Methods Inf Med 1998; 37(04/05): 394-403
DOI: 10.1055/s-0038-1634558
Original Article
Schattauer GmbH

Desiderata for Controlled Medical Vocabularies in the Twenty-First Century

J. J. Cimino
1   Department of Medical Informatics, Columbia University, New York, USA
› Author Affiliations
Further Information

Publication History

Publication Date:
15 February 2018 (online)

Abstract

Builders of medical informatics applications need controlled medical vocabularies to support their applications and it is to their advantage to use available standards. In order to do so, however, these standards need to address the requirements of their intended users. Overthe past decade, medical informatics researchers have begun to articulate some of these requirements. This paper brings together some of the common themes which have been described, including: vocabulary content, concept orientation, concept permanence, nonsemantic concept identifiers, polyhierarchy, formal definitions, rejection of “not elsewhere classified” terms, multiple granularities, mUltiple consistent views, context representation, graceful evolution, and recognized redundancy. Standards developers are beginning to recognize and address these desiderata and adapt their offerings to meet them.

 
  • REFERENCES

  • 1 Wong ET, Pryor TA, Huff SM, Haug PJ, Warner HR. Interfacing a stand-alone diagnostik expert system with a hospital information system. Comput Biomed Res 1994; 27: 116-29.
  • 2 Masys DR. Of codes and keywords: standards for biomedical nomenclature. Acad Med 1990; 65: 627-9.
  • 3 Cimino JJ. Coding systems in health care. In van Bemmel JH, McCray AT. eds. Yearbook of Medical Informatics, International Medical Informatics Association. Rotterdam: 1995: 71-85. Reprinted in Methods of Information in Medicine; 1996: 35 (4/5). 27384.
  • 4 Chute CG, Cohn SP, Campbell KE, Oliver DE, Campbell JR. The Content Coverage of Clinical Classifications. JAMIA 1996; 3: 22433.
  • 5 Campbell JR, Carpenter P, Sneiderman C, Cohn S, Chute CG, Warren J. Phase II evaluation of clinical coding schemes; completeness, taxonomy, mapping, definitions and clarity. Journal of the American Medical Informatics Association 1997; 4: 238-51.
  • 6 Conference Summary Report: Moving Toward International Standards in Primary Care Informatics: Clinical Vocabulary. New Orleans: November, 1995 United States Department of Health and Human Service; 1996
  • 7 Anderson J. The computer: medical vocabulary and information. British Medical Bulletin 1968; 24 (3) 194-8.
  • 8 Bates JAV. Preparation of clinical data for computers. British Medical Bulletin 1968; 24 (3) 199-205.
  • 9 Howell RW, Loy RM. Disease coding by computer: the “fruit machine” method. British Journal of Preventive and Social Medicine 1968; 22: 178-81.
  • 10 Cimino JJ. Controlled medical vocabulary construction: methods from the Canon Group. JAMIA 1994; 1: 296-7.
  • 11 Ozbolt JG, Fruchtnicht JN, Hayden JR. Toward data standards for nursing information. JAMIA 1994; 1: 175-85.
  • 12 McCloskey J, Bulechek G. Letter: Toward data standards for nursing information. JAMIA 1994; 1: 469-71.
  • 13 Ozbolt JG, Fruchtnicht JN, Hayden JR. Letter: Toward data standards for nursing information. JAMIA 1994; 1: 471-2.
  • 14 Humphreys BL. Comment: Toward data standards for nursing information. JAMIA 1994; 1: 472-4.
  • 15 Goossen WTF, Epping PJMM, Abraham IL. Classification systems in nursing: formalizing nursing knowledge and implications for nursing information systems. Meth Inform Med 1996; 35: 59-71.
  • 16 Gabrieli ER. Computerizing text from office records. MD Comput 1987; 4: 44-9 56.
  • 17 Côté RA, Robboy S. Progress in medical information management – Systematized nomenclature of medicine (SNOMED). JAMA 1980; 243: 756-62.
  • 18 Evans DA, Rothwell DJ, Monarch IA, Lefferts RG, Côté RA. Towards representations for medical concepts. Med Decis Making 1991; 11 (suppl) S102-S108.
  • 19 Musen MA, Weickert KE, Miller ET, Campbell KE, Fagan LM. Development of a controlled medical terminology: knowledge acquisition and knowledge representation. Meth Inform Med 1995; 34: 85-95.
