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

Have to query a longitudinal database

Want to collect data from multiple sources

Need automated alerts

Should link to on-line information resources

The Format of Information

Re-Use of Nonstandard Information

21 22 23 24 25 26 27 28 29

7

6

5

4

3

2

1

Blobs and Symbols

Text

Numeric

Signal

Structured

CodedStandard

CodedNLP

Interpretation

Image

Blobs

Symbols

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

Multiple Representations of MRSA1) Culture:

Specimen: BloodOrganism: S. aureus

Sensitivity test: MethicillinResult: Resistant

2) Blood Culture:Organism: S. aureus

Sensitivity test: MethicillinResult: Resistant

3) Blood Culture:Result: “MRSA”

4) Blood Culture:Organism: Methicillin-Resistant-Staph-Aureus

5) MRSA Culture: Positive

Result Table

Result Code Value

1

11 Culture

3

3

S. aureus

MRSA Positive: Solution 1

Terminology Table

Term Code Term Name

4 Methicillin

4

5 Resistant

5

2

2 Blood Spec.

Terminology Table

Term Code Term Name

Result Table

Result Code Value

66 Blood Cult

3

3

S. aureus

MRSA Positive: Solution 2

44 Methicillin

5

5 Resistant

Terminology Table

Term Code Term Name

Result Table

Result Code Value

“MRSA” 66 Blood Cult

MRSA Positive: Solution 3

6

Terminology Table

Term Code Term Name

Result Table

Result Code Value

6 Blood Cult

7

7

MRSA

MRSA Positive: Solution 4

Terminology Table

Term Code Term Name

Result Table

Result Code Value

88 MRSA Cult

9

9

Positive

MRSA Positive: Solution 5

Longitudinal Database

Terminology Table

Term Code Term Name1 Culture

2 Blood Spec.3 S. aureus4 Methicillin5 Resistant

6 Blood Culture7 MRSA8 MRSA Cult.

9 Positive

Result Table

Result Code Value

1 2

1 34 56 34 5

6 “MRSA”6 78 9

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

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

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

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

What Could We Do With Standards?

Summary data reporting

Lab Summary 1995

Lab Summary 1998

What Could We Do With Standards?

Summary data reporting

Exchange of information

Automated decision support

Integration with of health information resources

Take Home Message

Standards are hard to do Not much out there Can do neat things if standardized

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