Semantic Alignment between ICD-11 and SNOMED CT.

Due to fundamental differences in design and editorial policies, semantic interoperability between two de facto standard terminologies in the healthcare domain--the International Classification of Diseases (ICD) and SNOMED CT (SCT), requires combining two different approaches: (i) axiom-based, which states logically what is universally true, using an ontology language such as OWL; (ii) rule-based, expressed as queries on the axiom-based knowledge. We present the ICD-SCT harmonization process including: a) a new architecture for ICD-11, b) a protocol for the semantic alignment of ICD and SCT, and c) preliminary results of the alignment applied to more than half the domain currently covered by the draft ICD-11.

A large proportion of Swedish citizens refrain from seeking medical care--lack of confidence in the medical services a plausible explanation?

Equity in health and health care is and has been a long-standing goal in Swedish health care politics. This study aims to look into how different socio-demographic variables influence unmet needs i.e. why one would refrain from seeing a doctor, despite a perceived need for medical care. A nation-wide postal questionnaire was answered by 2648 (66%) randomly chosen individuals in the ages between 20 and 64 years. The questionnaire included questions on health and health care utilisation along with data on different socio-demographic variables. The proportion of citizens that refrain from visiting a physician despite a perceived need was higher (24%) than in any previous Swedish investigation. Women, those of a non-Swedish origin and those with a low level of education refrained from going to the physician to a higher extent than men, inborn citizens and those with a higher education. Stated reasons to why the respondents refrained from medical care were associated with confidence, primarily, finite availability and economy. It appears as the Swedish health care system is not fully adapted to provide for the so far unmet needs of a large proportion of the population and that this has equitable concerns.

What's in a class? Lessons learnt from the ICD - SNOMED CT harmonisation.

The upcoming ICD-11 will be harmonized with SNOMED CT via a common ontological layer (CO). We provide evidence for our hypothesis that this cannot be appropriately done by simple ontology alignment, due to diverging ontological commitment between the two terminology systems. Whereas the common ontology describes clinical situations, ICD-11 linearization codes are best to be interpreted as diagnostic statements. For the binding between ICD codes and classes from the ontological layer, a query-based approach is favoured.