Controlled Medical Terminologies: What can they do for me?

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Controlled Medical TerminologiesWhat can they
do for me?

• James J. Cimino, M.D.
• Department of Medical InformaticsColumbia
  University

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Definition

• Terminology
• A finite, enumerated set of terms intended to
  convey information unambiguously

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Some General Classes of Terms

• Diagnostic Procedures
• Therapeutic Procedures
• Medications
• Diagnoses
• Findings
• Organisms
• Anatomy

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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

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ICD9-CM Examples

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

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SNOMED

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

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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

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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"

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MeSH

• Medical Subject Headings
• National Library of Medicine
• Indexing the medical literature
• Multiple hierarchy
• Synonyms

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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

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UMLS

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

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Metathesaurus

• 80 sources
• 1,358,891 strings
• 626,893 concepts
• Strings have attributes
• Concepts have attributes, including Relations

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Metathesaurus
Lexical group
String
String
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Metathesaurus - MRCON

• C0153957ENGPL0180790PFS1084242benign
  neoplasm of heart
• C0153957ENGPL0180790VCS0245316Benign
  neoplasm of heart
• C0153957ENGPL0180790VOS1446737Benign
  neoplasm of heart, NOS
• C0153957ENGSL0524277PFS0599118Benign tumor
  of heart
• C0153957ENGSL0524278PFS0599510Benign tumour
  of heart
• C0153957ENGsL0018787PFS0900815Heart lt3gt
• C0153957ENGsL0018787VOS0047194Heart
• C0153957GERPL1258174PFS1500120Gutartige
  Neubildung Herz

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Metathesaurus - MRSO

• C0153957L0018787S0047194ICD10PSD15.13
• C0153957L0018787S0900815MTHMMU0031580
• C0153957L0180790S0245316ICD10PXD15.13
• C0153957L0180790S0245316ICD99PT212.70
• C0153957L0180790S0245316RCD98SYB727.3
• C0153957L0180790S1084242MTHPNU0012870
• C0153957L0180790S1446737SNMI98PTD3-F01003
• C0153957L0524277S0599118RCDAEPTB727.3
• C0153957L0524278S0599510RCD98PTB727.3
• C0153957L1258174S1500120DMDICDPTD15.11

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Metathesaurus - MRSTY

• C0153957T191Neoplastic Process

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Metathesaurus - MRREL

• C0002871CHDC0002891isaMSH99MTH
• C0002871CHDC0002892CSP98
• C0002871CHDC0002893RCD98
• C0002871RBC0221016MTHMTH
• C0002871RLC0002886mapped_toSNMI98SNMI98

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Uses of Terminology

• Storing in database
• Querying database
• Transferring data
• Billing
• Monitoring data
• Integration of systems

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MED

• Medical Entities Dictionary
• CPMC
• Multiple hierarchy
• Synonyms
• Translations
• Semantic links
• Attributes
• 60,000 concepts

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MED Structure
Medical Entity
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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

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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?

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How the Lab Fooled the Alert

• Alert looked for results No Growth
• Lab started reporting No Growth to Date
• No Growth to Dateltgt 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.

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How We Outsmarted the Lab
No Growth to Date
No Growth
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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

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Medical Entities Dictionary
Chemical
Gentamicin
Random Gentamicin Level Main-MeSH Supplementary-M
eSH "Gentamicin/bl" Measures Gentamicin
Injectable Gentamicin Trade-Name
Garamycin" Has-Ingredient Gentamicin
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Linking Text Reports to On-line Information
Sources

• Natural Language Processing
• Data representation to support reuse
• Codification of information needs

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MED Browsers

• www.cpmc.columbia.edu/resources/ med/browsers/

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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

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Questions?