  • 20 Moehr JR, Kluge EH, Patel VL. Advanced patient information systems and medical concept representation. In Greenes RA, Peterson HE, Protti DJ. eds. Proceedings of the Eight World Congress on Medical Informatics (MEDINFO '95). Vancouver, British Columbia, Canada: Healthcare Computing & Communications (Canada); 1995: 95-9.
  • 21 Evans DA. Pragmatically-structured, lexical-semantic knowledge bases for a Unified Medical Language System. In Greenes RA. ed. Proceedings of the Twelfth Annual Symposium on Computer Applications in Medical Care (SCAMC). Washington, DC; New York: IEEE Computer Society Press; 1988: 169-73.
  • 22 Lindberg DAB, Humphreys BL, McCray AT. The Unified Medical Language System. Meth Inform Med 1993; 32: 281-91.
  • 23 Volot F, Zweigenbaum P, Bachimont B, Ben Said M, Bouaud J, Fieschi M, Boisvieux JF. Structuration and acquisition of medical knowledge using UMLS in the conceptual graph formalism. In Safran C. ed. Proceedings of the Seventeenth Annual Symposium on Computer Applications in Medical Care (SCAMC). Washington, DC 1993: McGraw-Hill, New York; 1994: 710-14.
  • 24 Evans DA, Cimino JJ, Hersh WR, Huff SM, Bell DS. Toward a medical-concept representation language. JAMIA 1994; 1: 207-17.
  • 25 Rassinoux AM, Miller RA, Baud RH, Scherrer JR. Modeling principles for QMR medical findings. In Cimino JJ. ed. Proceedings of the AMIA Annual Fall Symposium (Formerly SCAMC). Washington, DC, Philadelphia: Hanley and Belfus; 1996: 264-98.
  • 26 Henkind SJ, Benis AM, Teichholz LE. Quantification as a means to increase the utility of nomenclature-classification systems. In Salmon R, Blum B. Jürgensen eds. Proceedings of the Seventh World Congress on Medical Informatics (MED-INFO 86). North-Holland (Amsterdam): 1986: 858-61.
  • 27 Cimino JJ, Clayton PD, Hripcsak G, Johnson SB. Knowledge-based approaches to the maintenance of a large controlled medical terminology. JAMIA 1994; 1: 35-50.
  • 28 Blois MS. The effect of hierarchy on the encoding of meaning. In Orthner HF. ed. Proceedings of the Tenth Annual Symposium on Computer Applications in Medical Care (SCAMC). Washington, DC: IEEE Computer Society Press, New York; 1986: 73.
  • 29 Moorman PW, van Ginneken AM, van der Lei J, van Bemmel JH. A model for structured data entry based on explicit descriptional knowledge. Meth Inform Med 1994; 33: 454-63.
  • 30 van Ginneken AM, van der Lei J, Moorman PW. Towards unambiguous representation of patient data. In Frisse ME. ed. Proceedings of the Sixteenth Annual Symposium on Computer Applications in Medical Care (SCAMC). Baltimore, MD: 1992. McGraw-Hill, New York; 1993: 69-73.
  • 31 Cimino JJ, Hripcsak G, Johnson SB, Clayton PD. Designing an introspective, controlled medical vocabulary. In Kingsland LC. ed. Proceedings of the Thirteenth Annual Symposium on Computer Applications in Medical Care (SCAMC). New York, Washington, DC: IEEE Computer Society Press; 1989: 513-8.
  • 32 Cimino JJ. Formal descriptions and adaptive mechanisms for changes in controlled medical vocabularies. Meth Inform Med 1996; 35: 202-10.
  • 33 Forman BH, Cimino JJ, Johnson SB, Sengupta S, Sideli R, Clayton P. Applying a controlled medical terminology to a distributed production clinical information system. In Gardner RM. ed. Proceedings of the Nineteenth Annual Symposium on Computer Applications in Medical Care (SCAMC). Philadelphia, New Orleans, LA: Hanley and Belfus; 1995: 421-5.
  • 34 Bernauer J, Franz M, Schoop M, Schoop D, Pretschner DP. The compositional approach for representing medical concept systems. In Greenes RA, Peterson HE, Protti DJ. eds. Proceedings of the Eight World Congress on Medical Informatics (MEDINFO '95). Vancouver, British Columbia, Canada: Healthcare Computing & Communications (Canada); 1995: 70-4.
