# Presentation: 554830

## Experience with Using the UMLS Semantic Network to Coordinate Controlled Terminologiesfor  a Large Clinical Data Repository

- James J. Cimino
- Department of Biomedical Informatics
- Columbia University College of Physicians and Surgeons
- National Library of Medicine, April 8, 2005

## Overview

- Background
- History
- General principles
- Empiric observations: Semantic Network in the Medical Entities Dictionary
- Lessons to be learned

## Clinical Data Architecture

- Central repository to collect data from myriad sources
- Myriad users of data - some not yet imagined

## New York Presbyterian HospitalClinical Information Systems Architecture

## Clinical Data Architecture

- Central repository to collect data from myriad sources
- Myriad users of data - some not yet imagined

- Patient-oriented, not visit oriented, database
- Relational, not hierarchical, model
- Entity-attribute-value model

## Entity-Attribute-Value Clinical Data Repository

## Clinical Data Architecture

- Central repository to collect data from myriad sources
- Myriad users of data - some not yet imagined
- Patient-oriented, not visit oriented, database
- Relational, not hierarchical, model
- Entity-attribute-value model

- Coded data wherever possible
- Unify terminology

## Medical Entities Dictionary: A Central Terminology Repository

- Medical Entities Dictionary: A Central Terminology Repository

## MED Structure

- Medical
- Entity

- CHEM-7

- Plasma
- Glucose
- Test

## Communicating Terminology Changes

## Solution: Hierarchical Integration

- K#1

- K#2

## Use of the UMLS in Patient  Care

- James J. Cimino, M.D.
- Center for Medical Informatics
- Columbia University
- Mont Pelerin, Switzerland 1994

## UMLS Semantic Network

- Strict hierarchy
- Semantic types:  132 (135)
- Semantic relations:  46 (53)
- Inheritance of relations:  6233 (6700)

## UMLS Metathesaurus

- Terms from 22 (100+) controlled vocabularies
- Total source terms:  311,046
- Total strings:  279,237 (5,000,000)
- Total concepts:  152,444 (1,000,000)
- Relationships:  1,484,994 (16,000,000)

## Medical Entities Dictionary

- Semantic Network
- Sources:  5
- Strings:  108,492
- Concepts:  35,281
- Semantic relations:  23 pairs
- Semantic Links:  145,672

## Comparisons - Methods

- CPMC Entities vs. UMLS Semantic Types
- MED Classes vs. UMLS Semantic Types
- MED Semantic Links vs. UMLS Semantic Relations
- MED Concepts vs. Metathesaurus Concepts
- MED Semantic Links vs. Meta Relations

## Comparisons - Results

- DB Entities

- Classes

- Links

- CPMC

- U
- M
- L
- S

- Types

- Relations

- Concepts

- Concepts

- Meta Links

- ++++

- +++

- +/-

- ++

- +++

## Summary

- Semantic Types provide good coverage
- Concepts provide good coverage in certain domains
- No technical reason why UMLS could not incorporate clinical vocabulary

## Where We Are Today - Repository

- Patients: 2.6 million
- Visits: >10 million since 1996 with archives going back to 1979
- Visit diagnoses, locations, procedures, providers, insurance
- Lab procedures: 16 million with 130 million results (to 1989)
- Radiology procedures reports: 5.7 million
- Pathology: 1.4 million
- Cardiology procedures: 1.5 million
- Resident signout notes:760,000
- Operative Notes: 426,000
- Clinical Notes: 400,000
- Discharge Summaries: 420000

- Medication orders:  >60 million
- ObGyn Procedure Reports: 241,000
- GI Procedure Reports: 101,000
- Neurology Procedure Reports: 54,000
- Ideatel BP’s: 215,000
- Ideatel Glucose: 650,000
- Consult Events: 18000
- HEENT Events:13000
- Hospitalist Notes:30000
- PFT: 25000
- Provider profiles 11000
- IDX 1.4 million
- East Campus

## Where We Are Today - MED

- Domains: 7++ (5)
- HP lab terms
- Misys lab terms
- Cerner lab terms
- Misys Radiology
- Digimedix drugs
- Cerner Drugs
- ICD9-based problem list terms
- Other applications
- Knowledge terms
- Size:
- Concept-based: 95,641 (35,281)
- Multiple hierarchy: 141,306
- Synonyms: 239,581 (108,492)
- Translations: 141,717
- Semantic link pairs: 52 (23)
- Semantic links: 225,698 (145,672)
- Attributes: 210,456

