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Terminology-driven mining of biomedical literature.

MOTIVATION: With an overwhelming amount of textual information in molecular biology and biomedicine, there is a need for effective literature mining techniques that can help biologists to gather and make use of the knowledge encoded in text documents. Although the knowledge is organized around sets of domain-specific terms, few literature mining systems incorporate deep and dynamic terminology processing. RESULTS: In this paper, we present an overview of an integrated framework for terminology-driven mining from biomedical literature. The framework integrates the following components: automatic term recognition, term variation handling, acronym acquisition, automatic discovery of term similarities and term clustering. The term variant recognition is incorporated into terminology recognition process by taking into account orthographical, morphological, syntactic, lexico-semantic and pragmatic term variations. In particular, we address acronyms as a common way of introducing term variants in biomedical papers. Term clustering is based on the automatic discovery of term similarities. We use a hybrid similarity measure, where terms are compared by using both internal and external evidence. The measure combines lexical, syntactical and contextual similarity. Experiments on terminology recognition and clustering performed on a corpus of MEDLINE abstracts recorded the precision of 98 and 71% respectively. AVAILABILITY: software for the terminology management is available upon request.

Abbreviations as Topic↗

Evaluation of a "lexically assign, logically refine" strategy for semi-automated integration of overlapping terminologies.

OBJECTIVE: To evaluate a "lexically assign, logically refine" (LALR) strategy for merging overlapping healthcare terminologies. This strategy combines description logic classification with lexical techniques that propose initial term definitions. The lexically suggested initial definitions are manually refined by domain experts to yield description logic definitions for each term in the overlapping terminologies of interest. Logic-based techniques are then used to merge defined terms. METHODS: A LALR strategy was applied to 7,763 LOINC and 2,050 SNOMED procedure terms using a common set of defining relationships taken from the LOINC data model. Candidate value restrictions were derived by lexically comparing the procedure's name with other terms contained in the reference SNOMED topography, living organism, function, and chemical axes. These candidate restrictions were reviewed by a domain expert, transformed into terminologic definitions for each of the terms, and then algorithmically classified. RESULTS: The authors successfully defined 5,724 (73%) LOINC and 1,151 (56%) SNOMED procedure terms using a LALR strategy. Algorithmic classification of the defined concepts resulted in an organization mirroring that of the reference hierarchies. The classification techniques appropriately placed more detailed LOINC terms underneath the corresponding SNOMED terms, thus forming a complementary relationship between the LOINC and SNOMED terms. DISCUSSION: LALR is a successful strategy for merging overlapping terminologies in a test case where both terminologies can be defined using the same defining relationships, and where value restrictions can be drawn from a single reference hierarchy. Those concepts not having lexically suggested value restrictions frequently indicate gaps in the reference hierarchy.

Algorithms↗

Auditing as part of the terminology design life cycle.

OBJECTIVE: To develop and test an auditing methodology for detecting errors in medical terminologies satisfying systematic inheritance. This methodology is based on various abstraction taxonomies that provide high-level views of a terminology and highlight potentially erroneous concepts. DESIGN: Our auditing methodology is based on dividing concepts of a terminology into smaller, more manageable units. First, we divide the terminology's concepts into areas according to their relationships/roles. Then each multi-rooted area is further divided into partial-areas (p-areas) that are singly-rooted. Each p-area contains a set of structurally and semantically uniform concepts. Two kinds of abstraction networks, called the area taxonomy and p-area taxonomy, are derived. These taxonomies form the basis for the auditing approach. Taxonomies tend to highlight potentially erroneous concepts in areas and p-areas. Human reviewers can focus their auditing efforts on the limited number of problematic concepts following two hypotheses on the probable concentration of errors. RESULTS: A sample of the area taxonomy and p-area taxonomy for the Biological Process (BP) hierarchy of the National Cancer Institute Thesaurus (NCIT) was derived from the application of our methodology to its concepts. These views led to the detection of a number of different kinds of errors that are reported, and to confirmation of the hypotheses on error concentration in this hierarchy. CONCLUSION: Our auditing methodology based on area and p-area taxonomies is an efficient tool for detecting errors in terminologies satisfying systematic inheritance of roles, and thus facilitates their maintenance. This methodology concentrates a domain expert's manual review on portions of the concepts with a high likelihood of errors.

