Patent Publication Number: US-10318635-B2

Title: Automated mapping of service codes in healthcare systems

Description:
RELATED APPLICATION 
     The present patent document claims the benefit under 35 U.S.C. § 120 as a continuation-in-part of U.S. patent application Ser. No. 14/037,548, which claims the benefit under 35 U.S.C. § 119(e) of Provisional U.S. Patent Application Ser. No. 61/707,288, filed Sep. 28, 2012, both of which are hereby incorporated by reference in their entirety. 
    
    
     FIELD 
     The present embodiments relate to automated or semi-automated mapping of service codes in healthcare systems. Mappings of the codes are created automatically or semi-automatically. 
     BACKGROUND 
     There has been a considerable rise in need for interoperability of data in the healthcare system. This is either to reduce costs or increase care quality. In hospital or health information exchange (HIE) and global healthcare networks or for healthcare research where statistics and cohorts are to be derived from large populations matching certain criteria, data from different collections may be combined or exchanged. To be useful, the data is interoperable. The criteria are defined in a semantically similar manner or somehow translated from different sources into a standard semantic representation such that searches can be performed seamlessly. 
     Semantic interoperability allows computer systems to transmit data with unambiguous, shared meaning. Semantic interoperability enables machine computable logic, inferencing, knowledge discovery, and/or data federation between information systems. Semantic interoperability provides for the packaging of data (syntax) and the simultaneous transmission of the meaning with the data (semantics). The information and the meaning of the information may be shared. 
     As part of the healthcare reform, the meaningful use guidelines regulate interoperability of data. The first phase requirement is just for lab data, but will extend to other data (clinical, demographic, and/or financial) in the future. However, many information systems or data sets at different healthcare entities are not semantically interoperable. To exchange information, a manual mapping or translation is used. For large amounts of data available in the medical field, manual mapping or translation is costly, time consuming, and error prone. 
     SUMMARY 
     By way of introduction, the preferred embodiments described below include methods, instructions, and systems for automatic mapping of semantics in healthcare. The mapping may be constrained to data related to a particular context such as a medical condition. Data sets have different semantics (e.g., Gender designated with M and F in one system and Sex designated with 1 or 2 in another system). For semantic interoperability, the semantic links between the semantic systems of different healthcare entities are created (e.g., Gender=Sex and/or 1=F and 2=M) by a processor from statistics of the data itself. The distribution of variables, values, or variables and values in the data itself, with or without other information and/or logic, is used to create a map from one semantic system to another. Similar distributions of other variable and/or values are likely to be for variables and/or values with the same meaning. 
     In a first aspect, a method for automatic mapping of semantics in healthcare involves accessing first transaction data of a first healthcare entity in a first database, the first transaction data corresponding to a collection of a first number of fields defined for a condition using a first semantic system to store information and calculating, by a processor, a first distribution of information in the first transaction data. The aspect also involves accessing second transaction data of a second healthcare entity in a second database, the second transaction data corresponding to a second semantic system different than the first semantic system and the second database comprising a second number of fields using the second semantic system to store information, the second number of fields larger than the first number of fields, and calculating, by the processor, a second distribution of information in the second transaction data. The aspect also involves comparing, by the processor, the first and second distributions with machine learning, and outputting, from the machine learning, a map relating the first number of fields using the first semantic system to information of the set of fields of the second number of fields using the second semantic system, the map being a function of the comparing. 
     In a second aspect, a system for automatic mapping of semantics in healthcare involves at least one memory operable to store a first transaction data of a first healthcare entity in a first database, the first transaction data corresponding to a collection of a first number of fields defined for a condition using a first semantic system to store information, and second transaction data of a second healthcare entity in a second database, the second transaction data corresponding to a second semantic system different than the first semantic system and the second database comprising a second number of fields using the second semantic system to store information, the second number of fields larger than the first number of fields. The aspect also involves a processor configured to calculate a first distribution of information in the first transaction data, calculate a second distribution of information in the second transaction data, compare the first and second distributions with machine learning, and output, based on the machine learning, a map relating the first number of fields using the first semantic system to information of the set of fields of the second number of fields using the second semantic system, the map being a function of the comparing. 
     In a third aspect, a non-transitory computer readable storage medium having stored therein data representing instructions executable by a programmed processor for mapping of semantics in healthcare. The storage medium contains instructions to access first transaction data of a first healthcare entity in a first database, the first transaction data corresponding to a collection of a first number of fields defined for a condition using a first semantic system to store information, calculate a first distribution of information in the first transaction data, access second transaction data of a second healthcare entity in a second database, the second transaction data corresponding to a second semantic system different than the first semantic system and the second database comprising a second number of fields using the second semantic system to store information, the second number of fields larger than the first number of fields, calculate a second distribution of information in the second transaction data, compare the first and second distributions with machine learning, and output, from the machine learning, a map relating the first number of fields using the first semantic system to information of the set of fields of the second number of fields using the second semantic system, the map being a function of the comparing. 
     The present invention is defined by the following claims, and nothing in this section should be taken as a limitation on those claims. Further aspects and advantages of the invention are discussed below in conjunction with the preferred embodiments and may be later claimed independently or in combination. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The components and the figures are not necessarily to scale, emphasis instead being placed upon illustrating the principles of the invention. Moreover, in the figures, like reference numerals designate corresponding parts throughout the different views. 
         FIG. 1A  is a flow chart diagram of one embodiment of a method for automatic mapping of service codes in healthcare; 
         FIG. 1B  is a flow chart diagram of one embodiment of a method for updating a data system using a mapping of service codes; 
         FIG. 2  shows example distributions of fields and/or values relative to a given field or value; 
         FIG. 3  is a block diagram of one embodiment of a system for automatic mapping of service codes in healthcare. 
         FIG. 4  is an example of an electronic medical record used to store medical information for patients using various fields. 