## What does this have to do with the SN?

- MED was initially based on UMLS design (creationism)
- UMLS SN was the “starter set”
- MED is “local UMLS” for CPMC
- General principles were established
- MED has developed without further conscious attention to the SN (evolution)
- MED content represents real-world terminology
- What follows are empiric observations, open to criticism; perhaps indefensible

## General Principles

- Everything is a class
- Multiple hierarchy
- Some relations are definitional
- At most, one part of relation pair is definitional
- Properties introduced at single points

## Observations on the SN in the MED

- Arrangement of SN in MED
- Multiple hierarchy of STs
- Size of ST classes in MED (vs Meta?)
- STs as introduction points
- Intersections

## UMLS Semantic Net in the MED

- A: T071: Medical Entity  [94729]
- .  A1: T072: Physical Object  [5618]
- .  +*A1.2: T017: Anatomical Structure  [577]
- .  A2: T077: Conceptual Entity  [77861]
- .  *B: T051: Event  [55450]

- Key:
-   “A1.2”: UMLS Tree address
-   “T071”: Semantic type ID
-   “Event”: MED Name
-   “+”: Multiple locations
-   “*”: Discontinuous tree address
-   “[577]”: Number of MED concepts

## UMLS Semantic Net in the MED

- A: T071: Medical Entity  [94729]
- .  A1: T072: Physical Object  [5618]
- .  .  A1.1: T001: Organism  [3153]
- .  .  .  A1.1.1: T002: Plant  [1]
- .  .  .  .  A1.1.1.1: T003: Alga  [0]
- .  .  .  A1.1.2: T004: Fungus  [273]
- .  .  .  A1.1.3: T005: Virus  [169]
- .  .  .  A1.1.4: T006: Rickettsia or Chlamydia  [5]
- .  .  .  A1.1.5: T007: Bacterium  [992]
- .  .  .  A1.1.6: T194: Archaeon  [0]
- .  .  .  A1.1.7: T008: Animal  [93]
- .  .  .  .  A1.1.7.1: T009: Invertebrate  [85]
- .  .  .  .  A1.1.7.2: T010: Vertebrate  [6]
- .  .  .  .  .  A1.1.7.2.1: T011: Amphibian  [0]
- .  .  .  .  .  A1.1.7.2.2: T012: Bird  [0]
- .  .  .  .  .  A1.1.7.2.3: T013: Fish  [0]
- .  .  .  .  .  A1.1.7.2.4: T014: Reptile  [0]
- .  .  .  .  .  A1.1.7.2.5: T015: Mammal  [1]
- .  .  .  .  .  .  A1.1.7.2.5.1: T016: Human  [0]

- Key:
-   “A1.2”: UMLS Tree address
-   “T071”: Semantic type ID
-   “Event”: MED Name
-   “+”: Multiple locations
-   “*”: Discontinuous tree address
-   “[577]”: Number of MED concepts

## UMLS Semantic Net in the MED

- A: T071: Medical Entity  [94729]
- .  +*A1.2: T017: Anatomical Structure  [577]
- .  .  A1.2.3: T021: Fully Formed Anatomical Structure  [230]
- .  .  .  A1.2.3.1: T023: Body Part, Organ, or Organ Component  [204]
- .  .  .  *A1.2.1: T018: Embryonic Structure  [2]
- .  .  .  *A1.2.2: T190: Anatomical Abnormality  [20]
- .  .  .  .  A1.2.2.1: T019: Congenital Abnormality  [0]
- .  .  .  .  A1.2.2.2: T020: Acquired Abnormality  [18]
- .  .  *A1.2.3.2: T024: Tissue  [66]
- .  .  *A1.2.3.3: T025: Cell  [61]
- .  .  *A1.2.3.4: T026: Cell Component  [11]
- .  .  *A1.2.3.5: T028: Gene or Genome  [0]
- .  .  *A1.4.2: T031: Body Substance  [56]
- .  .  +*A2.1.4.1: T022: Body System  [65]
- .  .  +*A2.1.5.1: T030: Body Space or Junction  [43]
- .  .  +*A2.1.5.2: T029: Body Location or Region  [117
- .  .  *A1.3: T073: Manufactured Object  [16]
- .  .  .  A1.3.1: T074: Medical Device  [6]
- .  .  .  A1.3.2: T075: Research Device  [0]
- .  .  .  A1.3.3: T200: Clinical Drug  [0]
- .  .  A1.4: T167: Substance [???]
- .  .  .  A1.4.1: T103: Chemical  [1942]
- .  .  .  .  A1.4.1.1: T120: Chemical Viewed Functionally  [1828]
- .  .  .  .  .  A1.4.1.1.1: T121: Pharmacologic Substance  [1468]
- .  .  .  .  .  .  +*A1.4.1.1.3.4: T127: Vitamin  [20]
- .  .  .  .  .  .  A1.4.1.1.1.1: T195: Antibiotic  [130]
- .  .  .  .  .  A1.4.1.1.3: T123: Biologically Active Substance  [530]
- .  .  .  .  . .   +A1.4.1.1.3.4: T127: Vitamin  [20]

