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Methods Inf Med 1999; 38(04/05): 239-252
DOI: 10.1055/s-0038-1634418
Original Article
Schattauer GmbH

Clinical Terminology: Why Is it so Hard?

A. L. Rector
1   Medical Informatics Group, Department of Computer Science, University of Manchester, Manchester, UK
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Publication History

Publication Date:
07 February 2018 (online)

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Abstract

Despite years of work, no re-usable clinical terminology has yet been demonstrated in widespread use. This paper puts forward ten reasons why developing such terminologies is hard. All stem from underestimating the change entailed in using terminology in software for ‘patient centred’ systems rather than for its traditional functions of statistical and financial reporting. Firstly, the increase in scale and complexity are enormous. Secondly, the resulting scale exceeds what can be managed manually with the rigour required by software, but building appropriate rigorous representations on the necessary scale is, in itself, a hard problem. Thirdly, ‘clinical pragmatics’ – practical data entry, presentation and retrieval for clinical tasks – must be taken into account, so that the intrinsic differences between the needs of users and the needs of software are addressed. This implies that validation of clinical terminologies must include validation in use as implemented in software.

Keywords

Terminology - Knowledge Representation - Medical Records - Natural Language
 

  • REFERENCES

  • 1 Sittig DF. Grand challenges in medical informatics. J Am Med Inform Assoc 1994; 1: 412-3.
    CrossrefPubMedGoogle Scholar
  • 2 CEN. TC251. CEN TC251 Home Page . 1999 CEN TC251: http://www.centc251.org/
    PubMedGoogle Scholar
  • 3 ISO TC215. Home Page . 1999 ISO TC215: http://www.imc.exec.nhs.uk/isotc215/
    PubMedGoogle Scholar
  • 4 ISO. TC215 WG3. Working Group on Terminology, Home Page . 1999 http://www.imc.exec.nhs.uk/isotc215/
    PubMedGoogle Scholar
  • 5 HL7.. Health Informatics Standards – HL7 . 1999 Duke University: http://www.mcis.duke.edu/standards/HL7/hl7.htm
    PubMedGoogle Scholar
  • 6 DICOM.. DICOM Standards Links . 1999 http://www.mcis.duke.edu/standards/DICOM/dicom.htm
    PubMedGoogle Scholar
  • 7 Solbrig H. Final submission to the CorbaMED Request for Proposals on Lexical Query Services (CorbaLex) . 1998 OMG.
    PubMedGoogle Scholar
  • 8 United States Senate,. Health Insurance Portability and Accountability Act, S1028 . 1996
    PubMedGoogle Scholar
  • 9 Rogers R, Reardon J. Barriers to a Global Information Society for Health: Recommendations for International Action, Report from the project G8-Enable . Oxford: IOS Press; 1999
    Google Scholar
  • 10 Walther E, Eriksson H, Musen MA. Plug-and-Play: Construction of task-specific expert-system shells using sharable context ontologies. . In: AAAI Workshop on Knowledge Representation Aspects of Knowledge Acquision . San José CA: 1992: 191-8.
    Google Scholar
  • 11 Musen M, Tu S, Das A, Shahar Y. EON: A component based architecture for automation of protocol-directed therapy . J Am Med Inform Assoc 1996; 3: 367-83.
    CrossrefPubMedGoogle Scholar
  • 12 Das SK, Fox J, Krause P. A unified framework for hypothetical and practical reasoning (1): theoretical foundations. . In: International Conference on Formal and Applied Practial Reasoning . Berlin: Springer Verlag; 1996
    Google Scholar
  • 13 Campbell K. Scalable methodologies for distributed development of logic-based convergent medical terminology. Method Inform Med 1998; 37: 426-39.
    PubMedGoogle Scholar
  • 14 Spackman KA, Campbell KE, Côté RA. SNOMED-RT: A Reference Terminology for Health Care. J Am Med Inform Assoc 1997; (Symposium special issue): 640-4.
    PubMedGoogle Scholar
  • 15 Cimino J. Desiderata for controlled medical vocabularies in the twenty-first century. Meth Inform Med 1998; 37 4-5 394-403.