Biology↗

Basic terminology in obtaining reimbursement for pharmacists' cognitive services.

PURPOSE: A basic overview and definitions of commonly used billing and reimbursement terminology that pharmacists will need to know to obtain reimbursement for cognitive services are provided. SUMMARY: Currently, the profession of pharmacy has been gathering momentum in its efforts to seek and obtain reimbursement for cognitive services. However, there have been major barriers in seeking reimbursement, including the lack of understanding by third-party payers of the pharmacist's role in patient care and the pharmacist's in-depth knowledge of pharmacotherapy, the lack of appropriate billing codes for pharmacists' services, and the lack of detailed knowledge and understanding by pharmacy practitioners of nondistributive reimbursement mechanisms, processes, and terminology. The types of services provided are usually described by the American Medical Association's Current Procedural Terminology (CPT) codes for the face-to-face provision of patient care services by a pharmacist. As of January 1, 2006, pharmacists have been able to indicate the appropriate diagnosis code from the International Classification of Diseases, 9th Revision (ICD-9) (ICD-10 will replace the ICD-9 on October 1, 2007), and CPT code when billing under a major medical plan that recognizes the pharmacist as a patient care service provider. Understanding the billing and reimbursement terminology will aid pharmacist communication with third-party payers, Medicare, and Medicaid. A glossary of the most commonly encountered terms in billing and reimbursement procedures for cognitive services is provided. Also included are lists of Web-based reimbursement resources and references on reimbursement for cognitive services by the pharmacist. CONCLUSION: An understanding of terminology is important in receiving reimbursement for cognitive services.

Drug Therapy↗

Understanding terminological systems. II: Experience with conceptual and formal representation of structure.

This article describes the application of two popular conceptual and formal representation formalisms, as part of a framework for understanding terminological systems. A precise understanding of the structure of a terminological system is essential to assess existing terminological systems, to recognize patterns in various systems and to build new terminological systems. Our experience with the application of this framework to five well-known terminological systems is described.

Humans↗

The content coverage and organizational structure of terminologies: the example of postoperative pain.

Concepts such as symptoms present specific representational challenges in the EMR. This is because concepts without clear boundaries and external referents such as physical objects can only be examined against other terminology-based concept representation systems. The truth and falsity of such concept representation is therefore relative to the terminology-based systems. Using the concept of acute postoperative pain as an example, we examined three terminology based approaches to representing the concept. Widely varying coverage across existing clinical terminologies was evident, although the common clinical approach to reporting attributes of symptoms provided a useful organizational structure and should be examined in relation to developing terminology and information models.

Humans↗

Change management of shared and local versions of health-care terminologies.

Local sites that adopt a shared health-care terminology for computer-based systems have local needs that prompt the local-terminology maintainers to make changes to the local version of the shared terminology. If the local site is motivated to conform to the shared terminology, then the burden lies with the local site to manage its own changes and to incorporate the changes of the shared version at periodic intervals. We call this process synchronization. We survey current approaches that address problems of sharing and local modification, and we present the CONCORDIA model, which supports carefully controlled divergence of a local version from a shared terminology. CONCORDIA provides the underlying design and methodology for the implementation of a synchronization-support tool.

Humans↗

Challenges in the development and testing of a reference terminology model for nursing interventions.

The purpose of this paper is to report the work of the Interventions Group of the first Nursing Terminology Summit (1999) and to describe the challenges and insights of this group as they have evolved a reference terminology model for nursing interventions. When the group began its work as part of the first meeting of the Nursing Terminology Summit, it had the overall objective of proposing the intervention component of a reference terminology model for nursing. Although there is not a definitive proposal for this to date, the group's exploration and analysis has clarified and explicated both the types of models of clinical information and the current " state of the art" of formal representations of nursing interventions as well as the relationship of nursing languages to these formal representations. In addition, it is our perspective that the work of this group is representative of the process and challenges facing many similar groups currently engaged in modeling efforts. Consequently, critical success factors of such efforts are identified and discussed. This paper reports both the specific outputs of the group related to progress in defining a terminology model of nursing interventions and observations and lessons learned regarding consensus modeling work.

Models, Theoretical↗

Integration of nursing assessment concepts into the medical entities dictionary using the LOINC semantic structure as a terminology model.

