SNOMED browser latest in informatics

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The Jan 15 issue of the JAVMA reported on the latest advances in veterinary informatics with HL-7, an American National Standards Institute-accredited standard for the electronic exchange of medical information. Concurrently, veterinary-related strides are being made with SNOMED, the Systemized Nomenclature of Human and Veterinary Medicine, to create a standardized veterinary terminology vital to building a consensus for veterinary medical standards.

At the forefront of the SNOMED work is Dr. Jeff Wilcke, professor of veterinary medical informatics and clinical pharmacology at the Virginia-Maryland Regional College of Veterinary Medicine. Dr. Wilcke's involvement in informatics began at the request of the late Dr. Richard Talbot, founding dean at Virginia-Maryland Regional College of Veterinary Medicine and 1991-1992 chairman of the AVMA Veterinary Medical Informatics Committee.

"He was looking for faculty to associate with his then-new veterinary informatics graduate program," Dr. Wilcke explained. When Dr. Talbot died in a plane crash in 1994 (see JAVMA, Oct 15, 1994), Dr. Wilcke continued the program and was named to the position of AVMA liaison to the SNOMED editorial board.

Dr. Wilcke said his research training was in pharmacokinetics, which is computer intensive. But he's been a computer enthusiast since he purchased his first DOS-based PC in the punched card days of 1983.

Dr. Jeffrey Wilcke
Dr. Jeffrey Wilcke

Sixteen years and a couple million keystrokes later, Dr. Wilcke recently participated in the beta test of SNOMED's new reference terminology (RT) file structure. A beta test is conducted by providing experienced computer users with a pre-release copy of a software or data product for their use.

"Users subsequently report on the utility of the software and the occurrence of such things as bugs or malfunctions." For his part of the beta test, Dr. Wilcke built an Internet-based browser, a tool for looking up medical concepts and terms in SNOMED and examining their definitions and relationships to each other.

Dr. Wilcke said that the process of compiling this information, although computerized, is largely manual and involved many hours of personal effort.

"The SNOMED-RT contains over 200,000 medical concepts," Dr. Wilcke explained. "Like a dictionary, a nomenclature must be organized so that the concepts can be located. Unlike a dictionary, alphabetical order is not enough." To facilitate the use of the nomenclature in medical information systems, the concepts must be related to each other to provide for the construction of definitions.

"For example, arthritis is located in joints, and its morphology includes evidence of inflammation. In 'SNOMED' language we might say, 'arthritis has topography joint and has morphology inflammation.' The SNOMED-RT file structure was created to facilitate the retrieval of these types of concepts."

The SNOMED organization liked the browser and its functionality enough to invite Dr. Wilcke to present his findings and impressions at a beta tester debriefing. On the basis of reaction to the browser by those in attendance at that meeting in Northbrook, Ill, on Sept 22, 1999, Dr. Wilcke was invited to present his new browser to the SNOMED users group meeting on Nov 5. Joining him and also giving presentations at the meeting was a prestigious array of informatics representatives from the Mayo Clinic, Duke Medical School, and MedicaLogic, a provider of human hospital information systems.

"Following that presentation," Dr. Wilcke said, "I have been approached by several medical schools and a manufacturer of human pharmaceuticals for access to the browser."

Dr. Wilcke said he built the browser to assist veterinarians who want to take a look at SNOMED for their medical records personnel at the colleges of veterinary medicine currently using the system.

This summer at the AVMA Annual Convention, Dr. Wilcke and Dr. Allen Hahn from the University of Missouri College of Veterinary Medicine will present an evaluation of the performance of SNOMED for recording and retrieving veterinary diagnoses from an electronic patient record as part of the 5th Annual Talbot Symposium on July 23. More advances are expected as the browser is implemented by an increasing numbers of veterinary health professionals.

While serving as chairman of the AVMA informatics committee, Dr. Talbot had said, "The time is here for a veterinary medical electronic global village, and the AVMA is the appropriate organization to lead the development of a national electronic communications network."

Part of Dr. Talbot's vision of would be realized with the 1994 inception of NOAH, a network for enhancing communication between veterinarians. Dr. Wilcke's work on SNOMED will assist in creating another step towards an electronic global village — a common language for veterinary computer systems.