Role of Terminologies in Clinical Settings

1. Role of Terminologies in Clinical Settings National Center for Biomedical Ontology Developer Conference July 25, 2008

2. Agenda • Mayo Clinic • Data Governance • Data Stewardship • Enterprise Data Modeling • Vocabulary • Processes and Tools • Terminology Management • Why? • Clinical Examples • Vision

3. Mayo Clinic • Mayo Clinic is the first and largest integrated, not-for-profit group practice in the world. • Doctors from every medical specialty work together to care for patients, joined by common systems and a philosophy of "the needs of the patient come first."

4. Mayo Clinic • More than 50,000 employees • More than half a million patients each year (from the United States and 150 countries around the world) • Various locations across the United States • Primary multidisciplinary clinics and hospitals in Rochester, Minnesota; Jacksonville, Florida; and Scottsdale/ Phoenix, Arizona • Network of clinics and hospitals across southern Minnesota, northern Iowa and western Wisconsin

5. Mayo Clinic

6. Mayo Clinic • Mayo’s 2007 total revenue was $6.9 billion • Mayo Clinic’s net operating income is reinvested to advance the science of medicine and to teach the next generation of health care professionals

7. Integrating Clinical Practice, Education & Research • Without research, knowledge does not move forward. • Without education—the sharing of that knowledge— patient care does not advance.

8. Clinical Practice • Integrated team of multidisciplinary physicians, scientists, and allied health professionals who work together to thoroughly diagnose and treat complex medical problems in every specialty.

9. Education • Mayo Clinic’s College of Medicine has five of the nation’s leading biomedical and health career schools: • Mayo Medical School • Mayo Graduate School • Mayo School of Graduate Medical Education • Mayo School of Health Sciences • Mayo School of Continuing Medical Education • Training the next generation of physicians, scientists, and health care professionals

10. Research • Mayo has led the way in many fields, including surgical techniques, early use of x-ray technology and laboratory medicine. • The number of staff with some part of their time dedicated to research activities totals more than 6,000. • Mayo’s annual budget for research exceeds $296 million.

11. The needs of the patient come first

12. Outcomes Good Decisions Require Good Data Data Information Knowledge Decision-making

13. Vocabulary Gaps • Disparate application-based vocabularies without a Mayo standard vocabulary • Decentralized vocabulary management design philosophies and oversight • Minimal linkages to external standards • Disparate tools to manage vocabulary content

14. Effects • Limited reuse of consistent, comparable vocabulary content inside/outside of the organization • Inconsistent management and oversight of vocabulary detail • Difficult analytics and reconciliation of content across systems and data sources • Costly, resource intensive, system integration • Difficult and slow to converge on processes and systems

15. Tomorrow’s Environment • Provide high quality, computationally comparable, reliable, and reusable data • Advance analytics, decision making, and business intelligence • Support ease of access and broad enterprise adoption of data standards • Improve internal and external interoperability of systems, processes, and data • Reduce costs incurred through redundant and disparate data definition, storage, and maintenance • Collaborate with industry and standards organizations to specify and enhance data standards

16. Getting There • Established Office of Data Governance • Data Governance Committee • Section of Data Stewardship

17. Mayo Clinic Data Governance Committee Enterprise Managed Meta Data Environment Oversight Team Data Stewardship Coordinating Group Enterprise Data Modeling & Vocabulary Oversight Team Communication Education Training Mayo Clinic Board of Governors / Management Team Governance Office of Data Governance Stewardship Section of Data Stewardship

18. Mayo Clinic Data Governance Committee Mayo Clinic Board of Governors / Management Team Governance Office of Data Governance Establishes & enforces policies, principles & standards to optimize Mayo’s enterprise data assets

19. Data Governance Principles • Mayo Clinic data is considered an enterprise asset owned by the organization • All Mayo Clinic employees are stewards of the organization’s assets, including the provision, use, & protection of data • Data Governance will use industry standards wherever possible • IT applications will be modeled consistent with the Enterprise Data Model whenever possible

20. Mayo Clinic Data Governance Committee Enterprise Managed Meta Data Environment Oversight Team Data Stewardship Coordinating Group Enterprise Data Modeling & Vocabulary Oversight Team Communication Education Training Mayo Clinic Board of Governors / Management Team Governance Office of Data Governance Stewardship • Implements and maintains Data Governance policies, principles & standards across Mayo Enterprise • Supports data modeling and data standardization projects • Enterprise Data Trust (EDT) • Non-EDT Section of Data Stewardship

