Desirable Clinical Terminology Characteristics and Present Adherence

1. Desirable Clinical Terminology Characteristics and Present Adherence James J. Cimino

2. Defining the Need for a Controlled Vocabulary • Recording primary clinical information • Multipurpose (re-use) • Sharing data • Maintenance

3. 1: Content • Must seek to be provide breadth and depth • Atoms versus molecules • A formal methodology is needed • Structure must not limit size

4. 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

5. 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

6. 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)

7. 5: Polyhierarchy • Needed for tree walking • Needed for inferencing • Needed for "essence" • Example: diseases of the liver which also involve the kidney

8. 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

9. NEC

10. NEC

11. 7: Reject "Not Elsewhere Classified" • Can never have a formal definition • Vocabulary changes induce semantic drift

12. 8: Multiple Granularities • Different levels for different purposes • Uncertainty is allowed, imprecision is not • We must be precise about our uncertainty

13. 9: Multiple Consistent Views • Multiple views for multiple purposes • Must not lead to inconsistency

14. A C B E D F H G I

15. A C B E D F H G I A C B E F D (G,H) (I)

16. A C B E D F H G I A E D F H G I

17. A C B E D F H G I A C B E D F H G I

18. A C B E F E E D F H G I H G H G I A C B D

19. A C B E D F H G I A C B E D F E H G I

20. A C B E D F H G I A C B E D F E H G I

21. 10: Representing Context • Needed: a grammar to show usage • "What is sensible to say" • Consider modeling "events"

22. 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

23. 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

24. 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

25. 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

26. 11: Graceful Evolution • Will always need to fix mistakes • Medical knowledge will grow • Bad reasons • Good reasons

27. 11: Graceful Evolution • Bad reasons: - Redundancy - Major name changes - Code reuse - Changed codes

28. 11: Graceful Evolution • Good reasons: - Simple addition - Refinement - Precoordination - Disambiguation - Obsolescence - Discovered redundancy - Minor name changes

29. 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"

30. Finding Pneumonia Left Lower Lobe 12: Recognize Redundancy

31. Finding Pneumonia Left Lower Lobe 12: Recognize Redundancy Left Lower Lobe Pneumonia

32. Finding Pneumonia Left Lower Lobe 12: Recognize Redundancy Left Lower Lobe Pneumonia is-a: Pneumonia

33. Finding Pneumonia Left Lower Lobe 12: Recognize Redundancy Left Lower Lobe Pneumonia is-a: Pneumonia has-site: Left Lower Lobe

34. Finding Pneumonia Left Lower Lobe 12: Recognize Redundancy Left Lower Lobe Pneumonia is-a: Pneumonia has-site: Left Lower Lobe participates-in: Finding

35. Finding Pneumonia Left Lower Lobe 12: Recognize Redundancy Left Lower Lobe Pneumonia is-a: Pneumonia has-site: Left Lower Lobe participates-in: Finding

36. What's Here Today? 1: Content 4: Nonsemantic Concept Identifiers 8: Multiple Granularities 10: Multiple Consistent Views

37. What May Be Here Soon? 2: Concept Orientation 3: Concept Permanence 5: Polyhierarchy 6: Formal Definitions 7: Reject "Not Elsewhere Classified"

38. What's Left? 10: Representing Context 11: Graceful Evolution 12: Recognize Redundancy

39. Keep Your Eye on the Goal • Recording primary clinical information • Multipurpose (re-use) • Sharing data • Maintenance