Query Health Concept-to-Codes (C2C) SWG Meeting #3 December 20,
2011 1
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Todays Agenda TopicTime Allotted Review of Updated Timeline and
Future Meeting Times Questions for Consideration and Proposed
outline of end deliverable 3:00 3:05 Presentation by Subject Matter
Experts Shawn Murphy i2B2 (Cont.) 3:05 - 3:15 Stan Huff CMIO
Intermountain Health 3:15 3:30 Rick Biehl DOQS 3:30 3:45 Oliver
Bodenreider - NLM 3:45 - 4:00 2
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Proposed Timeline Meeting 1 Dec 6Meeting 2 Dec 13Meeting 3 Dec
20Meeting 4 Jan 03Meeting 5 Jan 10Meeting 6 Jan 17th Tasks Review
of presented concept mapping frameworks to develop a proposed
approach Presentation and review of Draft Deliverable with the SWG
Tasks Presentation from 3-4 additional SMEs on Concept Mapping in
their organizations (if needed) Tasks Presentation from 3-4 SMEs on
Concept Mapping in their organizations Tasks Presentation from 3-4
SMEs on Concept Mapping in their organizations Tasks Introductions
Scope Proposed Approach Identify SME and presentation timeline for
next few meetings TODAY Coordinate offline activities to summarize
approaches and develop draft deliverable from presenters 3 Tasks
Presentation from 3-4 SMEs on Concept Mapping in their
organizations Starting Jan 3 rd, meeting times extended from
2:30-4:00pm Link -
http://wiki.siframework.org/C2C+SME+Presentation+Schedule
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Questions for Considerations Frameworks (Ex. - i2B2, PMN,
hQuery) Tools (Ex. RxNav, RELMA, LexEVS) Standards Overview and
Current Status How do you define concept mapping within your system
(e.g. are you mapping in between standards, or are you mapping from
standards to your local data dictionary)? Are there any internal
mechanism? Do you use any external tools? Are you able to maintain
the integrity of the original data in its native form (i.e. data as
collected and not modified)? How does your tool function? Are you
able to maintain the integrity of the original data in its native
form (i.e. data as collected and not modified)? How do your
standards relate to concept mapping? Are you able to maintain the
integrity of the original data in its native form (i.e. data as
collected and not modified)? Integration and Infrastructure How can
you integrate with external tools for mapping? JavaScript library?
Java? Web Services API? How can your tool be leveraged? Are there
any external APIs or other interfaces? What infrastructure is
necessary to implement / utilize your standard? Alignment to Query
Health Is your framework geared towards the Data Source? The
Information Requestor? Or Both? Is your tool geared towards the
Data Source? The Information Requestor? Or Both? Are the standards
developed around concept mapping at the data source level? The
Information Requestor level? Or Both? Maintenance Who maintains
your concept mapping tool? Who maintains the mappings and how often
are they released? What is the associated cost with maintenance?
Who maintains your concept mapping tool? Who maintains the mappings
and how often are they released? What is the associated cost with
maintenance ? Who maintains the development of standards? Who
maintains the mappings and how often are they released? What is the
associated cost with maintenance and periodic releases? 4
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Proposed Layout of Deliverable The deliverable will be a Word
document divided into the following sections. Abstract Short
summary of recommended concept mapping approach Background Scope
and Objectives Discovery SMEs / Organization Scan Distributed query
systems Concept mapping experts on standards/frameworks Other
relevant concept mapping tools Development and discussion of
targeted questions Review of short presentations by SME Discuss
Summary of gathered information on concept mapping General summary
of the organization Summary of the tool, framework, or standard
presented Key points from the presentation Conclusion
Recommendation on proposed framework for Concept Mapping Next Steps
5
Use cases for i2b2 Ontology Services 1 - Mapping a Global to a
Local Terminology for SHRINE queries 2 - Merging one terminology
into another to enable queries using two terminologies
simultaneously 7
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Ontology Use Case in i2b2 for Shared Health Research
Information Network (SHRINE) Queries are created using ontology
presented in web client Queries are distributed to multiple sites
using central ontology Central ontology is transformed to local
ontology at each site 8
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Distributed Query System Dark Blue = core i2b2 technology Light
Blue = SHRINE modules (cells) 9
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Example Using BioPortal SNOMED_CT to populate i2b2 ontology
10
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Bioportal Clinical Finding view 11
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NCBO Extraction workflow NCBO REST XML NCBO REST XML Request to
extract ontology i2b2 Metadata Extraction Workflow SNOMED view
Extracted Data Process 12
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Extracted SNOMED terms 13
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Providing mappings using NCBO services Mapping cell Need for
mapping different site-specific ontologies in cross-institutional
settings. (SNOMED_CT ICD-9, RxNORM NDC) First look for locally
mapped data Then seek mappings through NCBO services.