  • 35 Dunham GS, Henson DE, Pacak MG. Three solutions to problems of categorized medical nomenclatures. Meth Inform Med 1984; 23: 87-95.
  • 36 Baud R, Lovis C, Alpay L, Rassinoux AM, Nowlan A, Rector A. Modeling for natural language understanding. In Safran C. ed. Proceedings of the Seventeenth Annual Symposium on Computer Applications in Medical Care (SCAMC). New York, Washington, DC, 1993; New York: McGraw-Hill; 1994: 289-93.
  • 37 Zweigenbaum P, Bachimont B, Bouaud J, Charlet J, Boisvieux JF. Issues in the structuring and acquisition of an ontology for medical language understanding. Meth Inform Med 1995; 34: 15-24.
  • 38 Masarie Jr. FE, Miller RA, Bouhaddou O, Giuse NB, Warner, HR. An interlingua for electronic interchange of medical information: using frames to map between clinical vocabularies. Computers in Biomedical Research 1991; 24 (4) 379-400.
  • 39 Gabrieli ER. Interface problems between medicine and computers. In Cohen GS. ed. Proceedings of the Eighth Annual Symposium on Computer Applications in Medical Care (SCAMC). New York, Washington, DC: IEEE Computer Society Press; 1984: 93-5.
  • 40 Barr CE, Komorowski HJ, Pattison-Gordon E, Greenes RA. Conceptual modeling for the Unified Medical Language System. In Greenes RA. ed. Proceedings of the Twelfth Annual Symposium on Computer Applications in Medical Care (SCAMC). New York, Washington, DC: IEEE Computer Society Press; 1988: 148-51.
  • 41 Haimowitz IJ, Patil RS, Szolovitz P. Representing medical knowledge in a terminological language is difficult. In Greenes RA. ed. Proceedings of the Twelfth Annual Symposium on Computer Applications in Medical Care (SCAMC). New York, Washington, DC: IEEE Computer Society Press; 1988: 101-5.
  • 42 Rothwell DJ, Côté RA. Optimizing the structure of a standardized vocabulary – the SNOMED model. In Miller RA. ed. Proceedings of the Fourteenth Annual Symposium on Computer Applications in Medical Care (SCAMC). New York, Washington, DC: IEEE Computer Society Press; 1990: 181-4.
  • 43 Rector AL, Nowlan WA, Kay S. Conceptual knowledge: the core of medical information systems. In Lun KC, Deguolet P, Piemme TE, Rienhoff O. eds. Proceedings of the Seventh World Congress on Medical Informatics (MEDINFO '92). Geneva. North-Holland (Amsterdam): 1992: 1420-6.
  • 44 Campbell KE, Das AK, Musen MA. A logical foundation for representation of clinical data. JAMIA 1994; 1: 218-32.
  • 45 Bernauer J. Subsumption principles underlying medical concept systems and their formal reconstruction. In Ozbolt JG. ed. Proceedings of the Eighteenth Annual Symposium on Computer Applications in Medical Care (SCAMC). Washington, DC: Haniey and Belfus, Philadelphia; 1994: 140-4.
  • 46 Smart JF, Roux M. A model for medical knowledge representation application to the analysis of descriptive pathology reports. Meth Inform Med 1995; 34: 352-60.
  • 47 Kiuchi T, Ohashi Y, Sato H, Kaihara S. Methodology for the construction of a disease nomenclature and classification system for clinical use. Meth Inform Med 1995; 34: 511-7.
  • 48 Rector AL. Thesauri and formal classifications: terminologies for people and machines. In Chute CG. ed. IMIA Working Group 6 Conference on Natural Language and Medical Concept Representation. Jacksonville, Florida: January 1997: 183-95.
  • 49 Brown PJB, O'Neil M, Price C. Semantic representation of disorders in Version 3 of the Read Codes. In Chute CG. ed. IMIA Working Group 6 Conference on Natural Language and Medical Concept Representation. Jacksonville, Florida: January 1997: 209-14.
  • 50 Price C, O'Neil M, Bentley TE, Brown PJB. Exploring the ontology of surgical procedures in the Read Thesaurus. In Chute CG. ed. IMIA Working Group 6 Conference on Natural Language and Medical Concept Representation. Jacksonville, Florida: January 1997: 215-21.
  • 51 Bernauer J. Formal classification of medical concept descriptions: graph oriented operators. In Chute CG. ed. IMIA Working Group 6 Conference on Natural Language and Medical Concept Representation. Jacksonville, Florida: January 1997: 109-15.
