Vocabulary Sharing and Maintenance usingHL7Master File / Registry Infrastructure

Review PaperReview Paper

Mestrado em Informática Médica (FMUP)Mestrado em Informática Médica (FMUP)

António Cardoso MartinsFebruary 2009

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Table of contents

Introduction Introduction (Why?)(Why?)

– CommunicationCommunication

– What is the problemWhat is the problem

– Basic conceptsBasic concepts

– KeywordsKeywords

Objectives Objectives (What?)(What?)

Methods Methods (How?)(How?)

– Scientific publicationsScientific publications

– StandardsStandards

Results Results (What?)(What?)

((

– HL7 Master Files / HL7 Master Files / RegistriesRegistries

– Common Terminology Common Terminology ServicesServices

Discussion Discussion (What does it mean?)(What does it mean?)

Further Research Further Research (So what?)(So what?)

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Introduction

• One of the fundamental goals of computerized medical One of the fundamental goals of computerized medical information is that of precise, accurate and information is that of precise, accurate and unambiguous communication *unambiguous communication *

• ““Any meaningful exchange of utterances depends upon Any meaningful exchange of utterances depends upon the prior existence of an agreed upon set of semantic the prior existence of an agreed upon set of semantic and syntactic rules” **and syntactic rules” **

• Terminology interoperability in Medical IT is a bTerminology interoperability in Medical IT is a big ig requirement for the implementation of Electronic Health requirement for the implementation of Electronic Health Record (EHR)Record (EHR)

* Woody Beeler 2006, HL7 vocabularies: Bridging information models and vocabulary in HL7** ISO TR9007:1987 Information Processing Systems – Concepts and Technology for the Conceptual Schema andthe Information Base

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Thought or Reference

Referent Symbol

SymbolisesRefers to

Stands for

Adapted from C.K Ogden and I. A. Richards. The Meaning of Meaning.

“Rose”, “ClipArt”

IntroductionOgden’s Semiotic Triangle

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CONCEPT

Referent

Refers ToSymbolises

Stands For“Rose”,“ClipArt”

Refers ToSymbolises

Stands For“Rose”,“ClipArt”

CONCEPT

Symbol Symbol

“I see a ClipArt image of a rose”

Context Context

Formal SharedContext

Terminologies Terminologies

IntroductionMaking Shared Context Explicit

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IntroductionMany terminologies / code systems

• UMLS MetathesaurusUMLS Metathesaurus

• RxNormRxNorm

• FDAFDA

• ISO 3166-2 Country CodesISO 3166-2 Country Codes

• NANDANANDA

• International Classification of International Classification of Nursing PracticeNursing Practice

• HL7 Version 3 Code SystemHL7 Version 3 Code System

IdentifiersIdentifiers

• IANA Character SetsIANA Character Sets

• International Airport CodesInternational Airport Codes

*HL7 vocabularies: Bridging information models and vocabulary in HL7 (woody Beeler)

• LOINCLOINC

• CPT-4CPT-4

• NICNIC

• NOCNOC

• ICD-9-CMICD-9-CM

• ICD-10ICD-10

• SNOMED InternationalSNOMED International

• SNOMED-CTSNOMED-CT

• ISO 4217 Currency codesISO 4217 Currency codes

• ISO 639 Language CodesISO 639 Language Codes

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Introduction

• Producing reliable information is the ultimate goal of Producing reliable information is the ultimate goal of data processingdata processing

• An 'ocean' of data (petabytes of it)An 'ocean' of data (petabytes of it)

• Modern technologies enable efficient fusion of Modern technologies enable efficient fusion of heterogeneous dataheterogeneous data

• Danger of producing unreliable information if the Danger of producing unreliable information if the process of integration is based on erroneous process of integration is based on erroneous assumptionsassumptions

• How do we share and maintain vocabularies ??How do we share and maintain vocabularies ??

*Olga Brazhnik et John F. Jones 2006, Anatomy of data integration

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Admission

Pharmacy

Prescription

Laboratory

EHR

Management

IntroductionWhat is the problem

*EHR – Electronic Health Record

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Pharmacy

Prescription

EHR

IntroductionWhat is the problem

Route of Administration

Route of Administration

Route of Administration

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Pharmacy

Prescription

EHR

IntroductionWhat is the problem

Code Description

522 Rectal

523 Oral

Code Description

522 Rectal

523 Oral

Code Description

522 Rectal

523 OralRoute of Administration

Route of Administration

Route of Administration

Field Value

Patient_ID 32455

Drug 1233-44

Route 523

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Pharmacy

Prescription

EHR

IntroductionWhat is the problem

Code Description

522 Rectal

523 Oral

524 Vaginal

Code Description

522 Rectal

523 Oral

524 Nasogastric

Code Description

522 Rectal

523 Oral

524 Inhalation

Route of Administration

Route of Administration

Route of Administration

Code Description

522 Rectal

523 Oral

Code Description

522 Rectal

523 Oral

Code Description

522 Rectal

523 Oral

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Pharmacy

Prescription

EHR

IntroductionWhat is the problem

Code Description

522 Rectal

523 Oral

524 Vaginal

Code Description

522 Rectal

523 Oral

524 Nasogastric

Code Description

522 Rectal

523 Oral

524 Inhalation

Route of Administration

Route of Administration

Route of Administration

Field Value

Patient_ID 32455

Drug 1233-44

Route 524

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IntroductionKeywords

About the semanticsAbout the semantics

TaxonomyTaxonomy

OntologyOntology

TerminologyTerminology

Semantic interoperabilitySemantic interoperability

Controlled vocabularyControlled vocabulary

Vocabulary domainVocabulary domain

ClassificationsClassifications

About the syntax (information About the syntax (information model)model)