http://bioportal.bioontology.org/mappings/service/1101/ Mapper Cell
Request to map local code ICD9 SNOMED_CT NCBO REST XML NCBO REST
XML Locally Mapped data 14
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Integrating two i2b2 ontologies with NCBO services Integrate
ICD-9 into SNOMED For each SNOMED term, find a mapped ICD9 term:
Request to integrate Integration Workflow ICD9 into SNOMED_CT
SNOMED with ICD9 Data Mapper Cell Add new terms with SNOMED
hierarchy, ICD9 name, basecode NCBO REST XML NCBO REST XML 15
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SNOMED folder with ICD9 terms 16
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ICD10 folder with ICD9 terms 17
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Stanley M. Huff, MD Intermountain Healthcare 18
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Define concept mapping? Concept mapping is typically to support
data transformation Concept mapping is always purpose specific
Clinical care Public health reporting Billing Secondary use of data
19
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Information models Since mappings are typically for data
transformation or conversion, detailed clinical data models provide
context data 138 mmHg quals SystolicBPObs data Right Arm
BodyLocation data Sitting PatientPosition 20
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Kinds of mappings Structure changes and code translations on
storage Only normalized data in the EHR Usually from local codes to
standard codes Local lab test and result codes to LOINC Local
problems to SNOMED CT Clinical problems (SNOMED CT) to billing
codes (ICD-10) 21
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Mapping Tools Internal tools Lexical matching using Dice
Coefficient External tools RELMA Preservation of original data
Mostly eventual deletion of log files Responsibility of sending
system Geared to data source or requestor? I dont understand the
question We can use terminology services Can also use Java, Java
Script 22
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Maintenance of mappings We maintain our own mappings Cost 14
FTEs that create models, terminology, and mappings 1,200 HL7
interfaces 3 million patients 31,000 employees No one else uses our
mappings 23
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Rick Biehl, Ph.D Data Oriented Quality Solutions (DOQS) 24
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Query Health Clinical WG, 2011-12-20 25
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Query Health Clinical WG, 2011-12-20 CLINICAL PHENOTYPE
GENOTYPE 26
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Query Health Clinical WG, 2011-12-20 CLINICAL PHENOTYPE
GENOTYPE 27
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Query Health Clinical WG, 2011-12-20 28
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Query Health Clinical WG, 2011-12-20 29
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Query Health Clinical WG, 2011-12-20 30
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Query Health Clinical WG, 2011-12-20 CATEGORY Hospital
Physician Drug 31
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Query Health Clinical WG, 2011-12-20 ROLE Admitting Hospital
Transferring Hospital Attending Physician Consulting Physician
Admitting Physician Ordered Drug Administered Drug 32
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Query Health Clinical WG, 2011-12-20 PERSPECTIVE TYPE :
Network, Directed Acyclic Graph, or Hierarchy ICD-9 384.6
decomposes ICD-9 384 Acetaminophen is an Analgesic Tylenol brands
Acetaminophen Tylenol 350 Caps instantiates Tylenol Vesicle is an
Organelle Lower jaw bone is synonym of Mandible 33
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Query Health Clinical WG, 2011-12-20 How many analgesics were
administered? PERSPECTIVE ROLE CATEGORY Query all facts where a
drug (category) was administered (role) and Analgesic was available
in any higher perspective. 34
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Query Health Clinical WG, 2011-12-20 Data that complies with
the meta-model defined by the BFO will be able to behave in an
integrated way across widely varying federated data structures.
