VeNom Coding
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Development Project Status: Under Discussion
This project will add support for VeNom Codes.
VeNom stands for "Veterinary Nomenclature". From the VeNom Coding website:
The codes are a list of terms that are used in veterinary practice and have been standardised across institutes to facilitate academic discussion, research and clinical auditing.
Currently, the list consists of diagnoses, presenting complaints and administrative tasks associated with canine and feline veterinary work. The list is being developed to include standardised species and breed lists as well as medical and surgical procedures and standard therapeutics. Both general practice and referral practice terminologies are included.
Use of the codes will enable practices in the UK and Australia to participate in the VetCompass program. Information on VetCompass Australia can be found here.
The codes are broken down into the following groups:
- Diagnosis - 2326 entries
- Presenting Complaint - 406 entries
- Procedure - 849 entries
- Diagnostic Test - 109 entries
- Reason for Visit - 284 entries
- Species - 50 entries
- Breed - 1063 canine, feline and rabbit breeds (~1300 with synonyms)
- Administrative Task - 16 entries
- Physical Examination - 2 entries
Codes are also categorised as being for:
- Referral - reflects terms that are likely to be most appropriate in the referral setting
- Non-referral - presenting complaints have the prefix ‘presenting complaint -’ to highlight this is not strictly a diagnosis
- Both - terms apply to both referral and non-referral settings
The codes are maintained by the VeNom Coding Group, and are updated quarterly.
As such, there would be no facility within OpenVPMS to create or edit codes. A tool would be provided to load the official set of codes.
To obtain a copy of the codes for review, please contact the VeNom Coding Group here.
Presenting Complaint
Presenting complaint codes will be used to classify patient Clinical Problem acts.
The archetype will be modified to enable the selection of zero or more Presenting Complaint codes.
| Term | Top Level Modelling |
|---|---|
| Abdominal distension | Abdominal finding |
| Abdominal injury | Abdominal finding, Traumatic episode finding |
| Alopecia | Haircoat/skin (+ appendages) finding |
| Anal irritation | Alimentary tract/Digestive system finding |
| Anorexia | Nervous system finding |
| Appetite decreased | Nervous system finding |
| Appetite increased | Nervous system finding |
| Behavioural abnormality | Nervous system finding, Head and neck finding |
| Bleeding - bruising | Cardiovascular system finding, Wound finding |
Sample of VeNom Presenting Complaint codes
Diagnosis
Diagnosis codes will be used to classify patient Clinical Problem acts.
The archetype will be modified to enable the selection of zero or more Diagnosis codes.
| Term | Top Level Modelling |
|---|---|
| Abscess | Inflammatory disorder finding |
| Abscess - Cat bite abscess (CBA) | Inflammatory disorder finding, Wound finding, Traumatic episode finding |
| Abscess - dog bite abscess | Inflammatory disorder finding, Wound finding, Traumatic episode finding |
| Abscess - hepatic (liver) | Inflammatory disorder finding, Hepatobiliary system finding, Abdominal finding |
| Abscess - neck (cervical) | Inflammatory disorder finding, Head and neck finding |
| Abscess - oral (mouth) | Inflammatory disorder finding, Alimentary tract/Digestive system finding, Head and neck finding |
| Abscess - oral (mouth), dental (tooth) | Inflammatory disorder finding, Alimentary tract/Digestive system finding, Head and neck finding |
| Abscess - spinal cord | Inflammatory disoder finding, Nervous system finding |
| Acanthomatous adamantinoma - mandible | Mass lesion/swelling finding, Alimentary tract/Digestive system finding, Soft tissue finding, Head and neck finding |
Sample of VeNom Diagnosis codes
Diagnostic Test
Diagnostic Test codes will be used to classify OpenVPMS products (e.g. product.service).
The product archetypes will be modified to enable the selection of zero or more Diagnostic Test codes.
| Term | Top Level Modelling |
|---|---|
| Angiography | Diagnostic Imaging test, Cardiovascular system test |
| Antegrade pyelography | Diagnostic Imaging test, Urogenital system test |
| Antegrade urethrography | Diagnostic Imaging test, Urogenital system test |
| Arterial blood pressure measurement - invasive | Blood pressure measurement test, Cardiovascular system test |
| Arterial blood pressure measurement - non-invasive | Blood pressure measurement test, Cardiovascular system test |
| Barium study: Pharynx | Clinical Pathology test, Respiratory system test, Infectious disorder test |
| Barium study: Small intestine | Diagnostic Imaging test, Alimentary tract/Digestive system test |
| Barium study: Stomach | Diagnostic Imaging test, Alimentary tract/Digestive system test |
| Blood test (unspecified) | Diagnostic Imaging test, Alimentary tract/Digestive system test, Respiratory system test |
Sample of VeNom Diagnostic Test codes
Procedures
Procedure codes will be used to classify OpenVPMS products (e.g. product.service).
