1. The Medical Entities Dictionary Columbia University Department of Biomedical Informatics

2. The Medical Entities Dictionary

3. K#1 = 4.2 K#1 = 3.3 K#2 = 3.2 K#1 = 3.0 Retrieving Results Individually K#1 K#2 K#3 = 2.6 K#3

4. K#1 = 4.2 K#1 = 3.3 K#2 = 3.2 K#1 = 3.0 Retrieving Results by Class K#1 K#2 K K#3 K#3 = 2.6

5. What is in the MED? Sunquest lab terms Cerner lab terms Digimedix drugs Cerner Drugs Sunquest Radiology ICD9-based problem list terms Other applications Knowledge terms

6. How Big is the MED? Concept-based (77,500) Multiple hierarchy (115,000) Synonyms (180,000) Translations (125,000) Semantic links (270,000) Attributes (175,000)

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

11. Using the MED Translation –What is the ICD9 Code for …? –What is the display name for …? –What is the aggregation class for …? Translation Tables Class-based questions –Is Altace an antihypertensive? –What are all the antibiotics? Knowledge queries –What are the pharmaceutic ingredients of…?

12. Using the MED MED QueryMED Translation Table Interface Engine WebCIS Decision Support

13. The MED and Messaging Ancillary System Local Codes MED Codes Clinical Data Repository Other Subscribers Interface Engine Translation Table

14. Case Study: Aggregation for C2000 Labs have multiple codes for the same tests C2000 displays tests in spreadsheets (“buttons”) One code per column per button Unrecognized codes go into “Miscellaneous” Labs are always adding new tests and not telling How do we keep the C2000 buttons current?

15. C2000 Buttons in the MED

16. The “Lytes” Button

17. Intravascular Sodium Tests

18. C2000 Buttons in the MED

19. Querying for Button Parts

21. Operationalizing C2000 Aggregation Translation from lab code to MED code is done by interface engine Aggregation from MED code to C2000 button column (“Intravascular …”) is done by interface engine New lab tests that fall into existing columns are automatically aggregated New lab tests that don’t fall into existing columns can be identified before ending up in “Miscellaneous”

22. Translations with the MED Gentamicin Injectable Gentamicin Gentamicn Sensitivity Test Serum Gentamicin Level Gentamicin Toxicity Etiology Measures Sensitivity Substance Measured Has ingredient is-a Intravascular Gentamicin Tests Summary Reports Decision Rule Expert System Drug Information

27. The MED and Eclipsys Capturing data from ancillary systems Aggregation for summary reporting Keeping terminologies up to date (e.g., for order entry) Class-based decision rules Multiple hierarchies allowed Linking to on-line resources