     
    
    
     DETAILED DESCRIPTION 
     Most hospital information systems including but not limited to clinical system, lab systems, departmental systems (e.g., radiology and surgery), and financial systems (coding), use their own custom representations for various services or items. For example, one system may be represented the gender field by Sex where as other system may represent it as Gender. Similarly, one system may represent the values of this field as Male, Female or Unknown, where as the other system may represent the values of this field as M, F, null, and yet another system may represent the values as 1, 2 and 0. Similarly, an order for “white blood cell count measured using flow cytometric analysis” may be represented as “CBC” in the OBR field and as “WBC” in the corresponding OBX 3 value. Some other systems may represent this order in coded numeric values which need to be understood by the source system. 
     In order for systems to be semantically interoperable, the transactions (order, results, service, or other medical data) from one system represented in certain format (e.g. Gender=M) has to be understood by the other system (e.g. Sex=1). The system receiving data from another system maps the data to the known semantics. 
     This is analogous to situations where two people have to communicate and they speak different languages or different dialects of the language. The ways to completely remove this discrepancy are:
         1. System 1 sends data in the format that System 2 understands. That is System 1 which uses “Gender” as field and “M” as value, transforms this into “Sex” and “1” via an intermediate interface so that System 2 can understand. The variables and values are mapped between the two systems. This is like using a translator between the two people in the language analogy.   2. System 1 and System 2 use the same representation. It can be decided up front that field will be Gender and value will be M. This is like speaking a common language. They can be global and industry wide standards (e.g., SNOMED CT for clinical terminology or LOINC for lab codes etc). Unfortunately, most systems do not use these standards.   3. There exists a conversion (called a “map”) from System 1 representation into a “standard” representation. A similar map exists between standard representation and System 2 representation. This is analogous to translating both sides into English. Note that the Method #1 is a special case of this one where the map directly exists between System 1 and System 2.       

     Currently most systems employ Method #1 where, in order for different systems to communicate, a map is created manually for all codes that can be communicated. This is a very manually intensive effort leading to long and expensive implementation cycles. Some systems have started employing Method #2; however, the maps to standards are still created manually. 
     An automatic or semi-automatic approach to creating the maps is provided. In one embodiment, Methods #1, #2, and/or #3 are automated or semi-automated. This process of creating maps between the two system terminologies is sped up by processor based implementation, especially in the medical field where a large number of variables and value representations exist. The process relies on access to different databases by a mapping system. 
     Also, specific data elements of data systems may be associated with particular conditions, such as congestive heart failure or pneumonia, and map generation may be limited to analysis based on those specific data elements. Further, a map may be specifically generated for interoperability of those specific data elements associated with particular conditions. As this type of data element focusing may cause fewer required comparisons to facilitate data element matching between data systems, as described further below, the ultimate search space for map creation is thus reduced based on the desired condition context. Limiting the elements may provide more rapid operation of the mapping system. As such, resources may be available for further analysis of various data element types, such as structured and unstructured fields, to generate a map between systems. 
     A system may extract and translate (codify) information from structured and unstructured medical data into semantically normalized medical data. The system may extract only the data elements that are needed to property treat for a medical condition, or a group of medical conditions, such as heart failure and/or pneumonia. Thus, the problem size for mapping information between databases is constrained by the context of the medical condition. The system may significantly reduce the search space and therefore result in better performance. The system may also use an optimized combination of human resources and technology to adjudicate equivocal terms in extracted information. Further, the system may take advantage of the adjudication process by learning from previous adjudication to improve performance using machine learning. As such, data from disparate sources, such as different medical data systems used by different medical entities, may be normalized and mapped to align and/or link the data of the different medical data systems. This may facilitate multiple areas of medical care such as care coordination between medical personal and entities that use the different medical data systems by allowing an interoperability of the data used in the different systems. 
       FIG. 1A  shows a method for automatic mapping of semantics in healthcare. A processor semi-automatically or automatically creates a semantic map or relationship between different sets of medical data. Patient data, orders, services, communications, or other medical data from different healthcare systems are mapped to each other or to a standard. Statistics or distribution of the variables and/or values within the different data sets is used to link the variables and/or values having a same meaning between the data sets. 
     The acts of the left and right columns represent acts by different medical centers or acts performed on data from different local medical centers. Two are shown in this example, but three or more may be used. The acts in the center column represent acts by a map creation device (e.g., central server or processor of one or more medical centers). More than one map creation device may be used. The different medical centers may perform acts shown in the center column, and the device performing the acts of the center column may perform the acts of the different medical centers. 
     The methods of  FIG. 1A  and  FIG. 1B  are implemented by the system of  FIG. 3  or a different system. A processor performs the accessing, calculating, comparing, and outputting acts with or without user input for performing the acts once triggered to perform. Additional, different, or fewer acts may be provided. For example, act  48  is not provided, such as where statistics or distribution alone is used for creating the semantic map. As another example, act  54  is not performed. 
     In act  40 , service codes are obtained. Service codes are any transaction or collection of data related to medical service. For example, a laboratory system may receive orders or other messages at an interface from an information technology system. The orders include one or more variables (e.g., CBC), may contain values (e.g., Male), and may contain descriptions (e.g., text field describing the ordered test). As another example, the laboratory system may output a response or service message indicating the test (e.g., variable of CBC) and the value (e.g., value of OBX 3) with or without other information (e.g., a text description, notes, and/or patient information). As another example, a computerized or electronic medical record may contain various types of information (e.g., variables and values for a collection of patients). The service codes may use standardized coding or use non-standard or health care entity specific standards. The service codes are represented by transaction data. 
     An exemplary electronic medical record (“EMR”) is presented in  FIG. 4 . Health care providers may employ automated techniques for information storage and retrieval. The use of an EMR to maintain patient information is one such example. As shown in  FIG. 4 , an exemplary EMR  200  includes information collected over the course of a patient&#39;s treatment or use of an institution. The information may be collected using forms, form templates, form sections, or combinations thereof as well as other electronic data collection techniques. The information may include information from multiple sources including specialty purpose diagnostic machines such as computed tomography, X-ray, ultrasound, or magnetic resonance machines. For example, computed tomography (CT) images, X-ray images, laboratory test results, doctor progress notes, details about medical procedures, prescription drug information, radiological reports, other specialist reports, demographic information, family history, patient information, and billing (financial) information as generated by various specialty purpose machines may be stored in an EMR  200 . Any of this information may provide for information related to a condition for a patient and stored using a particular semantic system as used by the health care provider. As described herein, different health care providers may use different semantic systems, and as such, data elements, such as fields or service codes, of patient medical records in an EMR  200  may be organized differently using various combinations of fields or service codes for the storage of similar information relating to similar conditions. 