35
Query Health Clinical WG, 2011-12-20 Spatiotemporal Region SNAP
Continuant SPAN Occurrent Spatial Region Independent Continuant
Dependent Continuant Processual Entity Temporal Region Site Object
Object Aggregate Fiat Part of Object Boundary of Object 3D, 2D, 1D,
0D Quality Realizable Entity Function Role Disposition Scattered
Spatiotemporal Region Connected Spatiotemporal Region
Spatiotemporal Interval Spatiotemporal Instant Processual Context
Process Aggregate Process Fiat Part of Process Boundary of Process
Scattered Temporal Region Connected Temporal Region Temporal
Interval Temporal Instant Basic Formal Ontology (BFO) 37
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Query Health Clinical WG, 2011-12-20 Spatiotemporal Region SNAP
Continuant SPAN Occurrent Spatial Region Independent Continuant
Dependent Continuant Processual Entity Temporal Region Site Object
Object Aggregate Fiat Part of Object Boundary of Object 3D, 2D, 1D,
0D Quality Realizable Entity Function Role Disposition Scattered
Spatiotemporal Region Connected Spatiotemporal Region
Spatiotemporal Interval Spatiotemporal Instant Processual Context
Process Aggregate Process Fiat Part of Process Boundary of Process
Scattered Temporal Region Connected Temporal Region Temporal
Interval Temporal Instant Basic Formal Ontology (BFO) Calendar
Clock Clinical Data Warehouse (CDW) (a) 38
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Query Health Clinical WG, 2011-12-20 Spatiotemporal Region SNAP
Continuant SPAN Occurrent Spatial Region Independent Continuant
Dependent Continuant Processual Entity Temporal Region Site Object
Object Aggregate Fiat Part of Object Boundary of Object 3D, 2D, 1D,
0D Quality Realizable Entity Function Role Disposition Scattered
Spatiotemporal Region Connected Spatiotemporal Region
Spatiotemporal Interval Spatiotemporal Instant Processual Context
Process Aggregate Process Fiat Part of Process Boundary of Process
Scattered Temporal Region Connected Temporal Region Temporal
Interval Temporal Instant Basic Formal Ontology (BFO) Geopolitics
Calendar Clock Clinical Data Warehouse (CDW) (a) (b) 39
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Query Health Clinical WG, 2011-12-20 Spatiotemporal Region SNAP
Continuant SPAN Occurrent Spatial Region Independent Continuant
Dependent Continuant Processual Entity Temporal Region Site Object
Object Aggregate Fiat Part of Object Boundary of Object 3D, 2D, 1D,
0D Quality Realizable Entity Function Role Disposition Scattered
Spatiotemporal Region Connected Spatiotemporal Region
Spatiotemporal Interval Spatiotemporal Instant Processual Context
Process Aggregate Process Fiat Part of Process Boundary of Process
Scattered Temporal Region Connected Temporal Region Temporal
Interval Temporal Instant Basic Formal Ontology (BFO) Organization
Caregiver Patient Anatomy Diagnosis Procedure Material Facility
Accounting Geopolitics Calendar Clock Clinical Data Warehouse (CDW)
(a) (b) (c) 40
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Query Health Clinical WG, 2011-12-20 Spatiotemporal Region SNAP
Continuant SPAN Occurrent Spatial Region Independent Continuant
Dependent Continuant Processual Entity Temporal Region Site Object
Object Aggregate Fiat Part of Object Boundary of Object 3D, 2D, 1D,
0D Quality Realizable Entity Function Role Disposition Scattered
Spatiotemporal Region Connected Spatiotemporal Region
Spatiotemporal Interval Spatiotemporal Instant Processual Context
Process Aggregate Process Fiat Part of Process Boundary of Process
Scattered Temporal Region Connected Temporal Region Temporal
Interval Temporal Instant Basic Formal Ontology (BFO) Organization
Caregiver Patient Anatomy Diagnosis Procedure Material Facility
Accounting Geopolitics Calendar Clock Clinical Data Warehouse (CDW)
(d) 41
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Query Health Clinical WG, 2011-12-20 Spatiotemporal Region SNAP
Continuant SPAN Occurrent Spatial Region Independent Continuant
Dependent Continuant Processual Entity Temporal Region Site Object
Object Aggregate Fiat Part of Object Boundary of Object 3D, 2D, 1D,
0D Quality Realizable Entity Function Role Disposition Scattered
Spatiotemporal Region Connected Spatiotemporal Region
Spatiotemporal Interval Spatiotemporal Instant Processual Context
Process Aggregate Process Fiat Part of Process Boundary of Process
Scattered Temporal Region Connected Temporal Region Temporal
Interval Temporal Instant Basic Formal Ontology (BFO) Organization
Caregiver Patient Encounter Anatomy Diagnosis Procedure Material
Facility Accounting Geopolitics Calendar Clock Clinical Data
Warehouse (CDW) Operation (d) (e) 42
