Sign Connecticut Terms of Use Agreement Mobile

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we will try to make this uh interactive session so whenever you have any doubts or anything just unmute your mic and just talk to me i can't uh see it in the chats so you need to just talk okay um so what do you know about code systems to begin with do you have you heard about icd-10 ict stands for international uh classification of disease uh so it could be used by the clinicians patients uh to classify uh the codes of a particular disease or a diagnosis diagnostic names correct yes that is one way to put it yes that's correct icd-10 is for classification and it can be used by clinicians okay this is conditions and the like risk factors infections all those are categorized on on the basis of alphabetical order so like uh so these uh will be like like if it is diabetic mellitus it falls under e category it's a the code which starts with the e we might think like it will be like a diabetes endocrine related system specific to that maybe i think 11 something i guess that is a diabetes each system has their own alphabetic representation by saying that only we can under identify it is related to some particular system okay okay regardless then one more thing is like confirmed diagnosis only we have to code we cannot uh record for a provisional diagnosis means there is no if there is if it is not confirmed we cannot code like that there is one separate uh chapter for that like a risk factor or that that from that we can code okay okay correct all that is correct and i think you know a lot about icd and uh yeah you can see that's uh that's very good so good that's icd-10 and um now i'll start the talk with how icd and snomed are different okay so first of all icd is one of the most popular coding systems in india and we use it everywhere because it was introduced by insurance agencies to first of all give claims and second of all to report death statistics the reason for someone's death if we want they start using icd and from there it permeated into the clinic and everyone even in the hospital sometimes talk in terms of icd codes i've seen psychiatrists talk in terms of m a b like even the codes they know for each disorder what code it is now snomed ct was made for the sole purpose of entering data in the clinic itself during data capture a clinician entering the data that's what it's known ct was made there icd-10 is not such a code so this is what we will be discussing today so first is what is the difference between icd-10 and snomed so the first difference is icd-10 is a classification okay it classifies things based on what it is sonoma city is an ontology and we'll see what an ontology is i'll give you an example like let's say we'll take diabetes okay now diameters here are they classified with with coma with ketoacidosis with renal complications so there is for example diabetic nephropathy that the cataract all those things are there so now what is diabetes if you ask icd-10 all it knows is that it will tell that diabetes is an endocrine or nutritional or metabolic disease and the reason for that is very simple because icd doesn't care about diabetes itself it only cares that okay the clinician has put that code in correctly but if you take snomed ct and this is the snomed city browser all of you uh should know about this if you are to explore snowboard city i'll put the link later um so if i search for diabetes diabetes so you can see that there are hundreds of things under diabetes it's just not a diabetes mellitus it's a bronze diabetes latent diabetes diabetic diet diabetes uh research or diabetes managers [Music] um so we can see that diabetes mellitus is here but the thing is under sonoma ct diabetes is actually a type of disorder of glucose metabolism it is also a type of endocrine disorder of endocrine system and here you can see that the finding site they have labeled it as a structure of the endocrine system and under diabetes we have these 14 children there is type 1 diabetes type 2 diabetes under type 2 diabetes again we have these different things and inside that for example pregnancy and type 2 diabetes mellitus inside that there are again more subtypes so one thing you need to understand is icd-10 is a group classification what they do is they take different groups of codes for example all of these under diabetes type 2 diabetes mellitus type 2 they will take and they will code it under one category as a non-insulin dependent diabetes when it is and under that they have you know adult onset type 2 but under snomed ct you have much more fine grained control of what uh you can represent so it's it's meant for clinicians to use while entering data it's also it can also be used to or do statistical analysis but for that you will again be using something like icd-10 because most of the time other people use icd-10 okay so any questions so far as to any questions you can ask me anytime in the sun so the the difference is here under diabetes it's not only a type of endocrine disorder but it's also a type of disorder of glucose metabolism and this is because snomed ct is a multi-hierarchy system in that the same concept can have multiple parents and the same concept can also have multiple uh children under it so whereas in icd diabetes can only be a type of endocrine nutritional or metabolic disease it can't be both at the same time this will be even more evident in things like infectious diseases for example if you take tuberculosis for example here they classify respiratory tuberculosis bacteriologically and histologically confirmed now the thing is tuberculosis is also it's not just a respiratory disease it's also an infectious disease but in this case uh based on this we cannot identify that we can only identify that tuberculosis is an infectious disease because it falls under the infectious and parasitic diseases whereas in sonoma city if you take tuberculosis tuberculosis so you can see that it is a type of mycobacteriosis again microbacterium is the infectious agent and that itself is a type of infection caused by this thing bacterial and which is a bacterial infection