Transcript Desirable Clinical Terminology Characteristics and Present

Desirable Clinical Terminology
Characteristics and Present Adherence
James J. Cimino
Defining the Need for a
Controlled Vocabulary
• Recording primary clinical information
• Multipurpose (re-use)
• Sharing data
• Maintenance
1: Content
• Must seek to be provide breadth and depth
• Atoms versus molecules
• A formal methodology is needed
• Structure must not limit size
2: Concept Orientation
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Concepts, not terms
One meaning (nonvague)
No more than one meaning (nonambiguous)
Higher-level ambiguous
One concept per meaning (nonredundant)
May have multiple context-dependent
meanings
3: Concept Permanence
• Old concepts can't be deleted
• Example: non-A-non-B hepatitis
• Names can be changed as long as
meaning doesn't change (retronyms)
• Example: transvenous pacemaker
4: Nonsemantic Concept Identifiers
• Don't use the name
• Don't use a code that will run out of room
• Don't use a hierarchical code
• Meaningless integer (+/- check digit)
5: Polyhierarchy
• Needed for tree walking
• Needed for inferencing
• Needed for "essence"
• Example: diseases of the liver
which also involve the kidney
6: Formal Definitions
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Support understanding
Support maintenance
Structured and controlled (not narrative)
Represented through relationships within
the vocabulary
• Defintional versus assertional knowledge
• Additional effort minimal and will pay off
NEC
NEC
7: Reject "Not Elsewhere
Classified"
• Can never have a formal definition
• Vocabulary changes induce semantic drift
8: Multiple Granularities
• Different levels for different purposes
• Uncertainty is allowed, imprecision is not
• We must be precise about our uncertainty
9: Multiple Consistent Views
• Multiple views for multiple purposes
• Must not lead to inconsistency
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10: Representing Context
• Needed: a grammar to show usage
• "What is sensible to say"
• Consider modeling "events"
Controlled Medical Vocabulary
Definitional Knowledge
(how concepts define each other)
Pathologic
Function
Finding
is -a
is -a
Body Site
hassite
Joint
Swelling
has- Swelling
abnormality
is -a
Joint
is -a
Right Knee
Controlled Medical Vocabulary
Definitional Knowledge
(how concepts define each other)
Pathologic
Function
Finding
is -a
is -a
Swelling
Body Site
hassite
Joint
has- Swelling
abnormality
Assertional Knowledge
(how concepts combine)
is -a
Joint
is -a
Right Knee
Body Site
modifies
Finding
Controlled Medical Vocabulary
Definitional Knowledge
(how concepts define each other)
Pathologic
Function
Finding
is -a
is -a
Swelling
Body Site
hassite
Joint
has- Swelling
abnormality
Assertional Knowledge
(how concepts combine)
is -a
Joint
is -a
Right Knee
Body Site
modifies
Contextual Knowledge
(how concepts are used)
Finding
Finding
part-of
Physical Exam
part -of
Hospital
Progress
Admission
Note part-of
Controlled Medical Vocabulary
Definitional Knowledge
(how concepts define each other)
Pathologic
Function
Finding
is -a
is -a
Swelling
Assertional Knowledge
(how concepts combine)
Body Site
hassite
Joint
has- Swelling
abnormality
is -a
Body Site
modifies
Contextual Knowledge
(how concepts are used)
Finding
Finding
part-of
Physical Exam
part -of
Joint
Hospital
Progress
Admission
Note part-of
is -a
Right Knee
Hospital Admission
Progress Note Physical Exam
Progress Note
Electronic Medical Record
[Joint Swelling [Right Knee]]
Progress Note
11: Graceful Evolution
• Will always need to fix mistakes
• Medical knowledge will grow
• Bad reasons
• Good reasons
11: Graceful Evolution
• Bad reasons:
- Redundancy
- Major name changes
- Code reuse
- Changed codes
11: Graceful Evolution
• Good reasons:
- Simple addition
- Refinement
- Precoordination
- Disambiguation
- Obsolescence
- Discovered redundancy
- Minor name changes
12: Recognize Redundancy
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Synonyms are good
Redundant concepts are bad
Redundant expressions are inevitable
Example:
- Year 1: "Pneumonia", "Left Lower Lobe"
- Year 2: "Left Lower Lobe Pneumonia"
12: Recognize Redundancy
Finding
Pneumonia
Left Lower Lobe
12: Recognize Redundancy
Finding
Pneumonia
Left Lower Lobe
Left Lower Lobe Pneumonia
12: Recognize Redundancy
Finding
Pneumonia
Left Lower Lobe
Left Lower Lobe Pneumonia
is-a: Pneumonia
12: Recognize Redundancy
Finding
Pneumonia
Left Lower Lobe
Left Lower Lobe Pneumonia
is-a: Pneumonia
has-site: Left Lower Lobe
12: Recognize Redundancy
Finding
Pneumonia
Left Lower Lobe
Left Lower Lobe Pneumonia
is-a: Pneumonia
has-site: Left Lower Lobe
participates-in: Finding
12: Recognize Redundancy
Finding
Pneumonia
Left Lower Lobe
Left Lower Lobe Pneumonia
is-a: Pneumonia
has-site: Left Lower Lobe
participates-in: Finding
What's Here Today?
1: Content
4: Nonsemantic Concept Identifiers
8: Multiple Granularities
10: Multiple Consistent Views
What May Be Here Soon?
2: Concept Orientation
3: Concept Permanence
5: Polyhierarchy
6: Formal Definitions
7: Reject "Not Elsewhere Classified"
What's Left?
10: Representing Context
11: Graceful Evolution
12: Recognize Redundancy
Keep Your Eye on the Goal
• Recording primary clinical information
• Multipurpose (re-use)
• Sharing data
• Maintenance