Data typesData types

Code setCode set

Coded attributesCoded attributes

About the sharing of vocabulariesAbout the sharing of vocabularies

Master FilesMaster Files

RegistriesRegistries

RepositoriesRepositories

Common Terminology ServicesCommon Terminology Services

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IntroductionConcepts

• Vocabulary - Deal with the content, communication and Vocabulary - Deal with the content, communication and data storage of encoded information in HL7data storage of encoded information in HL7

• Code Set - Unique set of codes that represent a Code Set - Unique set of codes that represent a corresponding set of concepts in the real worldcorresponding set of concepts in the real world

• Master File - Set of common reference files (or Master File - Set of common reference files (or terminologies) used by one or more application systemsterminologies) used by one or more application systems

• Registry – Special case of a Master File as it allows Registry – Special case of a Master File as it allows applications to add and update new codesapplications to add and update new codes

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Objectives

• Gather scientific publications and other documentationGather scientific publications and other documentation

• Try to define how vocabularies can be shared and Try to define how vocabularies can be shared and maintained between any 2 applications, using standardsmaintained between any 2 applications, using standards

• Propose pointers for further study of the subjectPropose pointers for further study of the subject

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MethodsSearch in PubMed

"terminology as topic"[MeSH Terms]"terminology as topic"[MeSH Terms]

OR "vocabulary"[MeSH Terms]OR "vocabulary"[MeSH Terms]

OR "semantics"[MeSH Terms]OR "semantics"[MeSH Terms]

OR "classification"[MeSH Terms]OR "classification"[MeSH Terms]

OR "registries"[MeSH Terms]OR "registries"[MeSH Terms]

OR "semantics"[MeSH Terms]OR "semantics"[MeSH Terms]

AND (AND (

terminologyterminology[All Fields][All Fields]

OR OR ontologyontology[All Fields][All Fields]

OR "OR "vocabularyvocabulary"[All Fields]"[All Fields]

OR "OR "semanticsemantic"[All Fields] OR "semantics"[All Fields]"[All Fields] OR "semantics"[All Fields]

))

AND AND HL7HL7[All Fields][All Fields]

AND (AND (interoperabilityinteroperability[All Fields] OR interoperable[All Fields])[All Fields] OR interoperable[All Fields])

Results: 18Results: 18

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MethodsScienceDirect - Search

HL7HL7

AND AND terminologyterminology

AND ("AND ("Master FilesMaster Files" "

OR OR registryregistry OR registries) OR registries)

AND TITLE-ABSTR-KEYAND TITLE-ABSTR-KEY

((vocabularyvocabulary

OR OR ontologyontology

OR OR terminologyterminology

OR OR semanticsemantic

OR OR interoperabilityinteroperability

OR interoperable)OR interoperable)

Results: 21Results: 21

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Results

• There is a very small number of publications addressing There is a very small number of publications addressing the vocabulary sharing using standardsthe vocabulary sharing using standards

• Almost none refers to their maintenanceAlmost none refers to their maintenance

• Large number of different terminologiesLarge number of different terminologies

• The language localization is an obstacleThe language localization is an obstacle

• International differencesInternational differences

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Discussion

• Many people solved the problem communication Many people solved the problem communication between 2 systems, not the vocabulary sharing and between 2 systems, not the vocabulary sharing and synchronization of any 2 systemssynchronization of any 2 systems

The most promissing options are:The most promissing options are:

• HL7 Master Files / RegistriesHL7 Master Files / Registries

• Common Terminology Services (CTS)Common Terminology Services (CTS)

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Pharmacy

Prescription

EHR

Master Files

DiscussionMaster File / Registry Infrastructure

Route of Administration

Route of Administration

Route of Administration

Route of Administration

Code Description

522 Rectal

523 Oral

524 Inhalation

Code Description

522 Rectal

523 Oral

Code Description

522 Rectal

523 Oral

Code Description

522 Rectal

523 Oral

524 Inhalation

Code Description

522 Rectal

523 Oral

Code Description

522 Rectal

523 Oral

524 Inhalation

Code Description

522 Rectal

523 Oral

524 Inhalation

Code Description

522 Rectal

523 Oral

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DiscussionMaster File / Registry Infrastructure

René Spronk 2008, Registries and Master Files, http://www.ringholm.de/docs/00820_en.htm

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DiscussionCommon Terminology Services (CTS)

• The HL7 Common Terminology Services (HL7 CTS) is The HL7 Common Terminology Services (HL7 CTS) is an Application Programming Interface (API) an Application Programming Interface (API) specificationspecification

• Proposed standard API for vocabulary functions Proposed standard API for vocabulary functions required to enable use of a variety of code systems in required to enable use of a variety of code systems in HL7 standards and messagesHL7 standards and messages

• Intended to describe the basic functionality that will be Intended to describe the basic functionality that will be needed by HL7 Version 3 software implementations to needed by HL7 Version 3 software implementations to query and access terminological contentquery and access terminological content

LexGrid, https://cabig-kc.nci.nih.gov/Vocab/KC/index.php/LexGrid

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Further research

• How to How to integrate legacyintegrate legacy systems systems

– Integration enginesIntegration engines

• How to How to decentralize maintenancedecentralize maintenance of large terminologies of large terminologies

– Internet management of small partsInternet management of small parts

• How to deal with How to deal with updates / deprecationupdates / deprecation

– Versioning **Versioning **

• Different Different languagelanguage support support

– Internationalization (i18n)Internationalization (i18n)

• How to create a How to create a common repositorycommon repository ** **

– UMLS * metathesaurusUMLS * metathesaurus

* Unified Medical Language System** Stanley M. Huff et al. 1998, A Proposal for Incorporating Health Level Seven (HL7) Vocabulary in the UMLS Metathesaurus

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Questions?