A10:    Medical concept representation: from classification to understanding

Christopher G Chute MD DrPH. Professor. and Head of Medical Informatics, Mayo Foundation (USA)

Target level: BEGINNERS

The effective application of medical informatics tools to the conduct of health services research, quality improvement, clinical decision support or administrative practice management, requires a conceptual framework for representing and invoking clinical event data. Traditionally, such a framework has been realized by classification systems, such as the International Classification of Disease (ICDs). However, the pressures and needs for detailed clinical information, comparable data and standard representations are influencing the scope, rigor and impact of modern nomenclatures.

This tutorial will briefly trace the evolution of clinical classification from the 17th century efforts attributed to John Graunt, through Bertillon, to the present day repertoire of clinical, reimbursement, and co morbidity systems. The concept of multiaxial representation (à la SNOMED) and its logical extension to semantic frames will be considered. The strengths and weaknesses of several systems will be highlighted including: ICD-9-CM, ICD-10, CPT, SNOMED, DRGs, DSM-IV, Read codes, UMLS, and nursing classifications. Summaries of new systems, such as Galen or XML-based terminologies will be considered. A comprehensive handout includes all overhead slides and pertinent summaries of topics covered.

The proposed tutorial outlines, not only of the present resources and challenges in terminologies and classifications, but also provides an historical grounding of how these evolved. It attempts to be comprehensive, sampling many terminologies that illustrate design or implementation point not otherwise evident among the mainstream systems. The content has evolved over 9 years of presentation at AMIA, and at numerous other fora. To my knowledge, it has consistently received excellent to outstanding reviews, often to the surprise of attendees who would come thinking the topic good for them but hopelessly dry.

Who Should Attend

Clinicians, researchers, or administrators with an interest in understanding the maze of classifications and their relative merits from a principled consideration of their functions. No special skills or background are required.