1. Open Health Tools Distributed Terminology System Presentation Jack Bowie SVP Sales and Marketing Apelon, Inc. 1

2. Apelon Leading provider of healthcare terminology products and services Extensive and unique experience partnering with national agencies and healthcare enterprises to improve the quality, comparability & accessibility of clinical information Helps organizations turn terminologies and their use into business assets Develop and refine mission-critical data normalization processes

3. Key Achievements Twenty years development with the US National Library of Medicine on the UMLS Metathesaurus Supplier of the tools and services used to maintain SNOMED CT, ICD-9-CM, ICD-10-CM, and NDF-RT Supplier of tools and services to national health organizations: Australia’s NEHTA, Canada Health Infoway, Hong Kong Hospital Authority, and US FDA, NCI, NCHS, SSA, VHA Leading provider of commercial health data interoperability solutions: HIEs, EMRs, biotech, and content providers

4. Apelon Customers and Partners

5. Personnel Internationally known terminology experts Regular contributors to industry standards, publications and conferences

6. Apelon Solutions 6 Terminology Content Applications and Services People and Processes

7. Apelon and Open Source After many years of commercial availability, Apelon released the Distributed Terminology System (DTS ) vocabulary server as an open source project in April of 2007 Since then, DTS has been downloaded over 4000 times by organizations around the world Apelon supports DTS with a full range of commercial services 7

8. Apelon Confidential What is DTS? An enterprise vocabulary server used to : –Acquire & maintain standards –Integrate and manage local code sets –Map/interrelate terminologies –Deploy in applications

9. Apelon Confidential Examples of Terminology Services Term/name normalization: What is SNOMED CT name for “heart attack”? Code translation What is the ICD-9 code for Myocardial Infarction? Grouping and aggregation Is Myocardial Infarction a Cardiac Disease? Clinical knowledge What drug treats Myocardial Infraction? Local information Add L227 as the local code for Serum Calcium. Myocardial Infarction 410.91 Yes Streptokinase Okay

10. Apelon Confidential DTS Components Knowledge Base (Content) Server Client API GUI applications Utilities and samples Subscription content service Commercial software support service

11. Apelon Terminology Model Apelon MedDRA ICD9 HL7 SNOMED User Applications DTS SNOMED MedDRA HL7 ICD9 Rx Tx Dx Data Set Updates Web Services Application Developer API

12. DTS Components 12 DTS Vocabulary Server DTS Applications User Applications DTS Knowledgebase DTS Knowledgebase Terminology Update Service DTS API Enterprise quality, highly scalable repository Comprehensive terminology support

13. DTS Knowledgebase –Clinical framework (SNOMED CT) –Reimbursement code sets w/mappings: ICD, CPT, HCPCS –RxNorm, NDF-RT and other drug terminology and classification systems –Meaningful Use Standards: HL7, CVX, MVX, UNII –Specialty sets: LOINC, RadLex, NIC, NOC, and NANDA –Adverse event terminologies MedDRA, COSTART, WHOART –Mappings to MeSH and UMLS CUIs –Extensible with local additions

14. Apelon KB Architecture Local Namespaces Customer-specific data Concepts Properties Associations (mappings) Code and Value sets Protected during updates CPT Apelon KB SNOMED CT Apelon CT to CPT Local Subscription Namespaces Derived from industry sources Provided by Apelon “Read only” in DTS

15. DTS Components 15 DTS Vocabulary Server DTS Applications User Applications DTS Knowledgebase DTS Knowledgebase Terminology Update Service DTS API “Subscription” access to industry standard terminologies and thesauri Web downloadable differential updates Local content protected during updates

16. Subscription Update Process Apelon DTS SNOMED CT CPT Apelon CT to CPT Update Log Update exception events, e.g., local mappings to retired concepts CPT Apelon KB SNOMED CT Apelon CT to CPT Local

17. DTS Components 17 DTS Vocabulary Server DTS Applications User Applications DTS Knowledgebase DTS Knowledgebase Terminology Update Service DTS API High-performance server Extensive functionality Programmatic access to all functions Java and.NET clients

18. DTS Functionality API Services: –Search (w/spelling correction, stemming, contexts, etc.) –Navigation and code translation –Subsetting (extensional and intensional definitions) –Class/subsumption query –Workflow –Localization Performance features: –Connection pooling –Concept caching

19. DTS Components 19 DTS Vocabulary Server DTS Applications User Applications DTS Knowledgebase DTS Knowledgebase Terminology Update Service DTS API User applications have access to all DTS functions including modeling capabilities

20. DTS Components 20 DTS Vocabulary Server DTS Applications User Applications DTS Knowledgebase DTS Knowledgebase Terminology Update Service DTS API DTS Browser DTS Editor TermWorks Web Services

22. DTS Editor Browsing/searching Vocabulary/code set management (subsets) Local additions –Complete modeling environment –Add Concepts, Synonyms, properties and associations (relationships) Import/Export Workflow

24. DTS Editor Plug-in Architecture The DTS Editor Plug-in architecture is a framework for customizing and extending the DTS Editor platform with new features and modules Plug-ins have access to common DTS Editor facilities such as connection services, events, and drag-and-drop Plug-ins can used to implement: –Major new features –New data presentations –New data input or output formats

25. Graphic Viewer New, customizable, “graphic” views of terminologies

26. Table Editor Tabular representation of DTS concepts

27. Import Wizard Import data into DTS Namespaces from XML and CSV data files

28. Terminology Query Language Query/export language for DTS knowledgebases, includes XML export of full Namespace

29. DTS Roadmap Platform Support –New database support for DB2 (Q4 2010) and MySQL (Q1 2011). HL7 CTS2 Interface –Support for this emerging standard terminology service interface –Extended versioning support for Namespaces and Concepts –Expanded Subset functionality for Value Sets –Additional metadata on Namespaces and Concepts

30. Medical terminology in practice