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 …data with health information resources

The Re-Use of Clinical Data l Have to query a longitudinal database l Want to collect data from multiple sources l Need automated alerts l Should link to on-line information resources

The Format of Information

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

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

The Strange Case of MRSA l Database with 15 years of laboratory results l Medical knowledge changes over time l Information systems change over time l Institutions merge their data

Multiple Representations of MRSA Culture: Specimen: Blood Organism: S. aureus Sensitivity test: Methicillin Result: Resistant 2) Blood Culture: Organism: S. aureus Sensitivity test: Methicillin Result: Resistant 3) Blood Culture: Result: “MRSA” 4) Blood Culture: Organism: Methicillin-Resistant-Staph-Aureus 5) MRSA Culture: Positive 1)

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

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

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

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

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

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

Coding with Standards: Gender Data element - gender l Controlled terminology: Male, Female, Unknown l Representation: M, F, U; 0, 1, 2 l What about other values? – Genotypic – Phenotypic – Administrative l

What Standards are Out There? l ICD 9 -CM – – – l CPT – – l Procedures for billing No hierarchy NDC – – l Strict hierarchy Coarse granularity “Not Elsewhere Classified” Products-oriented No classification Codes reused Revisions in progress UMLS

What Standards are Out There? l UMLS – – l Subsumes many standards Provides extensive synonymy No hierarchy Near-synonymy Rx. Norm – – – Cooperation of NLM, FDA and VA Defines clinical drugs Mapping to pharmacy knowledge bases

What Standards are Out There? l LOINC – – l 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

What Could We Do With Standards? l Summary data reporting

Lab Summary 1995

Lab Summary 1998

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

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

Learning More SNOMED: http: //www. snomed. org/ UMLS: http: //www. nlm. nih. gov/research/umls LOINC: http: //www. regenstrief. org/loinc. htm MED: http: //www. cpmc. columbia. edu/homepages/ciminoj/med. html Standards: http: //www. hl 7. org/standards/developer. htm