[Orthopedic terminology of the knee--general terminology].
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Humans↗
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[Orthopedic terminology of the knee--terminology for instability].
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Humans↗
Terminology standards for nursing: collaboration at the summit.
OBJECTIVE: The objective of the 1999 Nursing Vocabulary Summit Conference was to seek consensus on and a common approach to the development of nursing terminology standards for use in information systems. METHODS: A four-day invitational conference brought together authors and representatives of responsible organizations concerned with the nursing terminologies recognized or under consideration by the American Nurses Association, along with experts on language and standards and representatives of professional organizations, federal agencies, and the health informatics industry. RESULTS: Participants distinguished between colloquial terminologies and reference terminologies, and between information models and terminology models. They agreed that most recognized nursing terminologies were colloquial terminologies and that a reference terminology was needed. They formed task forces to develop and test aspects of a reference terminology model prior to a second meeting in June 2000, at which they would determine readiness to collaborate on a single international standard. DISCUSSION: The 1999 Nursing Vocabulary Summit Conference changed the level of discussion about nursing vocabulary standards from a debate about the relative merits of the various terminologies recognized in the United States to an examination of methods for developing and testing a reference terminology model and, eventually, a reference terminology that could serve as an international standard.
American Nurses' Association↗
Standards for nursing terminology.
Terminology work in nursing has given rise to an increasing number of nursing terminologies. These generally take the form of controlled vocabularies. Because of the limitations of the controlled vocabulary approach, individual terminologies tend to be tuned to meet the specific needs of their intended users. Differences between terminologies are now a significant barrier to the comparison and interchange of health information. To agree on a single, multipurpose terminology would be problematic. However, several options for resolving unnecessary differences between nursing terminologies are currently being explored by international standards bodies and other groups, such as the U.S. Nursing Vocabulary Summit. One such option is the use of a terminology model to facilitate evolution toward a more coherent range of terminologies. The authors describe the motivation behind the development of a standard for nursing terminologies. They explain how a terminology model might form the basis for such a standard through a description of the approach taken by CEN TC251 (the Health Informatics Technical Committee of the European Committee for Standardization). They also discuss possible limitations of standardization.
Nursing↗
Interface terminologies: facilitating direct entry of clinical data into electronic health record systems.
Previous investigators have defined clinical interface terminology as a systematic collection of health care-related phrases (terms) that supports clinicians' entry of patient-related information into computer programs, such as clinical "note capture" and decision support tools. Interface terminologies also can facilitate display of computer-stored patient information to clinician-users. Interface terminologies "interface" between clinicians' own unfettered, colloquial conceptualizations of patient descriptors and the more structured, coded internal data elements used by specific health care application programs. The intended uses of a terminology determine its conceptual underpinnings, structure, and content. As a result, the desiderata for interface terminologies differ from desiderata for health care-related terminologies used for storage (e.g., SNOMED-CT), information retrieval (e.g., MeSH), and classification (e.g., ICD9-CM). Necessary but not sufficient attributes for an interface terminology include adequate synonym coverage, presence of relevant assertional knowledge, and a balance between pre- and post-coordination. To place interface terminologies in context, this article reviews historical goals and challenges of clinical terminology development in general and then focuses on the unique features of interface terminologies.
Clinical Medicine↗
Kaiser Permanente's Convergent Medical Terminology.
