In going through how Dr Seuss is passing meaningful-use, I covered what we can call the Nonsense CCD: though official tests pronounce it correct, which should make it meaningful for data exchange, its understood-by-nobody-else codes say otherwise. Its content is meaningless outside the organization that produced it.

Fortunately, Nonsense is only the lowest of three levels of correct CCD. I’ll talk about the creme de la creme later, but now let me discuss Mr. In Between, what I think of as “CCDs for Tourists”.

As always let’s begin in the weeds, again with good old allergy to strawberries …

"Allergy" is the disorder and "les fraises" sont la cause

les fraises? It’s French for strawberries. But why two languages? Why not just stick to English, say strawberries is the cause? After all, English isn’t limited to labeling disorders – such mixing and matching makes the listener focus on the form of expression rather than what’s being said!

Here’s CCD markup for this allergy, using concept schemes recommended by the powers that be …

<code code="106190000" displayName="Allergy" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED" />
...
<value xsi:type="CD"/>
<participant typeCode="CSM">
    <participantRole classCode="MANU">
        <playingEntity classCode="MMAT">
            <code code="4J2TY8Y81V" codeSystem="2.16.840.1.113883.4.9" codeSystemName="Unique Ingredient Identifier (UNII)" displayName="strawberry" />
            <name>strawberry</name>
        </playingEntity>
    </participantRole>
</participant>

We declare the disorder with SNOMED and the cause using the FDA’s Unique Ingredient Identifier scheme (UNII). Here’s two different concept schemes or languages if you will. Why two? Why not identity substance with SNOMED too?

<code code="106190000" displayName="Allergy" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED">
     <qualifier>
         <name code="246075003" displayName="causative agent" />
         <value code="102261002" displayName="strawberry" />
     </qualifier>
</code>

English and French, SNOMED and UNII, la même chose? Multi-lingual CCDs or CCDs for tourists.

Tourists? Ever waded through street vendors in the face of English, German, local labels and pointing, as you and they try to get your point across? This form of expression works but only for simple communication. It’s the world of Adam in the garden, labeling one plant after another, without any thought for the overarching concept plant, the world of stand-alone labels, not coherent expression.

Like most who’ve played with CCDs, I expect meaningful-use 2 to consign the Nonsense to the scrap heap but I’d go further and throw the Tourists in there too. But perhaps, I’m being too narrow-minded, too much of the “English should be our one and only language”, “let them eat SNOMED” sort. Why not live happily in babel? Because I want to do something with these patient-data dumps, damn it and I’d rather do it without a dictionary in hand.