Coping with Changing Controlled Vocabularies

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Coping with Changing Controlled Vocabularies

• James J. Cimino, M.D.
• Paul D. Clayton, Ph.D.
• Department of Medical Informatics
• Columbia University

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Changes in ICD9-CM

• Additions
• Deletions
• Minor Name Changes
• Major Name Changes
• Refinements

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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

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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

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Deletions

• 043.0 ACQUIRED IMMUNODEFICIENCY SYNDROME,
  UNSPECIFIED
• 305.13 TOBACCO USE DISORDER, IN REMISSION

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Minor Name Changes

• 070.41HEPATITIS C WITH HEPATIC COMAACUTE OR
  UNSPECIFIED HEPATITIS C WITH HEPATIC COMA
• 440.2 ATHEROSCLEROSIS OF ARTERIES OF THE
  EXTREMITIESATHEROSCLEROSIS OF NATIVE ARTERIES OR
  EXTREMITIES
• 770.1MASSIVE ASPIRATION SYNDROME OF
  NEWBORNMECONIUM ASPIRATION SYNDROME

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Major Name Changes

• 344.0HEMIPLEGIAHEMIPLEGIA AND HEMIPARESIS
• V45.0POSTSURGICAL CARDIAC PACEMAKER IN
  SITUCARDIAC DEVICE IN SITU

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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

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Code Change

• Removed
• 795.8 POSITIVE SEROLOGICAL OR VIRAL CULTURE
  FINDING FOR HUMAN IMMUNODEFICIENCY VIRUS (HIV)
  ASSOCIATED VIRUS (HTLV-III/LAV)
• Added
• 795.71 NONSPECIFIC SEROLOGIC EVIDENCE OF HUMAN
  IMMUNODEFICIENCY VIRUS (HIV)

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Volatile Vocabulary/Persistent Data
1980
1992
99.71 MERCURY-ZINC PACEMAKER
99.71 THERAPEUTIC PLASMAPHERESIS
???
99.71
Patient Database
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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

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Retrieval Using Historical Vocabulary

• IF (Code75.22 and Yearlt1990)
• OR (Code76.2 and Year1991)
• OR ((Code76.20 or Code76.21)
• AND Year1992)...

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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

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Deletion
Concept Code 10101 Concept Name Tobacco Use
Disorder, in Remission ICD9 Code 305.13 ICD9
Entry Code Old ICD9 Code
Concept Code 10101 Concept Name Tobacco Use
Disorder, in Remission ICD9 Code ICD9 Entry
Code 305.1 Old ICD9 Code 305.13
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Minor Name Change
Concept Code 31313 Concept Name Massive
Aspiration Syndrome of Newborn ICD9
Code 770.1 ICD9 Entry Code Old ICD9 Code
Concept Code 31313 Concept Name Meconium
Aspiration Syndrome ICD9 Code 770.1 ICD9 Entry
Code Old ICD9 Code
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Major Name Change
Code 21212 Name Mercury-Zinc Pacemaker ICD9 99.
71 Entry Old
Code 21212 Name Mercury-Zinc Pacemaker ICD9 En
try ltnonegt Old 99.71
Code 44444 Name Therapeutic Plasmapheresis ICD9
99.71 Entry Old
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Volatile Vocabulary/Persistent Data
1980
1992
99.71 MERCURY-ZINC PACEMAKER
MERCURY-ZINC PACEMAKER (Old Code 99.71)
21212
Patient Database
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Additional Situations

• New redundancy
• Discovering old redundancy
• Ambiguity
• Disambiguation
• Obsolescence
• Precoordination

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Advantages of Concept-Based Approach

• Database contains original meaning
• Concept-oriented retrieval is easier

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Conclusions

• Vocabulary changes are inevitable
• Store what the clinician means
• Map the vocabulary to the meanings, not the
  reverse

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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, ICUs, recovery rooms

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Access to Information Sources
???
Electronic Library
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Integrated Access to Information
Context
???
Concepts
Data
Clinical Information System
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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

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Implementations

• 3270 Admission/Discharge Profile ICD9 -gt MeSH
  -gt Medline
• X-Windows Laboratory SummaryLab terms -gt MeSH
  -gt Medline, DXplain, HSTAT
• Mosaic clinical information system

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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?