Access to Health Care Information Resources through Intelligent Controlled Terminologies

James J. Cimino, M.D.

Columbia University

Department of Medical Informatics

Overview

• What needs fixing?

• What is an "intelligent controlled

terminology?"

• How does it assist with access to

information resources?

What Needs Fixing?

• Finding the right resource is hard

• Using each resource is awkward

• It's easy to get overwhelmed

Example: Weird Organism

• Encountered on lab test result

• What resource has the right information?

• How do I get to the resource?

• How do I ask the question?

• What was that organism again?

Solution: "Infobuttons"

• Button is integrated with clinical system

• Knows that Medline has information

• Knows how to get to Medline

• Knows how to translate organism name

• Knows how to query Medline

• Result: one-touch Medline search

Under the Hood:Intelligent Controlled Terminology

• CPMC Medical Entities Dictionary (MED)

• Semantic network of 50,000 concepts

• Includes definitional information through

semantic relationships

• Tightly coupled with the Unified Medical

Language System

Medical Entities Dictionary

MedicalEntity

Substance LaboratorySpecimen Event

DiagnosticProcedure

LaboratoryTest

LaboratoryProcedure

CHEM-7PlasmaGlucose

PlasmaSpecimen

AnatomicSubstance

BioactiveSubstance

Glucose

Plasma

Chemical

Carbo-hydrate

Substance

Sampled

Part of

Has S

pecimen

Substance Measured

How does the Infobutton Work?

Clinician

Internet

Web Server

VocabularyServer

Information Source

ClinicalInformation

System

Information Source

Examples of Infobuttons

• Laboratory tests to Medline

• Laboratory tests to DXplain

• Cholesterol results to guideline

• X-ray reports to variety of Web resources

• Patient medications to drug references

screen shots galore• Laboratory tests to Medline

– Chem20– Question list

• Laboratory tests to DXplain– DXplain Diseases (list)– DXplain Disease (result)– List of findings– Differential diagnosis

• Cholesterol results to guideline– Does pt have CHD?– Recommendation lipid lowering agent

• X-ray reports to variety of Web resources– X-ray report– Findings– Questions– Medline results– Medline abstract– Chorus page

• Patient medications to drug references– ?????????

Advantages of Knowledge-Based Approach

• Re-use of terms by multiple applications

• Translation of terms between applications

• Integration of data from multiple sources

• Coordination of patient data with information resource concepts

• Ability to support maintenance of the terminology itself

Implications for Federal Information Resources

• Allow more sophisticated access to resources

• Reusability of terminology

• Maintenance of terminology