which is an infectious disease and here under tuberculosis if you go there are many other types of tuberculosis like there can be respiratory tuberculosis there can be tuberculor lesion of the lung tuberculoma which is probably in the brain so here you can see that you can represent a lot more using snomed ct than using a classification system like icd-10 so that is the first difference the first thing is the fine-grained nature of snomed and the second thing is snomed can then be mapped to icd-10 so if you look at something like ctvc here this particular thing this particular tuberculoma does not have an icd map but it has a ctv3 simple map to this but if it does have a map it will show up under icd-10 complex map so tuberculosis you see it shows up under icd-10 complex map as a 16.9 so the thing is uh you asking clinicians to record data by icd-10 doesn't make any sense because they can't think in terms of classifications they think in terms of what a concept is and they cannot remember numbers while dealing with a patient that's what snowmed city is made for now all of these things they do not have a number that you can even remember in fact the code for tuberculosis is uh five six seven one seven zero zero one and uh nobody expects you to remember this right so even these things nobody needs to remember the number you just input it based on a simple search mechanism so that is the main use of snomed ct you use this to get data from clinicians at the point of data entry now once you get this data once you have structured data there are a lot of things that you can do because of how snomed ct is laid out so for example you are responsible to make an emr an electronic health record and you take snomed city as the court system of choice and you realize that all the doctors are not choosing the same thing even for tuberculosis because there are multiple types of tuberculosis right there is active tuberculosis there are chronic tuberculosis so you see that all doctors are choosing very specific things now what you would you want at the end of the day to find out how many patients came to the hospital with tuberculosis uh is that something you can do yeah that's something that that is what a snowman city was made for and that's why they have this other section called expression constraint queries so i'll just show you a simple query so what you can do is you can ask snomed ct the this terminology service to give me all the types of tuberculosis there are in the system so for example this is asking snomed city all the types of clinical findings so i'll just execute this and show you uh so you we are getting a lot of findings and before this we'll we'll just this is clinical finding because snomed city is not only for clinical findings if you look at the taxonomy you can see that there is body structures there is clinical findings there is events there is observable entities that are organisms so you can use snomed city for all of this you can use it to pick drugs from a drug list in fact india the nrcs which is responsible for standards has made a drug list using snomed ct so you can search for uh you know drugs here you can search for other uh things like uh you know the specimen what specimen is it uh is it a blood specimen saliva bone all that uh so we have a lot of hierarchies here and i recommend you go check it all out and i'm not going to go into all that but um the basic thing is you can also query it in a very complex way if once you have given your doctors the freedom to choose the term however they like you can then do queries like okay let's do a type of all types of tuberculosis right so keyboard closes we get the code and this thing basically means give me all the descendants of all the types so if we execute and we see there are 257 concepts okay and if you see that there is a tuberculosis in mother complicating childbirth even that is a super specific term that has been brought up by this small query okay so this is called a ecl or expression constraint language and that is what sonoma city supports and you can see more examples of that here you can have all types of something you can have all descendants or self which will also include tuberculosis you can have all the ancestors all the parents of tuberculosis so let's just see what the parents of tuberculosis i'm pretty sure we'll get like see mycobacteriosis bacterial infection clinical finding all the way up to the snomed ct root concept so that is the root concept so um that is tomat city and well the thing is it's a very deep subject and this is just scratching the surface of what number ct is and what it can do i'll show you a little bit more complicated examples okay like for example you can even search by this so i told you that each terminology is also associated with attributes here right so for example uh the previous query in which we saw public closest in the mother or complicating childbirth and all that you can see that here it has a lot of attributes like pathological process it's an infectious process causative agent it's caused by mycobacterium tuberculosis so you can do other things as well like for example uh this query uh asks give me all the disorders of the lung that are associated with edema okay so i'm going to execute that and speak so here you get all the types of lung diseases which have edema so even whatever you want to think in terms of clinically you can represent it using a snomed ct query right so if you want to get all the types of infectious diseases that are caused by mycobacterium you can do that so uh tell me what you would like to query in case let's say i'll give you a um very easy scenario so we have a hospital and people are collecting data using snomed ct uh you want to somehow filter covert patients you want to somehow give an alert to someone if in case someone with covet comes what do you do what do you you know what is the basic thing that you should look for first anywhere temperature yeah temperature of the patient temperature correct body temperature yes body temperature excellent uh the symptoms uh like the body temperature then the symptoms like cold cough golden okay perfect