- Key:
-   “A1.2”: UMLS Tree address
-   “T071”: Semantic type ID
-   “Event”: MED Name
-   “+”: Multiple locations
-   “*”: Discontinuous tree address
-   “[577]”: Number of MED concepts

## 1:  Medical Entirity  [T071]
   MED-CODE
   UMLS-CODE
   NAME
   SUBCLASS-OF -> SUBCLASS (1: Medical Entity [T071])
   SUBCLASS -> SUBCLASS-OF (1: Medical Entity [T071])
   SYNONYMS
   PRINT-NAME
   HAS-PARTS -> PART-OF (1: Medical Entity [T071])
   PART-OF -> HAS-PARTS (1: Medical Entity [T071])
   DEFINITION
   MAIN-MESH
   SUPPLEMENTARY-MESH
   NAME-TOKEN
   DEFAULT-SHORT-DISPLAY-NAME
   DEFAULT-DISPLAY-NAME
   SPEECH-SYNONYM
   SPEECH-SYNTHESIS-NAME
   ENTITY-(HAS-RELATED)-PAGER-NUMBER
   ENTITY-(HAS)-MEDLEE-TARGET-TERM
   HIERARCHY-SELECTOR

-    MED-CODE
-    UMLS-CODE
-    NAME
-    SUBCLASS-OF -> SUBCLASS (1: Medical Entity [T071])
-    SUBCLASS -> SUBCLASS-OF (1: Medical Entity [T071])
-    SYNONYMS
-    PRINT-NAME
-    HAS-PARTS -> PART-OF (1: Medical Entity [T071])
-    PART-OF -> HAS-PARTS (1: Medical Entity [T071])
-    DEFINITION
-    MAIN-MESH
-    SUPPLEMENTARY-MESH
-    NAME-TOKEN
-    DEFAULT-SHORT-DISPLAY-NAME
-    DEFAULT-DISPLAY-NAME
-    SPEECH-SYNONYM
-    SPEECH-SYNTHESIS-NAME
-    ENTITY-(HAS-RELATED)-PAGER-NUMBER
-    ENTITY-(HAS)-MEDLEE-TARGET-TERM
-    HIERARCHY-SELECTOR

- Property Introduction Points

## 7: Body System [T022]
   ACTION-SITE-OF -> ACTION-SITE (98: Health Care Activity (Procedure) [T058])

14: Anatomical Structure [T017]
   SITE-OF-PROBLEM -> HAS-PROBLEM-SITE (30007: Patient Problem)
   OBSERVATION-SITE-OF -> OBSERVATION-SITE (94: Diagnostic Procedure [T060])

43: Chemical [T103]
   PHARMACEUTIC-COMPONENT-OF -> PHARMACEUTIC-COMPONENT (28103: Pharmacy Items (Drugs and Nondrugs))

50: Measureable Entity
   MEASURED-BY-PROCEDURE -> ENTITY-MEASURED (64964: Assessment Procedures)
   LOINC-ANALYTE-NAME

76: Disease or Syndrome [C0391828]
   ETIOLOGY -> CAUSES-DISEASES (135: Etiologic Agent)
   IS-HISTORIC-DISEASE-FOR -> HISTORIC-DISEASE (56164: Factors Related to Past Disease Influencing Health Status)

