coping with changing controlled vocabularies james j. cimino, m.d. paul d. clayton, ph.d. department...
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Coping with Changing Controlled Vocabularies
James J. Cimino, M.D.
Paul D. Clayton, Ph.D.
Department of Medical Informatics
Columbia University
Changes in ICD9-CM
Additions
Deletions
Minor Name Changes
Major Name Changes
Refinements
Additions
070.44: CHRONIC HEPATITIS C WITH HEPATIC COMA
333.92: NEUROLEPTIC MALIGNANT SYNDROME
512.1: IATROGENIC PNEUMOTHORAX
677: LATE EFFECTS OF COMPLICATION OF PREGNANCY, CHILDBIRTH, THE PUERPERUM
759.83: FRAGILE X SYNDROME
More Additions
789.6: ABDOMINAL TENDERNESS
V50.4: PROPHYLACTIC ORGAN REMOVAL
E869.4: ACCIDENTAL POISONING BY SECOND-HAND TOBACCO SMOKE
34.05: AUTOLOGOUS HEMATOPOETIC STEM CELL TRANSPLANT
Deletions
043.0: ACQUIRED IMMUNODEFICIENCY SYNDROME, UNSPECIFIED
305.13: TOBACCO USE DISORDER, IN REMISSION
Minor Name Changes
070.41:HEPATITIS C WITH HEPATIC COMAACUTE OR UNSPECIFIED HEPATITIS C WITH HEPATIC COMA
440.2: ATHEROSCLEROSIS OF ARTERIES OF THE EXTREMITIESATHEROSCLEROSIS OF NATIVE ARTERIES OR EXTREMITIES
770.1:MASSIVE ASPIRATION SYNDROME OF NEWBORNMECONIUM ASPIRATION SYNDROME
Major Name Changes
344.0:HEMIPLEGIAHEMIPLEGIA AND HEMIPARESIS
V45.0:POSTSURGICAL CARDIAC PACEMAKER IN SITUCARDIAC DEVICE IN SITU
Refinements
441.0: DISSECTING ANEURYSM (ANY PART)
441.0: DISSECTING AORTIC ANEURYSM
441.00: DISSECTING AORTIC ANEURYSM OF UNSPECIFIED SITE
441.01: DISSECTING THORACIC AORTIC ANEURYSM
441.02: DISSECTING ABDOMINAL AORTIC ANEURYSM
441.03: DISSECTING THORACOABDOMINAL AORTIC ANEURYSM
Code Change
Removed795.8: POSITIVE SEROLOGICAL OR VIRAL CULTURE
FINDING FOR HUMAN IMMUNODEFICIENCY VIRUS (HIV) ASSOCIATED VIRUS (HTLV-III/LAV)
Added795.71: NONSPECIFIC SEROLOGIC EVIDENCE OF
HUMAN IMMUNODEFICIENCY VIRUS (HIV)
Volatile Vocabulary/Persistent Data
99.71 MERCURY-ZINC PACEMAKER 99.71 THERAPEUTIC PLASMAPHERESIS
1980 1992
Patient Database
99.71
???
Historical Vocabulary
Store the code
Keep track of when the code changes
Look up the meaning of the code based on date it was used
Retrieval Using Historical Vocabulary
IF (Code=75.22 and Year<1990)
OR (Code=76.2 and Year=1991)
OR ((Code=76.20 or Code=76.21)
AND Year=1992)...
CPMC Approach: Encode the Meaning
Each code corresponds with one meaning (concept)
Each concept may or may not have an ICD9 Code
If ICD9 term changes meaning, it is no longer associated with the concept
Deletion
Concept Code: 10101Concept Name: Tobacco Use Disorder, in RemissionICD9 Code: 305.13ICD9 Entry Code:Old ICD9 Code:
Concept Code: 10101Concept Name: Tobacco Use Disorder, in RemissionICD9 Code:ICD9 Entry Code: 305.1Old ICD9 Code: 305.13
Concept Code: 31313Concept Name: Massive Aspiration Syndrome of NewbornICD9 Code: 770.1ICD9 Entry Code:Old ICD9 Code:
Minor Name Change
Concept Code: 31313Concept Name: Meconium Aspiration SyndromeICD9 Code: 770.1ICD9 Entry Code:Old ICD9 Code:
Major Name Change
Code: 21212Name: Mercury-Zinc PacemakerICD9: 99.71Entry:Old:
Code: 21212Name: Mercury-Zinc PacemakerICD9:Entry: <none>Old: 99.71
Code: 44444Name: Therapeutic PlasmapheresisICD9: 99.71Entry:Old:
Volatile Vocabulary/Persistent Data
99.71 MERCURY-ZINC PACEMAKER
1980 1992
Patient Database
21212
MERCURY-ZINC PACEMAKER(Old Code 99.71)
Additional Situations
New redundancy
Discovering old redundancy
Ambiguity
Disambiguation
Obsolescence
Precoordination
Advantages of Concept-Based Approach
Database contains original meaning
Concept-oriented retrieval is easier
Conclusions
Vocabulary changes are inevitable
Store what the clinician means
Map the vocabulary to the meanings, not the reverse
Definitions
Users: attendings, nurses, residents, respiratory care technicians, dieticians, social workers, students
Knowledge: textbooks, bibliographic databases, guidelines (passive), algorithms (active)
Point of care: clinic, emergency room, in-patient floors, ICU’s, recovery rooms
Access to Information Sources
???
“Electronic Library”
Integrated Access to Information
???
Clinical Information System
Context
Con
cept
s
Data
“Medline Button” Design
Application-specific questions (Mad Libs)
Coded clinical information to fill in the blanks
Medical Entities Dictionary of concepts
Translation using the UMLS
Scripts for accessing on-line resources
Implementations
3270 Admission/Discharge Profile:ICD9 -> MeSH -> Medline
X-Windows Laboratory Summary:Lab terms -> MeSH -> Medline, DXplain,
HSTAT
Mosaic clinical information system
Challenges
What questions arise in different contexts?
What information source is right for each?
How are the concepts translated?
How are complex retrievals performed?
How is the knowledge presented?