so so we'll see for body temperature first first uh we'll see for example fever right like fever is something that people may put inside their uh sonoma city says thing they'll just enter it as fever but sometimes they may not enter it as fever in fact they will empty it as something else which is for example there is hyper pyrexia there is uh there is the doctors can do all sorts of stuff they can enter it as uh as very specific type of yoga for example cough with fever now what you want to do is you want to query all the types of fever so if you query all the types of fever no matter what the doctor enters in their system for example post procedural all these types of fever you will get and you can create an alert system to automatically alert someone in case uh they have increased body temperature and fuel so that's something that's very trivial to do in this case so that is uh how you know you can use nomenclature practically in your uh systems now sometimes in slo-mit city there is a uh the concept is not present okay so even that you know even for that they have a very good method to extend snomed city so what you can do is you can write your own extension by means of making your own files and then add it to snomed city in your own extension and then those concepts will again show up so for all that you can uh look at the snomed ct's website and uh there they have a good foundation course that's free if you're really interested in that take the foundation code and um another thing that snomed city introduces is the concept of post coordination okay so i'll just search for uh snomed ct post coordinate okay so these are snomed city expressions right so sometimes uh the concept that that we want is not present in this hierarchy okay so can you think of some really complicated concept that you think won't show up here if you're if you can then let me know i'll tell you how we can represent that with the snomed ct expression um so like you saw here uh in the uh in the expression constraint language the same way you can in fact represent uh something in stomach city using uh this so this is a query so since you're asking give me all the types of but instead if you sometimes if you want the doctor to choose something and refine it themselves for example you have a clinical finding and let the doctor just say that the finding site is a pulmonary valve structure you can also do that so this is a valid uh course no medicine concept and they you need not only enter numbers just like that but you can also enter big queries like this and a snomed ct capable system for this we need something called description logic and that would be it's a little complicated but you can take a look at all this description logic semantic web owl ontology and all of that so a system will be able to uh read this and then figure out what kind of thing it is and it will still show up in the search even if it's not part of snomed ctp so this is called a post coordinated nomad ct expression not a lot of people use it but that's something that you can do and in fact they have something called the mrcm which is the machine readable concept model and for each uh concept for example a clinical finding can have all of these attributes a clinical finding you can be can happen after something can happen before something so let's say you want to represent something like um appendicitis after the patient had a procedure okay like you want to represent that concept you need not make a new sonoma city concept and get the approval of sonoma city international and all that you can just go ahead and easily just since it's a clinical finding this by the statement that i showed you you can easily just add the clinical finding after whatever so here you just search for that and you click on that and that's it you have created a post coordinated expression so these are things to keep in mind when you are creating a swimwear ct enable system post coordination is a rather a complex topic and you can explore that at your own leisure ut querying is very important because when we record things using this code system it will be a waste not to utilize these queries that are available and you need not even make this into your own system you can use something like the snomed ct browser and learn about these kind of queries and you can just get all the types of uh codes and then filter your ehr based on that so that will be a good use case of number uh so up next what do we have ecl i covered post coordination okay inference engine is the description logic that i talked about in fact every nomad city for example let's take cataract if you look at the diagram they have all these things like the cataract is a type of disorder of lens it's a degenerative disorder of eye it's a cataract binding and it has these attributes that's an associated morphology of abnormally applied structure it has a finding site of lengths of the eye so you can this is represented as a class axiom definition so this is a computable class axiom that uh you can compute using things like ontology web language it's not very popular it's not very well known but it's something that you can do if you're interested in programming your own snomed ct inference engine so you can just take all of this and make your own system to do these kind of inferences so that is about it like there is a concept and the concept has parents the concept has children and the concept has attributes so these attributes are basically what where is what what is what so that is snomed ct in a nutshell any questions that you have about snomed city how you can use it what is it for and anything closer okay okay good uh so you you need to explore this in your own pace in your in in further detail and uh the stomach cte documentation is a really good place to get started they also have a foundation course which is free of cost you can also take that and they have a lot of videos explaining what snomed ct is how you can use it but if you just know that it's a code system meant for doctors and clinicians and it's much more detailed uh and you can do these sort of fancy queries on it i think that should be