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Desirable Clinical Terminology Characteristics and Present Adherence. James J. Cimino. Defining the Need for a Controlled Vocabulary. Recording primary clinical information Multipurpose (re-use) Sharing data Maintenance. 1: Content. Must seek to be provide breadth and depth
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Desirable Clinical Terminology Characteristics and Present Adherence James J. Cimino
Defining the Need for a Controlled Vocabulary • Recording primary clinical information • Multipurpose (re-use) • Sharing data • Maintenance
1: Content • Must seek to be provide breadth and depth • Atoms versus molecules • A formal methodology is needed • Structure must not limit size
2: Concept Orientation • Concepts, not terms • One meaning (nonvague) • No more than one meaning (nonambiguous) • Higher-level ¹ ambiguous • One concept per meaning (nonredundant) • May have multiple context-dependent meanings
3: Concept Permanence • Old concepts can't be deleted • Example: non-A-non-B hepatitis • Names can be changed as long as meaning doesn't change (retronyms) • Example: transvenous pacemaker
4: Nonsemantic Concept Identifiers • Don't use the name • Don't use a code that will run out of room • Don't use a hierarchical code • Meaningless integer (+/- check digit)
5: Polyhierarchy • Needed for tree walking • Needed for inferencing • Needed for "essence" • Example: diseases of the liver which also involve the kidney
6: Formal Definitions • Support understanding • Support maintenance • Structured and controlled (not narrative) • Represented through relationships within the vocabulary • Defintional versus assertional knowledge • Additional effort minimal and will pay off
7: Reject "Not Elsewhere Classified" • Can never have a formal definition • Vocabulary changes induce semantic drift
8: Multiple Granularities • Different levels for different purposes • Uncertainty is allowed, imprecision is not • We must be precise about our uncertainty
9: Multiple Consistent Views • Multiple views for multiple purposes • Must not lead to inconsistency
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A C B E D F H G I A C B E F D (G,H) (I)
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A C B E F E E D F H G I H G H G I A C B D
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10: Representing Context • Needed: a grammar to show usage • "What is sensible to say" • Consider modeling "events"
Controlled Medical Vocabulary Definitional Knowledge (how concepts define each other) Pathologic Function Finding Body Site is -a has- site is -a is -a Joint Joint Swelling Swelling is -a has- abnormality Right Knee
Controlled Medical Vocabulary Assertional Knowledge Definitional Knowledge (how concepts combine) (how concepts define each other) Pathologic Function Finding Body Site modifies is -a has- site Finding Body Site is -a is -a Joint Joint Swelling Swelling is -a has- abnormality Right Knee
Controlled Medical Vocabulary Contextual Knowledge Assertional Knowledge Definitional Knowledge (how concepts are used) (how concepts combine) (how concepts define each other) Pathologic Function Finding Body Site part-of Physical Exam Finding modifies is -a has- site Finding Body Site part -of is -a is -a Joint Joint Swelling Hospital Progress Swelling is -a Admission Note has- abnormality part-of Right Knee
Controlled Medical Vocabulary Contextual Knowledge Assertional Knowledge Definitional Knowledge (how concepts are used) (how concepts combine) (how concepts define each other) Pathologic Function Finding Body Site part-of Physical Exam Finding modifies is -a has- site Finding Body Site part -of is -a is -a Joint Joint Swelling Hospital Progress Swelling is -a Admission Note has- abnormality part-of Right Knee Hospital Admission Progress Note Physical Exam Progress Note Progress Note [Joint Swelling [Right Knee]] Electronic Medical Record
11: Graceful Evolution • Will always need to fix mistakes • Medical knowledge will grow • Bad reasons • Good reasons
11: Graceful Evolution • Bad reasons: - Redundancy - Major name changes - Code reuse - Changed codes
11: Graceful Evolution • Good reasons: - Simple addition - Refinement - Precoordination - Disambiguation - Obsolescence - Discovered redundancy - Minor name changes
12: Recognize Redundancy • Synonyms are good • Redundant concepts are bad • Redundant expressions are inevitable • Example: - Year 1: "Pneumonia", "Left Lower Lobe" - Year 2: "Left Lower Lobe Pneumonia"
Finding Pneumonia Left Lower Lobe 12: Recognize Redundancy
Finding Pneumonia Left Lower Lobe 12: Recognize Redundancy Left Lower Lobe Pneumonia
Finding Pneumonia Left Lower Lobe 12: Recognize Redundancy Left Lower Lobe Pneumonia is-a: Pneumonia
Finding Pneumonia Left Lower Lobe 12: Recognize Redundancy Left Lower Lobe Pneumonia is-a: Pneumonia has-site: Left Lower Lobe
Finding Pneumonia Left Lower Lobe 12: Recognize Redundancy Left Lower Lobe Pneumonia is-a: Pneumonia has-site: Left Lower Lobe participates-in: Finding
Finding Pneumonia Left Lower Lobe 12: Recognize Redundancy Left Lower Lobe Pneumonia is-a: Pneumonia has-site: Left Lower Lobe participates-in: Finding
What's Here Today? 1: Content 4: Nonsemantic Concept Identifiers 8: Multiple Granularities 10: Multiple Consistent Views
What May Be Here Soon? 2: Concept Orientation 3: Concept Permanence 5: Polyhierarchy 6: Formal Definitions 7: Reject "Not Elsewhere Classified"
What's Left? 10: Representing Context 11: Graceful Evolution 12: Recognize Redundancy
Keep Your Eye on the Goal • Recording primary clinical information • Multipurpose (re-use) • Sharing data • Maintenance