-    ACTION-SITE-OF -> ACTION-SITE (98: Health Care Activity (Procedure) [T058])
- 14: Anatomical Structure [T017]
-    SITE-OF-PROBLEM -> HAS-PROBLEM-SITE (30007: Patient Problem)
-    OBSERVATION-SITE-OF -> OBSERVATION-SITE (94: Diagnostic Procedure [T060])
- 43: Chemical [T103]
-    PHARMACEUTIC-COMPONENT-OF -> PHARMACEUTIC-COMPONENT (28103: Pharmacy Items (Drugs and Nondrugs))
- 50: Measureable Entity
-    MEASURED-BY-PROCEDURE -> ENTITY-MEASURED (64964: Assessment Procedures)
-    LOINC-ANALYTE-NAME
- 76: Disease or Syndrome [C0391828]
-    ETIOLOGY -> CAUSES-DISEASES (135: Etiologic Agent)
-    IS-HISTORIC-DISEASE-FOR -> HISTORIC-DISEASE (56164: Factors Related to Past Disease Influencing Health Status)

- Medical Properties

## 83: Laboratory Finding or Test Result [T034]
   RESULT-TYPE-->TESTS -> TEST-->RESULT-TYPE (94: Diagnostic Procedure [T060])

86: Finding [T033]
   FINDING-(REFERS-TO)->ORGANISM

93: Laboratory Diagnostic Procedure
   COLLECTED-BY -> COLLECTED-FOR (33023: Specimen Collection [C0200345])

94: Diagnostic Procedure [T060]
   UNITS
   TEST-->RESULT-TYPE -> RESULT-TYPE-->TESTS (83: Laboratory Finding or Test Result [T034])
   OBSERVATION-SITE -> OBSERVATION-SITE-OF (14: Anatomical Structure [T017])
   TEST-(HAS)-ABNORMAL-FLAG -> ABNORMAL-FLAG-(FOR)-TEST (77746: Abnormal Flag Value)

98: Health Care Activity (Procedure) [T058]
   PROCEDURE-(INDICATES)->PT-PROBLEM -> PT-PROBLEM-(INDICATED-BY)->PROCEDURE (30007: Patient Problem)
   ACTION-SITE -> ACTION-SITE-OF (7: Body System [T022])

-    RESULT-TYPE-->TESTS -> TEST-->RESULT-TYPE (94: Diagnostic Procedure [T060])
- 86: Finding [T033]
-    FINDING-(REFERS-TO)->ORGANISM
- 93: Laboratory Diagnostic Procedure
-    COLLECTED-BY -> COLLECTED-FOR (33023: Specimen Collection [C0200345])
- 94: Diagnostic Procedure [T060]
-    UNITS
-    TEST-->RESULT-TYPE -> RESULT-TYPE-->TESTS (83: Laboratory Finding or Test Result [T034])
-    OBSERVATION-SITE -> OBSERVATION-SITE-OF (14: Anatomical Structure [T017])
-    TEST-(HAS)-ABNORMAL-FLAG -> ABNORMAL-FLAG-(FOR)-TEST (77746: Abnormal Flag Value)
- 98: Health Care Activity (Procedure) [T058]
-    PROCEDURE-(INDICATES)->PT-PROBLEM -> PT-PROBLEM-(INDICATED-BY)->PROCEDURE (30007: Patient Problem)
-    ACTION-SITE -> ACTION-SITE-OF (7: Body System [T022])

- Medical Properties

## 135: Etiologic Agent
   CAUSES-DISEASES -> ETIOLOGY (76: Disease or Syndrome [C0391828])

1181: Antibiotic Sensitivity Tests
   SENSITIVITY-ANALYTE -> SENSITIVITY-ANALYTE-OF (44440: Antibiotic or Bacterial Enzyme Inhibitor)

32291: Sampleable Entity
   SAMPLED-BY -> SYSTEM-SAMPLED (64970: Sample Entity)
   LOINC-SYSTEM-CODE

44440: Antibiotic or Bacterial Enzyme Inhibitor
   SENSITIVITY-ANALYTE-OF -> SENSITIVITY-ANALYTE (1181: Antibiotic Sensitivity Tests)