     An EMR may include a plurality of data sources, each of which typically reflects a different aspect of a patient&#39;s care. Alternatively, the EMR is integrated into one data source. Structured data sources, such as financial, laboratory, and pharmacy databases, generally maintain patient information in database tables. Information may also be stored in unstructured data sources, such as, for example, free text, images, and waveforms. Often, characteristics, such as key clinical findings, are stored within unstructured physician reports, annotations on images or other unstructured data source. 
     The fields or service codes may be related to data elements associated with a particular context  60 , shown in  FIG. 1 . The context may be associated based on definitions of data indicated as required, helpful, or otherwise relevant to the diagnosis, treatment, and/or care of patients having a particular condition or conditions. In an embodiment, the associated context may include data needed to properly treat a condition. Also, some fields or service codes may be specifically assigned to, or defined for, a context. 
     The context may include any context operable to focus the mapping of data elements between systems. The context may be specified as a list of data elements, or fields, of a particular collection of data and/or as an identification of the type of data to be associated with a condition. The context may be derived from any source. Insurance standards, regulatory bodies, clinical standards, and/or business standards, or any other standards may provide a source of context information for a condition. These may be considered context categories. For example, a collection of fields having information determined to be relevant for congestive heart failure diagnosis, as determined using clinical standards, may involve alcohol and drug use history fields, hypertension history fields, prior chest pain history fields, and ejection fraction fields. The fields of the collection may be fields containing structured data sources which generally maintain patient information in database tables. Information may also be stored in unstructured data sources, such as, for example, free text, images, and waveforms. Often, characteristics, such as key clinical findings, are stored within unstructured physician reports, annotations on images or other unstructured data source. For example, an ejection fraction measurement or result may be located as notes or other unstructured data in an electrocardiogram report. In an embodiment, when a field, or group of fields, are identified as having the desired information, this field or group of fields are identified as part of a collection of fields for the indicated data element context  60 . In an embodiment, a number of fields may be specifically defined for a condition. The defined fields may be defined as fields related to, or storing data related to, the condition using a particular semantic system for the description and/or organization of the data. 
     In an embodiment, a user may indicate the context through a selection of data elements of interest for the user. The data elements may be of interest for any reason. For example, the data elements may be related to specific fields that the user has identified as relevant for a treatment and/or diagnosis of a condition. 
     In an embodiment, the data element context  60  may be provided as a list of fields of a particular transaction data of an information technology system. For example, an information technology system may store data in hundreds of fields regarding various data about patients, but only ten of those fields may contain information relevant to a condition. A context for that condition may be provided as a list of those ten fields. Fields not identified as relevant to a condition are excluded or not used. 
     The data element context  60  may be determined using other techniques as well. Information, such as the information indicated above as relevant to congestive heart failure, may be identified, and fields containing the information may be identified. The fields may be identified through manual techniques, such as being specifically identified by a user, or automatically by techniques such as data mining and identification from data collections. Any data mining may be used. 
     The service codes are obtained from different medical entities. Within a hospital or other healthcare provider, different systems or departments may use different semantics. These different systems are different medical entities. Different hospitals, healthcare facilities or networks may use different semantics, so represent different medical entities. 
     In act  42 , the transaction data of different healthcare entities are accessed. Data related to patients is accessed. The transaction data is clinical data, such as data gathered as routine in diagnosis and/or treatment of a patient. For example, the transaction data includes billing records, physician notes, medical images, pharmacy database, lab records, and/or other information gathered about a patient. The transaction data may include requests, queries, results, acknowledgements, or other interface records. In one embodiment, messages in a HIE system represent the transaction data. Transaction data may be accessed differently for different healthcare entities. In an embodiment, one healthcare entity may have only the transaction data identified based the provided data element context  60  access, whereas a different healthcare entity may have transaction data accessed without the context limitation. As such, the different healthcare entity may have more transaction data accessed. 
     The transaction data is for a plurality of patients. The medical center collects transaction data in a database, such as a computerized patient record or system storage. The collection is in one location or distributed over multiple locations. For each patient that visits, patient data is collected. For a given condition, there may be patient data for multiple (e.g., tens, hundreds, or thousands) patients. For a given healthcare entity, there may be patient data for multiple patients. 
     The access at a given healthcare entity is by requests to or pushes from a database. Alternatively, communications are routed, copied or intercepted for access to the transactions, such as obtaining a copy of orders inbound to an interface or responses outbound from an interface. A separate collection of transactions may be created, or a collection existing for other purposes is used. For each healthcare entity, one or more different databases are accessed. Different databases are accessed for different entities. In alternative embodiments, the transaction data from the different healthcare entities is collected and stored in a common database. 
     Since the transaction data is from different healthcare entities, the transaction data being accessed is different. Due to the medical entities being in different geographic regions, having different types of patients, and/or different approaches to diagnosis and/or treatment, the transaction data is different even with the same semantics. 
     Where different semantics are used, the transaction data is different. Different semantic systems are used. The semantic systems correspond to different labels or use of language for the same meaning. The fields (e.g., variables) and/or values used for a same thing or concept may be different for the different semantic systems. Some of the fields and/or variables may be the same (e.g., using Gender in both but “heart attack” and “cardiac event” in the different semantic systems). The transaction data from the different healthcare entities corresponds to at least one semantic difference, so are different semantic systems. 
     Each medical entity may use unique and multiple information systems and differ in clinical practice including the way (e.g. language) in which data is collected. For semantic normalization, transactions are translated to a semantic interoperable environment. The normalization is performed automatically to limit usage of resources. Local medical entity terms are semantically mapped to a standard or to terms of another medical entity. For example, the terms are mapped to an ontology. For example, an ontology includes the National Cancer Institute Thesaurus, which is accessed through the open source Jena framework. Additional concepts for radiotherapy authored in the open source Protégé editor (Stanford Center for Biomedical Informatics Research, Palo Alto, Calif., USA) may be included. 