Recent investigations have tested the applicability of various terminology models for the representing nursing concepts including those related to nursing diagnoses, nursing interventions, and standardized nursing assessments as a prerequisite for building a reference terminology that supports the nursing domain. We used the semantic structure of Clinical LOINC (Logical Observations, Identifiers, Names, and Codes) as a reference terminology model to support the integration of standardized assessment terms from two nursing terminologies into the Medical Entities Dictionary (MED), the concept-oriented, metadata dictionary at New York Presbyterian Hospital. Although the LOINC semantic structure was used previously to represent laboratory terms in the MED, selected hierarchies and semantic slots required revisions in order to incorporate the nursing assessment concepts. This project was an initial step in integrating nursing assessment concepts into the MED in a manner consistent with evolving standards for reference terminology models. Moreover, the revisions provide the foundation for adding other types of standardized assessments to the MED.

Dictionaries, Medical as Topic↗

Description of a drug hierarchy in a concept-based reference terminology.

A concept-based reference terminology that covers all aspects of healthcare is essential in developing the Electronic Health Record (EHR). SNOMED Clinical Terms (CT), scheduled for release in December 2001, integrates the relative strengths of SNOMED RT, and the United Kingdom s Clinical Terms Version 3, formerly known as the Read Codes Version 3. It promises to be the most comprehensive terminology available. Since a significant portion of the EHR can be drug-related information, we describe here some of the background information and rationale for the structure and scope of the merged drug hierarchy within SNOMED CT. A controlled drug terminology within a reference terminology has the potential to support a number of functions within healthcare practice. One of the functions proposed is to serve as the bridge between reference terminology and drug knowledge bases.

Clinical Medicine↗

Culling a clinical terminology: a systematic approach to identifying problematic content.

The College of American Pathologists and the National Health Service (NHS) in the United Kingdom are merging their respective clinical terminologies, SNOMED RT and Clinical Terms Version 3, into a new terminology, SNOMED CT. This requires mapping concept descriptions between the two existing terminologies. During the mapping process, many descriptions were identified as being potentially problematic. They require further review by the SNOMED editorial process before either (1) being incorporated into SNOMED CT, or (2) retired from active use. This article presents data on the concept descriptions that were identified as needing further review during the early phases of SNOMED CT development. Based on this work, we describe fourteen types of problematic terminology content. Identifying problematic terminology content can be approached in a systematic manner.

Clinical Medicine↗

Integrating existing drug formulation terminologies into an HL7 standard classification using OpenGALEN.

Many terminologies exist for the form of drugs--i.e. tablets, capsules, sprays, suppositories, etc. However, they have surprisingly different content. To communicate medication messages effectively, a mechanism is needed to translate between these existing terminologies. An ontological approach, based on techniques developed by OpenGALEN, has been used to build a drug form terminology for HL7 version 3. It integrates existing terminologies from commercial drug information vendors and regulatory authorities, and provides a framework for translating between them. To date, term sets have been included from First DataBank, the FDA, Multum and Micromedex, to produce a terminology of 820 concepts. The approach is made practical by distributing the knowledge engineering effort to volunteers with experience of the domain, and then integrating the knowledge into a logically consistent classification.

Chemistry, Pharmaceutical↗

Strength in numbers: exploring redundancy in hierarchical relations across biomedical terminologies.

OBJECTIVES: To investigate three aspects of the redundancy of hierarchical relations across biomedical terminologies: 1) What proportion of the relations is redundant?, 2) Which terminologies tend to overlap with other terminologies?, and 3) Is there a link between redundancy and semantic consistency?. METHODS: Hierarchical relations are counted in the various families of terminologies integrated into the UMLS and an index of redundancy is computed for each relation. Similarity among sources is computed using the classical cosine method. Semantic consistency is evaluated by reference to the UMLS Semantic Network. RESULTS: Overall, 29% of the 1,128,261 relations examined exhibit redundancy. Most similar sources include consecutive versions of terminologies. The link between redundancy and semantic consistency is weak. DISCUSSION: Applications of these findings are discussed, including selecting sources, selecting useful relations, and auditing the categorization of UMLS concepts.

Terminology as Topic↗

The Open Terminology Services (OTS) project.