-    CAUSES-DISEASES -> ETIOLOGY (76: Disease or Syndrome [C0391828])
- 1181: Antibiotic Sensitivity Tests
-    SENSITIVITY-ANALYTE -> SENSITIVITY-ANALYTE-OF (44440: Antibiotic or Bacterial Enzyme Inhibitor)
- 32291: Sampleable Entity
-    SAMPLED-BY -> SYSTEM-SAMPLED (64970: Sample Entity)
-    LOINC-SYSTEM-CODE
- 44440: Antibiotic or Bacterial Enzyme Inhibitor
-    SENSITIVITY-ANALYTE-OF -> SENSITIVITY-ANALYTE (1181: Antibiotic Sensitivity Tests)

- Medical Properties

## 59511: Clinical Repository Table
   TABLE-HAS-COLUMN -> COLUMN-IS-IN-TABLE (59512: Clinical Repository Column)

59512: Clinical Repository Column
   COLUMN-IS-IN-TABLE -> TABLE-HAS-COLUMN (59511: Clinical Repository Table)

59528: Generic Column
   COLUMN-HAS-PERMITTED-VALUES -> IS-PERMITTED-VALUE-FOR-COLUMN (67164: Verification Concept for Generic Column)

59729: Data Entry Form Component
   REPEAT-TYPE(DATA-ENTRY-COMPONENT)
   NUMBER-REPEATS(DATA-ENTRY-COMPONENT)
   REPEAT-LAYOUT-TYPE(DATA-ENTRY-COMPONENT)

59732: Form Field Allowable Values
   ALLOWABLE-VALUE-(FOR)->DATA-ENTRY-FIELD -> DATA-ENTRY-FIELD-(HAS)->ALLOWABLE-VALUE (42646: Data Entry Form Field)

-    TABLE-HAS-COLUMN -> COLUMN-IS-IN-TABLE (59512: Clinical Repository Column)
- 59512: Clinical Repository Column
-    COLUMN-IS-IN-TABLE -> TABLE-HAS-COLUMN (59511: Clinical Repository Table)
- 59528: Generic Column
-    COLUMN-HAS-PERMITTED-VALUES -> IS-PERMITTED-VALUE-FOR-COLUMN (67164: Verification Concept for Generic Column)
- 59729: Data Entry Form Component
-    REPEAT-TYPE(DATA-ENTRY-COMPONENT)
-    NUMBER-REPEATS(DATA-ENTRY-COMPONENT)
-    REPEAT-LAYOUT-TYPE(DATA-ENTRY-COMPONENT)
- 59732: Form Field Allowable Values
-    ALLOWABLE-VALUE-(FOR)->DATA-ENTRY-FIELD -> DATA-ENTRY-FIELD-(HAS)->ALLOWABLE-VALUE (42646: Data Entry Form Field)

- Data Dictionary Properties

## 21762: ICD9 Element
   ICD9-CODE
   ICD9-ENTRY-CODE
   OLD-ICD9-CODE
   ICD9-NAME

23147: American Hospital Formulary Service Class
   AHFS-CLASS-CODE

28104: Drug Enforcement Administration (DEA) Controlled Substance Category
   DEA-CODE

-    ICD9-CODE
-    ICD9-ENTRY-CODE
-    OLD-ICD9-CODE
-    ICD9-NAME
- 23147: American Hospital Formulary Service Class
-    AHFS-CLASS-CODE
- 28104: Drug Enforcement Administration (DEA) Controlled Substance Category
-    DEA-CODE

- Controlled Terminology Properties

## 1178: Number or String Result
   EVENT-ID-OF -> EVENT-ID (9876: CPMC Event)
   EVENT-PATIENT-ID-OF -> EVENT-PATIENT-ID (9876: CPMC Event)
   EVENT-ORGANIZATION-OF -> EVENT-ORGANIZATION (9876: CPMC Event)
   EVENT-LOCATION-OF -> EVENT-LOCATION (9876: CPMC Event)
   PARTICIPANT-ID-OF -> PARTICIPANT-ID (30352: Medical Event Participant)

