managing vocabulary for a centralized clinical system james j. cimino, md; stephen b. johnson, phd;...

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Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton, PhD Department of Medical Informatics - Columbia University New York, New York, USA

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Page 1: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

Managing Vocabulary for a Centralized Clinical System

James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA;

Paul D. Clayton, PhD

Department of Medical Informatics - Columbia UniversityNew York, New York, USA

Page 2: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

Gérer Vocabulaire pour un Système Médical Centralisé

James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA;

Paul D. Clayton, PhD

Départment d’Informatique Médical - Columbia UniversityNew York, New York, USA

Page 3: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

Gérer Vocabulaire por un Système Médical Centralisé:

Technique Automatique de Knowledge-Base

Posser la Théorie en Usage

Page 4: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

Système Distributif

Page 5: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

Dêpot Clinique Central(Fantaisie)

Page 6: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

Dêpot Clinique Central(Realité)

Page 7: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

Contrôle Central du Vocabulaire

Page 8: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

Construction du Vocabulaire

• Compréhension

• Modelage

• Création

• Maintenance

Page 9: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

La Théorie:

“L’approche knowledge-based à la

representation améliorerais la

maintenance et la utilisation.”

Page 10: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

Medical Entities Dictionary (MED)

• La réseaux semantique

• La multiple hiérarquie

• La representation Frame-based concept

• 46,000 concepts

Page 11: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

MED: La StructureMedicalEntity

Substance LaboratorySpecimen

Event

LaboratoryTest

LaboratoryProcedure

CHEM-7PlasmaGlucose

PlasmaSpecimen

AnatomicSubstance

BioactiveSubstance

Glucose

Plasma

Chemical

Carbo-hydrate

Substance

Sampled

Part of

Has S

pecimen

Substance Measured

DiagnosticProcedure

Page 12: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

K+1 = 4.2

K+1 = 3.3

K+2 = 3.2

K+1 = 3.0

K+3 = 2.6

Récupération de Résultat Individuel

K+1

K+2 K+

3

Page 13: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

K+1 = 4.2

K+1 = 3.3

K+2 = 3.2

K+1 = 3.0

K+3 = 2.6

Récupération de Résultat par Classe

K+1

K+2 K+

3

K

Page 14: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

Tâche de Maintenance

• Le nouveau vocabulaire (Laboratoire)

• Le changement du vocabulaire (Pharmacie)

Page 15: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

Le Nouveau Vocabulaire

• Primitif lab: 2533 termes

• Nouveau lab: 5291 termes

• Distribuition: Juin 15, 1994

• Activation: Juillet 24, 1994

Page 16: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

Changement du Vocabulaire

• Commence avec 2091 drogues• En deux années, l’addition de

2327 drogues• Classification:

– Ingrédient– AHFS Classe– Allergie– DEA– Forme

Page 17: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

L’addition des Termes Nouveaux

• Identification de termes superflus

• Addition de termes nouveaux dans les classes existant

• Addition de nouvelles classes

Page 18: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

L’addition des Termes dans une Classe

• Théorie: On peux utilisé les attributs du nouveau terme pour la identification des classes

• Usage: “Pousser” en Termes

Page 19: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

“Pousser” en TermeMedicalEntity

LaboratoryTest

PlasmaGlucose

Test

BioactiveSubstance

Glucose

Carbo-hydrate

ChemistryTest

Chem-7Glucose

TestStat

GlucoseTest

Chem-20Glucose

Test

StatGlucose

Test

StatGlucose

Test

Chemical

Page 20: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

La Création des Classes

• Théorie: On peux découvrir le modéle de l’attribute que on identifié les classes potentiel

• Usage: Partition recursive des classes qui existent

Page 21: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

La Découvert de Classes Nouveaux

MedicalEntity

LaboratoryTest

Hepatitis BCore Antigen

Chemical

ChemistryTest

CoreAntigen

Hepatitis BCore Antigen

Test

HBC

Antigen

MedicalEntity

LaboratoryTest

Hepatitis BCore Antigen

Chemical

ChemistryTest

CoreAntigenHBC

Antigen

Page 22: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

screen shot: MED Editor

Page 23: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

screen shot: MED Editor proposing a new class

Page 24: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

Maintenance Semi-automatique

• Traverser la liste des drogues

• Identifier de nouvelles drogues

• Faire la connection de drogues aux ingrédiants

• Suggérer la classe “preparation”

• Ajouter une drogue nouvelle sur la supervision de l’homme

Page 25: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

Classification Interatif

Adding "LASIX 20MG TAB"Generic Ingredient "FUROSEMIDE"AHFS Class "DIURETICS"Add to "FUROSEMIDE PREPARATION"? y

Adding "ZAROXOLYN 5MG CAP"Generic Ingredient "METOLAZONE"AHFS Class "DIURETICS"Add to "DIURETICS"? nCreate METOLAZONE PREPARATION" Class? y

Page 26: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

Classification AutomatiqueMedicalEntity

Drug

PharmacologicSubstance

Sulfameth-oxizole

Chemical

Antibiotic

Bactrim"S1", "65"

Trimethoprim/Sulfamethoxizole

PreparationsTrimeth-

oprim

Septra"S1"

Sulfa Allergy"S1"

AllergyClass

TrimethoprimAllergy

"65"

Page 27: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

Statistique de Correction

• Entre les 2091 drogues originaux:– 334 avec classes – 289 avec classes multiples– 173 sans allergies

• Entre les 2327 drogues additionelles:– 28 avec classes– 141 avec classes multiples– 57 sans allergies

Page 28: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

La Direction Future:Web-Browser

• Independence de plateforme

• Disponible partout

Page 29: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

screen shot: Web

Page 30: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

La Direction Futur:X-Based Browser/Editor

• L’utilisation du vocabulary server

• Plusieurs éditeurs au même temps

• Prêt à usage

Page 31: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

screen shot: Accessmed

Page 32: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

La Direction Future:K-Rep

• Un produit IBM

• Comprendre l’approche Knowledge-base

• Subsumption des termes automatique

• La application de la recherche en direction

à la realité du monde

Page 33: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

screen shot: K-Rep

Page 34: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

L’impact de la “Théorie en Usage”:Mieux Administration

• Plus facile de fusionner le nouveaux

vocabulaire

• Administration automatique

• Améliorer la qualité du vocabulaire

Page 35: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

L’impact de la Mieux Administration:Le Vocabulaire Plus Util

• MED est courant par les systèmes departmentaux

• C’est facile de trouver une MED terme

• Supporte les multiple niveaux des concepts

• Mielleur précision dans les database questions

Page 36: Managing Vocabulary for a Centralized Clinical System James J. Cimino, MD; Stephen B. Johnson, PhD; George Hripcsak, MD; Claire L Hill, MA; Paul D. Clayton,

Voir pour vous même

http://www.cpmc.columbia.edu/homepages/ciminoj