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Integrating Clinical Systemsby
Integrating Controlled Vocabularies
James J. Cimino, MD
Center for Medical InformaticsColumbia University
New York, New York, USA
...collecting patient information
...links to financial systems
...automated decision support
...library at the bedside
Integrated Information Means...
Stand-alone clinical systems
Several billing systems
Clinical alert system
Local- and wide-area networks
On-line educational resources
The Columbia Computing Environment
Federation of Systems
Central Patient Database
Central Controlled Vocabulary
Advantages of Central Vocabulary
Resource for system developers
Single update point
Brings vocabularies together
Issues
Understand the vocabulary
Integrate the terms
Maintenance
Central Vocabulary Design
Semantic network of concepts
Content from:– Unified Medical Language System (UMLS)– Ancillary systems– Standard controlled vocabularies
Browsing and editing tools
Medical Entities DictionaryMedicalEntity
Substance LaboratorySpecimen Event
DiagnosticProcedure
LaboratoryTest
LaboratoryProcedure
CHEM-7PlasmaGlucose
PlasmaSpecimen
AnatomicSubstance
BioactiveSubstance
Glucose
Plasma
Chemical
Carbo-hydrate Substa
nce
Sampled
Part of
Has
Specimen
Substance Measured
Vocabulary Sources
Clinical laboratories
Pharmacy
Cardiology
Discharge coding
Radiology
Primary Care
Current Size
41,000 concepts
146 slots
51,500 parent/child links
40,000 other semantic links
240,000 strings
Vocabulary Browser/Editors
Knowledge Engineering Environment (KEE) - 386 and 370
PC-MUMPS
RS/6000 and X-Windows
Editor Functions
Lexical and graphic browsing
Addition and deletion functions
Inheritance
Automatic classification
mumps editor - take a photo!!!
X-browser - get a stock photo!!!
Success Stories
Repairing vocabularies
Database extension
Confidential data display
Summary reporting
Medline Button
Medical Logic Modules
Repairing Vocabularies
Radiology
Laboratory
Pharmacy
Autoclassifying the Laboratory
Stat SerumGlucose
LaboratoryTest
PlasmaGlucose
FastingGlucose
Chem-7Glucose
SMAC20Glucose
Stat SerumGlucose
BloodGlucose
PlasmaGlucose
FastingGlucose
Chem-7Glucose
SMAC20Glucose
LaboratoryTest
GlucoseTest
SerumGlucose
SerumGlucose
Autoclassify the Pharmacy: Before
Drug
Empirin #3Bayer Aspirin
SalicylateAllergy
AnalgesicOpiateAllergy
NonsteroidalAnti-inflamm.
Allergy
Autoclassify the Pharmacy: After
Drug
Empirin #3Bayer Aspirin
AspirinDrugs
CodeineDrugs
SalicylateAllergy
AnalgesicOpiateAllergy
NonsteroidalAnti-inflamm.
Allergy
Results of Autoclassification
971 new classes
334 drugs classified by type
289 drugs into two or more types
173 drugs into allergy classes
Database Extension
Information model for new applications
Merging the new with the old
Adding organization to the model
Summary reporting - stock photo!!!!
Confidential Data Display
Need to display sensitive data (HIV)
Need an extra level of security
Step 1: create a new class in the MED
Step 2: have the application check for class membership
Medline Button - stock photo 1 !!!
Medline Button - stock photo 2 !!!
Medline Button - stock photo 3 !!!
Medline Button - stock photo 4 !!!
Medline Button - stock photo 5 !!!
MLM Alert - stock photo 1 !!!
MLM Alert - stock photo 2 !!!
Medical Logic Modules
Clinical alerts
Data interpretation
Finding research patients
Monitoring hospital resources
Current Challenges
Editing environment
Expansion of automated updates
Vocabulary content
Conclusions
Integrating vocabularies helps
Complex vocabulary model pays off
Automated maintenance works