21. Enterprise Managed Meta Data Environment Oversight Team Data Stewardship Coordinating Group Enterprise Data Modeling & Vocabulary Oversight Team Communication Education Training Stewardship Section of Data Stewardship • Members • Key Data Stewards from across enterprise • Forum for • Defining consistent principles & practices • Developing & nourishing Data Stewardship Network

22. Subject Area Model Enterprise Managed Meta Data Environment Oversight Team Data Stewardship Coordinating Group Enterprise Data Modeling & Vocabulary Oversight Team Communication Education Training Conceptual Model Entity Model (BIM) Enterprise Data Model Stewardship Section of Data Stewardship • Defining Enterprise Data Model (EDM) • Consistent, integrated definition of Mayo’s data

23. Enterprise Managed Meta Data Environment Oversight Team Data Stewardship Coordinating Group Enterprise Data Modeling & Vocabulary Oversight Team Communication Education Training Stewardship Section of Data Stewardship • Define common and consistent vocabulary based on standards • Align vocabulary with EDM

24. Enterprise Managed Meta Data Environment Oversight Team Data Stewardship Coordinating Group Enterprise Data Modeling & Vocabulary Oversight Team Communication Education Training Stewardship Section of Data Stewardship Developing Enterprise Managed Meta Data Environment (eMMe) • Definition of data • Source of data • Steward for data • Valid values • Reference standard

25. Enterprise Managed Meta Data Environment Oversight Team Data Stewardship Coordinating Group Enterprise Data Modeling & Vocabulary Oversight Team Communication Education Training Stewardship Section of Data Stewardship • Create awareness • Educate stewardship teams • Publish policies & standards

26. Subject Area Model Concept Model Business Information Models Enterprise Data Model Enterprise Data Model Strategic Enterprise data is modeled, defined consistently(based on standards), and shared.

27. Subject Area Model Concept Model Business Information Models Enterprise Data Model Enterprise Data Model Strategic Enterprise data is modeled, defined consistently(based on standards), and shared.

28. Subject Area Model Concept Model Business Information Models Enterprise Data Model Enterprise Data Model Strategic Enterprise data is modeled, defined consistently(based on standards), and shared.

29. Value Set Management • Hispanic or Latino • Mexican • Puerto Rican • Cuban • Central American • South American • Not Hispanic or Latino • Unknown • Choose Not to Disclose • Unable to Provide

30. Uncontrolled Terminology?

31. Think Fast!

32. Think Fast!

33. Think Fast! ?

34. What is Vocabulary • Concepts, terms, and their meaning and relationships. • Includes • External vocabularies • SNOMED CT, CPT, ICD 9, LOINC, etc. • Internal vocabularies • Enterprise standard value sets

35. Enterprise Vocabulary • Terms and Definitions • Epidemic - an unusual, higher than expected level of infection or disease in a defined population in a given period. • Minor Wound - the dressing adequately contains drainage, or a wound which is very small, such as a stitch abscess. Terms and Definitions

36. Enterprise Vocabulary • Relationships • Department of Laboratory Medicine and Pathology • Anatomic Pathology • Experimental Pathology • Clinical Microbiology • Transfusion Medicine Terms and Definitions Relationships

37. Enterprise Vocabulary • Synonyms Terms and Definitions Relationships Synonyms

38. Enterprise Vocabulary • Preferred Terms Terms and Definitions Relationships Synonyms Preferred Terms

39. Enterprise Vocabulary • Value Sets Terms and Definitions Relationships Synonyms Preferred Terms Value Sets

40. Enterprise Vocabulary • Concept - accepted notion (unit of knowledge) with a defined set of characteristics Example: Concept: Constant Pain Source: SNOMED CT Concept Code: 426206001 Terms and Definitions Relationships Synonyms Preferred Terms Value Sets Concept

41. Enterprise Vocabulary • Mappings Concept: Constant Pain Source: SNOMED CT Concept Code: 426206001 Terms and Definitions Relationships Synonyms Preferred Terms Value Sets Concept Mappings

42. Enterprise Vocabulary • Putting it all together Term mapped to concept Concept mapped to terms and other concepts (e.g., other standards) Terms and Definitions Relationships Synonyms Preferred Terms Value Sets Concept Mappings Putting it all together