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The Role of Standard Terminologies in Facilitating Integration

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

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The Role of Standard Terminologies in Facilitating Integration

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  1. The Role of Standard Terminologies in Facilitating Integration James J. Cimino, M.D. Departments of Biomedical Informatics and Medicine Columbia University

  2. Integration of… …data with each other …systems that exchange data …data with decision support systems …data with health information resources

  3. 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

  4. The Format of Information

  5. 7 6 5 4 3 2 1 21 22 23 24 25 26 27 28 29 Re-Use of Nonstandard Information

  6. Standard Coded Numeric Coded NLP Symbols Text Structured Interpretation Image Signal Blobs Blobs and Symbols

  7. 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

  8. Multiple Representations of MRSA • Culture: Specimen: Blood Organism: S. aureus Sensitivity test: Methicillin Result: Resistant • Blood Culture: Organism: S. aureus Sensitivity test: Methicillin Result: Resistant • Blood Culture: Result: “MRSA” • Blood Culture: Organism: Methicillin-Resistant-Staph-Aureus • MRSA Culture: Positive

  9. Result Table Terminology Table Result Code Value Term Code Term Name 1 2 1 Culture 3 2 Blood Spec. 4 5 3 S. aureus 4 Methicillin 5 Resistant MRSA Positive: Solution 1 1

  10. Result Table Terminology Table Result Code Value Term Code Term Name 6 3 6 Blood Cult 4 5 3 S. aureus 4 Methicillin 5 Resistant MRSA Positive: Solution 2

  11. Result Table Terminology Table Result Code Value Term Code Term Name MRSA Positive: Solution 3 6 6 “MRSA” Blood Cult

  12. Result Table Terminology Table Result Code Value Term Code Term Name 7 7 MRSA MRSA Positive: Solution 4 6 6 Blood Cult

  13. Result Table Terminology Table Result Code Value Term Code Term Name 8 9 8 MRSA Cult 9 Positive MRSA Positive: Solution 5

  14. Longitudinal Database Terminology Table Result Table Value Term Code Result Code Term Name 1 1 Culture 2 2 1 Blood Spec. 3 3 4 S. aureus 5 4 6 Methicillin 3 Resistant 5 5 4 6 6 Blood Culture “MRSA” 7 6 MRSA 7 MRSA Cult. 9 8 8 Positive 9

  15. 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

  16. 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

  17. 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

  18. 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

  19. What Could We Do With Standards? • Summary data reporting

  20. Lab Summary 1995

  21. Lab Summary 1998

  22. What Could We Do With Standards? • Summary data reporting • Exchange of information • Automated decision support • Integration with of health information resources

  23. Take Home Message Standards are hard to do Not much out there Can do neat things if standardized

  24. Learning More SNOMED: http://www.snomed.org/ UMLS: http://www.nlm.nih.gov/research/umls LOINC: http://www.regenstrief.org/loinc/loinc.htm MED: http://www.cpmc.columbia.edu/homepages/ciminoj/med.html Standards: http://www.hl7.org/standards/developer.htm

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