    PubMedGoogle Scholar
  • 16 ISO,. ISO 1087: Terminology – Vocabulary . 1990 ISO.
    PubMedGoogle Scholar
  • 17 NHS National Health Service Executive.. Information for Health: An information strategy for the modern NHS 1998-2005 . 1998. UK National Health Service Executive:; http://www.imt4nhs.exec.nhs.uk/.
    Google Scholar
  • 18 Dick RS, Steen EB. eds. The Computer-Based Patient Record: An essential technology for health care . Washington, DC: National Academy Press; 1991
    Google Scholar
  • 19 Norman DA. The Invisible Computer: Why good products can fail, the personal computer is so complex, and information appliances are the solution . Cambridge Mass: MIT Press; 1998
    Google Scholar
  • 20 Sager N, Lyman MS, Bucknall C, Nhan NT, Tick LJ. Natural Language Processing and the Representation of Clinical Data. J Am Med Inform Soc 1994; 1 (Suppl. 01) 142-60.
    PubMedGoogle Scholar
  • 21 Baud RH, Rodrigues J-M, Wagner JC, Rassinoux A-M, Lovis C, Rush P, TrombertPaviot B, Scherrer J-R. Validation of concept representation using natural language generation. J Am Med Inform Assoc 1997; (Fall Symposium Supplement): 841.
    PubMedGoogle Scholar
  • 22 Lovis C, Baud R, Michel P-A, Scherre J-R. Morphosemantic decomposition and semantic representation to allow fast and efficient natural language recognition. J Am Med Inform Assoc 1997; (Fall Symposium Supplement): 873.
    PubMedGoogle Scholar
  • 23 Rasinoux A-M, Juge C, Michel P-A, Baud R, Lemaitre D, Jean F-C, Degoulet P, Scherrer J-R. Analysis of medical jargon: The RECIT system. In: Fifth conference on Artificial Intelligence in Medicine Europe (AIME ’95) . Pavia, Italy: Springer; 1995: 42-42.
    Google Scholar
  • 24 Wagner J, Rassinoux A-M, Baud R, Scherrer J-R. Generating noun phrases from a medical knowledge representation. In: Twelfth International Congress of the European Federation for Medical Informatics, MIE-94. Lisbon, Portugal: 1994: 218-23.
    Google Scholar
  • 25 Zweigenbaum P, Bachimont B, Bouaud J, Charlet J. Issues in the structuring and acquisition of an ontology for medical language understanding. Method Inform Med 1995; 34 1/2 15-24.
    PubMedGoogle Scholar
  • 26 Hahn U, Romacker M, Schulz S. How knowledge drives understanding – matching medical ontologies with the needs of medical language processing. Artif Intell Med 1999; 15 (Suppl. 01) 25-52.
    CrossrefPubMedGoogle Scholar
  • 27 Nowlan WA. Clinical workstation: Identifying clinical requirements and understanding clinical information. Int J Bio-Med Comput 1994; 34: 85-94.
    CrossrefPubMedGoogle Scholar
  • 28 Kirby J, Cope N, Souza AD, Fowler H, Gain R. The PEN&PAD Data Entry System. In: Medical Informatics Europe (MIE-96) . Copenhagen: IOS Press; 1996: 430-4.
    Google Scholar
  • 29 Moorman P, van Ginneken AMvG, Siersema PD, van der Lei J, van Bemmel JH. Evaluation of reporting based on descriptional knowledge. JAMIA 1995; 2 (Suppl. 06) 365-73.
    PubMedGoogle Scholar
  • 30 Kay S, Purves IN. Medical records and other stories: a narroatological framework. Meth Inform Med 1996; 35 (Suppl. 02) 72-87.
    PubMedGoogle Scholar
  • 31 Simon HA. The Sciences of the Artificial . 2 ed. MIT Press 1969; 1981: 247.
    Google Scholar
  • 32 British National Formulary . British Pharmaceutical Society; 1998
    Google Scholar
  • 33 Borgida A. Description logics in data management. IEEE Transactions on Knowledge and Data Engineering 1995; 7 (Suppl. 05) 671-82.
    CrossrefPubMedGoogle Scholar
  • 34 MacGregor R. The evolving technology of classification-based knowledge representation systems. In: Principles of Semantic Networks: Explorations in the representation of knowledge. Sowa J. ed. San Mateo, CA: Morgan Kaufmann; 1991: 385-400.
    Google Scholar
  • 35 Sowa J. Conceptual Structures: Knowledge Representation in Mind and Machine . New York: John Wiley & Sons; 1985
    Google Scholar
