The Role of Standard Terminologies in Facilitating Integration James J. Cimino, M.D. Departments of...
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Transcript of The Role of Standard Terminologies in Facilitating Integration James J. Cimino, M.D. Departments of...
The Role of Standard Terminologies in Facilitating Integration
James J. Cimino, M.D.
Departments of Biomedical Informatics and Medicine
Columbia University
Integration of…
…data with each other
…systems that exchange data
…data with decision support systems
…data with health information resources
The Re-Use of Clinical Data
Have to query a longitudinal database
Want to collect data from multiple sources
Need automated alerts
Should link to on-line information resources
Blobs and Symbols
Text
Numeric
Signal
Structured
CodedStandard
CodedNLP
Interpretation
Image
Blobs
Symbols
The Strange Case of MRSA
Database with 15 years of laboratory results
Medical knowledge changes over time
Information systems change over time
Institutions merge their data
Multiple Representations of MRSA1) Culture:
Specimen: BloodOrganism: S. aureus
Sensitivity test: MethicillinResult: Resistant
2) Blood Culture:Organism: S. aureus
Sensitivity test: MethicillinResult: Resistant
3) Blood Culture:Result: “MRSA”
4) Blood Culture:Organism: Methicillin-Resistant-Staph-Aureus
5) MRSA Culture: Positive
Result Table
Result Code Value
1
11 Culture
3
3
S. aureus
MRSA Positive: Solution 1
Terminology Table
Term Code Term Name
4 Methicillin
4
5 Resistant
5
2
2 Blood Spec.
Terminology Table
Term Code Term Name
Result Table
Result Code Value
66 Blood Cult
3
3
S. aureus
MRSA Positive: Solution 2
44 Methicillin
5
5 Resistant
Terminology Table
Term Code Term Name
Result Table
Result Code Value
“MRSA” 66 Blood Cult
MRSA Positive: Solution 3
6
Terminology Table
Term Code Term Name
Result Table
Result Code Value
6 Blood Cult
7
7
MRSA
MRSA Positive: Solution 4
Terminology Table
Term Code Term Name
Result Table
Result Code Value
88 MRSA Cult
9
9
Positive
MRSA Positive: Solution 5
Longitudinal Database
Terminology Table
Term Code Term Name1 Culture
2 Blood Spec.3 S. aureus4 Methicillin5 Resistant
6 Blood Culture7 MRSA8 MRSA Cult.
9 Positive
Result Table
Result Code Value
1 2
1 34 56 34 5
6 “MRSA”6 78 9
Coding with Standards: Gender
Data element - gender Controlled terminology: Male, Female,
Unknown Representation: M,F,U; 0,1,2 What about other values?
– Genotypic– Phenotypic– Administrative
What Standards are Out There?
ICD9-CM– Strict hierarchy– Coarse granularity– “Not Elsewhere Classified”
CPT– Procedures for billing– No hierarchy
NDC– Products-oriented– No classification– Codes reused– Revisions in progress
UMLS
What Standards are Out There?
UMLS– Subsumes many standards– Provides extensive synonymy– No hierarchy– Near-synonymy
RxNorm– Cooperation of NLM, FDA and VA– Defines clinical drugs– Mapping to pharmacy knowledge bases
What Standards are Out There?
LOINC– Good domain coverage of laboratory– Principled design– Working on hierarchy– Extending to all observations
SNOMED-CT– Merger of SNOMED and Read Clinical Terms– Rich semantics– Principled design– Public domain– Coordination with other terminologies
What Could We Do With Standards?
Summary data reporting
Exchange of information
Automated decision support
Integration with of health information resources