John S. Carter

VA national drug file reference terminology: A cross-institutional content coverage study

BACKGROUND Content coverage studies provide valuable information to potential users of terminologies. We detail the VA National Drug File Reference Terminologys (NDF-RT) ability to represent dictated medication list phrases from the Mayo Clinic. NDF-RT is a description logic-based resource created to support clinical operations at one of the largest healthcare providers in the US. METHODS Medication list phrases were extracted from dictated patient notes from the Mayo Clinic. Algorithmic mappings to NDF-RT using the SmartAccess Vocabulary Server (SAVS) were presented to two non-VA physicians. The physicians used a terminology browser to determine the accuracy of the algorithmic mapping and the content coverage of NDF-RT. RESULTS The 509 extracted documents on 300 patients contained 847 medication concepts in medication lists. NDF-RT covered 97.8% of concepts. Of the 18 phrases that NDF-RT did not represent, 10 were for OTCs and food supplements, 5 were for prescription medications, and 3 were missing synonyms. The SAVS engine properly mapped 773 of 810 phrases with an overall sensitivity (precision) was 95.4% and positive predictive value (recall) of 99.9%. CONCLUSIONS This study demonstrates that NDF-RT has more general utility than its initial design parameters dictated

Guideline and quality indicators for development, purchase and use of controlled health vocabularies.

Developers and purchasers of controlled health terminologies require valid mechanisms for comparing terminological systems. By Controlled Health Vocabularies, we refer to terminologies and terminological systems designed to represent clinical data at a granularity consistent with the practice of todays healthcare delivery. Comprehensive criterion for the evaluation of such systems historically have been lacking and the known criteria are inconsistently applied. Although there are many papers which describe specific desirable features of a controlled health vocabulary, to date there is not a consistent guide for evaluators of terminologies to reference, which will help them compare implementations of terminological systems on an equal footing [Methods Inf. Med. 37 (1998) 394, J. Am. Med. Inform. Assoc. 5 (1998) 503]. This guideline serves to fill the gap between academic enumeration of desirable terminological characteristics and the practical implementation or rigorous evaluations which will yield comparable data regarding the quality of one or more controlled health vocabularies.

Toward Terminology as Infrastructure

In the near future, high-level meetings at cancer care and research enterprises may be distracted by discussions of the terminology computers use to support collaborative interactions. Because the productivity of these enterprises will depend on comprehensive and timely terminology, discussions of terminology shortfalls may dominate management discussions until they are overcome and creating and maintaining quality terminology become part of the enterprise infrastructure. Because cancer research and care is necessarily broadly collaborative, this may happen to cancer enterprises before it happens to most other biomedical and healthcare enterprises.