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Coping with Changing Controlled Vocabularies

Coping with Changing Controlled Vocabularies. James J. Cimino, M.D. Paul D. Clayton, Ph.D. Department of Medical Informatics Columbia University. Changes in ICD9-CM. Additions Deletions Minor Name Changes Major Name Changes Refinements. Additions.

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Coping with Changing Controlled Vocabularies

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  1. Coping with Changing Controlled Vocabularies James J. Cimino, M.D. Paul D. Clayton, Ph.D. Department of Medical Informatics Columbia University

  2. Changes in ICD9-CM • Additions • Deletions • Minor Name Changes • Major Name Changes • Refinements

  3. Additions 070.44: CHRONIC HEPATITIS C WITH HEPATIC COMA 333.92: NEUROLEPTIC MALIGNANT SYNDROME 512.1: IATROGENIC PNEUMOTHORAX 677: LATE EFFECTS OF COMPLICATION OF PREGNANCY, CHILDBIRTH, THE PUERPERUM 759.83: FRAGILE X SYNDROME

  4. More Additions 789.6: ABDOMINAL TENDERNESS V50.4: PROPHYLACTIC ORGAN REMOVAL E869.4: ACCIDENTAL POISONING BY SECOND-HAND TOBACCO SMOKE 34.05: AUTOLOGOUS HEMATOPOETIC STEM CELL TRANSPLANT

  5. Deletions 043.0: ACQUIRED IMMUNODEFICIENCY SYNDROME, UNSPECIFIED 305.13: TOBACCO USE DISORDER, IN REMISSION

  6. Minor Name Changes 070.41:HEPATITIS C WITH HEPATIC COMAACUTE OR UNSPECIFIED HEPATITIS C WITH HEPATIC COMA 440.2: ATHEROSCLEROSIS OF ARTERIES OF THE EXTREMITIESATHEROSCLEROSIS OF NATIVE ARTERIES OR EXTREMITIES 770.1:MASSIVE ASPIRATION SYNDROME OF NEWBORNMECONIUM ASPIRATION SYNDROME

  7. Major Name Changes 344.0:HEMIPLEGIAHEMIPLEGIA AND HEMIPARESIS V45.0:POSTSURGICAL CARDIAC PACEMAKER IN SITUCARDIAC DEVICE IN SITU

  8. Refinements 441.0: DISSECTING ANEURYSM (ANY PART) 441.0: DISSECTING AORTIC ANEURYSM 441.00: DISSECTING AORTIC ANEURYSM OF UNSPECIFIED SITE 441.01: DISSECTING THORACIC AORTIC ANEURYSM 441.02: DISSECTING ABDOMINAL AORTIC ANEURYSM 441.03: DISSECTING THORACOABDOMINAL AORTIC ANEURYSM

  9. Code Change Removed 795.8: POSITIVE SEROLOGICAL OR VIRAL CULTURE FINDING FOR HUMAN IMMUNODEFICIENCY VIRUS (HIV) ASSOCIATED VIRUS (HTLV-III/LAV) Added 795.71: NONSPECIFIC SEROLOGIC EVIDENCE OF HUMAN IMMUNODEFICIENCY VIRUS (HIV)

  10. Volatile Vocabulary/Persistent Data 1980 1992 99.71 MERCURY-ZINC PACEMAKER 99.71 THERAPEUTIC PLASMAPHERESIS ??? 99.71 Patient Database

  11. Historical Vocabulary • Store the code • Keep track of when the code changes • Look up the meaning of the code based on date it was used

  12. Retrieval Using Historical Vocabulary IF (Code=75.22 and Year<1990) OR (Code=76.2 and Year=1991) OR ((Code=76.20 or Code=76.21) AND Year=1992)...

  13. CPMC Approach: Encode the Meaning • Each code corresponds with one meaning (concept) • Each concept may or may not have an ICD9 Code • If ICD9 term changes meaning, it is no longer associated with the concept

  14. Deletion Concept Code: 10101 Concept Name: Tobacco Use Disorder, in Remission ICD9 Code: 305.13 ICD9 Entry Code: Old ICD9 Code: Concept Code: 10101 Concept Name: Tobacco Use Disorder, in Remission ICD9 Code: ICD9 Entry Code: 305.1 Old ICD9 Code: 305.13

  15. Minor Name Change Concept Code: 31313 Concept Name: Massive Aspiration Syndrome of Newborn ICD9 Code: 770.1 ICD9 Entry Code: Old ICD9 Code: Concept Code: 31313 Concept Name: Meconium Aspiration Syndrome ICD9 Code: 770.1 ICD9 Entry Code: Old ICD9 Code:

  16. Major Name Change Code: 21212 Name: Mercury-Zinc Pacemaker ICD9: 99.71 Entry: Old: Code: 21212 Name: Mercury-Zinc Pacemaker ICD9: Entry: <none> Old: 99.71 Code: 44444 Name: Therapeutic Plasmapheresis ICD9: 99.71 Entry: Old:

  17. Volatile Vocabulary/Persistent Data 1980 1992 99.71 MERCURY-ZINC PACEMAKER MERCURY-ZINC PACEMAKER (Old Code 99.71) 21212 Patient Database

  18. Additional Situations • New redundancy • Discovering old redundancy • Ambiguity • Disambiguation • Obsolescence • Precoordination

  19. Advantages of Concept-Based Approach • Database contains original meaning • Concept-oriented retrieval is easier

  20. Conclusions • Vocabulary changes are inevitable • Store what the clinician means • Map the vocabulary to the meanings, not the reverse

  21. Definitions • Users: attendings, nurses, residents, respiratory care technicians, dieticians, social workers, students • Knowledge: textbooks, bibliographic databases, guidelines (passive), algorithms (active) • Point of care: clinic, emergency room, in-patient floors, ICU’s, recovery rooms

  22. Access to Information Sources ??? “Electronic Library”

  23. Integrated Access to Information Context ??? Concepts Data Clinical Information System

  24. “Medline Button” Design • Application-specific questions (Mad Libs) • Coded clinical information to fill in the blanks • Medical Entities Dictionary of concepts • Translation using the UMLS • Scripts for accessing on-line resources

  25. Implementations • 3270 Admission/Discharge Profile: ICD9 -> MeSH -> Medline • X-Windows Laboratory Summary:Lab terms -> MeSH -> Medline, DXplain, HSTAT • Mosaic clinical information system

  26. Challenges • What questions arise in different contexts? • What information source is right for each? • How are the concepts translated? • How are complex retrievals performed? • How is the knowledge presented?

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