9876: CPMC Event
   EVENT-ID -> EVENT-ID-OF (1178: Number or String Result)
   EVENT-DATE -> EVENT-DATE-OF (30349: Date Result)
   EVENT-PATIENT-ID -> EVENT-PATIENT-ID-OF (1178: Number or String Result)
   EVENT-PARTICIPANT -> PARTICIPANT-OF (30352: Medical Event Participant)
   EVENT-ORGANIZATION -> EVENT-ORGANIZATION-OF (1178: Number or String Result)
   EVENT-LOCATION -> EVENT-LOCATION-OF (1178: Number or String Result)
   EVENT-STATUS -> STATUS-OF (30355: CPMC Status Term)
   EVENT-(HAS)-ORGANIZATION -> ORGANIZATION-(FOR)-EVENT (81475: CPMC Coded Organizations)

30344: CPMC Order
   ORDER-QUANTITY -> ORDER-QUANTITY-OF (30350: Quantity Result)
   ORDER-FREQUENCY -> ORDER-FREQUENCY-OF (32504: Order Frequency)
   ORDER-START-DATE -> ORDER-START-DATE-OF (30349: Date Result)
   ORDER-STOP-DATE -> ORDER-STOP-DATE-OF (30349: Date Result)

30352: Medical Event Participant
   PARTICIPANT-OF -> EVENT-PARTICIPANT (9876: CPMC Event)
   PARTICIPANT-ID -> PARTICIPANT-ID-OF (1178: Number or String Result)
   PARTICIPANT-NAME -> PARTICIPANT-NAME-OF (32653: ID Number Plus Text Result)

-    EVENT-ID-OF -> EVENT-ID (9876: CPMC Event)
-    EVENT-PATIENT-ID-OF -> EVENT-PATIENT-ID (9876: CPMC Event)
-    EVENT-ORGANIZATION-OF -> EVENT-ORGANIZATION (9876: CPMC Event)
-    EVENT-LOCATION-OF -> EVENT-LOCATION (9876: CPMC Event)
-    PARTICIPANT-ID-OF -> PARTICIPANT-ID (30352: Medical Event Participant)
- 9876: CPMC Event
-    EVENT-ID -> EVENT-ID-OF (1178: Number or String Result)
-    EVENT-DATE -> EVENT-DATE-OF (30349: Date Result)
-    EVENT-PATIENT-ID -> EVENT-PATIENT-ID-OF (1178: Number or String Result)
-    EVENT-PARTICIPANT -> PARTICIPANT-OF (30352: Medical Event Participant)
-    EVENT-ORGANIZATION -> EVENT-ORGANIZATION-OF (1178: Number or String Result)
-    EVENT-LOCATION -> EVENT-LOCATION-OF (1178: Number or String Result)
-    EVENT-STATUS -> STATUS-OF (30355: CPMC Status Term)
-    EVENT-(HAS)-ORGANIZATION -> ORGANIZATION-(FOR)-EVENT (81475: CPMC Coded Organizations)
- 30344: CPMC Order
-    ORDER-QUANTITY -> ORDER-QUANTITY-OF (30350: Quantity Result)
-    ORDER-FREQUENCY -> ORDER-FREQUENCY-OF (32504: Order Frequency)
-    ORDER-START-DATE -> ORDER-START-DATE-OF (30349: Date Result)
-    ORDER-STOP-DATE -> ORDER-STOP-DATE-OF (30349: Date Result)
- 30352: Medical Event Participant
-    PARTICIPANT-OF -> EVENT-PARTICIPANT (9876: CPMC Event)
-    PARTICIPANT-ID -> PARTICIPANT-ID-OF (1178: Number or String Result)
-    PARTICIPANT-NAME -> PARTICIPANT-NAME-OF (32653: ID Number Plus Text Result)

- Data Modeling Properties

## 40441: Display Information [C0010996]
   DEFAULT-DISPLAY-FOR -> HAS-DEFAULT-DISPLAYS (94: Diagnostic Procedure [T060])
   DISPLAYS-ELEMENTS-OF -> ELEMENTS-DISPLAYED-BY (94: Diagnostic Procedure [T060])
   HAS-DISPLAY-PARAMETERS -> IS-DISPLAY-PARAMETER-OF (94: Diagnostic Procedure [T060])
   DISPLAY-PARAMETER-ORDER

