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The Role of Standard Terminologies in Facilitating Integration James J. Cimino, M.D. Departments of Biomedical Informatics and Medicine Columbia University.

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Presentation on theme: "The Role of Standard Terminologies in Facilitating Integration James J. Cimino, M.D. Departments of Biomedical Informatics and Medicine Columbia University."— Presentation transcript:

1 The Role of Standard Terminologies in Facilitating Integration James J. Cimino, M.D. Departments of Biomedical Informatics and Medicine Columbia University

2 Integration of… …data with each other …systems that exchange data …data with decision support systems …data with health information resources

3 The Re-Use of Clinical Data l Have to query a longitudinal database l Want to collect data from multiple sources l Need automated alerts l Should link to on-line information resources

4 The Format of Information

5 Re-Use of Nonstandard Information 21 22 23 24 25 26 27 28 29 76543217654321

6 Blobs and Symbols Text Numeric SignalStructuredCodedStandard Coded NLP Interpretation Image Blobs Symbols

7 The Strange Case of MRSA l Database with 15 years of laboratory results l Medical knowledge changes over time l Information systems change over time l Institutions merge their data

8 Multiple Representations of MRSA 1) Culture: Specimen: Blood Organism: S. aureus Sensitivity test: Methicillin Result: Resistant 2) Blood Culture: Organism: S. aureus Sensitivity test: Methicillin Result: Resistant 3) Blood Culture: Result: “MRSA” 4) Blood Culture: Organism: Methicillin-Resistant-Staph-Aureus 5) MRSA Culture: Positive

9 Result Table Result Code Value 1 1 1 Culture 3 3 S. aureus MRSA Positive: Solution 1 Terminology Table Term Code Term Name 4 Methicillin 4 5 Resistant 5 2 2 Blood Spec.

10 Terminology Table Term Code Term Name Result Table Result Code Value 6 6 Blood Cult 3 3 S. aureus MRSA Positive: Solution 2 4 4 Methicillin 5 5 Resistant

11 Terminology Table Term Code Term Name Result Table Result Code Value “MRSA” 6 6 Blood Cult MRSA Positive: Solution 3

12 6 Terminology Table Term Code Term Name Result Table Result Code Value 6 Blood Cult 7 7 MRSA MRSA Positive: Solution 4

13 Terminology Table Term Code Term Name Result Table Result Code Value 8 8 MRSA Cult 9 9 Positive MRSA Positive: Solution 5

14 Longitudinal Database Terminology Table Term Code Term Name 1 Culture 2 Blood Spec. 3 S. aureus 4 Methicillin 5 Resistant 6 Blood Culture 7 MRSA 8 MRSA Cult. 9 Positive Result Table Result Code Value 1 2 1 3 4 5 6 3 4 5 6 “MRSA” 6 7 8 9

15 Coding with Standards: Gender l Data element - gender l Controlled terminology: Male, Female, Unknown l Representation: M,F,U; 0,1,2 l What about other values? – Genotypic – Phenotypic – Administrative

16 What Standards are Out There? l ICD9-CM – Strict hierarchy – Coarse granularity – “Not Elsewhere Classified” l CPT – Procedures for billing – No hierarchy l NDC – Products-oriented – No classification – Codes reused – Revisions in progress l UMLS

17 What Standards are Out There? l UMLS – Subsumes many standards – Provides extensive synonymy – No hierarchy – Near-synonymy l RxNorm – Cooperation of NLM, FDA and VA – Defines clinical drugs – Mapping to pharmacy knowledge bases

18 What Standards are Out There? l LOINC – Good domain coverage of laboratory – Principled design – Working on hierarchy – Extending to all observations l SNOMED-CT – Merger of SNOMED and Read Clinical Terms – Rich semantics – Principled design – Public domain – Coordination with other terminologies

19 What Could We Do With Standards? l Summary data reporting

20 Lab Summary 1995

21 Lab Summary 1998

22 What Could We Do With Standards? l Summary data reporting l Exchange of information l Automated decision support l Integration with of health information resources

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26 Take Home Message l Standards are hard to do l Not much out there l Can do neat things if standardized

27 Learning More SNOMED: http://www.snomed.org/http://www.snomed.org/ UMLS: http://www.nlm.nih.gov/research/umlshttp://www.nlm.nih.gov/research/umls LOINC: http://www.regenstrief.org/loinc/loinc.htmhttp://www.regenstrief.org/loinc/loinc.htm MED: http://www.cpmc.columbia.edu/homepages/ciminoj/med.htmlhttp://www.cpmc.columbia.edu/homepages/ciminoj/med.html Standards: http://www.hl7.org/standards/developer.htmhttp://www.hl7.org/standards/developer.htm


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