Comparing various Concept Dictionary options in Bahmni

Brief Overview

In this option you are choosing to run Bahmni with a custom concept dictionary that contains clinical terms decided by you (and your clinical terminology team).

In this option you are choosing to load Bahmni with publicly available and opensource CIEL dictionary comprising of 50K+ terms with SNOMED, ICD10, LOINC, RxNorm reference mappings, already done. The Bahmni Concept Dictionary will be loaded with CIEL data and you will use CIEL Terms to record data on the Bahmni UI.

For more details see: https://openconceptlab.org/2022/10/19/ciel-bridging-terminology-for-the-global-community/

• In this option you are choosing to load Bahmni with few pre-configured Bahmni custom concepts and also connecting it to SNOMED Terminology Server, which will act as a real-time terminology server. You are going to use SNOMED CT terms on Bahmni UI to record clinical data.

• Whenever a SNOMED term is chosen on the UI, that term is pulled into Bahmni, and stored into the Concept Dictionary.

• So, over time, Bahmni concept dictionary starts reflecting a list of your facility commonly used clinical terms.

• For more details see this wiki page. SNOMED CT has over 300K clinical terms.

• Similar to prev column, but Bahmni concept dictionary is pre-loaded with CIEL data as the base dictionary.

• For most operations you will still be using SNOMED CT terms on the Bahmni UI for recording data (because Bahmni will be referencing SNOMED TS server for real time lookups of terms).

Which option is used most frequently in the real world with Bahmni?

Majority of the real world deployments of Bahmni (until v0.93) before Bahmni Lite have used a Custom Dictionary.

Since Bahmni Lite v1.0 release in June2023, new adopters have started evaluating / adopting CIEL dictionary. CIEL is being used with OpenMRS already in many real world settings.

SNOMED CT is used widely in many EHRs across the world. But in Bahmni, since this is a recent development, we don’t yet have any known real-world deployment of Bahmni-SNOMED TS directly.

(Same as prev column)

Which configuration of Bahmni comes out-of-the-box with this option?

default-config (currently default for Bahmni-Standard for Hospitals)

clinic-config (with Bahmni Lite)

snomed-default-config (with Bahmni Lite & SNOMED configuration)

snomed-clinic-config (with Bahmni Lite and SNOMED Configuration). Has some known issues, see this link.

How do I report a term that should be present in standard dictionary but it somehow isn’t?

You can add it yourself.

Drop an email to Dr. Andrew Kanter

Inform SNOMED international, or check if your country has already added it in the country specific extensions.

(Same as prev column)

Can I use OCL (Open Concept Lab) to manage terms?

Yes

Yes

No, the SNOMED-TS (terminology server) acts as the TS here. In this configuration OCL is not involved.

(Same as prev column)

While recording Diagnosis in Bahmni what terms will I see on the UI?

Your custom terms

CIEL terms or any custom terms added by you to the Concept Dictionary.

• SNOMED terms under Clinical Findings (404684003).

• Can be configured via global.properties.

(Same as prev column)

For recording Chief Complaints in Bahmni what terms will I see?

Your custom terms

CIEL terms or any custom terms added by you to the Concept Dictionary.

An ECL query specified in the form designer for Chief Complaints in the H&E form. Currently configured same as Clinical Findings. See documentation.

(Same as prev column)

For recording Drugs in Bahmni what terms will I see?

1. Your custom terms as loaded in Drug Concepts.

2. You can also use initialiser module to load drugs.

1. CIEL terms or any custom terms added by you to the Drug Concepts.

2. You can use initialiser module to load drugs via csv. See example.

1. Custom terms added in Drug Concepts (but should have SNOMED CT reference mappings for CDSS features to work)

2. You can use initializer module to load drugs via csv. See example.

(Same as prev column)

What terms can I use in the Form Designer for Questions/Answers?

Your custom terms can be used.

Any CIEL dictionary or custom added term can be used.

1. Any custom term directly added into Concept Dictionary can be used.

2. SNOMED TS terms can be used as Answers (by specifying a ValueSet url or ECL urls). See documentation.

(Same as prev column)

Can I use my own custom terms along with this option?

Yes.

Yes, but recommend checking with Dr. Andrew Kanter, who maintains CIEL dictionary if the term can be added to standard CIEL distribution.

1. The new terms should be added into SNOMED TS server under the correct “parent” concept, for them to show up in Bahmni.

2. For questions/answers in Forms, one can directly add them into Concept Dictionary.

(Same as prev column)

How are conflicts in Concept Names handled (when a custom concept is also present)?

You cannot add two concepts with the same FSN.

You cannot add two concepts with the same FSN.

1. You cannot add two concepts with the same FSN.

2. While copying a concept from SNOMED TS into Bahmni, the following concept resolution logic is applied: https://github.com/Bahmni/openmrs-module-snomed#concept-resolution

3. If the FSN already exists in Bahmni, then during copying from SNOMED TS, the synonyms are added to existing concept (but FSN is untouched).

(Same as prev column)

Will I be able to report data in SNOMED CT?

1. Yes

2. See this documentation.

(Same as prev column)

Will I be able to use Bahmni’s custom CDSS integration over FHIR?

Will I be able to use Bahmni ICD10 reporting feature?

Will be be able to use Hierarchical reporting to aggregate specific diseases into a parent group easily?

Can I use this option in an offline / on-premise installation of Bahmni?

Is there any performance impact?

Migrate to another terminology set?

Is there a docker-compose option available that packages this set out-of-the-box for me to try?

If I use OpenELIS (Lab), or Odoo, or DCM4chee, will this option work?

Can i use the Patient FHIR Export feature?

What competency is expected of the clinicians who will be recording this data?

Is this option FREE or PAID or OpenSource?

How often does this option get updated with new terms?

What advantages will I get with this option?

What possible disadvantages I should consider with this option?

Any Other Information?