enough uh to begin with um and uh yeah that's so much ct uh now let's go to link so how many of you have heard of launch before have you used it somewhere any experience with flying like practically we don't have like idea the class is done on that okay okay what what did you learn in your classes it's related to like uh laboratory terminology technology scholarly how to get the like on the basis of if like on the basis of the disease or some we can um get the course or like if you have it is not that exact number like code we should know anything can on the basis of that we can search the report okay okay uh correct uh that's about right so link is used for anything where you can ask a question if you can ask a question there is probably a long code for that um so the thing is snomed ct also uh has a thing for it and it's called observable entity so you have something called as observable entity and under this you have many for example assessment scores for example this is an assessment score for a dim object recognition battery score we have this under snomed ct also uh but launching provides a more comprehensive uh you know framework for this the most common thing is it's not just for laboratory values it's mostly used there but it's also used for things that you can measure in the clinical space like if you take blood pressure or pulse you can still represent that using lying codes uh so here this is what is knowing and there are multiple parts to the i think this is a message uh hl seven and here they tell you how the login code should be inserted and now in fire they use the code system obviously so long-term basics i think you must have already seen about this in theory they have multiple parts i have the component the property when it was analyzed what type of specimen it was used uh what is the scale that was used and the method so most all of these except the method are mandatory so method is the only part that is optional here so let's take an example so here uh they say for uh the leukocyte blood count so what it is a leukocyte manual count of white blood cells and cerebral fluid specimen so this thing representing based on all these six uh accesses or parts we can say that the component what you are analyzing is the leukocyte and the property is the number of concentration of that and you are doing it point in time most of it is going to be point in time nothing except a very few that are going to be over a duration of a day like for example urinary output in 24 hours that's going to be done over a duration everything else is point and time and the specimen is the csr and the scale is the quantity so quantity means how many are there how many white blood cells are that and method is manual code right so and based on that they have three different names they have the fully specified name which is the the blah blah blah manual account the long common name the leukocyte number per volume instead of this to it and the shortening wbc number csr manual uh so that's the short name so again we'll come to scope of link it it's basically for both laboratory and clinical as we'll see and right now they are expanding their uh whole scope uh the thing is you won't be using lowing codes in isolation you will mostly be using long codes or as part of a panel so this is a practical tip i'll just show you how you would go about doing searching for lawing codes for example so let's just take blood pressure for example i'm just searching blood pressure light okay and you will get here systolic blood pressure right suppose you get this so you shouldn't just take the systolic blood pressure and start measuring all of your findings as a systolic blood pressure you should instead see what it is uh a part of like the member of the panel so once you find the member of the panel blood pressure panel you click on that because most of the times even active line codes are not that commonly used there are only a few knowing codes that are commonly used and they're always part of a panel so if they are part of a panel you can go ahead to the blood pressure panel and see what are all the other things that they use for example the systolic blood pressure the diastolic blood pressure mean uh blood pressure method blood pressure cuff size all of this they have automatically you know put under a panel so panels are very important and in fact uh there is even uh okay i need to log in i think the lawyer panels that is the uh panel so they have a long panel browser so they have for laboratory orders they have 150 i mean 563 panels and like that they have panels for everything uh so let's just look at one laboratory autos panel to give you an idea i'll just go to uh urine analysis okay so these are all different panels so let's just go to the urinary analysis dipstick panel so under the dipstick panel you have another panel and under that you have all of these codes so the main takeaway should be do not use lowing codes from randomly acquired codes use it which is always part of a panel and uh one more thing is usually people like open ehr they have already uh they have a mapping to link and you can take a look at their systems and then map to which code that you want to use in line and again mapping to link doesn't mean that you don't have your own local codes in the hospital so in your hospital you always need to have local codes for administrative purposes and you will map that to launch using realm there is a tool here called ralma but you need not really use that you can always just do it manually in whatever way that you find suitable so i'll show you one more thing in fact uh link and snomed recently got into an agreement and they came up with the this uh the snomed ct lawing cooperative package right so here what they do is i told you about fnomicity expressions right so they look something like this so here what they are doing is they are mapping a long code into a sonoma city expression this is an observable entity which inherits blood direct sight blood specimen time aspect single point in time component calcium electrolyte uh scale dysthesis you can see that all parts of link that we just talked about all