This paper describes Kaiser Permanente's (KP) enterprise-wide medical terminology solution, referred to as our Convergent Medical Terminology (CMT). Initially developed to serve the needs of a regional electronic health record, CMT has evolved into a core KP asset, serving as the common terminology across all applications. CMT serves as the definitive source of concept definitions for the organization, provides a consistent structure and access method to all codes used by the organization, and is KP's language of interoperability, with cross-mappings to regional ancillary systems and administrative billing codes. The core of CMT is comprised of SNOMED CT, laboratory LOINC, and First DataBank drug terminology. These are integrated into a single poly-hierarchically structured knowledge base. Cross map sets provide bi-directional translations between CMT and ancillary applications and administrative billing codes. Context sets provide subsets of CMT for use in specific contexts. Our experience with CMT has lead us to conclude that a successful terminology solution requires that: (1) usability considerations are an organizational priority; (2) "interface" terminology is differentiated from "reference" terminology; (3) it be easy for clinicians to find the concepts they need; (4) the immediate value of coded data be apparent to clinician user; (5) there be a well defined approach to terminology extensions. Over the past several years, there has been substantial progress made in the domain coverage and standardization of medical terminology. KP has learned to exploit that terminology in ways that are clinician-acceptable and that provide powerful options for data analysis and reporting.
Health Maintenance Organizations↗
Representation of ophthalmology concepts by electronic systems: intercoder agreement among physicians using controlled terminologies.
OBJECTIVE: To assess intercoder agreement for ophthalmology concepts by 3 physician coders using 5 controlled terminologies (International Classification of Diseases 9, Clinical Modification [ICD9CM]; Current Procedural Terminology, fourth edition; Logical Observation Identifiers, Names, and Codes [LOINC]; Systematized Nomenclature of Medicine, Clinical Terms [SNOMED-CT]; and Medical Entities Dictionary). DESIGN: Noncomparative case series. PARTICIPANTS: Five complete ophthalmology case presentations selected from a publicly available journal. METHODS: Each case was parsed into discrete concepts. Electronic or paper browsers were used independently by 3 physician coders to assign a code for every concept in each terminology. A match score representing adequacy of assignment for each concept was assigned on a 3-point scale (0, no match; 1, partial match; 2, complete match). For every concept, the level of intercoder agreement was determined by 2 methods: (1) based on exact code matching with assignment of complete agreement when all coders assigned the same code, partial agreement when 2 coders assigned the same code, and no agreement when all coders assigned different codes, and (2) based on manual review for semantic equivalence of all assigned codes by an independent ophthalmologist to classify intercoder agreement for each concept as complete agreement, partial agreement, or no agreement. Subsequently, intercoder agreement was calculated in the same manner for the subset of concepts judged to have adequate coverage by each terminology, based on receiving a match score of 2 by at least 2 of the 3 coders. MAIN OUTCOME MEASURES: Intercoder agreement in each controlled terminology: complete, partial, or none. RESULTS: Cases were parsed into 242 unique concepts. When all concepts were analyzed by manual review, the proportion of complete intercoder agreement ranged from 12% (LOINC) to 44% (SNOMED-CT), and the difference in intercoder agreement between LOINC and all other terminologies was statistically significant (P<0.004). When only concepts with adequate terminology were analyzed by manual review, the proportion of complete intercoder agreement ranged from 33% (LOINC) to 64% (ICD9CM), and there were no statistically significant differences in intercoder agreement among any pairs of terminologies. CONCLUSIONS: The level of intercoder agreement for ophthalmic concepts in existing controlled medical terminologies is imperfect. Intercoder reproducibility is essential for accurate and consistent electronic representation of medical data.
Decision Support Systems, Clinical↗
[Compliance with terminology standards in reflux, ulcers, and gastritis: A study of 881 consecutive upper gastrointestinal endoscopy reports].
