Use of the UMLS in Patient Care James J. Cimino, M.D. Center for Medical Informatics Columbia University

UMLS in Patient Care l Quick overview of the UMLS l Quick overview of clinical system at Columbia-Presbyterian Medical Center l Comparison of UMLS and CPMC l Recommendations

Unified Medical Language System l U.S. National Library of Medicine l Three Knowledge Sources –Semantic Network –Metathesaurus –Information Sources Map

UMLS Semantic Network l Strict hierarchy l Semantic types: 132 l Semantic relations: 46 l Inheritance of relations: 6233

UMLS Semantic Network Process_of

UMLS Metathesaurus l Terms from 22 controlled vocabularies l Total source terms: 311,046 l Total strings: 279,237 l Total concepts: 152,444 l Relationships: 1,484,994

UMLS Metathesaurus Body Fluid Blood Plasma Extracellular Space Dehydration Other Narrower has_part contained_in

CPMC Clinical Database Person Clinical Event ProviderPatient Medical Entity LocationOrganization Clinical DatabaseMED

Medical Entities Dictionary l Semantic Network l Sources: 5 l Strings: 108,492 l Concepts: 35,281 l Semantic relations: 23 pairs l Semantic Links: 145,672

Medical Entities Dictionary Medical Entity Substance Laboratory Specimen Event Diagnostic Procedure Laboratory Test Laboratory Procedure CHEM-7 Plasma Glucose Plasma Specimen Anatomic Substance Bioactive Substance Glucose Plasma Chemical Carbo- hydrate Substance Sampled Part of Has Specimen Substance Measured

Comparisons - Methods l CPMC Entities vs. UMLS Semantic Types l MED Classes vs. UMLS Semantic Types l MED Semantic Links vs. UMLS Semantic Relations l MED Concepts vs. Metathesaurus Concepts l MED Semantic Links vs. Meta Relations

Comparisons - Results DB EntitiesClassesLinks CPMC UMLSUMLS Types Relations Concepts Meta Links /

Recommendations - General l Make “Event” a temporal concept l Conceptual vs. Physical polarization l Directed Acyclic Graph l Merge Network and Metathesaurus

Recommendations - Specific l Tests have Specimens l Tests have Parts l Separate Medications from Chemicals l Liberalize assignment of Relations

Summary l Semantic Types provide good coverage l Concepts provide good coverage in certain domains l No technical reason why UMLS could not incorporate clinical vocabulary