  • 36 Lenat DB, Guha RV. Building Large Knowledge-Based Systems: Representation and inference in the Cyc Project . Reading, MA: Addison-Wesley; 1989: 372.
    Google Scholar
  • 37 Fikes R, Cutkosky M, Gruber T, Baalen JV. Knowledge sharing technology – project overview . Sharing Laboratory: Stanford University, Knowledge; 1991
    Google Scholar
  • 38 Bateman JA. Upper modelling: a general organization of knowledge for natural language processing . USC/Information Sciences Institute; 1989
    Google Scholar
  • 39 Touretzky D. The Mathematics of Inheritance Systems . Los Altos, CA: Morgan Kauf-mann; 1986
    Google Scholar
  • 40 Brachman R, Levesque H. The tractability of subsumption in frame-based description languages . in AAAI-84. Morgan Kaufman:; 1984: 34 7.
    Google Scholar
  • 41 Doyle J, Patil R. Two theses of knowledge representation: Language restrictions, taxonomic classification and the utility of representation services. Artif Intell 1991; 48: 261-97.
    CrossrefPubMedGoogle Scholar
  • 42 Guarino N, Giaretta P. Ontologies and knowledge bases: towards a terminological clarification. In: Towards Very Large Knowledge Bases. Mars N. ed, Editor. IOS Press: Amsterdam.; 1995: 25-32.
    Google Scholar
  • 43 Rosse C, Shapiro IG, Brinkley JF. The Digital Anatomist foundational model: Principles for defining and structuring its concept domain. J Am Med Inform Assoc; 1998. (1998 Fall Symposium Special issue).
    Google Scholar
  • 44 Rector A. Coordinating taxonomies: Key to re-usable concept representations. In: Fifth Conference on Artificial Intelligence in Medicine Europe (AIME ’95).. 1995. Pavia, Italy: Springer:; 17-28.
    Google Scholar
  • 45 Rogers J, Rector A. The GALEN ontology. In: Medical Informatics Europe (MIE 96) . Copenhagen: IOS Press:; 1996: 174-8.
    Google Scholar
  • 46 Farquhar A, Fikes R, Pratt W, Rice J. Collaborative Ontology Construction for Information Integration . Knowledge Systems Laboratory, Stanford University; 1996
    Google Scholar
  • 47 Rector AL. et al. Reconciling Users’ Needs and Formal Requirements: Issues in developing a Re-Usable Ontology for Medicine. IEEE Transactions on Information Technology in BioMedicine 1999; 02 (Suppl. 04) 229-42.
    PubMedGoogle Scholar
  • 48 Rector A. Thesauri and formal classifications: Terminologies for people and machines. Method Inform Med 1998; 37 4-5 501-9.
    PubMedGoogle Scholar
  • 49 Cruse DA. Lexical Semantics . Cambridge, England: Cambridge University Press; 1986
    Google Scholar
  • 50 Padgham L, Lambrix P. A Framework for Part-of Hierarchies in Terminological Logics . In: KR-94. 1994: 485-96.
    Google Scholar
  • 51 Odell JJ. Six different kinds of composition. J Object Oriented Progr 1994; 5 (Suppl. 08) 10-5.
    PubMedGoogle Scholar
  • 52 Winston M, Chaffin R, Hermann D. A taxonomy of part-whole relations. Cognitive Science 1987; 11: 417-44.
    CrossrefPubMedGoogle Scholar
  • 53 Rector A, Rossi Mori A, Consorti F, Zanstra P. Practical development of re-usable terminologies: GALEN-IN-USE and the GALEN Organisation. Int J Med Inf 1998; 48 1-3 71-84.
    CrossrefPubMedGoogle Scholar
  • 54 Rossi Mori A, Galeazzi E, Consorti F, Bidgood WD. Conceptual Schemata for Terminology: A continuum from headings to values in patient records and messages. J Am Med Inform Assoc; (Fall Symposium Special Issue): 1997: 650-4.
    Google Scholar
  • 55 Rossi Mori A, Consorti F. Integration of clinical information across patient records: a comparison of mechanisms used to enforce semantic coherence. IEEE Transactions on Information Technology in BioMedicine, 1999; 4 (Suppl. 02) 243-53.
    PubMedGoogle Scholar
  • 56 Oliver DE, Shahar Y, Shortliffe EH, Musen MA. Representing change in controlled medical vocabularies. Artif Intell Med 1999; 15 (Suppl. 01) 53-76.
    CrossrefPubMedGoogle Scholar
  • 57 Campbell K, Cohn S, Chute C, Rennels G, Shortliffe E. Gálapagos. Computer-based support for evolution of a convergent medical terminology. In: AMIA Fall Symposium. Washington DC: Hanley and Belfus, Inc; 1996: 269-73.