BACKGROUND: The German version of the Minimal Standard Terminology document for endoscopy was discussed in 1997 and 1998, and finally published at the end of 1999 as one of the German Gastroenterology Society guidelines. The diagnoses and descriptive terms included in this standard terminology are based on the consensus views of a large number of German endoscopists (20 endoscopists based in Munich and 20 elsewhere in Germany). The aim of the present study was to investigate how much spontaneous compliance there is with the descriptive terms included in the standard terminology - both among the members of the consensus discussions, and among colleagues not involved in this project. METHODS: A total of 881 endoscopy reports with the diagnoses of reflux, ulcer, and gastritis were collected from 11 centers (2 hospitals and 9 private offices, with a total of 26 examiners) over a one-month period. Nine of the 26 examiners were actively involved in the terminology consensus discussion. The rate of occurrence of the descriptive terms contained in the standard terminology was assessed for the diagnoses listed above. RESULTS: Compliance with the descriptive terms was high (> 90 %) only for basic parameters such as the Savary classification of reflux and the area in which gastroduodenal ulcers were located. Other important parameters, such as the extent (length) of Barrett's esophagus, ulcer size, and circumferential location, were reported in only three-quarters of cases or less. The descriptions of gastritis were inconsistent. There was no difference in the degree of compliance either between endoscopists using free dictation and those using computerized text blocks, or between members of the terminology group and those not involved in preparing the terminology. CONCLUSIONS: Adherence to standard terminology and its descriptive parameters is poor even among specialized gastroenterologists who have been involved in terminology consensus discussions. Compliance needs to be improved by providing suitable software programs with automatic reporting functions.
Barrett Esophagus↗
Merging terminologies.
A terminology is a systematic, authoritative collection of concept names, or terms, in some domain. No single terminology names all the important concepts in biomedicine. One approach to creating a more comprehensive biomedical terminology is to merge existing biomedical terminologies, as the UMLS( Metathesaurus( has done for the last six years. Because existing terminologies may overlap--for example, one terminology may name a concept also named by another terminologyQthe terminologies in the Metathesaurus must be merged. Some terminologies suggest merges through their structure or content e.g., they suggest synonyms or connections to other terminologies; other merges can be suggested by algorithm. Regardless, all merges in the Metathesaurus must be approved by a human editor with appropriate domain knowledge. By the time Meta-U96 is released early in 1996, one prototype and seven released versions of the Metathesaurus will have been produced by a sequence of four qualitatively different methods, named for the way in which they merge terms: #1 "Term Rewrite Rules, #2 "Transitive Closure on Facts," #3 "Fact-at-a-Time Concept Merging," and #4 "Action-at-a-Time Object Processing." The development of each method has been constrained by the annual Metathesaurus release schedule. The first two methods made the best use of limited computational resources, and the last two make better use of human editing resources.
National Library of Medicine (U.S.)↗
Terminology of gonadal anomalies in fish and amphibians resulting from chemical exposures.
Given the recent increase in the number of studies describing the ability of chemicals to exert endocrine-disrupting effects, not only in fish but in a variety of other oviparous groups such as amphibians and reptiles, there is an urgent need to harmonize the terminology currently used in describing pathological changes of the gonads. In addition to difficulties in comparing results from different studies, there is also the risk of miscommunication by using terms that imply a certain clinical relevance which may not be true for the species examined. Especially in the case of the recent and controversial issue about potential effects of the triazine herbicide atrazine on amphibians, clinical terminology has been utilized beyond its true meaning by using terms such as "chemical castration" to describe occurrence of TOs or ovarian tissue in the testis of male frogs exposed to environmental chemicals (Hayes 2004). In clinical terminology, castration is defined as the removal of the gonads or their destruction by an external influence, resulting in a nonfertile organism. However, Hayes (2004) did not investigate any possible effects on the fertility of the test animals and thus did not know if these animals were truly castrated. Similarly, terms such as intersex, hermaphrodite, and sex reversal have been used in ways that appear inappropriate with regard to their clinical meaning in a series of different studies with fish or frogs (see previous sections for a detailed discussion). To ensure the appropriate use of certain terminology in a field as controversial and complex as the study of endocrine disruption, we have attempted, in this chapter, to harmonize the terminology used to describe changes in gonadal development of vertebrates such as fish and amphibians, especially frogs (see Table 3). Where appropriate, the terminology suggested was adopted directly from the clinical terminology. However, as outlined here there are substantial differences between the developmental biology of oviparous vertebrates and mammals, and especially humans, that necessitate modification of the definitions of some of the clinical terms. Where appropriate, therefore, the terminology proposed in this manuscript was redefined based on the biological meanings of the terms used in clinical diagnosis. Considering the large increase in research in the area of reproductive endocrine disruption over the past decades, the authors see an increasing need for a harmonization of terms to be used to describe effects observed in the investigated species. Agreement on a common terminology will allow scientists to better communicate and compare their work, and will enable risk assessors to conduct large-scale evaluations of environmental endocrine disruption by fitting the information from individual studies into a synthesis of normal and abnormal conditions of gonadal tissues.