The Open Terminology Services (OTS) project provides a common, well-specified mechanism to access terminological content in a vendor and platform neutral fashion. The project includes a freely available API specification and an open source reference implementation. The API specification derives from the OMG Lexicon Query Services interface specification as a foundation and defines mechanisms for browsing, querying and import terminological content. The Java-based reference implementation uses the Lightweight Directory Access Protocol (LDAP) for a back end, and provides a mechanism to query and distribute heterogeneous terminological content using a common format. The project includes the CTS (Central Terminology Services) subset under HL7.

Information Systems↗

Automating terminological networks to link heterogeneous biomedical databases.

As cross-disciplinary research escalates, researchers are facing the challenge of linking disparate biomedical databases that have been developed without common indexes. Manually indexing these large-scale databases is laborious and often impractical. Solutions involving mediating terminologies have been proposed, but coordination of terms from the databases of interest to these mediating terminologies is also laborious, and regular synchronization between indexes is an additional problem. In this study we describe a novel method of linking heterogeneous databases using terminology networks constructed with automated mapping methods. Linkage was established between two disparate biomedical databases (SNOMED-CT and HDG), using two relevant intermediating databases (UMLS and OMIM). One gold standard of 514 distinct matches is used as proof-of-principle. In conclusion, as hypothesized, 1) Manually curated pathways provide high precision, but offer low recall, 2) the automated terminology pathways can significantly increase recall at acceptable precision. Taken together, our conclusion may suggest the combined manual and automated terminology networks could offer recall and precision in an incremental manner

Abstracting and Indexing↗

Introducing standardized terminologies to nurses: Magic wands and other strategies.

Information technology advances have created a revolution that is transforming health care delivery. Practice, documentation, and communication are becoming data-driven. As a result, vendors are rapidly developing and upgrading their computerized clinical information systems; more health care providers are purchasing and implementing these systems. Many systems include standardized terminologies intended for use by nurses. It is imperative that nurses use these terminologies accurately and consistently in order to generate high-quality clinical data. Leaders and terminology committee members employed at practice, education, and research sites need to develop educational strategies to support nurse users as part of well-organized, systematic introductory programs Program requisites include a long-term vision, teamwork, positive attitudes, and adequate resources. This paper is designed to summarize standardized terminologies, benefits and challenges for nurse users, and educational strategies to introduce the terminologies to nurses successfully. The authors will describe the planning, implementation, and evaluation-maintenance strategies they used to introduce the Omaha System to diverse groups.

Humans↗

Interactive visualization and navigation of complex terminology systems, exemplified by SNOMED CT.

Free-text queries are natural entries into the exploration of complex terminology systems. The way search results are presented has impact on the user's ability to grasp the overall structure of the system. Complex hierarchies like the one used in SNOMED CT, where nodes have multiple parents (IS-A) and several other relationship types, makes visualization challenging. This paper presents a prototype, TermViz, applying well known methods like "focus+context" and self-organizing layouts from the fields of Information Visualization and Graph Drawing to terminologies like SNOMED CT and ICD-10. The user can simultaneously focus on several nodes in the terminologies and then use interactive animated graph navigation and semantic zooming to further explore the terminology systems without loosing context. The prototype, based on Open Source Java components, demonstrates how a number of Information Visualisation methods can aid the exploration of medical terminologies with millions of elements and can serve as a base for further development.

Data Display↗

Scalable and expressive medical terminologies.

The K-Rep system, based on description logic, is used to represent and reason with large and expressive controlled medical terminologies. Expressive concept descriptions incorporate semantically precise definitions composed using logical operators, together with important non-semantic information such as synonyms and codes. Examples are drawn from our experience with K-Rep in modeling the InterMed laboratory terminology and also developing a large clinical terminology now in production use at Kaiser-Permanente. System-level scalability of performance is achieved through an object-oriented database system which efficiently maps persistent memory to virtual memory. Equally important is conceptual scalability-the ability to support collaborative development, organization, and visualization of a substantial terminology as it evolves over time. K-Rep addresses this need by logically completing concept definitions and automatically classifying concepts in a taxonomy via subsumption inferences. The K-Rep system includes a general-purpose GUI environment for terminology development and browsing, a custom interface for formulary term maintenance, a C+2 application program interface, and a distributed client-server mode which provides lightweight clients with efficient run-time access to K-Rep by means of a scripting language.

Artificial Intelligence↗