Terminology and Terminological Systems

238 Pages·2012·7.031 MB·English

by  Peter L. Elkin

Health Informatics

Peter L. Elkin
Editor
Terminology and
Terminological Systems
Editor
Peter L. Elkin, M.D., MACP, FACMI
Physician, Researcher and Author
New York, NY
USA
Additional material to this book can be downloaded from http://extras.springer.com
ISBN 978-1-4471-2815-1 ISBN 978-1-4471-2816-8 (eBook)
DOI 10.1007/978-1-4471-2816-8
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It is a sunny day. It was not always sunny in the life of the
dedicated physician from southern Pennsylvania. The goals of
a lifetime exist mostly in the mind of those who hold them dear.
Lifetimes of adjustments and sacrifi ces culminate in a sense of
purpose, honor, and dedication. Goals like positively
infl uencing the lives of others are relative in time and space to
one’s own vision. Happiness predicated on a consistent view of
the present and future is irreconcilable with the ever more
rapid evolution of the present. Time once the close friend and
trusted ally of the thoughtful becomes a consistent reminder of
the limits of Man. Dreams may be infi nite, but our capacity to
implement them is not. Trusting in the prioritization of others
oft leads to a constant pressure toward mediocrity. Comfort can
be found in the familiar, so does mediocrity yield the same
warm complacency. Struggle though empowering does not lead
to happiness. Accomplishments being relative by almost all
standards, our struggles are in vane.
In this spirit, I submit this work whose timeliness will be
limited and whose goal will need to evolve with the
sophistication of the student. As a teaching text, it melds history
with theory and logic. As a vision, it opens the mind to a
greater potential, and it is my profound hope that in the telling
I can stimulate thought and progress in the representation of
language and the instantiation of thought.
I am continually inspired and enthralled with the human
mind’s ability to imagine a better future, and I am of the belief
that we can create any manifest future that we can imagine. My
hope is that this textbook inspires you to make a difference in
people’s lives.
Herein, we imagine improved healthcare through better
organization, dissemination and reasoning about real patient
problems, routinely elevated by ubiquitously available medical
and ontological knowledge.
I dedicate this book to the two great women in my life, my
mother Lorretta Elkin who spent her life in dedication to truth
and honesty and her children, along with my wife Margaret
Ann who has dedicatedly inspired this admitted workaholic.
Peter L. Elkin
Foreword
This book addresses a deep and pervasive paradox. On the one hand, “termi-
nology” is central to healthcare. Simply put, education, patient records, labo-
ratory testing, procedures, medication, reimbursement, assessment of quality,
regulatory compliance, and research could not exist without it. On the other
hand, “awareness” of terminology as a rate-limiting resource is low, gener-
ally. That terminology is something that could be missing or present, or good
or bad, or the subject – in current parlance – of “best practices,” just has not
occurred to many outside the relatively narrow confi nes of medical informat-
ics. And those within that fi eld have only the literature – spread across many
journals and sources – to guide them.
The pages that follow put a stake in the ground. As is explained, terminol-
ogy comes from somewhere – both historically (millennia) and at present
(from various authorities), and it is going somewhere (at this writing,
“Meaningful Use” – in the United States – will require it, and attempts to cre-
ate international terminology are making progress). Further, terminology is
already intimately connected with technology – information technology in
particular. As implied in many sections of this book, terminology empowers
computers as healthcare strives to catch up with the productive use of infor-
mation technology in other fi elds.
One reason for the apparent shortfall in the use of information technology
in healthcare and in biomedicine – again relative to other domains – is the
healthcare and biomedical terminology challenge. First, the magnitude
requirements for just lab tests, medications, procedures, and diagnoses dwarf
that found in any other signifi cant context, and the burgeoning “naming”
requirements for the study and use of “genotype-to-phenotype” links have
required the development of distributed provenance mechanisms. Second, the
terminologies discussed in this book evolve continuously; authoritative rep-
ertoires of names for lab tests and medications change every day, and the
names of procedures and diagnoses change annually, and sometimes more
often. Third, seemingly obvious terminology-based queries prove to be
research problems currently: examples are “What is our (local) experience
with patients like mine?” “Which enterprise evidences ‘best practice’ for
diagnosis X?” and “What can we learn from aggregating data from multiple
sites that we cannot learn from the individual sites?”
Those attempting to address these challenges – locally, nationally, or inter-
nationally – need to appreciate the ideas discussed in this book. For example,
those helping to manage care or research enterprises will be called upon to
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viii Foreword
supervise the management of terminology as an asset. Narrowly, terminol-
ogy will be an asset because it will be the only way to “normalize” enter-
prise care and research data; more broadly, terminology may make explicit
what makes the enterprise unique. At this writing, an emerging enterprise
imperative is to integrate the terminology used to care for patients with the
terminology used to conduct research relevant to those patients; standard
terminology will need to coexist with novel names for research driven
observations. On an individual and enterprise level, local terminology inno-
vation will need to be coordinated with evolving extraproject, and extra-
enterprise, terminology authorities.
This book could not have been written 20 years ago. Twenty-fi ve years
ago, the notion that terminology should be concept-based was all but unknown
in healthcare; now, almost all important terminologies are at least partly con-
cept-based. In parallel, because there was no general model of what a termi-
nology was or should be, there were no tools to support terminology
development and maintenance. Steady progress since then has improved both
terminology content and the technology and processes used to sustain that
content. This is the fi rst book devoted to that story.
Students, practitioners, or managers who absorb the material here will
have an advantage over their peers who lack it. Near term, terminology will
become the bottleneck for the deployment of innovation and the assessment
of quality in healthcare; opening that bottleneck will require understanding of
elements of this text. Midterm, terminology will be an asset to be leveraged
in care and research; for example, interenterprise clinical and research data
aggregation – a central topic here – will become a dominant paradigm.
Longer-term, but within the professional lives of informatics students who
will learn from this book, terminology development and maintenance will
become a distributed activity undertaken by individuals and by “crowds” (as
in crowd-sourcing). As with software, maintenance will come to dominate
creation as an intellectual and operational activity. Emerging “best practices”
in terminology – based on many of the ideas covered in this book – will
specify how local, distributed, national, and international maintenance should
be undertaken productively.
Ridgefi eld, CT, USA Mark Samuel Tuttle
Nashville, TN, USA Steven H. Brown
Series Preface

This series is directed to healthcare professionals leading the transformation
of healthcare by using information and knowledge. For over 20 years, Health
Informatics has offered a broad range of titles: some address specifi c profes-
sions such as nursing, medicine, and health administration; others cover spe-
cial areas of practice such as trauma and radiology; still other books in the
series focus on interdisciplinary issues, such as the computer based patient
record, electronic health records, and networked healthcare systems. Editors
and authors, eminent experts in their fi elds, offer their accounts of innova-
tions in health informatics. Increasingly, these accounts go beyond hardware
and software to address the role of information in infl uencing the transforma-
tion of healthcare delivery systems around the world. The series also increas-
ingly focuses on the users of the information and systems: the organizational,
behavioral, and societal changes that accompany the diffusion of information
technology in health services environments.
Developments in healthcare delivery are constant; in recent years, bioin-
formatics has emerged as a new fi eld in health informatics to support emerg-
ing and ongoing developments in molecular biology. At the same time, further
evolution of the fi eld of health informatics is refl ected in the introduction of
concepts at the macro or health systems delivery level with major national
initiatives related to electronic health records (EHR), data standards, and
public health informatics.
These changes will continue to shape health services in the twenty-fi rst
century. By making full and creative use of the technology to tame data and
to transform information, Health Informatics will foster the development and
use of new knowledge in healthcare.
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