Abnormalities, Drug-Induced↗
Terminologia anatomica: new terminology for the new anatomist.
Over many years, anatomical terminology has been the subject of much controversy and disagreement. Previously, the International Anatomical Nomenclature Committee has been responsible for the production of six editions of Nomina Anatomica. In 1989 a new committee, the Federative Committee on Anatomical Terminology (FCAT), was created by its parent body, the International Federation of Associations of Anatomists (IFAA). FCAT has worked for 9 years and published Terminologia Anatomica (TA) in 1998. FCAT's aim has been to democratize the terminology and make it the internationally accepted, living language of anatomy. The worldwide adoption of the same terminology would eliminate national differences, which were causing extreme confusion in instances where the same structure was known by several names. The new terminology is thus the result of worldwide consultation and contains Latin and equivalent English terms. It is indexed in Latin and English and contains an index of eponyms in order to find the correct non-eponymous term. The future goal of FCAT is to continue to improve the terminology-new structures are described, different terms come into use, and the terminology needs to be expanded to include terms used by clinicians for structures that currently do not appear in the list. Future versions of the terminology must accommodate the needs of all who use it, both in the clinical and scientific worlds.
Anatomy↗
Determining sources for formal nursing terminology systems.
OBJECTIVE: The purpose of this study is to assess the relative merits of aspects--labels or informal definitions--of traditional nursing terminology systems as the foundational sources for target formal nursing terminology systems. DESIGN: This study builds upon and compares the findings of two previous experiments in which formal terminology systems, one based on informal definitions, the other based on labels, were developed under the GALEN approach and used to generate hierarchies of nursing interventions drawn from the Nursing Interventions Classification. MEASUREMENTS: The two generated hierarchies were compared to see whether, and to what extent, they captured a test set of hierarchical relationships implicit within and derived from the Nursing Interventions Classification. An analysis of the relevant conceptual representations was carried out in those cases where a hierarchical relationship from the test set was absent from either of the generated hierarchies. RESULTS: The hierarchy generated from the formal terminology system based on informal definitions contained none of the test set of hierarchical relationships. Reasons included structural differences between conceptual representations; different levels of specificity; and deficiencies within the formal terminology system itself. The hierarchy generated from the formal terminology system based on labels contained all but one of the test set. The reason for the one absence was inconsistent usage within source and target. CONCLUSIONS: While it may be possible to derive formal terminology systems from informal definitions for nursing interventions, the inherent complexity within those informal definitions brings into question the utility of such systems. This study demonstrates that it may be more productive to base formal nursing terminology systems on labels, simpler sources with limited discursive content and a higher degree of consistency.
Computational Biology↗
Representation of ophthalmology concepts by electronic systems: adequacy of controlled medical terminologies.
