1. Controlled Medical Terminologies: What can they do for me? James J. Cimino, M.D. Department of Medical Informatics Columbia University

2. Definition Terminology: A finite, enumerated set of terms intended to convey information unambiguously

3. Some General Classes of Terms Diagnostic Procedures Therapeutic Procedures Medications Diagnoses Findings Organisms Anatomy

4. ICD-9/10 and -CM 9th International Classification of Diseases WHO for collecting health statistics Clinical Modifications added 10th edition Clinical modifications under construction Strict hierarchy Synonyms and “index” terms Code determines place in hierarchy

5. ICD9-CM Examples ------Diseases----- 003. @ OTHER SALMONELLA INFECTIONS 003.0 SALMONELLA GASTROENTERITIS 003.2 @ LOCALIZED SALMONELLA INFECTIONS 003.20 LOCALIZED SALMONELLA INFECTION, UNSPECIFIED 003.21 SALMONELLA MENINGITIS 003.29 OTHER LOCALIZED SALMONELLA INFECTIONS ------Procedures----- 01. @ INCISION AND EXCISION OF SKULL, BRAIN,... 01.0 @ CRANIAL PUNCTURE 01.01 CISTERNAL PUNCTURE 01.09 OTHER CRANIAL PUNCTURE

6. SNOMED Systematized Nomenclature of Medicine College of American Pathologists Organized into axes Synonyms Assemble complex terms from axes SNOMED-RT (Reference Terminology) under development

7. SNOMED - Axes D - Diseases C - Drugs F - Function L - Living Organisms X - Manufacturers G - Modifiers M - Morphology J - Occupations A - Physical Agents P - Procedures S - Social Context T - Topography

8. SNOMED - Examples "D3-15000" "01" "Myocardial infarction, NOS" "(T-32020) (M-54700)" "D3-15000" "02" "Infarction of heart, NOS" "(T-32020) (M-54700)" "D3-15000" "02" "Cardiac infarction, NOS" "(T-32020) (M-54700)” "D3-15000" "02" "Heart attack, NOS” "(T-32020) (M-54700)" "D3-15010" "01" "Microinfarct of heart” "(T-32000) (M-54701)” "C-C137A" "01" "Bufferin Analgesic Tablets" "C-C137B" "01" "Bufferin Analgesic Caplets" "M-54700" "01" "Infarct, NOS" “M-54700" "02" "Infarction, NOS" "M-54700" "05" "Infarcted" "M-54701" "01" "Focal infarct" "M-54701" "02" "Microscopic infarct" "S-10120" "01" "Mother, NOS"

9. MeSH Medical Subject Headings National Library of Medicine Indexing the medical literature Multiple hierarchy Synonyms

10. MeSH Example D011014: Pneumonia D018410: Pneumonia, Bacterial D007877: Legionnaires' Disease D011018: Pneumonia, Pneumococcal D011019: Pneumonia, Mycoplasma D009175: Mycoplasma Infections D011002: Pleuropneumonia, Contagious D011022: Pneumonia, Rickettsial D011023: Pneumonia, Staphylococcal D001996: Bronchopneumonia D009956: Ornithosis D011001: Pleuropneumonia D011015: Pneumonia, Aspiration D011017: Pneumonia, Lipid D011020: Pneumonia, Pneumocystis carinii D011024: Pneumonia, Viral

11. UMLS Unified Medical Language System National Library of Medicine Metathesaurus groups terms under single concept id No new hierarchy Translation of terms

12. Metathesaurus 80+ sources 1,358,891 strings 626,893 concepts Strings have attributes Concepts have attributes, including Relations

13. Metathesaurus String Lexical group Concept String Lexical group String Lexical group Concept String Lexical group

14. Metathesaurus - MRCON C0153957|ENG|P|L0180790|PF|S1084242|benign neoplasm of heart C0153957|ENG|P|L0180790|VC|S0245316|Benign neoplasm of heart C0153957|ENG|P|L0180790|VO|S1446737|Benign neoplasm of heart, NOS C0153957|ENG|S|L0524277|PF|S0599118|Benign tumor of heart C0153957|ENG|S|L0524278|PF|S0599510|Benign tumour of heart C0153957|ENG|s|L0018787|PF|S0900815|Heart C0153957|ENG|s|L0018787|VO|S0047194|Heart C0153957|GER|P|L1258174|PF|S1500120|Gutartige Neubildung: Herz

15. Metathesaurus - MRSO C0153957|L0018787|S0047194|ICD10|PS|D15.1|3| C0153957|L0018787|S0900815|MTH|MM|U003158|0| C0153957|L0180790|S0245316|ICD10|PX|D15.1|3| C0153957|L0180790|S0245316|ICD99|PT|212.7|0| C0153957|L0180790|S0245316|RCD98|SY|B727.|3| C0153957|L0180790|S1084242|MTH|PN|U001287|0| C0153957|L0180790|S1446737|SNMI98|PT|D3- F0100|3| C0153957|L0524277|S0599118|RCDAE|PT|B727.|3| C0153957|L0524278|S0599510|RCD98|PT|B727.|3| C0153957|L1258174|S1500120|DMDICD|PT|D15.1|1 |

16. Metathesaurus - MRSTY C0153957|T191|Neoplastic Process|

18. Metathesaurus - MRREL C0002871|CHD|C0002891|isa|MSH99|MTH|| C0002871|CHD|C0002892||CSP98||| C0002871|CHD|C0002893||RCD98||| C0002871|RB|C0221016||MTH|MTH|| C0002871|RL|C0002886|mapped_to|SNMI98 |SNMI98||

19. Uses of Terminology Storing in database Querying database Transferring data Billing Monitoring data Integration of systems

20. MED Medical Entities Dictionary CPMC Multiple hierarchy Synonyms Translations Semantic links Attributes 60,000 concepts

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

22. Terminology and Automated Decision Support Data monitor checks for triggering conditions Medical Logic Modules decide if warning conditions are present Message sent to appropriate channel Example: Tuberculosis culture result

23. Caveats: TB Example Monitors for delayed culture results Sends message if result not equal to the code “No growth” One day, dozens of alerts about positive results but no organism was reported What happened?

24. How the Lab Fooled the Alert Alert looked for results = “No Growth” Lab started reporting “No Growth to Date” “No Growth to Date”<> “No Growth” Solution: Use the controlled terminology to map all No-Growth-like lab terms into a single class, and have the alert logic refer to the class.

25. No Growth after... How We Outsmarted the Lab No Growth No Growth after 48 Hours No Growth after 72 Hours “No Growth” Results No Growth after 24 Hours No Growth to Date

26. Linking to On-line Resources with Terminology Clinician reviewing reports will have information needs On-line information sources can satisfy that need Data from report can be used to automate the query

27. Laboratory Test Medical Entities Dictionary Has Ingredient Measures Chemical Aminoglycoside Antibiotic Gentamicin Serum Gentamicin Test Drug Injectable Gentamicin Trade-Name: Garamycin" Has-Ingredient: Gentamicin Measures Random Gentamicin Level Main-MeSH: Supplementary-MeSH: "Gentamicin/bl" Measures: Gentamicin

33. Linking Text Reports to On-line Information Sources Natural Language Processing Data representation to support reuse Codification of information needs

45. MED Browsers www.cpmc.columbia.edu/resources/ med/browsers/

47. Summary Computers need controlled terminologies (CTs) Different CTs for different needs (granularity) Bridging between CTs facilitates bridging between applications Consider use of/indexing with CTs in consumer applications

48. Questions?