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Query Health Clinical WG, 2011-12-20 Spatiotemporal Region SNAP
Continuant SPAN Occurrent Spatial Region Independent Continuant
Dependent Continuant Processual Entity Temporal Region Site Object
Object Aggregate Fiat Part of Object Boundary of Object 3D, 2D, 1D,
0D Quality Realizable Entity Function Role Disposition Scattered
Spatiotemporal Region Connected Spatiotemporal Region
Spatiotemporal Interval Spatiotemporal Instant Processual Context
Process Aggregate Process Fiat Part of Process Boundary of Process
Scattered Temporal Region Connected Temporal Region Temporal
Interval Temporal Instant Basic Formal Ontology (BFO) Organization
Caregiver Patient Encounter Anatomy Diagnosis Procedure Material
Facility Accounting Geopolitics Calendar Clock Clinical Data
Warehouse (CDW) Operation Facts (d) (f) (e) 43
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Query Health Clinical WG, 2011-12-20 Spatiotemporal Region SNAP
Continuant SPAN Occurrent Spatial Region Independent Continuant
Dependent Continuant Processual Entity Temporal Region Site Object
Object Aggregate Fiat Part of Object Boundary of Object 3D, 2D, 1D,
0D Quality Realizable Entity Function Role Disposition Scattered
Spatiotemporal Region Connected Spatiotemporal Region
Spatiotemporal Interval Spatiotemporal Instant Processual Context
Process Aggregate Process Fiat Part of Process Boundary of Process
Scattered Temporal Region Connected Temporal Region Temporal
Interval Temporal Instant Basic Formal Ontology (BFO) Organization
Caregiver Patient Encounter Anatomy Diagnosis Procedure Material
Facility Accounting Geopolitics Calendar Clock Clinical Data
Warehouse (CDW) Operation Facts (d) (g) (f) (e) 44
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Query Health Clinical WG, 2011-12-20 Spatiotemporal Region SNAP
Continuant SPAN Occurrent Spatial Region Independent Continuant
Dependent Continuant Processual Entity Temporal Region Site Object
Object Aggregate Fiat Part of Object Boundary of Object 3D, 2D, 1D,
0D Quality Realizable Entity Function Role Disposition Scattered
Spatiotemporal Region Connected Spatiotemporal Region
Spatiotemporal Interval Spatiotemporal Instant Processual Context
Process Aggregate Process Fiat Part of Process Boundary of Process
Scattered Temporal Region Connected Temporal Region Temporal
Interval Temporal Instant Basic Formal Ontology (BFO) Organization
Caregiver Patient Encounter Anatomy Diagnosis Procedure Material
Facility Accounting Geopolitics Calendar Clock Clinical Data
Warehouse (CDW) Operation Facts Queries happen here! 45
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Query Health Clinical WG, 2011-12-20 Thank You! You are welcome
to contact me for additional information at any time: Richard E.
Biehl, Ph.D. Data-Oriented Quality Solutions [email protected]
46
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Oliver Bodenreider, M.D. NLM 47
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NLM resources for Clinical Concept Mapping Standards and
Interoperability (S&I) Framework Clinical Concept Mapping
(Sub-Work Group) December 20, 2011 Dr. Olivier Bodenreider U.S.
National Library of Medicine, Bethesda, MD 48
Integrating vocabularies Biomedical literature Biomedical
literature MeSH Genome annotations Genome annotations GO Model
organisms Model organisms NCBI Taxonomy Genetic knowledge bases
OMIM Clinical repositories Clinical repositories SNOMED CT Other
subdomains Other subdomains Anatomy FMA UMLS 50
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Integrating vocabularies Biomedical literature Biomedical
literature Genome annotations Genome annotations Model organisms
Model organisms Genetic knowledge bases Clinical repositories
Clinical repositories Other subdomains Other subdomains Anatomy
51
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Integrating vocabularies Genome annotations Genome annotations
GO Model organisms Model organisms NCBI Taxonomy Genetic knowledge
bases OMIM Other subdomains Other subdomains Anatomy FMA UMLS
Addison Disease (D000224) Addison's disease (363732003) Biomedical
literature Biomedical literature MeSH Clinical repositories
Clinical repositories SNOMED CT UMLS C0001403 52
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What does UMLS stand for? Unified Medical Language System UMLS
Unified Medical Language System UMLS Metathesaurus 53
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Organize terms Synonymous terms clustered into a concept
Preferred term Unique identifier (CUI) Addison's disease Addison
DiseaseMeSHD000224 Primary hypoadrenalismMedDRA10036696 Primary
adrenocortical insufficiencyICD-10E27.1 Addison's disease
(disorder)SNOMED CT363732003 C0001403 54