OBJECTIVE: To assess the adequacy of 5 controlled medical terminologies (International Classification of Diseases 9, Clinical Modification [ICD9-CM]; Current Procedural Terminology 4 [CPT-4]; Systematized Nomenclature of Medicine, Clinical Terms [SNOMED-CT]; Logical Identifiers, Names, and Codes [LOINC]; Medical Entities Dictionary [MED]) for representing concepts in ophthalmology. DESIGN: Noncomparative case series. PARTICIPANTS: Twenty complete ophthalmology case presentations were sequentially selected from a publicly available ophthalmology journal. METHODS: Each of the 20 cases was parsed into discrete concepts, and each concept was classified along 2 axes: (1) diagnosis, finding, or procedure and (2) ophthalmic or medical concept. Electronic or paper browsers were used to assign a code for every concept in each of the 5 terminologies. Adequacy of assignment for each concept was scored on a 3-point scale. Findings from all 20 case presentations were combined and compared based on a coverage score, which was the average score for all concepts in that terminology. MAIN OUTCOME MEASURES: Adequacy of assignment for concepts in each terminology, based on a 3-point Likert scale (0, no match; 1, partial match; 2, complete match). RESULTS: Cases were parsed into 1603 concepts. SNOMED-CT had the highest mean overall coverage score (1.625+/-0.667), followed by MED (0.974+/-0.764), LOINC (0.781+/-0.929), ICD9-CM (0.280+/-0.619), and CPT-4 (0.082+/-0.337). SNOMED-CT also had higher coverage scores than any of the other terminologies for concepts in the diagnosis, finding, and procedure categories. Average coverage scores for ophthalmic concepts were lower than those for medical concepts. CONCLUSIONS: Controlled terminologies are required for electronic representation of ophthalmology data. SNOMED-CT had significantly higher content coverage than any other terminology in this study.
Humans↗
Standardized terminology in endoscopic ultrasound.
Standardized terminology is a prerequisite for meaningful collaboration and communication. This issue has been addressed for regular gastrointestinal endoscopy, through the OMED terminology and minimal standard terminology (MST) for endoscopic reporting. However, no similar initiative was taken for endoscopic ultrasound, although the need for a specific reporting language may be even greater for ultrasound investigations. This report describes the process and results of 'The International Working Group for Minimal Standard Terminology in Gastrointestinal Endosonography'. The resulting 'Minimal standard terminology in gastrointestinal endosonography' is presently available in a 1.0 version, and will now be subjected to clinical testing to further improve the selection and definition of core terms. It is reasonable to expect a fusion of this Endoscopic ultrasound (EUS) terminology with the general endoscopy MST terminology in the near future, to supply software developers with a joint standardized terminology.
Endosonography↗
Standardized terminological services enabling semantic interoperability between distributed and heterogeneous systems.
The interconnection of heterogeneous computer applications in medicine raises the issue of semantic interoperability, going beyond traditional approaches of terminological standardization in basically three aspects. First, the variety of medical vocabularies that currently coexist in different domains is a major barrier for the integration of autonomously developed applications. Fortunately, with the Unified Medical Language System (UMLS) there are machine-readable terminological sources that cover and integrate most of the existing medical vocabularies. Second, the exchanged data need to be processed by a machine for different purposes like patient data integration, access to literature and knowledge bases as well as clinical audit and research. Medical vocabularies provided as passive dictionaries are no longer sufficient. Software system developers should take advantage of terminological services for refining user queries, for mapping the user's terms to appropriate medical vocabularies etc. Third, the services should be accessible uniformly and transparently. In the CORBAmed initiative a proposal for a standardized interface for querying and accessing computerized medical terminology resources was created. Based on the mentioned principles the MUSTANG system (Medical UMLS based Terminology Server for Authoring, Navigating and Guiding the Retrieval to Heterogeneous Knowledge Sources) has been developed. It is implemented on a Windows NT platform using the ORACLE database management and development software. The terminological services are accessible via multiple interfaces. The MUSTANG-System and the experiences with using terminological services in practice are described. Opposed to other levels of standardization like syntactical message standards there is much more a hesitation in the use of standardized terminology.
Humans↗
Terminology support for development of sharable knowledge modules.