    Google Scholar
  • 58 Cimino J, Clayton PD. Coping with changing controlled vocabularies. In: Eighteenth Annual Symposium on Computer Applications in Medical Care . Washington, DC: Hanley & Belfus, Inc, Philadelphia PA:; 1994: 1359.
    Google Scholar
  • 59 Rossi Mori A, Consorti F, Galeazzi E, Merialdo P. A second generation of terminological systems is coming. In: Medical Informatics Europe ’97 . 1997. Porto Carras, Greece: IOS Press:; 436-40.
    Google Scholar
  • 60 Kirby J, Rector AL. The PEN & PAD Data Entry System: From prototype to practical system. In: AMIA Fall Symposium . Washington DC: Hanley and Belfus, Inc:; 1996: 709-13.
    Google Scholar
  • 61 Lussier YA, Maksud M, Desruisseaux B, Yale P-P, St-Arneault R. Pure MD. A computerized patient record software for direct data entry by physicians using keyboard-free pen-based portable computer. In: Sixteenth Annual Symposium on Computer Applications in Medical Care (SCAMC-92). Baltimore, MD: McGraw-Hill:; 1992: 261-63.
    Google Scholar
  • 62 Brown P, O’Neil M, Price C. Semantic definition of disorders in Version 3 of the Read Codes. Method Inform Med 1998; 37: 415-19.
    PubMedGoogle Scholar
  • 63 Shortliffe E, Barnett G, Cimino J, Greenes R, Huff S, Patel V. Collaborative medical informatics research using the Internet and the World Wide Web. J Am Med Inform Assoc 1996. Symposium Supplement:; 1996: 125-9.
    Google Scholar
  • 64 Pratt W. Dynamic organisation of search results using the UMLS. J Am Med Inform Assoc. (1997 Fall Symposium Special Issue): 1997: 480-4.
    PubMedGoogle Scholar
  • 65 Detmer WM, Barnett GO, Hersh WR. Med-Weaver: Integrating decision support, literature searching and web exploration using the UMLS Metathesaurus. J Am Med Inform Assoc. (1997 Fall Symposium Special Issue): 1997: 490-4.
    PubMedGoogle Scholar
  • 66 Goldberg HS, Hsu C, Law V, Safran C. Validation of clinical problems using a UMLS based semantic parser. J Am Med Inform Assoc. (1998 Fall Symposium Special Issue): 1998: 805-9.
    PubMedGoogle Scholar
  • 67 Spackman KA, Campbell KE. Compositional concept representation using SNOMED: Towards further convergence of clinical terminologies. J Am Med Inform Assoc. (1998 Fall Syposium special issue): 1998: 740-4.
    PubMedGoogle Scholar
  • 68 GALEN,. Home Page URL: . http://www.cs.man.ac.uk/mig/galen 1997
    PubMedGoogle Scholar
  • 69 Rector AL, Baud R, Ceusters W, Claassen W, Rodrigues J-M, Mori JRR, Haring EVD, Solomon WD, Zanstra P. A comprehensive approach to developing and integrating multilingual classifications: GALEN’s Classification Workbench. J Am Med Inform Assoc Fall Symposium Special Issue:. 1998: 1115.
    PubMedGoogle Scholar
  • 70 Rector A, Rossi Mori A, Consorti F, Zanstra P. Making sound re-usable terminology practical: The GALEN approach. In: Towards and Electronic Health Care Record, Europe . London: Medical Records Institute, Newton Mass; 1998: 298-305.
    Google Scholar
  • 71 Rogers JE, Price C, Rector AL, Solomon WD, Smejko N. Validating clinical terminology structures: Integration and cross-validation of Read Thesaurus and GALEN. J Am Med Inform Assoc. Fall Symposium Special Issue 1998: 845-9: (in press).
    PubMedGoogle Scholar
  • 72 Horrocks I. The CAMELOT Web Page . http://www.cs.man.ac.uk/~horrocks/Camelot/ 1998
    PubMedGoogle Scholar
  • 73 Horrocks I. Using an expressive description logic: FaCT or Fiction. In: Principles of Knowledge Representation and Reasoning: Proceedings of the Sixth International Conference on Knowledge Representation (KR 98) . San Francisco, CA: Morgan Kauf-mann; 1998. (in press).
    Google Scholar
  • 74 Rogers J, Solomon D, Rector A, Zanstra P. From rubrics to dissections to GRAIL to classifications. in Medical Informatics Europe (MIE-97) . Thessaloniki, Greece: IOS Press:; 1997: 241-5.
    Google Scholar