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Source Vocabularies 160 source vocabularies 21 languages Broad
coverage of biomedicine 8M names (normalized) 2.6M concepts >10M
relations Common presentation (2011AB) 55
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Source Vocabularies in UMLS General vocabularies anatomy (FMA,
Neuronames) drugs (RxNorm, First DataBank, Micromedex) medical
devices (UMD, SPN) Several perspectives clinical terms (SNOMED CT)
information sciences (MeSH) administrative terminologies (ICD-9-CM,
ICD-10-CM, CPT-4) data exchange terminologies (HL7, LOINC) 56
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Source Vocabularies in UMLS Specialized vocabularies nursing
(NIC, NOC, NANDA, Omaha, ICNP) dentistry (CDT) oncology (PDQ)
psychiatry (DSM, APA) adverse reactions (MedDRA, WHO ART) primary
care (ICPC) Terminology of knowledge bases ( AI/Rheum, DXplain, QMR
) The UMLS serves as a vehicle for the regulatory standards (HIPAA,
HITSP, Meaningful Use) The UMLS serves as a vehicle for the
regulatory standards (HIPAA, HITSP, Meaningful Use) 57
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Source vocabularies in RxNorm Gold Standard Alchemy Master Drug
Data Base (Medi-Span, Wolters Kluwer Health) Multum MediSource
Lexicon Micromedex DRUGDEX Medical Subject Headings FDA National
Drug Code Directory FDA Structured Product Labels Natl Drug Data
File (First DataBank Inc.) VHA National Drug File RT SNOMED
Clinical Terms (drug information) VHA National Drug File 26 67 46
66 55 38 85 88* 13 (terms in thousands, as of October 2011) 116* 19
58
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Application Programming Interfaces UMLS SOAP-based Supports
term-to-cui, code-to-cui and cui-to code (+ mapping relations)
https://uts.nlm.nih.gov//doc/devGuide/index.html
https://uts.nlm.nih.gov//doc/devGuide/index.html RxNorm SOAP-based
and RESTful Supports term-to-rxcui, code-to-rxcui and rxcui-to code
http://rxnav.nlm.nih.gov/ http://rxnav.nlm.nih.gov/ 59
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Questions for Considerations Frameworks (Ex. - i2B2, PMN,
hQuery) Resources and Tools (UMLS/UTS, RxNorm/RxNav) Standards
Overview and Current Status How do you define concept mapping
within your system (e.g. are you mapping in between standards, or
are you mapping from standards to your local data dictionary)? Are
there any internal mechanism? Do you use any external tools? Are
you able to maintain the integrity of the original data in its
native form (i.e. data as collected and not modified)? Terminology
integration system Source transparency (most original terminologies
can be recreated from the UMLS; generally not the case for RxNorm)
How do your standards relate to concept mapping? Are you able to
maintain the integrity of the original data in its native form
(i.e. data as collected and not modified)? Integration and
Infrastructure How can you integrate with external tools for
mapping? JavaScript library? Java? Web Services API? UMLS: - GUI:
UTS - API: SOAP-based RxNorm - GUI: RxNav - API: SOAP-based +
RESTful What infrastructure is necessary to implement / utilize
your standard? Alignment to Query Health Is your framework geared
towards the Data Source? The Information Requestor? Or Both?
Includes all major clinical terminologies Bridges between query
(text, code) and data source (standard code) Are the standards
developed around concept mapping at the data source level? The
Information Requestor level? Or Both? Maintenance Who maintains
your concept mapping tool? Who maintains the mappings and how often
are they released? What is the associated cost with maintenance?
NLM develops the UMLS and RxNorm (data + tooling) Release schedule
- UMLS: twice yearly - RxNorm: monthly No fee to the end user (but
license agreement required*) Who maintains the development of
standards? Who maintains the mappings and how often are they
released? What is the associated cost with maintenance and periodic
releases? 60
Other things you would need to know UMLS license agreement
https://uts.nlm.nih.gov/help/license/LicenseAgreement.pdf
https://uts.nlm.nih.gov/help/license/LicenseAgreement.pdf
MetamorphoSys
http://www.nlm.nih.gov/research/umls/implementation_resource
s/metamorphosys/index.html
http://www.nlm.nih.gov/research/umls/implementation_resource
s/metamorphosys/index.html UMLS Terminology Services (UTS)
https://uts.nlm.nih.gov/ https://uts.nlm.nih.gov/ 63
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References: RxNorm RxNorm home page Content
http://www.nlm.nih.gov/research/umls/
http://www.nlm.nih.gov/research/umls/ RxNav home page Browser +
APIs http://rxnav.nlm.nih.gov/ http://rxnav.nlm.nih.gov/ 64