1 The Business Case for Large-Scale Ontology Projects: Are we at a tipping point? Mark A. Musen, M.D., Ph.D. Stanford Medical Informatics Stanford University

2 Medicine boasts a great tradition of work in controlled terminology 724Unspecified disorders of the back 724.0Spinal stenosis, other than cervical Spinal stenosis, unspecified region Spinal stenosis, thoracic region Spinal stenosis, lumbar region Spinal stenosis, other 724.1Pain in thoracic spine 724.2Lumbago 724.3Sciatica 724.4Thoracic or lumbosacral neuritis 724.5Backache, unspecified 724.6Disorders of sacrum 724.7Disorders of coccyx Unspecified disorder of coccyx Hypermobility of coccyx Coccygodynia 724.8Other symptoms referable to back 724.9Other unspecified back disorders

3 In the past, most emphasis has been on form, not content HL7 standard addressed message structure Arden Syntax for medical logic modules standardized processes but was silent about the data being processed The most popular tutorial at the annual AMIA meeting reamins one on XML

4 The world is changingand ontologies are now essential Widespread legislative mandate for computer-based physician order entry (CPOE) to promote patient safety Recognition that semantic data integration helped track down SARS and may be essential for combating bio-terrorism The advent of high-throughput techniques in biology has led to more data than anyone knows how to analyze

5 Some very positive signs Companies such as Apelon are marketing description logic directly to health-care organizations The caBIG initiative from NCI is bringing ontologies to the masses (at least to the nations cancer centers) Every NIH institute know wants to create its own ontology

6 : NCI has pioneered the use of distributed ontology editing

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8 Lots of places in medical practice where ontologies are urgently needed Patient problems (e.g., chest pain, shortness of breath, abnormal skin lesions) Best practices and clinical guidelines Repositories of clinical trials for archiving negative results and adverse reactions Pharmacogenomics and genomic medicine