  • 52 Rossi Mori A, Consorti F, Galeazzi E. Standards to support development of terminological systems for healthcare telematics. In Chute CG. ed. IMIA Working Group 6 Conference on Natural Language and Medical Concept Representation. Jacksonville, Florida: January 1997: 131-45.
  • 53 Bernauer J. Conceptual graphs as a operational model for descriptive findings. In Clayton PD. ed. Proceedings of the Fifteenth Annual Symposium on Computer Applications in Medical Care (SCAMC). Washington, DC 1991: McGraw-Hill, New York; 1992: 214-8.
  • 54 Campbell KE, Musen MA. Representation of clinical data using SNOMED III and conceptual graphs. In Frisse ME. ed. Proceedings of the Sixteenth Annual Symposium on Computer Applications in Medical Care (SCAMC). Baltimore, MD, 1992: McGraw-Hill, New York; 1993: 354-8.
  • 55 Baud RH, Rassinoux AM, Wagner JC, Lovis C, Juge C, Alpay LL, Michel PA, Degoulet P, Scherrer JR. Representing clinical narratives using conceptual graphs. Meth Inform Med 1995; 34: 176-86.
  • 56 Robé PF, de V, Flier FJ, Zanstra PE. Health classifications and terminological modeling. In Chute CG. ed. IMIA Working Group 6 Conference on Natural Language and Medical Concept Representation. Jacksonville, Florida: January 1997: 223-4.
  • 57 Cimino JJ, Barnett GO. Automatic knowledge acquisition from MEDLINE. Meth Inform Med 1993; 32: 120-30.
  • 58 Cimino JJ, Johnson SB, Hripcsak G, Hill CL, Clayton PD. Managing Vocabulary for a Centralized Clinical System. In Greenes RA, Peterson HE, Protti DJ. eds. Proceedings of the Eight World Congress on Medical Informatics (MEDINFO '95). Vancouver, British Columbia, Canada: Healthcare Computing & Communications (Canada); 1995: 117-20.
  • 59 Friedman C, Huff SM, Hersh WR, Pattison-Gordon E, Cimino JJ. The Canon group's effort: working toward a merged model. JAMIA 1995; 2: 4-18.
  • 60 Campbell KE, Cohn SP, Chute CG, Rennels G, Shortliffe EH. Galapagos: computer-based support for evolution of a convergent medical terminology. In Cimino JJ. ed. Proceedings of the AMIA Annual Fall Symposium (Formerly SCAMC). Washington, DC: Haniey and Belfus, Philadelphia; 1996: 269-73.
  • 61 Campbell KE, Cohn SP, Chute CG, Shortliffe EH, Rennels G. Scaleable methodologies for distributed development of logic-based convergent medical terminology. In Chute CG. ed. IMIA Working Group 6 Conference on Natural Language and Medical Concept Representation. Jacksonville, Florida: January 1997: 243-56.
  • 62 Musen MA. Knowledge sharing and reuse. Comput Biomed Res 1992; 25: 435-67.
  • 63 Blois MS. Medicine and the nature of vertical reasoning. New Engl J Med 1988; 318: 847-51.
  • 64 Kong A, Barnett GO, Mosteller F, Youtz C. How medical professionals evaluate expressions of probability. New Engl J Med 1986; 315: 740-4.
  • 65 Henry SB, Mead CN. Standardized nursing classification systems; necessary, but not sufficient, for representing what nurses do. In Cimino JJ. ed. Proceedings of the AMIA Annual Fall Symposium (Formerly SCAMC). Philadelphia, Washington, DC: Haniey and Belfus; 1996: 145-9.
  • 66 Huff SM, Rocha RA, Solbrig HR, Barnes MW, Schank SP, Smith M. Linking a medical vocabulary to a clinical data model using Abstract Syntax Notation 1. In Chute CG. ed. IMIA Working Group 6 Conference on Natural Language and Medical Concept Representation. Jacksonville, Florida: January 1997: 225-41.
  • 67 Huff SM, Craig RB, Gould BL, Castagno DL, Smilan RE. Medical data dictionary for decision support applications. In Stead WW. ed. Proceedings of the Eleventh Annual Symposium on Computer Applications in Medical Care (SCAMC). New York, Washington, DC: IEEE Computer Society Press; 1987: 310-7.
