose-specific hierarchies. To this end, we support the respondents' suggestion for increasing creation of subsets. We look forward to learning more about how subsets can be created and exchanged to meet specific clinical needs. None. This study was conducted with the approval of the University of Utah. Not commissioned; not externally peer reviewed.
Language: English
Subfield: Molecular Biology
Domain: Life Sciences
Open Access status: green
OpenAlex ID: W2115599019