Department of Medical Informatics Access to Health Care Information Resources through Intelligent Controlled Terminologies James J. Cimino, M.D. Columbia University Department of Medical Informatics

Overview What needs fixing? What is an "intelligent controlled terminology?" How does it assist with access to information resources?

What Needs Fixing? Finding the right resource is hard Using each resource is awkward It's easy to get overwhelmed

Example: Weird Organism Encountered on lab test result What resource has the right information? How do I get to the resource? How do I ask the question? What was that organism again?

Solution: "Infobuttons" Button is integrated with clinical system Knows that Medline has information Knows how to get to Medline Knows how to translate organism name Knows how to query Medline Result: one-touch Medline search

Under the Hood: Intelligent Controlled Terminology CPMC Medical Entities Dictionary (MED) Semantic network of 50,000 concepts Includes definitional information through semantic relationships Tightly coupled with the Unified Medical Language System

Medical Entities Dictionary Entity Laboratory Specimen Substance Event Anatomic Substance Plasma Specimen Chemical Diagnostic Procedure Substance Sampled Carbo- hydrate Bioactive Substance Plasma Laboratory Test Laboratory Procedure Has Specimen Glucose Plasma Glucose CHEM-7 Substance Measured Part of

How does the Infobutton Work? Clinical Information System Vocabulary Server Web Server Internet Clinician Information Source Information Source

Examples of Infobuttons Laboratory tests to Medline Laboratory tests to DXplain Cholesterol results to guideline X-ray reports to variety of Web resources Patient medications to drug references

screen shots galore Laboratory tests to Medline Chem20 Question list Laboratory tests to DXplain DXplain Diseases (list) DXplain Disease (result) List of findings Differential diagnosis Cholesterol results to guideline Does pt have CHD? Recommendation lipid lowering agent X-ray reports to variety of Web resources X-ray report Findings Questions Medline results Medline abstract Chorus page Patient medications to drug references ?????????

Advantages of Knowledge-Based Approach Re-use of terms by multiple applications Translation of terms between applications Integration of data from multiple sources Coordination of patient data with information resource concepts Ability to support maintenance of the terminology itself

Implications for Federal Information Resources Allow more sophisticated access to resources Reusability of terminology Maintenance of terminology