of these parts can easily be mapped as nomad ct attributes under the observable entity but here under the observable entity you have component direct site has realization inherits and in fact loinc only has six snomed has about one two three four five six seven eight nineteen more than fifteen such attributes so this is much more detail but link is used more commonly in many circles so that's why they came out with this uh mapping so that even if somebody uses a long code you can still map it as a sonoma ct expression and from that you can do things like the snomed ct query so if you want to know all the specimens that use blood as the specimen you can go ahead and do that so that is uh you know the longing and how it fits together with snomed ct uh now i would like to know uh about your use case since it's just you three you tell me how what you will be doing in the next few years and how you are going to be using snomed city online then i think i'll answer questions as you ask them and we'll go from there so how what do you want to know more about how do you see yourself using this uh then i'd like to help you more in detail uh yeah hi sir this is milan actually i want to know how this how this lions and on snomed city we can uh put it in it concept so that i mean the health id concept are you asking how to implement this in your own system was that the question yes yes exactly yeah so um i'll show you a demo implementation of uh you know sonoma ct in fact i've just been working on this in the morning [Music] um you can see my screen right yes sir okay so i you first thing you need is a terminology service okay uh there are many terminology services out there for sonoma uh you can use snowstorm you can use hermes that's the one i'm using in this one so what i'm going to do is i'm going to show you a small example of something individual so here this is just a very random thing like here in this case i just changed whatever i already made but this one can take in a snomed ct uh code set so what you want to do is when this is actually the glasgow commerce scale so you want to choose you know whatever you have and here you have the data being generated in fact this is in the open ehr format uh but here this is where there is a snomed ct so here people can choose based on sonoma city so let's say you want only problems right like the patient comes with you with headache so so you can choose headache and here you can see that it chose headache but under uh the terminology here you can see this it's snomed ct headache and the code is automatically put and in fact if we go to the snomed city browser and search for this code or under international version if we search for this we have the thing headache okay and it's finding site is head structure so you once you record this like that you can ask questions like how many people came to me with pain in the head or even you can even render a nice ui with pain in the head like you can put a red color area in a body of a human being and make it that based on the fact that you know that the finding site is that structure so so that this is one implementation you can just you just ask them to search and it they need not search headache exactly they can even search pain in pain and head and that also maps to headache it's the same thing like we can we have multiple synonyms for the same uh term someone might even search cephalodynia for example and let's just see if that works that fellow thing is wrong i mean nobody in their right mind would search cephalodenia but in case they do they're prolotynia yeah cephalodynamics again still headache so this is one way that you can use it in a system you have a terminology service and you can watch my videos actually i'll make a few on this especially how to implement snomed ct how to put it in your own system and all that and the way you download snomed ct is you for indians at least you need to go to mlds so this is the website that is hosted by snomed city and india cooperatively and this is under the national release center and here i already have my application approved so you need to first sign up and get your application approved and after you get your on i have a educational license because you can also get an educational license in a matter of two three days then here you have our packages so see this is the india kobit 19 extension for snomed city here you can see their common drug codes for india the india patient instruction language extension so you have so many things that are given by the national release center for india but you can just download this so you just look at this there is a zip file here and you can you just download that and this is the release notes it says what it does and all that so that's how you just agree to their license and you download that and inside how the file is uh laid out uh how you can i'll just extract this and show you you get modified today so nowhere city so here you have three different files one is the delta the full and the snapshot okay so uh the snapshot is this point in time or give me all the concepts that this extension has and the thing is this is an extension it's not a full terminology for that you need to download uh the sonoma city international edition so snomed city international edition you need to have for all these extensions to work so first you download that and on top of that we'll just see in the covered edition what all they released okay so we have a lot of files here so the main files you need to be worried about is the concept file which tells what are the new concepts that they release you see that they have released these concepts there is uh the name of the concept is not here it's under another file called description so under uh this file you can see there are some new codes that they released they released severe acute respiratory syndrome corona virus ii negative 2019 kobe negative novel coronavirus negative all these new terms they release isolation at home because of infection so the thing is uh you have an ehr and you need to update the snomed ct with all these new codes if you are to do these sort of analytics if you want