Desiderata for Controlled Medical Vocabularies James J. Cimino.

Desiderata for ControlledMedical Vocabularies

James J. Cimino

Background

• Attempt to synthesize requirements expressed in the literature for the past decade

• Prepared for the IMIA Working Group 6 Jacksonville, Florida, January 1997

• Methods of Information in Medicine, 37(4/5), 1998

Desideratum I: Content

• Must seek to be provide breadth and depth

• Atoms versus molecules

• A formal methodology is needed

• Structure must not limit size

Desideratum II: Concept Orientation

• Concepts, not terms

• One meaning (nonvague)

• No more than one meaning (nonambiguous)

• Higher-level ambiguous

• One concept per meaning (nonredundant)

• May have multiple context-dependent meanings

Desideratum III:Concept Permanence

• Old concepts can't be deleted

- Example: non-A-non-B hepatitis

• Names can be changed as long as meaning doesn't change (retronyms)

- Example: transvenous pacemaker

Desideratum IV:Nonsemantic Concept Identifiers

• Don't use the name

• Don't use a code that will run out of room

• Don't use a hierarchical code

• Meaningless integer (+/- check digit)

Desideratum V: Polyhierarchy

• Needed for tree walking

• Needed for inferencing

• Needed for "essence"

• Example: diseases of the liver which also involve the kidney

Desideratum VI:Formal Definitions

• Support understanding

• Support maintenance

• Structured and controlled (not narrative)

• Represented through relationships within the vocabulary

• Defintional versus assertional knowledge

• Additional effort minimal and will pay off

Desideratum VII: Reject "Not Elsewhere Classified"

• Can never have a formal definition

• Vocabulary changes induce semantic drift

• There are valid alternatives

Desideratum VIII:Multiple Granularities

• Different levels for different purposes

• Uncertainty is allowed, imprecision is not (we must be precise about our uncertainty)

Desideratum IX:Multiple Consistent Views

• Multiple views for multiple purposes

• Must not lead to inconsistency

A

B C

D E F

HG I

A

B C

D E F

HG I

A

B C

D E F(G,H) (I)

A

D E F

HG I

A

B C

D E F

HG I

A

B C

D E F

HG I

A

B C

D E F

HG I

A

B C

D F

I

E

HG

A

B C

D E F

HG I

E

HG

A

B C

D E F

HG I

E

A

B C

D E F

HG I

Desideratum X:Representing Context

• Needed: a grammar to show usage

• "What is sensible to say"

• Consider modeling "events"

Controlled Medical Vocabulary

Definitional Knowledge(how concepts define each other)

Body Site

Joint

is -a

Finding

JointSwelling

PathologicFunction

Swelling

is -a is -a

Right Kneeis -a

has-abnormality

has-site



Assertional Knowledge(how concepts combine)

Body Site

Body Site Findingmodifies

Joint

is -a

Finding

JointSwelling

PathologicFunction

Swelling

is -a is -a

Right Kneeis -a

has-abnormality

has-site




Contextual Knowledge(how concepts are used)