Lack of an agreed infrastructure for terminology is identified as one of the major barriers to interchange of knowledge modules and integration of knowledge bases with other clinical information systems. The goal of the GALEN project is to bridge this gap between different terminology systems through the construction of a terminology server, which is based on a rich conceptual model with mapping facilities to natural language expressions and coding schemas. The long term goal is to support communication between medical information systems. Arden Syntax is a standard format for the creation of knowledge modules, with sharability as one of the main objectives. Since Arden Syntax is based on a data-driven approach, the data items used need to be adapted to locally available terminology. The GALEN approach appears to be complementary to Arden Syntax and to the development of sharable knowledge modules. The major theme of this paper is utilization of the GALEN terminology server for knowledge module authoring. Two systems are presented, a knowledge base manager and a client to the terminology server, allowing the user to navigate in the semantic network and to import concept definitions and terms into the knowledge modules. The benefit of the terminology server, allowing the user to navigate in the semantic network and to import concept definitions and terms into the knowledge modules. The benefit of the terminology services is discussed.
Artificial Intelligence↗
[Histologic classification and terminology of precancerous lesions of the cervix].
INTRODUCTION: Precancerous changes of the cervix frequently occur in women in their reproductive age and are associated with sexually transmitted diseases. The evolution of these lesions qualifies them as precursors of malignancy, and their origination is associate with various risk factors, human papillomavirus (HPV) being the most important one. A proper clinical approach to and treatment of these changes depend on histologic diagnosis, which must be both terminologically adequate and apprehensive. PREVIOUS CLASSIFICATIONS AND TERMINOLOGY: The continuous change in nomenclature and lack of a uniform terminology has become the source of confusion and misunderstanding between gynecologists and pathologists. The term carcinoma in situ was first introduced in 1930 to denote the lesion, which is a reliable precursor of malignancy. Less intensive epithelial changes of the cervix were classified as dysplasia. Depending on extensive the change was, dysplasias were subclassified into mild, moderate and severe. Carcinoma in situ and various degrees of dysplasias were more precisely defined at the First International Congress of Exfoliative Cytology, which has also enabled the biological differentiation between these entities. The histologic differentiation of these lesions was, however, subjective and quite unreliable. UP-TO-DATE CLASSIFICATION AND TERMINOLOGY: Cellular changes in carcinoma in situ and in severe dysplasias were mutually so similar that pathologists could not make a reproducible difference between these lesions. Therefore, a conclusion was reached that these changes were one and the same process, whereas the differences were merely of quantitative nature. This discovery resulted in a terminological change, i.e. in a unique term--cervical intraepithelial neoplasia (CIN), with its gradation from 1 to 3. The 3rd grade of cervical intraepithelial neoplasia, according to the new terminology, encompassed changes which pathologists could not properly differentiate before. Many other changes with various, mostly descriptive terminology have also been included in the CIN category, thus preventing misunderstanding between pathologists and gynecologists. Besides the CIN classification, which has been most widely used today, there is also a division into only two biologically different categories: low-grade cervical intraepithelial neoplasia (Lo-CIN) and high-grade cervical intraepithelial neoplasia (Hi-CIN). The latter modification is included in the Bethesda system of cytologic diagnoses as low-grade squamous intraepithelia lesion (L-Sil) and high-grade squamous intraepithelial lesions (H-Sil). CONCLUSION: The use of a uniform terminology and classification minimizes the problem of diagnosing precancerous cervical lesions and enables adequate clinical treatment of these patients.
Female↗
Terminology access methods leveraging LDAP resources.
Health terminologies have become more complex, more massive, and more ubiquitous in the modern healthcare enterprise. Present technology makes the use of these terminologies by humans, unaided by machines, virtually impossible. However, system and message interoperability can be severely compromised if the software services deploying terminology content and interfaces are themselves non-standard. We review some characteristics for good terminology services and introduce an open-source, robust, widely deployed and widely available software resource to underpin terminology service implementations. The Lightweight Directory Access Protocol, or LDAP, is compared with alternative technologies. We describe a reference implementation of terminology services built around the HL7 Common Terminology Services using LDAP methods. We propose that LDAP is well suited as a common platform for federated, synchronized, and algorithmically distributed terminology content from multiple sources.
Algorithms↗