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Integrating Clinical Systems by Integrating Controlled Vocabularies James J. Cimino, MD Center for Medical Informatics Columbia University New York, New York, USA. Integrated Information Means. ...collecting patient information ...links to financial systems ...automated decision support
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Integrating Clinical Systemsby Integrating Controlled VocabulariesJames J. Cimino, MDCenter for Medical InformaticsColumbia UniversityNew York, New York, USA
Integrated Information Means... • ...collecting patient information • ...links to financial systems • ...automated decision support • ...library at the bedside
The Columbia Computing Environment • Stand-alone clinical systems • Several billing systems • Clinical alert system • Local- and wide-area networks • On-line educational resources
Advantages of Central Vocabulary • Resource for system developers • Single update point • Brings vocabularies together
Issues • Understand the vocabulary • Integrate the terms • Maintenance
Central Vocabulary Design • Semantic network of concepts • Content from: • Unified Medical Language System (UMLS) • Ancillary systems • Standard controlled vocabularies • Browsing and editing tools
Medical Entity Laboratory Specimen Substance Event Anatomic Substance Plasma Specimen Diagnostic Procedure Chemical Substance Sampled Carbo- hydrate Bioactive Substance Laboratory Procedure Laboratory Test Plasma Has Specimen Plasma Glucose CHEM-7 Glucose Substance Measured Part of Medical Entities Dictionary
Vocabulary Sources • Clinical laboratories • Pharmacy • Cardiology • Discharge coding • Radiology • Primary Care
Current Size • 41,000 concepts • 146 slots • 51,500 parent/child links • 40,000 other semantic links • 240,000 strings
Vocabulary Browser/Editors • Knowledge Engineering Environment (KEE) - 386 and 370 • PC-MUMPS • RS/6000 and X-Windows
Editor Functions • Lexical and graphic browsing • Addition and deletion functions • Inheritance • Automatic classification
Success Stories • Repairing vocabularies • Database extension • Confidential data display • Summary reporting • Medline Button • Medical Logic Modules
Repairing Vocabularies • Radiology • Laboratory • Pharmacy
Laboratory Test Plasma Glucose SMAC20 Glucose Chem-7 Glucose Fasting Glucose Stat Serum Glucose Laboratory Test Glucose Test Serum Glucose Blood Glucose Serum Glucose Fasting Glucose Chem-7 Glucose Plasma Glucose SMAC20 Glucose Stat Serum Glucose Autoclassifying the Laboratory
Autoclassify the Pharmacy: Before Drug Allergy Salicylate Allergy Opiate Allergy Nonsteroidal Anti-inflamm. Analgesic Bayer Aspirin Empirin #3
Autoclassify the Pharmacy: After Drug Allergy Salicylate Allergy Opiate Allergy Nonsteroidal Anti-inflamm. Analgesic Aspirin Drugs Codeine Drugs Bayer Aspirin Empirin #3
Results of Autoclassification • 971 new classes • 334 drugs classified by type • 289 drugs into two or more types • 173 drugs into allergy classes
Database Extension • Information model for new applications • Merging the new with the old • Adding organization to the model
Confidential Data Display • Need to display sensitive data (HIV) • Need an extra level of security • Step 1: create a new class in the MED • Step 2: have the application check for class membership
Medical Logic Modules • Clinical alerts • Data interpretation • Finding research patients • Monitoring hospital resources
Current Challenges • Editing environment • Expansion of automated updates • Vocabulary content
Conclusions • Integrating vocabularies helps • Complex vocabulary model pays off • Automated maintenance works
