Coping with Changing Controlled Vocabularies

James J. Cimino, M.D.

Paul D. Clayton, Ph.D.

Department of Medical Informatics

Columbia University

Changes in ICD9-CM

Additions

Deletions

Minor Name Changes

Major Name Changes

Refinements

Additions

070.44: CHRONIC HEPATITIS C WITH HEPATIC COMA

333.92: NEUROLEPTIC MALIGNANT SYNDROME

512.1: IATROGENIC PNEUMOTHORAX

677: LATE EFFECTS OF COMPLICATION OF PREGNANCY, CHILDBIRTH, THE PUERPERUM

759.83: FRAGILE X SYNDROME

More Additions

789.6: ABDOMINAL TENDERNESS

V50.4: PROPHYLACTIC ORGAN REMOVAL

E869.4: ACCIDENTAL POISONING BY SECOND-HAND TOBACCO SMOKE

34.05: AUTOLOGOUS HEMATOPOETIC STEM CELL TRANSPLANT

Deletions

043.0: ACQUIRED IMMUNODEFICIENCY SYNDROME, UNSPECIFIED

305.13: TOBACCO USE DISORDER, IN REMISSION

Minor Name Changes

070.41:HEPATITIS C WITH HEPATIC COMAACUTE OR UNSPECIFIED HEPATITIS C WITH HEPATIC COMA

440.2: ATHEROSCLEROSIS OF ARTERIES OF THE EXTREMITIESATHEROSCLEROSIS OF NATIVE ARTERIES OR EXTREMITIES

770.1:MASSIVE ASPIRATION SYNDROME OF NEWBORNMECONIUM ASPIRATION SYNDROME

Major Name Changes

344.0:HEMIPLEGIAHEMIPLEGIA AND HEMIPARESIS

V45.0:POSTSURGICAL CARDIAC PACEMAKER IN SITUCARDIAC DEVICE IN SITU

Refinements

441.0: DISSECTING ANEURYSM (ANY PART)

441.0: DISSECTING AORTIC ANEURYSM

441.00: DISSECTING AORTIC ANEURYSM OF UNSPECIFIED SITE

441.01: DISSECTING THORACIC AORTIC ANEURYSM

441.02: DISSECTING ABDOMINAL AORTIC ANEURYSM

441.03: DISSECTING THORACOABDOMINAL AORTIC ANEURYSM

Code Change

Removed795.8: POSITIVE SEROLOGICAL OR VIRAL CULTURE

FINDING FOR HUMAN IMMUNODEFICIENCY VIRUS (HIV) ASSOCIATED VIRUS (HTLV-III/LAV)

Added795.71: NONSPECIFIC SEROLOGIC EVIDENCE OF

HUMAN IMMUNODEFICIENCY VIRUS (HIV)

Volatile Vocabulary/Persistent Data

99.71 MERCURY-ZINC PACEMAKER 99.71 THERAPEUTIC PLASMAPHERESIS

1980 1992

Patient Database

99.71

???

Historical Vocabulary

Store the code

Keep track of when the code changes

Look up the meaning of the code based on date it was used

Retrieval Using Historical Vocabulary

IF (Code=75.22 and Year<1990)

OR (Code=76.2 and Year=1991)

OR ((Code=76.20 or Code=76.21)

AND Year=1992)...

CPMC Approach: Encode the Meaning

Each code corresponds with one meaning (concept)

Each concept may or may not have an ICD9 Code

If ICD9 term changes meaning, it is no longer associated with the concept

Deletion

Concept Code: 10101Concept Name: Tobacco Use Disorder, in RemissionICD9 Code: 305.13ICD9 Entry Code:Old ICD9 Code:

Concept Code: 10101Concept Name: Tobacco Use Disorder, in RemissionICD9 Code:ICD9 Entry Code: 305.1Old ICD9 Code: 305.13

Concept Code: 31313Concept Name: Massive Aspiration Syndrome of NewbornICD9 Code: 770.1ICD9 Entry Code:Old ICD9 Code:

Minor Name Change

Concept Code: 31313Concept Name: Meconium Aspiration SyndromeICD9 Code: 770.1ICD9 Entry Code:Old ICD9 Code:

Major Name Change

Code: 21212Name: Mercury-Zinc PacemakerICD9: 99.71Entry:Old:

Code: 21212Name: Mercury-Zinc PacemakerICD9:Entry: <none>Old: 99.71

Code: 44444Name: Therapeutic PlasmapheresisICD9: 99.71Entry:Old:

Volatile Vocabulary/Persistent Data

99.71 MERCURY-ZINC PACEMAKER

1980 1992

Patient Database

21212

MERCURY-ZINC PACEMAKER(Old Code 99.71)

Additional Situations

New redundancy

Discovering old redundancy

Ambiguity

Disambiguation

Obsolescence

Precoordination

Advantages of Concept-Based Approach

Database contains original meaning

Concept-oriented retrieval is easier

Conclusions

Vocabulary changes are inevitable

Store what the clinician means

Map the vocabulary to the meanings, not the reverse

Definitions

Users: attendings, nurses, residents, respiratory care technicians, dieticians, social workers, students

Knowledge: textbooks, bibliographic databases, guidelines (passive), algorithms (active)

Point of care: clinic, emergency room, in-patient floors, ICU’s, recovery rooms

Access to Information Sources

???

“Electronic Library”

Integrated Access to Information

???

Clinical Information System

Context

Con

cept

s

Data

“Medline Button” Design

Application-specific questions (Mad Libs)

Coded clinical information to fill in the blanks

Medical Entities Dictionary of concepts

Translation using the UMLS

Scripts for accessing on-line resources

Implementations

3270 Admission/Discharge Profile:ICD9 -> MeSH -> Medline

X-Windows Laboratory Summary:Lab terms -> MeSH -> Medline, DXplain,

HSTAT

Mosaic clinical information system

Challenges

What questions arise in different contexts?

What information source is right for each?

How are the concepts translated?

How are complex retrievals performed?

How is the knowledge presented?