     The transaction data is accessed using existing routines or formats of the respective healthcare entities. Alternatively, specialized programs or formatting may be used to access. In one embodiment, the access is through data mining to reformat the transaction data. A data miner may be run using the Internet or local network. A user may control the mining without access to transaction data. The data miner creates a database of structured information relevant to the creation of the semantic mapping. The data miner may mine both structured and unstructured data. The created structured clinical information may or may not also be accessed using the Internet. 
     The mining is performed using a domain knowledge base. The domain knowledge base may be encoded as an input to the system by manual programming or as machine-learnt programs that produce information that can be understood by the system. The data miner system uses the domain knowledge to determine what data to extract, how to extract the data, and how to determine the values, variables, linguistics, and/or other information from the data. 
     The domain-specific criteria for mining the data sources may include institution-specific domain knowledge. For example, this may include information about the data available at a particular medical entity, document structures at the medical entity, policies of a medical entity, guidelines of a medical entity, and/or any variations of a medical entity. The data miner is configured or programmed to access data at a given medical entity. Data miners at different medical entities may be configured as appropriate for the respective medical entity. 
     The domain-specific criteria may also include disease-specific domain knowledge. For example, the disease-specific domain knowledge may include various factors that influence risk of a disease, disease progression information, complications information, outcomes and variables related to a disease, measurements related to a disease, and policies and guidelines established by medical bodies. 
     In one embodiment, a data miner includes components for extracting information from the databases of patient data (computerized patient records), combining available evidence in a principled fashion over time, and drawing inferences from this combination process. The mined medical information may be stored in the structured CPR database. Any form of data mining may be used. 
     In one embodiment, the system will assimilate information from both imaging and non-imaging sources within the computerized patient record (CPR). These data can be automatically extracted, combined, and analyzed in a meaningful way, and the results presented. Such a system may also help avoid mistakes, as well as provide a novice with knowledge “captured” from expert users based on a domain knowledge base of a disease of interest and established clinical guidelines. 
     In one embodiment, data element context  60  for a condition may be provided as a list of fields. Further, service codes and/or transaction data for only these fields may be obtained from data of a first information technology system, whereas service codes and/or transaction data may be accessed for all or most of the fields for a second information technology system without the context constraints applied to the access of the first information technology system. As such, the number of fields accessed in the first information technology system may be smaller than the number of fields accessed in the second information technology system. 
     The extraction is the same or different for each medical entity and information technology system associated with each medical entity. Since the medical entities may have different policies and/or computerized patient record or other transaction systems, different extraction and/or access may be used. 
     In act  44 , a map relating the different semantic systems to each other is created. A processor determines the variables and/or values in one semantic system that have the same meaning as variables and/or values in the other semantic system. The syntax of the data and the meaning of the data elements are related or linked to each other. The map may relate the entirety of the different transaction data from the medical entities, or selected transaction data from the different entities. For example, the map may be generated for, and/or limited to, information identified using the data element context  60 . 
     The map is created using statistical information. Statistics of the service codes indicate the semantic links. The transaction data itself is used. The mappings are derived from the statistical power of data in an automated manner. For example, if a ‘demographic’ field with two values is identified consistently, the probability of the field being a gender field is very high. This guess may be made initially, and refined (strengthened or weakened) as more data is obtained. As another example, assume the initial or final guess about the gender field. The field usually has 2 values, 1 and 2. Now the task is to understand whether 1 stands for male or female. Looking at other aspects of the data, an order for a pregnancy test or a breast cancer screening in the transaction data descriptions when the value of the gender field is always 2, indicates a high probability that 2 means female given that ordering such tests would be next to impossible in a male. Where the pregnancy test description is provided, this variable itself may be used to associate the 2 with female. Where the description is not provided or not trusted, the fact that the distribution other variables, including a high count for a variable related to pregnancy testing, matches in both semantic systems indicates that 2 and female are the same. This strengthens the initial link of the field to gender and/or determines the links for the values. 
     In one embodiment, the statistics are derived from distributions of information in the transaction data. Distributions are calculated for each set of transaction data (e.g., for each semantic system) in act  46 . The distributions calculated for one set of transaction data may be limited to distributions of only the transaction data related to the data element context  60 , whereas the distributions calculated for another set of transaction data are calculated for the whole of the transaction data, without context limitation. The distributions may be calculated based on information of one transaction data for a medical entity based on data element context  60 , but calculated for a transaction data of another medical entity in a manner not limited by the data element context. The distribution is of a number of occurrences of variables, values, or variables and values. For a given variable or value in a given semantic system, the number of occurrences of other values and/or variable fields in the data set is determined. For example, a variable for Gender is selected. The number of CBC, breast cancer tests, aspirin prescriptions, colonoscopy, x-ray scans, and other variables associated with the occurrence of the Gender field for patients is counted. Similarly, the counts are made for variables—the number of other fields including gender occurring when a patient record has the aspirin prescription field. The counts for a variable may include in one distribution or provide separate distributions counts for values associated with the same variable and/or other variables. Similarly, distributions are calculated for values represented in the transaction data. 
       FIG. 2  shows three example distributions D1-3. Each of distributions D1 and D2 are from transaction data of a same semantic system, but are for different base variable or value. The distribution D3 is from transaction data of a different semantic system. Tens or hundreds of distributions may be calculated. Additionally or alternatively, other information than distribution may be used to derive statistics about the transaction data. 
     In act  50 , the calculated distributions are compared. Any comparison may be used. For example, a statistical similarity is calculated. A difference in means, difference in standard deviations, chi-square, Kullback-Leiber (KL) divergence, correlation, and/or other measure of similarity may be used. The distribution for a given variable or value in one semantic set is compared to all or some of the distributions in the other semantic set. The distribution or distributions with the greatest similarity (i.e., least distance) are more likely associated with the same meaning (e.g., same variable or value). For example and referring to  FIG. 2 , D2 is more similar to D3 than D1 is to D3. Thus, the field or value for which D3 was calculated is more likely to mean or be the same as the field for which D2 was calculated, providing a hypothesis for a semantic link. 
