Formal Descriptions and Adaptive Mechanisms for Changes in Controlled Medical Vocabularies

Abstract:

Standard controlled medical vocabularies are typically based on a coding scheme, while medical informatics applications tend to have a more formal conceptual foundation. When such applications attempt to use data coded with standard vocabularies, problems can arise when the standard vocabulary changes over time. A formal taxonomy is presented for describing the semantic changes which can occur in a vocabulary, such as simple addition, refinement, precoordination, disambiguation, redundancy, obsolescence, discovered redundancy, major name changes, minor name changes, code reuse, and changed codes. The taxonomy is described that used to effect change in one concept-based vocabulary (the Medical Entities Dictionary), and the utility of the approach is demonstrated by applying it to the changes appearing in the 1994 release of the International Classification of Diseases, Ninth Edition, with Clinical Modifications (ICD-9-CM).

Keywords:

Controlled Medical Vocabulary - Nomenclature - Taxonomy - Electronic Patient Records - Medical Record Coding

• References

• 1 United States National Center for Health Statistics. International Classification of Diseases, Ninth Revision, with Clinical Modifications. Washington DC: 1980
• 2 Jollis JG, Ancukiewicz M, DeLong ER, Pryor DB, Muhlbaier LH, Mark DB. Discordance of databases designed for claims payment versus clinical information systems. Implications for outcomes research. Ann Intern Med 1993; 119: 844-50.
• 3 Nelson BD, Gardner RM, Hedrick G, Gould P. Decision support for concurrent utilization review using the HELP system. JAMIA 1994; 1: 339-52.
• 4 Cimino JJ, Johnson SB, Aguirre A, Roderer N, Clayton PD. The Medline Button. In: Frisse ME. ed. Proceedings of the Sixteenth Annual Symposium on Computer Applications in Medical Care. New York: McGraw-Hill; 1992: 81-5.
• 5 Gersenovic M. The ICD family of classifications. Meth Inform Med 1995; 34: 172-5.
• 6 Lindberg DAB, Humphreys BL, McCray AT. The Unified Medical Language System. Meth Inform Med 1993; 32: 281-91.
• 7 Tuttle MS, Olson NE, Campbell KE, Sherertz DD, Nelson SJ, Cole WG. Formal Properties of the Metathesaurus. In: Ozbolt JG. ed. Proceedings of the Eighteenth Annual Symposium on Computer Applications in Medical Care. New York: McGraw-Hill; 1994: 145-9.
• 8 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.
• 9 Campbell KE. Distributed Development of a Logic-based Controlled Medical Terminology. (Dissertation proposal). Stanford CA: Stanford University; 1994
• 10 Cimino JJ, Clayton PD. Coping with changing controlled vocabularies. In: Ozbolt JG. ed. Proceedings of the Eighteenth Annual Symposium on Computer Applications in Medical Care. New York: McGraw-Hill; 1994: 135-9.
• 11 World Health Organisation. International Classification of Diseases Index. Manual for the International Statistical Classification of Diseases. (9th ed).. Geneva: 1977
• 12 McCray AT, Aronson AR, Browne AC, Rindfleisch TC, Razi A, Srinivasan S. UMLS knowledge for biomedical language processing. Bull Med Libr Assoc 1993; 81: 184-94.
• 13 Cimino JJ, Hripcsak G, Johnson SB, Friedman C, Clayton PD. Prototyping a vocabulary management system in an object-oriented environment. In: Timmers T, Blum BI. eds. Proceedings of the International Medical Informatics Association Working Conference on Software Engineering in Medical Informatics. Amsterdam: North Holland; 1990: 429-39.
• 14 Cimino JJ, Johnson SB, Hripcsak G, Hill CL, Clayton PD. Managing vocabulary for a centralized clinical system. In: Kaihara S, Greenes RA. eds. Proceedings of the World Congress on Medical Informatics, Medinfo 95. Vancouver: 1995: 117-20.