to find out how many people are at home right now you can't do that without having everyone use the same codes at least across a hospital right so that's why uh nrcs released all this record from covet 19. see these records from code 19 record from sars kobe 2 i'm pretty sure all of them belong to the same concept these are just multiple words but in the uh here you can see under concept id which concept they are related to so they have id effective time active module id and concept id and other concept id is what will tell you uh which concept it belongs to okay so for all this you need to look at the snomed ct website and uh do it in a little bit more detail if you also want i can uh maybe teach you if you're interested but i think as of now you're just getting started so this is the basic gist of what it is and yet in the relationships file we have all the different types of relationship so here there is a source id and a destination id so that's basically it's telling uh it's it's like a map so basically there are multiple types of concepts but one of the concept is is uh israel means like infectious disease is a type of disease so like that's how you draw the line so these relationship files are used to draw the line between one concept to another like for example uh tuberculosis is a type of uh respiratory disease so those kind of things and also the attributes attributes are also given based on these relationships so that you can see based on the type id um the type id has multiple things like it's a finding site etc so uh here is the owl ontology so for this you need to learn about description logic and how owl works and uh based on that you can just use the this particular this equivalence class blah blah blah blah this big thing you can just use that and give it to a descr ption logic reasoner there are many out there one is graph db and neo4j these kind of databases work on uh description logic pro to j just another one so these things uh you can just use this and upload it in those kind of databases and do logical reasoning from this also so that is this is just the file that was released by india renarcs so that's how you implement snomed ct you you download this file you make a terminology server or you can download a terminology server from some online repository and you make the front end where you ask them to type and then bring out a search there are other concepts too you can just ask them to put a checkbox tick and then associate that with a snomed city concept but the most common one is searching any other questions so that how we can this this healthcare if you take emr system and hospital it is huge it is lot of tools are involved clubbed together to make it as a one common platform so as if students what and all they should learn in deeper for the future so now they are starting their career into healthcare ideas analyst or some executive so that for growing further into this what are the tools or the packages they should learn by means whenever i'm interacting whenever i'm engaging session i'm co-writing so i'll be teaching about what is my sql and how the course has to be written on how to create the database tables in that context i'll be teaching then software engineering and object oriented concepts likewise i am narrowing down as data warehousing etc but when it comes to this type of health i.t standards they are now there somehow they decided that they were going to work for this i.t standard for their benefit and how to grow further into their profession what are the things they should learn from okay okay good um okay so i'll tell you two things that you need to learn in order to be successful in the field so one thing is definitely uh hl75 okay so this is a messaging standard that is almost becoming the standard at least for this ticket so you need to learn uh hl7 fire the second thing is open ehr and if you ask me i would say open ehr is even more important than h07 fire the reason is because healthcare data is not a standard okay you cannot for example you you are making a health i.t system based on the doctor's needs okay then you put your tables you write your schema for your database and then you migrate and then you have 100 tables let's say for uh blood pressure you have systolic you have diastolic that's it then tomorrow the doctor comes in the doctor will be like oh i need the position in which the patient was uh taken this blood pressure was also taken then what do you do you need to change your schema again make a migration put your put your new column then this team's happening right this is a very common thing that happens in healthcare especially health id which is the back and forth between the health it professional and the doctor so this is what open hr was made for so what they are saying is let the doctors and the health idea experts come up with these things called archetypes and templates and you you can assemble multiple archetypes and templates into each other and make something and then this final thing you give it to the health it people and no matter what it is it should work using this template so that is what openhr is basically saying and i even uh made a short video about this how open hr works and what to do or not there are tools available so first thing i'll say is for hl7 and fire learn happy okay happy fire first learn this this is a java library okay and i learn about this one you will be very easily employed in a lot of places uh just by knowing how to uh write i think java is very common in the health id space everyone usually uses java any other languages that you use you learnt anything else that is uh more common or what do you guys mostly programming about python or python okay good what else uh okay i i would suggest you learn java because it's a very very common in the health id space java.net these are the main uh things that people build uh health id systems at least now they are using that so at least open ehr is trying to change that so what it is doing is uh if you take for example a blood pressure right it's uh it's not so simple in fact blood pressure has uh these many data types like inside blood