     By repeating the comparisons for different variables and/or values, a set of links are created to represent the map. If any links have sufficient confidence, the corresponding distributions may be removed as options for linking with other variables or values. Alternatively, possibilities are not removed until all possible links have been tested. An iterative process may be used to select the most strongly linked (e.g., greatest similarity) and then subsequently select from remaining options. Other approaches may be used for linking, including using logic-based inclusion and exclusion of possible links or hypotheses. 
     The statistics of occurrence may be used alone to create the map. In other embodiments, other information in addition to the statistics is used. In act  48 , other information is calculated. The map is created as a function of the statistical information from the service codes, patient data associated with the service codes, population statistics, and/or institution (e.g., system, department, or healthcare entity) information. A data mining solution is data driven and statistical in nature. The mappings are learned from transaction data from disparate sources. Transaction level, patient level, population level, system level and institution level information are used to form hypotheses. For example, amongst millions of laboratory transactions, 90% of the laboratory transactions refer to the same common tests. For example during a physical exam, one of the most common lab orders is a blood test for a lipid panel. Matching these distributions from various systems provides insights about which codes could be referring to the same tests in the disparate systems. In fact, it has been established that almost 90% of lab test transactions capture only 400 (out of the few thousand) LOINC codes, as the rest of the lab tests are rare in general patient populations. The most common or most rare lab tests may be identified and used for determining what information is used to create the map. In other embodiments, this statistical information is used as transaction data or in a same way as transaction data for creating the map. The non-transaction data may be used in an offline process for map creation. The 90% probability may be used to weight greater similarity measures, strengthening the match. 
     As another example, in addition to the statistical information from the data, knowledge such as ‘linguistic’ information in the descriptors is used. For example, if a descriptor has information about blood test or Hb (short for Hemoglobin), this information can be used to augment the hypotheses, ruling out possible links. A thesaurus may be used to logically rule in or out links or to weight links (more or less likely) based on descriptors with words that are synonyms or not. Similarly, units of measure may be used to rule out links. 
     The number of associated characteristics may be used. For example, variables have a number of possible values (e.g., 2 or 3 for gender). If the numbers are not within a threshold amount of each other, then the link is ruled out or reduced in weight (or vise versa). A variable with 25 possible values is not likely to have the same meaning as a variable with only 2 or 3 possible values. The number of patients for which a variable occurs may be used. If the relative frequencies are similar, the variables are more likely linked. Other number of associated characteristics may be used as additional statistics or information in addition to statistics. 
     The characteristics of the data field or value may be used. Descriptors, location of the field within the file structure, type of label (e.g., numerical, text, or numerical and text), field or value limitations (e.g., length of field—10 verses 100 characters), or other information is used to increase or decrease the likelihood of being linked. 
     The various input features from acts  46  and  48  are compared in act  50 . Other information may be calculated from the input features to derive additional or alternative inputs, such as calculating characteristics of the distributions. As another example, the measures of similarities resulting from comparison are used as input features for further comparison. A cascade or hierarchal approach may be used. 
     In one embodiment, distributions calculated for a first transaction data related to data element context  60  are compared to distributions calculated for a second transaction data of a different semantic system that has no context limitation. For example, a first transaction data may involve 1000 fields of data, wherein only 20 fields are identified as related to the data element context. A second transaction data may involve 1100 fields that make use of a different semantic system. Distributions will be calculated for the data of the 20 fields of the first transaction data, and the data of the 1100 fields of the second transaction data. The distributions of the 20 fields of the first transaction data may be compared to the distributions of the 1100 fields of the second transaction data. Links may be generated based on this comparison between the first transaction data and the second transaction data. These links indicate transaction data of the second transaction data that is related to the data element context  60  as well as the particular transaction data of the first transaction data to which the respective second transaction data is linked. 
     In one embodiment, a transaction data may be a subset of a total transaction data of a first healthcare entity in a first database. Some fields of data of the total transaction data may be excluded from the accessing, calculating, and comparing described above. The exclusion may be based on the data element context  60 . For example, the excluded fields may contain data that is determined not to be relevant to a condition, such as by not being selected by a user or any other technique operable to distinguish fields containing data related or relevant to a condition from fields containing data not related or relevant to a condition. 
     To create the map with one or more links, the comparison of act  50  is implemented by a programmed processor. Any programming may be used, such as a sequence of rules or logic. Fuzzy logic techniques may be used. Unsupervised or semi-supervised machine learning is used. Where prior examples or samples of the different semantic systems are available, supervised machine learning may be used. 
     In one embodiment, the unsupervised or semi-supervised machine learning receives the transaction data, information calculated from the transaction data (e.g., the distributions), and/or other information and learns the links between variables and/or values in the different semantic systems. The values and/or variables with the same meaning are linked. Alternatively or additionally, the values and/or variables more likely to have the same meaning are identified for manual linking in the semi-supervised approach. 
     For unsupervised learning, the semantic links are made using unlabeled data. Any unsupervised machine learning may be used, such as clustering or blind signal separation with feature extraction for dimensionality reduction. For example, principle component analysis, independent component analysis, non-negative matrix factorization, or singular value decomposition are used. Combinations of techniques may be used. Neural network models, such as self-organizing maps or adaptive resonance theory may be used. The vigilance parameter may be pre-determined or provided during or as part of creating the map. 
     The statistical information (e.g., distributions, statistics derived from the distributions, measures of similarity, and/or other statistics related to the transaction data) is an input feature for the unsupervised learning. By performing the machine learning, the similarity or links forming the map are learned by the processor. 
     Either within the kernel for the machine learning or as part of use of an output of the machine learning, further limitations, constraints, logic, or other information may be used. The machine learning indicates a strength, such as a probability, similarity, or distance, of a link. The links above a threshold strength are possible links or hypotheses. Any threshold level may be used, such as a pre-determined probability or a number of highest hypotheses for any given variable or value. Possible links with strengths above the threshold are output, and possible links with strengths below the threshold are not output as hypotheses. An iterative fitting of hypotheses or user input may resolve conflicts where multiple possible links may occur for one or more variables or values. 
