Concept-oriented Standardization and Statistics-oriented Classification: Continuing the Classification versus Nomenclature Controversy

Abstract

Nowadays, most activities on controlled medical vocabularies focus on the provision of a sufficient atomic-level granularity for representing clinical data. Amongst others, clinical vocabularies should be concept oriented, compositional and should also reject “Not Elsewhere Classified” [1]. We strongly share the opinion that there is a need to deal with serious deficits of existing manually created vocabularies and with new demands for computer-based advanced processing and exchange of medical language data. However, we do not share the opinion that methodological requirements like observational and structural comparability needed for sound statistics should not be included in desiderata of controlled medical vocabularies. Statistical-oriented classifications are not developed for representing detailed clinical data but for providing purposedependent classes where cases of interest are assigned uniquely. Either statistical classifications are not included into the set of controlled medical vocabularies in the sense of Cimino, or his desiderata are misleading. We argue that statistical classifications should be linked to (formal) concept systems, but again this linkage does not change their different natures. With this article we continue the “classification versus nomenclature” controversy referring to Cote [2].

Keywords

Medical Informatics - Controlled Vocabulary - Documentation - Data Interpretation/Statistical

• REFERENCES

• 1 Cimino JJ. Desiderata for Controlled Medical Vocabularies in the Twenty-First Century. Meth Inform Med 1998; 37: 394-403.
• 2 Coté RA. Editorial: Ending the classification versus nomenclature controversy. Medical Informatics 1983; 8: 1-4.
• 3 Chute CG, Cohn SP, Campbell KE. et al. The content coverage of clinical classifications. Journal of the American Medical Informatics Association 1996; 3 (3) 224-33.
• 4 Cimino JJ. Review paper: coding systems in health care. Methods of Information in Medicine 1996; 35 (4-5) 273-84.
• 5 Chute CG, Coté RA. Computerized Natural Medical Language Processing for Knowledge Representation: Overview of IMIA Working Group Conference, Geneva, September 1988. In: Barber B, Cao D, Gin D. et al. eds. Proc. of the MEDINFO 89 – 6th International Conference on Medical Informatics in Peking/Singapure. Amsterdam: North-Holland; 1989: 878-81.
• 6 van Bemmel JH. Handbook of Medical Informatics. In: Houten/Diegem: Bohn Stafleu Van Loghum; 1997
• 7 Leiner F, Haux R. Systematic Planning of Clinical Documentation. Methods of Information in Medicine 1996; 35: 25-34.
• 8 Baud RH, Rassinoux AM, Wagner JC. et al. Representing Clinical Narratives Using Conceptual Graphs. Methods of Information in Medicine 1995; 34 (1/2) 176-86.
• 9 Wingert F, Rothwell DJ, Coté RA. Automated indexing into SNOMED and ICD. In: Proc. of the IMIA-WG6 International Working Conference in Geneva, 1988. Scherrer J-R, Coté RA, Mandil SH. eds. Amsterdam: North-Holland; 1989: 201-39.
• 10 Moorman PW, van Ginneken AM, van der Lei J, van Bemmel JH. A model for structured data entry based on explicit descriptional knowledge. Methods of Information in Medicine 1994; 33: 454-63.
• 11 Nowlan WA, Rector AL. Medical Knowledge Representation and Predictive Data Entry. In: Proc. of the AIME 91 – 3rd Conference on Artificial Intelligence in Medicine Europe. Stefanelli M, Hasman A, Fieschi M. et al. eds. Berlin: Springer; 1991: 105-16.
• 12 Feinstein AR. Scientific Standards in Epidemiologic Studies of the Menace of Daily Life. Science 1988; 242: 1257-63.
• 13 Giere W, Schuster RW. Informationsaustausch zwischen Krankenhaus und Praxis. Der Praktische Arzt, Arzt für Allgemeinmedizin 1975; 8: 1-4.
• 14 UICC. TNM Classification of Malignant Tumours. (edited by Hermanek P, Sobin LH. ) Berlin: Springer; 1987
• 15 Giere W. The BAIK Model. In: Open Systems in Medicine. Fleck E. ed. Amsterdam: IOS Press; 1995: 24-34.
• 16 Wüster E. Begriffs- und Themaklassifikation: Unterschiede in ihrem Wesen und in ihrer Anwendung. Nachrichten für Dokumentation. 1971 22. (3/4) 98-104 143-50.
• 17 National Library of Medicine (NLM). Medical Subject Headings (MeSH): Tree Structures (Thesaurus for searching in the onlinedatabase “MEDLINE”). Bethesda, MD: Nlm-Med-85-03; 1985
• 18 Ingenerf J. Taxonomic vocabularies in medicine: the intention of usage determines different established structures. In: Proc. of the MED INFO 95 – 8th Int. Conf. on Medical Informatics in Vancouver, BC, Canada. Greenes RA, Peterson HE, Protti DJ. eds. Amsterdam: North-Holland; 1995: 136-9.
• 19 Frutiger P. Language and knowledge interfaces: progress towards IMIA's WG6 recommendations. In: Proc. of the M ED INFO 86 – 5th International Conference on Medical Informatics in Washington, DC. Salamon R, Blum BI, Jorgensen M. eds. Amsterdam: North-Holland; 1986: 76-80.