The product archetypes will be modified to enable the selection of zero or more Procedure codes.
| Term | Top Level Modelling |
|---|---|
| (De)scale and polish | Non-surgical procedure, Alimentary tract/Digestive system procedure, Head and neck procedure |
| Abdominal cavity: Abscess drainage/removal | Soft Tissue surgical procedure, Abdominal procedure |
| Abdominal cavity: Exploratory laparotomy (coeliotomy) | Soft Tissue surgical procedure, Abdominal procedure |
| Abdominal cavity: Laparoscopy | Soft Tissue surgical procedure, Abdominal procedure |
| Abdominal cavity: Lymph node biopsy - percutaneous | Diagnostic procedure, Lymphatic system procedure, Immune system procedure, Haematopoietic system procedure, Abdominal procedure |
| Abdominal cavity: Lymph node biopsy - surgical | Diagnostic procedure, Surgical procedure, Lymphatic system procedure, Immune system procedure, Haematopoietic system procedure, Abdominal procedure |
| Abdominal cavity: Lymph node fine needle aspiration (FNA) | Diagnostic procedure, Lymphatic system procedure, Immune system procedure, Haematopoietic system procedure, Abdominal procedure |
| Abdominal cavity: other procedure | Abdominal procedure |
| Abdominal cavity: Peritonitis treatment - drain placement | Soft Tissue surgical procedure, Abdominal procedure |
Sample of VeNom Procedure codes
Reason for Visit
The patient Visit archetype will be modified to allow the visit to be assigned a single Reason Visit code. The existing free-form reason node will be retained to allow additional text to be added.
| Term | Top Level Modelling |
|---|---|
| Admit for surgery | Reason for visit |
| Aggressive | Reason for visit |
| Agitated | Reason for visit |
| Anxious | Reason for visit |
| Attacked by other animal | Reason for visit |
| Bald | Reason for visit |
| Bandage problem | Reason for visit |
| Barking | Reason for visit |
| Been kicked | Reason for visit |
Species and Breeds
Existing practices will have a lot of data using their own species and breed classifications, so the intention is to allow OpenVPMS species and breeds codes in conjunction with VeNom species and breeds. This will be done by:
- creating lookup.speciesVeNom and lookup.breedVeNom codes
- changing the party.patientpet archetype to enable selection of either OpenVPMS or VeNom codes
Users can then make any orderly transition to VeNom codes by replacing their lookups with the VeNom equivalent as needed.
It also allows the creation of temporary species and breed codes if VeNom doesn't provide one.
Administrative Task
There is no single place where administrative tasks can be logged.
Is this useful?
| Term |
|---|
| Admin task - Admission for medical care (includes procedures) with hospitalisation |
| Admin task - Admission for medical care (includes procedures) without hospitalisation |
| Admin task - Boarding discharge |
| Admin task - Estimate |
| Admin task - Export certificate |
| Admin task - Hospitalisation |
| Admin task - Insurance form |
| Admin task - New client |
| Admin task - New patient |
Sample of VeNom Administrative Task codes
Physical Examination codes
At present, VeNom only provides 2 Physical Examination codes.
These could be either added to a product, or patient Clinical Problem?
| Term |
|---|
| Health (Wellness) check - no abnormalities detected |
| Health check - no abnormalities detected |
VeNom Physical Examination codes
Database Changes
The database will need to be modified in order for classifications to be added to acts.
This will be done by adding an act_classifications table that links the acts table to the lookups table.
Comments
Re: VeNom Coding
It sounds like a grand ideal to me.
If the implementation doesnt add complication to the user workspace then I think it should be implemented. It adds a nice level of consistency that can be helpful when referring or sending a patient history for a teleconsult.
With regard to Physical Exam codes are they not both a presenting complaint and diagnosis combined
1. Presenting complaint Health Check.
2. Diagnosis No Abnormality detected.
I think the administrative tasks are interesting. Certainly valuable from a assessment of practice performance. Not entirely sure where they belong...as you say there isnt once place. Again its almost a classification issue. If you asked me a patient visit could be associated with 1 or more of those codes.
Ben
Re: VeNom Coding
Use of the codes would be optional.
For Clinical Problems, there would be two new fields, to support addition of Presenting Complaint and Diagnosis codes.
For products there would be two new fields to support addition of Diagnostic Test and Procedures codes.
For Visits there would be new field to support addition of a Reason for Visit code (maybe multiple codes should be supported?).
I'm not sure why Physical examination codes are separate. The two present codes could be modelled as Diagnosis codes. It may be possible to just use the one Clinical Problem field to hold both Diagnosis and Physical Exam codes.
Administrative tasks could be associated with a Visit, but not all are related to a single patient (e.g. Estimate, Phone Call, Opt out of data sharing). Some of them can also be derived using reporting (e.g New Customer, New Patient, Estimate).
-Tim
Re: VeNom Coding
Note that in 1.8, Clinical Problems have been extended to support Presenting Complaint and Diagnosis codes.
Re: VeNom Coding
... and in 1.9, Appointments and Visits have been extended to support VeNom Reason For Visit codes.