     The strengths may be altered prior to thresholding. For example, linguistics information is used in the machine learning kernel or on the outputs from the machine learning to rule out possible links. The descriptions may not include any synonyms, so the strength is reduced. As another example, a rule (e.g., pregnancy test only for female) or population statistics relating characteristics of the variables or values may rule out particular combinations or deal with common errors in statistics based linking. The rule or population information is included in the kernel for the machine learning or is applied to the output. Rather than absolute alteration (removing the hypothesis), the weight of the strength may be altered. For example, linguistic, text matching (billy direct˜billy rubin direct), relationship in an ontology or medical thesaurus, or other information may be used to show that the strength (e.g., probability of proper linking or same meaning) should be increased or decreased. The amount of increase or decrease may be based on statistics, pre-determined, or otherwise set. 
     The creation of the map is performed once. The map may be then be used. Alternatively, the creation may be on-going or occur in real time. Calculating the distributions and comparing is performed for additional transactions for the healthcare entity received after previously comparing. An initial map is updated as more and more transactions are received. By repeatedly observing transactions as added during the course of the healthcare business, the hypotheses used for creating the map are proven or disproven. The newly created transaction data is added to the previous transaction data and the creation is performed independently of any existing map. Alternatively, the newly created transaction data is tested against the statistics and/or existing map to confirm or not proper semantic linking. This approach may also be used to correct any existing mappings that have been created manually. The transaction data is used to learn a map, and this learned map is compared to the manually created map. Any differences are highlighted for user decision. 
     In act  52 , the created map is output. The map is a function of the comparison of distributions. Using the comparison of statistics from different sets of data, the map is created and output. 
     The map includes links between variables and/or values in one semantic system to variables and/or values in another semantic system. For example, Gender in one data set is linked to Sex in another data set. All or less than all of the variables and/or values of one data set may be linked to corresponding all or less than all of the variables and/or values of the other data set. The map may not be complete, but instead be a starting point for further manual mapping. As more transactions are received, the links for mapping for variables and/or values not previously linked may be formed. The confidence in the linking may be sufficiently increased due to receiving additional transactions. Low confidence links transition to higher or sufficient confidence links. Coverage of the mapping gradually increases. Alternatively, the map is complete as initially formed. 
     In one embodiment, different medical entities may have data systems that operate using a first and a second semantic system. The first medical entity using the first semantic system may have a data element context  60  of a first data system identified such that a first number of fields are identified as a collection of fields relating to the data element context  60 . A second number of fields of a second data system, using the second semantic system, may be related to the first number of fields as a translation from the first semantic system as used in the first set of fields to the second semantic system as used in the second set of fields. Further, at least one of the set of fields of the second number of fields may involve unstructured data. This field involving unstructured data of the second number of fields may be mapped to a field, or group of fields, of the first set of fields, which may contain structured or unstructured data. The map may also include a translation from the second semantic system to the first semantic system. The translation may involve translating unstructured data into structured data. Further, a translation may involve formatting. The formatting may be formatting as specified for data used and/or stored in the first set of fields of the first medical entity. Formatting may involve any type of formatting for the storage and/or presentation of data. For example, a number of characters, a capitalization standard, a data type, and/or any other formatting may be specified. 
     In one embodiment, the output solicits user selection of possible links. Options based on the comparison calculations are provided. In some cases, given the paucity of data, more than one hypothesis may be plausible. Using thresholding, more than one possible link may result. Any number of possible links or hypotheses for a given variable or value may be output, such as two to five. For example, one link has a 45% probability and another link has a 55% probability where the threshold to establish a link is 90%. Human intervention is used to manually create the link. Both possible links, as well as descriptor or other extracts from the transaction data (e.g., sample messages), are output to the user. Using check boxes, graphic programming, or other user interface, the user is solicited to select one of the links and not another. Even with this manual involvement, the creation of the map is still considerably more efficient than manually creating the entire map as a human has to simply verify amongst a limited set. The manual intervention in the machine learning in the form of selection may be used to guide future learning. The selection itself may be used as an input in further learning so that the same information is more likely automatically linked in other map creations or in updates. 
     Sometimes, the hypotheses are strong as evidenced by the data, and there is only one final option for a particular field-field or value-value mapping. Human intervention is not used. The user merely selects files or data sets, activates the creation, and monitors output. The user does not select the link. The comparison and output for the link occur without user selection of the link. 
     After selection by the processor and/or the user, a final map includes one-to-one semantic linking of all values and/or variables of a given set. Less than all possible values or variables may be linked, such as where the map creation is configured to link only a predetermined sub-set of values and/or variables. Alternatively, the predetermined set of links is all of the values and variables. One data set may include one or more values or variables that do not exist in the other data set. Similarly, the number of occurrences may be sufficiently small, that statistical linking is non-determinative. The map may be created without linking such values or variables. Manual linking may be used for non-determinative values or variables. 
     Over time, profiles of these distributions and their corresponding maps are created. For some situations, typical types of profiles are created that may be applied in other situations. For example, at any given time, a new medical facility or entity is to be added to an existing system. The transactional data from the new medical entity is used to create a distribution. By comparing the new distributions to existing distributions from other medical entities, a hypothesis mapping is provided for any matches or sufficiently close matches. 
     In act  54 , the created map is used. Information from one data set may be mapped to information from another data set. Since the semantic relationship is known, data may be aggregated from both semantic systems. Data federation, knowledge discovery (e.g., learning statistical relationships for diagnosis or treatment), inferencing, or other operation using a larger data set is performed. Mapping may be used to allow communication or interoperability between different systems. The map is used to extract and translate. 
     Creating the map automatically using, at least in part, statistics from the data, may be used to reduce implementation time for healthcare information systems, such as hospital, physician, or lab systems. Disparate systems may communicate with each other in a seamless manner using the created map. The map is applied as part of hospital information exchange (HIE). The map may be created for commissioning a new computer network infrastructure or for adding a disparate system to an existing computer network infrastructure, such as when a healthcare entity decides to add a primary care practice within a physician network or decides to use a new lab provider. 