pressure there are systolic diastolic mean arterial pulse pressure uh what was the were they sleeping or awake uh were they exerting themselves what was the tilt to the position cuff size there are so many things to take into consideration so open hr says uh don't worry about all that just uh you create your archetypes and templates and in fact this is a system that works based on archetypes and templates i'll show you how this is uh what do you say a dream ehr system i would like to be in the future but it's currently not like that uh so i'll just show you um because we still have time uh so how you can take all of this and make something a doctor can use immediately okay so i'm just going to login with google block and this has been something that i've been working very recently uh so better if i showed you right now okay so what you ask is you ask your doctor to create the template a health i.t professional uh so the health a person who knows a little bit about both the what the clinical requirement and the a little bit of the technology especially open ensure they create a template okay now let's say it's just a template you want to when the patient comes you want to listen to their problems and you want to just write down the problems and with the problem you just want to record the blood pressure okay like for some reason so i'm just a problem problem and dp okay i'm just calling it problem nb okay okay problem will be so in the under the content now what you do is you add uh blood pressure first actually let's record the problem first problem which is a problem diagnosis now if you put it you could automatically see that open ehr already with hundreds of people's collective effort they have made this problem which is like problem or diagnosis name uh the clinical description body site whatever they've made so many so now uh this problem diagnosis name what we'll do is we will code it using snomed ct okay so you uh you cannot set your army with your terminals okay terminology is normal url uh uri really doesn't matter but let's just keep it like that okay uh now let that be and i don't want anything else the body side and all that we can automatically calculate using the diagnosis most of the time date onset also i don't want all i want is just the fact that what is the problem okay so i'm just even course description we can ask them to write a free text just comment nothing i don't know anything you know i said last updated no no no okay so the problem or diagnosis uh that is the one thing and the next thing is blood pressure okay so i'm adding blood pressure also so under blood pressure let's just measure systolic and diastolic and you also this they they are asking to measure multiple times yeah you're not gonna do that you're just gonna wash your historic industry okay nothing else everything was 24 hour average no protocol nothing this is actually you can exclude all optional and don't be notified and that's for it okay everything else is cancelled out only the system so now what i'll do is i can export this as a web template okay this is a template that you give to the system the final ehr system you give this okay and whatever it is it will work with that so now i'm just going to go to i'm going to clear this go to settings and i'm going to add a template in documents called problem and vp and i just added it just like that okay now problem on vp you can see that it automatically is rendering the systolic and diastolic okay so now here under problem diagnosis it does not render properly because tree does not have inputs input does not have list whatever that's because we need to tell that this is in fact a search okay and if we put it as search please configure terminology url and constrain okay terminology url i have it running under localhost 8080 ah sorry substrate and constraint so constraint is again the query that we want to constrain it to so i told you right uh we can constrain it as a clinical finding so under the taxonomy we don't want body structures we want uh only clinical finding okay so the problem cannot be anything but a clinical finding right so we'll constrain it to only that okay and now i'm just going to save it and that's it uh the bp uh problem and repeat problem head okay credit install it one property and that's it that's how you automatically generate an interface based on just you see this this just took me five minutes and the doctor can change it any time he wants in fact it's it's not just that problem and diagnosis we let's change that to anatomical structures for now just to show you that snomed ct can do much more okay under a snomed ct concept let's go to body structure okay we will constrain it instead uh problem in bp we will constrain this to body structure okay and i'm going to save that so now if you type it's showing only body structures you can see fetal head head so the head is a different entire head it's a body structure instead of problem but it doesn't make sense to make it that uh now anyway this this tool is open source i've released it on github uh you can just search for medbox ui and you will get it but that's that's the future that uh i would like to see like at least uh learn happy fire learn a little bit about uh open ehr and uh that's it java.net uh is very common in the health space and if you want to get a job this should be enough but if you want to make a difference in the hospital if you want everyone to have a nice you know have a better experience creating interfaces to for the doctors to easily do things then i will suggest you look at openhr so you look at openhr and start building your system based on that again like all the old stuff you will need to provide legacy support but slowly we need to move to a better future so i hope like it helped you a little bit yeah thank you for this session uh mr siddharth and if any any more things required i already shared your linkedin profile link to them they may be connecting with you still any any message if you want you can pass and pass it to me i'll pass it to them thank you thank you thank you milan thank you thank you sir thank you sir thank you bye bye bye bye bye sir