Body Site

Body Site FindingFinding Physical Exam

ProgressNote

HospitalAdmission

part-of

part -of

part-of

modifies

Joint

is -a

Finding

JointSwelling

PathologicFunction

Swelling

is -a is -a

Right Kneeis -a

has-abnormality

has-site

Electronic Medical Record





Body Site


ProgressNote

HospitalAdmission

part-of

part -of

part-of

modifies

Joint

is -a

Finding

JointSwelling

PathologicFunction

Swelling

is -a is -a

Right Kneeis -a

has-abnormality

has-site






Body Site


ProgressNote

HospitalAdmission

part-of

part -of

part-of

modifies

Hospital Admission

Joint

is -a

Finding

JointSwelling

PathologicFunction

Swelling

is -a is -a

Right Kneeis -a

has-abnormality

has-site






Body Site


ProgressNote

HospitalAdmission

part-of

part -of

part-of

modifies

Hospital Admission

Progress Note Progress Note

Joint

is -a

Finding

JointSwelling

PathologicFunction

Swelling

is -a is -a

Right Kneeis -a

has-abnormality

has-site

Progress Note






Body Site


ProgressNote

HospitalAdmission

part-of

part -of

part-of

modifies

Hospital Admission

Progress Note

Progress Note

Progress Note

Joint

is -a

Finding

JointSwelling

PathologicFunction

Swelling

is -a is -a

Right Kneeis -a

has-abnormality

has-site






Body Site


ProgressNote

HospitalAdmission

part-of

part -of

part-of

modifies

Hospital Admission

Progress Note

Progress Note

Progress Note

Physical Exam

Joint

is -a

Finding

JointSwelling

PathologicFunction

Swelling

is -a is -a

Right Kneeis -a

has-abnormality

has-site






Body Site


ProgressNote

HospitalAdmission

part-of

part -of

part-of

modifies

Hospital Admission

Progress Note

Progress Note

Progress Note

Physical Exam

Finding:

Joint

is -a

Finding

JointSwelling

PathologicFunction

Swelling

is -a is -a

Right Kneeis -a

has-abnormality

has-site






Body Site


ProgressNote

HospitalAdmission

part-of

part -of

part-of

modifies

Hospital Admission

Progress Note

Progress Note

Progress Note

Physical Exam

Finding: [Joint Swelling]

Joint

is -a

Finding

JointSwelling

PathologicFunction

Swelling

is -a is -a

Right Kneeis -a

has-abnormality

has-site






Body Site


ProgressNote

HospitalAdmission

part-of

part -of

part-of

modifies

Hospital Admission

Progress Note

Progress Note

Progress Note

Physical Exam

Finding: [Joint Swelling [Right Knee]]

Joint

is -a

Finding

JointSwelling

PathologicFunction

Swelling

is -a is -a

Right Kneeis -a

has-abnormality

has-site

Desideratum XI:Graceful Evolution

• Will always need to fix mistakes

• Medical knowledge will grow

• Bad reasons

• Good reasons


• Bad reasons:

- Redundancy

- Major name changes

- Code reuse

- Changed codes


• Good reasons:

- Simple addition

- Refinement

- Minor name changes

- Precoordination

- Disambiguation

- Obsolescence

- Discovered redundancy

Desideratum XII:Recognize Redundancy

• Synonyms are good• Redundant concepts are bad• Redundant expressions are inevitable• Example:

- Year 1: "Pneumonia", "Left Lower Lobe"

- Year 2: "Left Lower Lobe Pneumonia"


Pneumonia

Finding

Left Lower Lobe


Left Lower Lobe Pneumonia Pneumonia

Finding

Left Lower Lobe


Left Lower Lobe Pneumonia is-a: Pneumonia

Pneumonia

Finding

Left Lower Lobe


Left Lower Lobe Pneumonia is-a: Pneumonia has-site: Left Lower Lobe

Pneumonia

Finding

Left Lower Lobe


Left Lower Lobe Pneumonia is-a: Pneumonia has-site: Left Lower Lobe participates-in: Finding

Pneumonia

Finding

Left Lower Lobe

Status Report

I. Content

II. Concept Orientation

III. Concept Permanence

IV. Nonsemantic Concept Identifiers

V. Polyhierarchy

VI. Formal Definitions

Status Report

• VII. Reject "Not Elsewhere Classified"

• VIII. Multiple Granularities

• IX. Multiple Consistent Views

• X. Representing Context

• XI. Graceful Evolution

• XII. Recognize Redundancy

Practical Considerations

• Think “Concept Orientation”

• Have an editorial policy

• Consider explicit definitions

• Nonsemantic identifiers

• Include “is-a” attribute

• Pay attention to maintenance issues

• Include data dictionary in terminology

• Please: reject NEC!

Desiderata for Controlled Medical Vocabularies James J. Cimino.

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