1. Controlled Vocabularies for Capturing Clinical Encounters
James J. Cimino, M.D.
Department of Medical Informatics
Columbia University

2. Why Use a Controlled Vocabulary?
Efficient storage
Anticipatory data capture
Record abstraction for billing, reporting, research...
Automated decision support

3. What are the Options? ICD-9-CM ICD-10 ICPC NANDA DSM-IV MeSH UMLS
Gabrieli Nomenclature
Read Clinical Codes
SNOMED International

4. Why Aren’t We Using Them?
Abstracting systems provide insufficient detail
Comprehensive vocabularies may be too expressive
Organizational mismatch between developers and users
Adaptation of legacy systems to standard vocabularies

5. Possible Solution: Collaborative Vocabulary Construction
Users contribute to design and content
Content drawn from legacy systems
Contributions made via the Internet
Updates in near-real time

6. The InterMed Collaboratory
HPCC Project from NLM
Multiple investigator groups
Columbia University
Harvard University
Stanford University
University of Utah
Net-based collaborative research

7. The Collaborative Approach
Agree on a domain of interest
Model the domain
Hierarchies
Semantic attributes
Contribute content

8. Browsers and Editors
Ontolingua
K-Rep
AccessMED
Web MED Browser

9. Contributions to the InterMed MED
Find a class for your term in the Web browser
Click on the “Add” button
Enter the name
Add other parents and children
Refine semantic attributes
Click on “UMLS” button

10. Outcomes Exploration of Internet-based vocabulary collaboration
Expansion of domain coverage
Vocabulary that fits user needs
Contributions to the UMLS