-    DEFAULT-DISPLAY-FOR -> HAS-DEFAULT-DISPLAYS (94: Diagnostic Procedure [T060])
-    DISPLAYS-ELEMENTS-OF -> ELEMENTS-DISPLAYED-BY (94: Diagnostic Procedure [T060])
-    HAS-DISPLAY-PARAMETERS -> IS-DISPLAY-PARAMETER-OF (94: Diagnostic Procedure [T060])
-    DISPLAY-PARAMETER-ORDER

- Application Properties

## 42645: Data Entry Form
   FORM-(IS-PART-OF)->FORMSET -> FORMSET-(CONTAINS)->FORM (66436: Data Entry Form Sets)

42646: Data Entry Form Field
   DATA-ENTRY-FIELD-(HAS)->ALLOWABLE-VALUE -> ALLOWABLE-VALUE-(FOR)->DATA-ENTRY-FIELD (59732: Form Field Allowable Values)
   FORM-FIELD-(HAS)->FIELD-TYPE -> FIELD-TYPE-(FOR)->FORM-FIELD (66295: Data Entry Field Type)
   FORM-FIELD-(OBEYS)->PREFILL-RULE -> PREFILL-RULE-(FOR)->FORM-FIELD (66311: Prefill Rules)
   FORM-FIELD-MAXIMUM-VALUE
   FORM-FIELD-MINIMUM-VALUE
   FORM-FIELD-MAXIMUM-CHARACTER-COUNT

59732: Form Field Allowable Values
   ALLOWABLE-VALUE-(FOR)->DATA-ENTRY-FIELD -> DATA-ENTRY-FIELD-(HAS)->ALLOWABLE-VALUE (42646: Data Entry Form Field)

66295: Data Entry Field Type
   FIELD-TYPE-(FOR)->FORM-FIELD -> FORM-FIELD-(HAS)->FIELD-TYPE (42646: Data Entry Form Field)

66308: Layout Type
   LAYOUT-TYPE-(FOR)->FORM-STRUCTURE -> FORM-STRUCTURE-(HAS)->LAYOUT-TYPE (66405: Data Entry Form Structure)

-    FORM-(IS-PART-OF)->FORMSET -> FORMSET-(CONTAINS)->FORM (66436: Data Entry Form Sets)
- 42646: Data Entry Form Field
-    DATA-ENTRY-FIELD-(HAS)->ALLOWABLE-VALUE -> ALLOWABLE-VALUE-(FOR)->DATA-ENTRY-FIELD (59732: Form Field Allowable Values)
-    FORM-FIELD-(HAS)->FIELD-TYPE -> FIELD-TYPE-(FOR)->FORM-FIELD (66295: Data Entry Field Type)
-    FORM-FIELD-(OBEYS)->PREFILL-RULE -> PREFILL-RULE-(FOR)->FORM-FIELD (66311: Prefill Rules)
-    FORM-FIELD-MAXIMUM-VALUE
-    FORM-FIELD-MINIMUM-VALUE
-    FORM-FIELD-MAXIMUM-CHARACTER-COUNT
- 59732: Form Field Allowable Values
-    ALLOWABLE-VALUE-(FOR)->DATA-ENTRY-FIELD -> DATA-ENTRY-FIELD-(HAS)->ALLOWABLE-VALUE (42646: Data Entry Form Field)
- 66295: Data Entry Field Type
-    FIELD-TYPE-(FOR)->FORM-FIELD -> FORM-FIELD-(HAS)->FIELD-TYPE (42646: Data Entry Form Field)
- 66308: Layout Type
-    LAYOUT-TYPE-(FOR)->FORM-STRUCTURE -> FORM-STRUCTURE-(HAS)->LAYOUT-TYPE (66405: Data Entry Form Structure)

- Document Properties

## Chemical  [T103]
Measureable Entity
Etiologic Agent
      1780 cases.

Measureable Entity
Laboratory Finding or Test Result  [T034]
Finding  [T033]
Etiologic Agent
Microbiology Result
Patient Problem
Laboratory Results
      1399 cases.

Laboratory Finding or Test Result  [T034]
Finding  [T033]
Patient Problem
Laboratory Results
      3309 cases.

Laboratory Finding or Test Result  [T034]
Finding  [T033]
Patient Problem
Laboratory Results
New York Hospital (NYH) Laboratory Nomenclature Term
      1601 cases.