       FIG. 1B  shows a flowchart for an embodiment that involves using the map  54 . In act  55  the map may be used to extract information. For example, information may be extracted from transaction data as indicated by the map. The map may relate a specific data element context  60  of a first data system to a second data system. The map may then indicate what data is extracted from either the first or the second data system. 
     Also, in act  59  the map may be used to update in the information of a transaction data with information extracted from another transaction data. In an embodiment, the map is used to update transaction data of a data system with information extracted from a transaction data. The map may be used in any way to facilitate the updating. For example, the map may indicate which data elements of a data system are updated with what particular extracted information. 
     The map may indicate translations from one semantic system to another, and the map may be used to translate the extracted information into information formatted appropriately for updating data elements of a data system. As such, in act  57  the map may be used to translate information from one semantic system to another semantic system. For example, the map may contain rules for modifying information of a transaction data to conform to formatting rules of related information of a second transaction data. The formatting rules may be manually created, or automatically derived from the formatting of information in the respective data systems. 
     In one embodiment, a map may be created based on data element context  60 , and information may be extracted from fields of a first data system related to a collection of fields of a second data system using the data element context  60 . The information extracted from the first data system may be translated into a semantic system used by the second data system, and fields of the second data system may be updated with the extracted and translated information using the map. 
     In one embodiment, data element context  60  may be indicated from various context categories and a map may indicate from which category the related information is indicated belongs. Further, the data element context  60  may be displayed or otherwise presented to a user with labels of the particular context category origin for data elements indicating the data element context  60 . For example, a data element having information indicating an insurance coverage level will have a label as an “Insurance” context category, whereas a data element having information indicating an ejection fraction will be labeled as a “Clinical” context category. In such an embodiment, a user may be able to manually select data elements of each category to include with the data element context  60 . 
       FIG. 3  shows one embodiment of a system for automatic mapping of service codes in healthcare. The map between data sets with different semantics is created. The system implements the method of  FIG. 1A ,  FIG. 1B , or other methods. 
     The system includes one or more databases  12 ,  14 , a processor  16 , a memory  18 , and a display  20 . In one embodiment, the system is a server or computer. The processor  16 , memory  18 , and display  20  may be a standalone device or connected to a wired or wireless computer network. Additional, different, or fewer components may be provided. For example, additional databases  12 ,  14  are provided. As another example, the databases  12 ,  14  are not provided and the transaction data is stored in the memory  18 . 
     Each database  12 ,  14  is a memory, buffer, or other structure for storing data. The databases  12 ,  14  store transaction data for different healthcare entities. Each healthcare entity is a hospital, institution, research facility, office, medical learning hospital, university, department, computer system, device, or other entity involved in communicating or storing transaction data. The healthcare entity may be involved in the treatment and/or diagnosis of patients. Routine data gathered for one or more patients is stored at each healthcare entity. The storage may be off-site, but is “at” the healthcare entity by being available for access at the healthcare entity. 
     The different healthcare entities have patient data for different sets of patients. The different healthcare entities may have the same or different standards of care, processes, treatments, patient approaches, devices, information technology infrastructures, management, or other care related approaches. Similarly, the types of patients (e.g., socio-economic, racial, or other differences) most common for the different healthcare entities may be similar or different. In one embodiment, the different healthcare entities are associated with treatment of patients in different counties, states, and/or countries. Due to any of these differences or for other reasons, one or more variables and/or one or more values may be labeled differently between the healthcare entities. Some variables and/or values may have the same semantic meaning and be labeled the same. The databases  12 ,  14  store transaction data using different semantic systems. The medical data is stored in different representations of the same thing (e.g., Gender vs. Sex or 1 verses Female). 
     The processor  16  accesses the transaction data from the databases  12 ,  14  as needed or to aggregate for creating the map translating across the different semantic systems. The processor  16  is configured by hardware and/or software to link values and/or variables of the medical data from the database  12  with values and/or variables of the medical data from the database  14 . Alternatively, the processor  16  links from each database  12 ,  14  to a standard semantic system (i.e., a third semantic system). The links indicate corresponding semantic meaning in the representations. In an embodiment, the processor  16  accesses a subset of a total amount of information, such as a collection of fields, of a first database  12 , but accesses a whole of the information, or fields, of a second database  14 . The subset of the total amount of the information of the first database  12  may be determined using a context. The context for the subset of information may be related to a medical condition. Links may be created between the subset of the information of the first database  12  and a subset of the information of the second database  14 . 
     The processor  16  creates the links using similarity of distribution of the values and/or variables in the sets of medical data. Any statistical analysis of the medical data and comparison between sets may be used. In one embodiment, the processor  16  applies unsupervised machine learning. The map of links between fields or values of the different sets of medical data is output from or using the machine learning. The map may be of links between subsets of information of the databases based on a context. 
     The databases  12  and  14  may be stored on the same of different memories. For example, a database  12  may be located on a memory that is located in a different physical location than another database  14 . 
     The processor  16  is or is not affiliated or part of any of the healthcare entities and corresponding databases  12 ,  14 . In one embodiment, the processor  16  is managed by a different entity than the healthcare entities and is a service provider of semantic maps. The processor  16  is located in a different building, campus, region, or geographic location than any of the healthcare entities. In other embodiments, one or more of the healthcare entities host and manage the processor  16 . The processor  16  may or may not share a campus, building, or facility with one of the healthcare entities. 
     The processor  16  is a hardware device with processing implemented in various forms of hardware, software, firmware, special purpose processors, or a combination thereof. Some embodiments are implemented in software as a program tangibly embodied on a program storage device (e.g., the memory  18 ). The processor  16  may be a computer, personal computer, server, PACs workstation, imaging system, medical system, network processor, network, or other now know or later developed processing system. The processor  16  may be operatively coupled to other components, such as the memory  18  and the display  20 . The processor  16  is implemented on a computer platform having hardware components. The other components include the memory  18 , a network interface, an external storage, an input/output interface, the display  20 , and/or a user input. Additional, different, or fewer components may be provided. The computer platform may also include an operating system and microinstruction code. The various processes, methods, acts, and functions described herein may be part of the microinstruction code or part of a program (or combination thereof) which is executed via the operating system. 