• 20 Zaiss A, Schulz S, Graubner B, Klar R. Conversion table between ICD-9 and ICD-10. In: Proc. of the MIE 96 – 12th International Conference on Medical Informatics in Europe in Copenhagen (Denmark). Brender J, Christensen JP, Scherrer J-R. et al. eds. Amsterdam: IOS Press; 1996: 193-7.
• 21 Rector AL, Nowlan WA, Kay S. Foundations for an electronic medical record. Methods of Information in Medicine 1991; 30: 179-86.
• 22 Haux R. Knowledge-based decision support for diagnosis and therapy: on the multiple usability of patient data. Methods of Information in Medicine 1989; 28: 69-77.
• 23 Wingert F. Automated Mapping of ICD into SNOMED. In: Orthner HFBBI. ed. 1989: 199-204.
• 24 Coté RA. International Classification for Health and Disease: the expandable common core concept. Medical Informatics 1983; 8: 5-16.
• 25 Rothwell DJ. SNOMED based knowledge representation. Methods of Information in Medicine 1995; 34: 209-13.
• 26 Rector AL, Nowlan WA, Kay S. Goals for concept representation in the GALEN project. In: Proc. of the SCAMC 93 – 17th Annual Symposium on Computer Applications in Medical Care, Washington DC. Safran C. ed. New York: McGraw-Hill; 1993: 414-8.
• 27 Campbell KE, Das AK, Musen MA. A logical foundation for representation of clinical data. Journal of the American Medical Informatics Association 1994; 1 (3) 218-32.
• 28 Ingenerf J. On the relationship between description logics and conceptual graphs – with some references to the medical domain. In: Proc. of the 19th Annual Conference of the Gesellschaft für Klassifikation (GfKl) in Basel, Switzerland, March 1995. Bock HH, Posasek W. eds. Berlin: Springer; 1996: 355-69.
• 29 Doyle J, Patii RS. Two theses of knowledge representation: language restrictions, taxonomic classification, and the utility of representation services. Artificial Intelligence 1991; 48: 261-97.
• 30 Ceusters W, Deville G, Buekens F. The Chimera of Purpose- and Language Independent Concept Systems in Health Care. In: Proc. of the MIE 94 – 12th International Conference on Medical Informatics in Europe, Lisbon (Portugal). Barahona P, Veloso M, Bryant J. eds. 1994: 208-12.
• 31 Rector AL. Coordinating Taxonomies: Key To Re-usable Concept Representations. In: Proc. of the AIME 95 – 5th Conference on Artificial Intelligence in Medicine Europe. New York: Barahona P, Stefanelli M, Wyatt J. eds. Springer; 1995: 17-28.
• 32 Hirs WM. The use of terminological principles and methods in medicine. In: Proc. of the MEDINFO 92 – 7th International Conference on Medical Informatics in Geneva Palexpo, Switzerland. Lun KC, Degoulet P, Piemme TE. et al. eds. Amsterdam: North-Holland; 1992: 1452-7.
• 33 Thurmayr R. Use of a Conversion Table from ICD/E-Code to SNOMED. In: Proc. of the IFIP-IMIA WG6 International Working Conference in Ottawa, 1984. Coté RA, Protti DJ, Scherrer J-R. eds. Amsterdam: North-Holland; 1985: 333-7.
• 34 Rodgers FE, Solomon WD, Rector AL. et al. Rubrics to Dissections to GRAIL to Classifications. In: Proc. of the Medical Informatics Europe (MIE) '97. Pappas C, Maglaveras N, Scherrer J-R. eds. Amsterdam: IOS Press; 1997: 241-5.
• 35 Coté RA, Rothwell DJ, Palotay JL. et al. The Systematized Nomenclature of Human and Veterinary Medicine – SNOMED International (4 volumes). Chicago: College of American Pathologists; 1993
• 36 Kolodzig C, Diekmann F. Diagnosenkodierung: Nutzung von DV-Systemen (wie ID DIACOS). Deutsches Ärzteblatt 1992; 89 (3) 92-6.
• 37 Assimacopoulos A, Le Coultre C, Griesser V, Scherrer J-R. Nomenclature or Classification? – Eighteen Months of Interactive Coding of Diagnosis and Surgical Procedures Within the Integrated Hospital Information System (HIS) DIOGENE. In: Proc. of the MEDINFO 86 – 5 th International Conference on Medical Informatics in Washington, DC. Salamon R, Blum BI, Jorgensen M. eds. Amsterdam: North-Holland; 1986: 865-9.
• 38 Satomura Y, do Amarai MB. Automated diagnostic indexing by natural language processing. Medical Informatics 1992; 17: 149-63.
• 39 Delamarre D, Burgun A, Seka LP, Le Beux P. Automated Coding of Patient Discharge Summaries Using Conceptual Graphs. Methods of Information in Medicine 1995; (4): 345-51.
• 40 Rector AL. Faithfulness or comparability. Methods of Information in Medicine 1996; (3): 218-9.
• 41 ISO 1087. Terminology – Vocabulary. Berlin: Beuth; 1990
• 42 ISO 5127/6. Documentation and information (Vocabulary), Part 6: Documentary languages. Berlin: Beuth; 1983
• 43 Rescher N. Introduction to Logic. New York: St. Martin's Press; 1964
• 44 World Health Organization (WHO). Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death – Ninth Revision of the International Classification of Diseases. Geneva: WHO; 1977
• 45 Coté RA, Rothwell DJ. The classification – nomenclature issues in medicine: a return to natural language. Medical Informatics 1989; 14 (1) 25-41.
• 46 CEN-ENV-12264. Medical Informatics – Categorical structure of systems of concepts – Model for representation of semantics. Brussels: CEN; 1995