- Measureable Entity
- Etiologic Agent
-       1780 cases.
- Measureable Entity
- Laboratory Finding or Test Result  [T034]
- Finding  [T033]
- Etiologic Agent
- Microbiology Result
- Patient Problem
- Laboratory Results
-       1399 cases.
- Laboratory Finding or Test Result  [T034]
- Finding  [T033]
- Patient Problem
- Laboratory Results
-       3309 cases.
- Laboratory Finding or Test Result  [T034]
- Finding  [T033]
- Patient Problem
- Laboratory Results
- New York Hospital (NYH) Laboratory Nomenclature Term
-       1601 cases.

- 207 Intersection Classes

## Laboratory Finding or Test Result  [T034]
Finding  [T033]
Patient Problem
New York Hospital (NYH) Laboratory Nomenclature Term
      2906 cases.

Laboratory Diagnostic Procedure
Diagnostic Procedure  [T060]
Health Care Activity (Procedure)  [T058]
Event  [T051]
Laboratory Diagnostic Batteries
Single-Result Laboratory Test
New York Hospital (NYH) Laboratory Concept
Assessment Procedures
      1197 cases.

Laboratory Diagnostic Procedure
Diagnostic Procedure  [T060]
Health Care Activity (Procedure)  [T058]
Event  [T051]
Laboratory Diagnostic Batteries
New York Hospital (NYH) Laboratory Concept
Assessment Procedures
      1822 cases.

- Finding  [T033]
- Patient Problem
- New York Hospital (NYH) Laboratory Nomenclature Term
-       2906 cases.
- Laboratory Diagnostic Procedure
- Diagnostic Procedure  [T060]
- Health Care Activity (Procedure)  [T058]
- Event  [T051]
- Laboratory Diagnostic Batteries
- Single-Result Laboratory Test
- New York Hospital (NYH) Laboratory Concept
- Assessment Procedures
-       1197 cases.
- Laboratory Diagnostic Procedure
- Diagnostic Procedure  [T060]
- Health Care Activity (Procedure)  [T058]
- Event  [T051]
- Laboratory Diagnostic Batteries
- New York Hospital (NYH) Laboratory Concept
- Assessment Procedures
-       1822 cases.

- 207 Intersection Classes

## Laboratory Diagnostic Procedure
Diagnostic Procedure  [T060]
Health Care Activity (Procedure)  [T058]
Event  [T051]
Single-Result Laboratory Test
New York Hospital (NYH) Laboratory Concept
Assessment Procedures
      3200 cases.

Laboratory Diagnostic Procedure
Diagnostic Procedure  [T060]
Health Care Activity (Procedure)  [T058]
Event  [T051]
Single-Result Laboratory Test
CPMC Single-Result Laboratory Test
Assessment Procedures
      3197 cases.

Health Care Activity (Procedure)  [T058]
Event  [T051]
ICD9 Element
Verification Concept for Generic Column
     10048 cases.

- Diagnostic Procedure  [T060]
- Health Care Activity (Procedure)  [T058]
- Event  [T051]
- Single-Result Laboratory Test
- New York Hospital (NYH) Laboratory Concept
- Assessment Procedures
-       3200 cases.
- Laboratory Diagnostic Procedure
- Diagnostic Procedure  [T060]
- Health Care Activity (Procedure)  [T058]
- Event  [T051]
- Single-Result Laboratory Test
- CPMC Single-Result Laboratory Test
- Assessment Procedures
-       3197 cases.
- Health Care Activity (Procedure)  [T058]
- Event  [T051]
- ICD9 Element
- Verification Concept for Generic Column
-      10048 cases.

- 207 Intersection Classes

## Revisiting Recommendations - General

- Make “Event” a temporal concept
- Conceptual vs. Physical polarization
- Directed Acyclic Graph
- Merge Network and Metathesaurus

## Revisiting Recommendations - Specific

- Tests have Specimens
- Tests have Parts
- Separate Medications from Chemicals
- Liberalize assignment of Relations

## Revisiting Summary

- Semantic Types provide good coverage
- Concepts provide good coverage in certain domains
- No technical reason why UMLS could not incorporate clinical vocabulary

## Lessons to be Learned

- The MED is representative of clinical care
- MED classes work well as introduction points
- Multiple hierarchy works
- Semantic Network is largely intact
- Unifying organization for anatomy needed
- Further study of MED will suggest additional types and relations