     A user interface is provided for creating the map. The user interface is at the processors  16 . The user interface may be limited to arranging for learning of the map. In this configuration, the user may select an input features, statistics, data sets, variables and/or values to link, or other set-up options by selection, input, or from a menu. For creating the map from this arrangement information, further user input is not provided. Alternatively, the user guides a semi-supervised process, such as for selecting from a limited (e.g., 2-5) number of hypotheses for a link. 
     The user interface may also be used to determine a context for a map. A user may select particular information, such as particular fields, of a first database  12  and the map may contain links to corollary information in fields of a second database  14 . 
     The user input may be a mouse, keyboard, track ball, touch screen, joystick, touch pad, buttons, knobs, sliders, combinations thereof, or other now known or later developed input device. The user input operates as part of a user interface. For example, one or more buttons are displayed on the display. The user input is used to control a pointer for selection and activation of the functions associated with the buttons. Alternatively, hard coded or fixed buttons may be used. 
     The user interface may include the display  20 . The display  20  is a CRT, LCD, plasma, projector, monitor, printer, or other output device for showing data. 
     The processor  16  operates pursuant to instructions. The instructions and/or transaction data for creating the map are stored in a non-transitory computer readable memory such as an external storage, ROM, and/or RAM. The instructions for implementing the processes, methods and/or techniques discussed herein are provided on computer-readable storage media or memories, such as a cache, buffer, RAM, removable media, hard drive or other computer readable storage media. Computer readable storage media include various types of volatile and nonvolatile storage media. The functions, acts or tasks illustrated in the figures or described herein are executed in response to one or more sets of instructions stored in or on computer readable storage media. The functions, acts or tasks are independent of the particular type of instructions set, storage media, processor or processing strategy and may be performed by software, hardware, integrated circuits, firmware, micro code and the like, operating alone or in combination. In one embodiment, the instructions are stored on a removable media device for reading by local or remote systems. In other embodiments, the instructions are stored in a remote location for transfer through a computer network or over telephone lines. In yet other embodiments, the instructions are stored within a given computer, CPU, GPU or system. Because some of the constituent system components and method acts depicted in the accompanying figures may be implemented in software, the actual connections between the system components (or the process steps) may differ depending upon the manner of programming. 
     The instructions may be operable to cause the processor  16  to access first transaction data of a first healthcare entity in a first database, the first transaction data corresponding to a collection of a first number of fields defined for a condition using a first semantic system to store information and calculate a first distribution of information in the first transaction data. The instructions may also be operable to cause the processor  16  to access second transaction data of a second healthcare entity in a second database, the second transaction data corresponding to a second semantic system different than the first semantic system and the second database comprising a second number of fields using the second semantic system to store information, the second number of fields larger than the first number of fields, and calculate a second distribution of information in the second transaction data. The instructions may also be operable to cause the processor  16  to compare the first and second distributions with machine learning and output, from the machine learning, a map relating the first number of fields using the first semantic system to information of the set of fields of the second number of fields using the second semantic system, the map being a function of the comparing. 
     The same or different computer readable media may be used for the instructions, the transaction data, and the map. The transaction data are stored in an external storage (databases  12 ,  14 ), but may be in other memories. The external storage may be implemented using a database management system (DBMS) managed by a processor and residing on a memory, such as a hard disk, RAM, or removable media. Alternatively, the storage is internal to the processor  16  (e.g. cache). The external storage may be implemented on one or more additional computer systems. For example, the external storage may include a data warehouse system residing on a separate computer system, a PACS system, or any other now known or later developed hospital, medical institution, medical office, testing facility, pharmacy, lab, or other medical patient record storage system. The external storage, an internal storage, other computer readable media, or combinations thereof store data for at least one patient record for a patient. The patient record data may be distributed among multiple storage devices. 
     The processor  16  has any suitable architecture, such as a general processor, central processing unit, digital signal processor, application specific integrated circuit, field programmable gate array, digital circuit, analog circuit, combinations thereof, or any other now known or later developed device for processing data. Likewise, processing strategies may include multiprocessing, multitasking, parallel processing, and the like. A program may be uploaded to, and executed by, the processor. The processor implements the program alone or includes multiple processors in a network or system for parallel or sequential processing. 
     In the arrangement of  FIG. 3 , the processor  16  and the databases  12 ,  14  communicate through one or more networks. Wired and/or wireless communications are used. The networks may be local area, wide area, public, private, enterprise, or other networks. Any communication format may be used, such as e-mail, text, or TCP/IP. Direct or indirection communication is provided. The communications may or may not be secured, such as using a public key infrastructure. Alternatively, the communication is by manual data transfer, such as using a memory stick. 
     It is to be understood that the present embodiments may be implemented in various forms of hardware, software, firmware, special purpose processors, or a combination thereof. Preferably, the present embodiments are implemented in software as a program tangibly embodied on a program storage device. The program may be uploaded to, and executed by, a machine comprising any suitable architecture. Preferably, the machine is implemented on a computer platform having hardware such as one or more central processing units (CPU), a random access memory (RAM), and input/output (I/O) interface(s). The computer platform also includes an operating system and microinstruction code. The various processes and functions described herein may either be part of the microinstruction code or part of the program (or combination thereof) which is executed via the operating system. In addition, various other peripheral devices may be connected to the computer platform such as an additional data storage device and a printing device. 
     It is to be understood that, because some of the constituent system components and method steps are preferably implemented in software, the actual connections between the system components (or the process steps) may differ depending upon the manner in which the present invention is programmed. 
     While this invention has been described in conjunction with the specific embodiments outlined above, it is evident that many alternatives, modifications, and variations will be apparent to those skilled in the art. Accordingly, the preferred embodiments of the invention as set forth above are intended to be illustrative, not limiting. A variety of modifications to the embodiments described will be apparent to those skilled in the art from the disclosure provided herein. Thus, the present invention may be embodied in other specific forms without departing from the spirit or essential attributes thereof.