1. AMIA 2007 Monday, Nov. 12 11:30-1:30 National Library of Medicine National Institutes of Health U.S. Dept. of Health & Human Services UMLS ® Users Meeting

2. 2 Welcome & Agenda NLM Overview and Update Metathesaurus (JW, JK, KWF) MetamorphoSys (KWF) User Education and Outreach (RK, SE) IHTSDO (BLH) Effective Use of UMLS in EHR Systems (BLH) Questions for users How do you use the UMLS? What do you need? How can we make the UMLS more useful?

3. 3 Metathesaurus Production

4. 4 Metathesaurus Sources Challenges Frequency and timing of releases Update cycles of critical vocabularies Value of dormant sources Selecting new sources What sources do you use?

5. 5 Source data representation Rationalizing source inversion Term Types Toward greater consistency of source analysis and representation Improved documentation for internal processing and user understanding

6. 6 Tradeoff in representing sources Individual source transparency Absolute uniformity across all sources

7. 7 Strings, atoms, TTYs and ATVs Is a particular source string a name? If so, it is part of an atom and should appear in the ‘STR’ field of MRCONSO Otherwise, it may need to go into the ‘ATV’ field of MRSAT What does the NLM mean by the ‘TTY’ (termtype) field of MRCONSO? Fundamental aspect of an atom TTY assignment lies at the intersection of source- asserted data and NLM-asserted data

8. 8 Inter-terminology Mapping The UMLS is a valuable resource in the creation and publication of inter-terminology mappings HHS has given NLM the responsibility for funding, coordinating, and/or performing official mappings between standard clinical terminologies and HIPAA code sets: SNOMED CT to ICD9CM general purpose map already in the UMLS reimbursement specific map - draft of rule-based mappings created, currently under review LOINC to CPT 2,000 mappings for lab LOINC available in the UMLS additional mappings for radiology LOINC currently under review SNOMED CT to MeSH to facilitate link from electronic medical record to medical literature currently being created by NLM editors

9. 9 MetamorphoSys Transition MetamorphoSys (MMSys) is the essential tool for subsetting and customizing the Metathesaurus MMSys needs to balance between providing stable core functions and innovative new features The solution: a robust core MMSys and well- documented ‘plug-in’ architecture with public APIs for new features Advantages: new features will not interfere with core functions users can also write and share their own plug-ins Timeline: MMSys released in 2008AA will remain unchanged for 1 year First release of the new MMSys in 2009AA

10. 10 Purpose-specific subsets The Content View Flag (CVF) field, which is present in all Metathesaurus data files, is a convenient and flexible way of labeling a purpose-specific subset Examples: the NLP subset, the KP/VA Problem list subset Clinical Observations Recording and Encoding (CORE) subset project – to define a subset to support consistent high level encoding of clinical information based on real clinical data contributed by major health care providers (e.g. Mayo Clinic, Kaiser Permanente, Intermountain Healthcare, Regenstrief Institute) User contribution of their own subsets (e.g. terms used in a cardiology clinic) is welcome

11. 11 UMLS Education and Outreach New Users Page Online Demos Step-by-Step pages Narrated Introduction UMLS Basics transitioning to online modules Office hours still available Getting starting Webcasts

12. UMLS Community Page

13. UMLS Webcast page

14. 14 SNOMED CT ownership changed 4/26/2007 NLM is US Member, with right to distribute SNOMED CT In UMLS and native format US represented on IHTSDO Board, General Assembly, & Standing Committees – 15 people (4 US gov’t ) Working Groups – open to all IHTSDO 2008 Work Plan Complementary US priorities for 2008 – in development US SNOMED CT content request process - one on the list

15. 15 Effective Use of UMLS in EHR Systems Overnight integration of vocabulary updates into UMLS concept structure is not feasible yet (perhaps ever?) Not taking advantage of UMLS in EHR systems is at best unfortunate and can be really counterproductive How do you handle this issue? What can NLM do quickly to help?

16. 16 Discussion Questions How often should we release the UMLS? When? Do you use legacy Original Release Format (ORF)? What Metathesaurus sources do you use? What translations do you use? What enhancements would you make to MetamorphoSys? What subsets do you use or create? Should we reproduce them? How can we better support you?

17. 17 Thank you