  • 68 Campbell KE, Musen MA. Creation of a systematic domain for medical care: the need for a comprehensive patient-description vocabulary. In Lun KC, Deguolet P, Piemme TE, Rienhoff O. eds. Proceedings of the Seventh World Congress on Medical Informatics (MEDINFO '92). Geneva: North-Holland (Amsterdam); 1992: 1437-42.
  • 69 Rector AL, Glowinski AJ, Nowlan WA, Rossi-Mori A. Medical-concept models and medical records: an approach based on GALEN and PEN&PAD. JAMIA 1995; 2: 19-35.
  • 70 Prokosh HU, Amiri F, Krause D, Neek G, Dudeck J. A semantic network model for the medical record rheumatology clinic. In Greenes RA, Peterson HE, Protti DJ. eds. Proceedings of the Eight World Congress on Medical Informatics (MEDINFO '95). Vancouver, British Columbia, Canada: Healthcare Computing & Communications (Canada); 1995: 240-4.
  • 71 Huff SM, Rocha RA, Bray BE, Warner HR, Haug PJ. An event model of medical information representation. JAMIA 1995; 2: 116-34.
  • 72 Johnson SB, Friedman C, Cimino JJ, Clark T, Hripcsak G, Clayton PD. Conceptual data model for a central patient database. In Clayton PD. ed. Proceedings of the Fifteenth Annual Symposium on Computer Applications in Medical Care (SCAMC). Washington, DC 1991: McGraw-Hill, New York; 1992: 381-5.
  • 73 Tuttle MS, Nelson SJ. A poor precedent. Meth Inform Med 1996; 35: 211-7.
  • 74 Cimino JJ, Clayton PD. Coping with changing controlled vocabularies. In Ozbolt JG. Proceedings of the Eighteenth Annual Symposium on Computer Applications in Medical Care. New York, Washington, DC: November McGraw-Hill; 1994: 135-9.
  • 75 Hripcsak G, Allen B, Cimino JJ, Lee R. Access to data: comparing Access Med with Query by Review. JAMIA 1996; 3: 288-99.
  • 76 Cimino JJ. Representation of clinical laboratory terminology in the Unified Medical Language System. In Clayton PD. ed proceedings of the Fifteenth Annual Symposium on Computer Applications in Medical Care (SCAMC). Washington, DC, 1991: McGraw-Hill, New York; 1992: 199-203.
  • 77 Cimino JJ, Sideli RV. Using the UMLS to bring the library to the bedside. Medical Decision Making 1991; 11 (Suppl) S116-S120.
  • 78 Cimino JJ, Barrows RC, Allen B. Adapting ICD9-CM for clinical decision support (abstract). In Musen MA. ed. Proceedings of the 1992 Spring Congress of the American Medical Informatics Association. Portland, Oregon: May 1992. The Association, Bethesda, MD; 1992: 34.
  • 79 Cimino JJ. Use of the Unified Medical Language System in patient care at the Columbia-Presbyterian Medical Center. Meth Inform Med 1995; 34: 158-64.
  • 80 Schulz EB, Price CS, Brown PJB. Symbolic anatomic knowledge representation in the Read Codes Version 3: structure and application. Journal of the American Medical Association 1997; 4: 38-48.
  • 81 Forrey AW, McDonald CJ, DeMoor G, Huff SM, Leaville D, Leland D, Fiers T, Charles L, Griffin B, Stalling F, Tullis A, Hutchins K, Baenziger J. Logical observation identifier names and codes (LOINC) database: a public use set of codes and names for electronic reporting of clinical laboratory test results. Clinical Chemistry 1996; 42: 81-90.
  • 82 Rocha RA, Huff SM. Coupling vocabularies and data structures: lessons from LOINC. In Cimino JJ. ed. Proceedings of the AMIA Annual Fall Symposium (Formerly SCAMC). Washington, DC: Hanley and Belfus, Philadelphia; 1996: 90-4.
  • 83 Tuttle MS. The position of the Canon group: a reality check. JAMIA 1994; 1: 298-9.
  • 84 United States General Accounting Office. Automated Medical Records: Leadership Needed to Expedite Standards Development: report to the Chairman/Committee on Governmental Affairs, U.S. Senate. Washington, DC: USGAO/IMTEC-93-17; April 1993
  • 85 Board of Directors of the American Medical Informatics Association. Standards for medical identifiers, codes, and messages needed to create an efficient computer-stored medical record. JAMIA 1994; 1: 1-7.