A mentor of mine once used the expression “Fit-For-Purpose” and I believe it captures an important and practical principle for orienting a discussion around the use of clinical terminology. Controlled clinical terminology is a means, not an end and it is too easy to become obsessed with the systems, artifacts, and science around terminology and forget the many valuable reasons and objectives for implementing it. Your objectives must drive your approach to the creation, management and implementation of terminology. This discussion is not a comprehensive list of considerations, rather it provides examples of things you should think about when implementing and utilizing terminology.
Here are some use scenarios defined in the Lexical Query Services specification that capture the types of things you might want to do with terminology:
- Mediation – Using terminology to transform/translate messages or data records from one form or representation into another. (data exchange)
- Normalization – Eliminating redundant and invalid content by unifying the multiple codes and terms used to describe concepts into a single, concept-based terminology. (analytics and decision support)
- Standardization – translating local codes to standards for the purpose of information exchange. (data exchange and regulatory requirements)
- Information Acquisition – Using terminology to aid in the process of entering coded data (pick-lists, structured documentation).
- Information Display – Using terminology to translate coded data elements into human or machine-readable external forms.
- Indexing and Inference – Using terminology to inquire about associations which may or may not pertain between various concepts.
Once you know what you want to do with terminology it is important to consider the lifecycle of the content and the interaction it has with your systems. These considerations will drive decisions regarding the architecture of your terminology environment and your strategy for integrating (mapping) and structuring internal and external/third party content.
Considerations such as:
- Can you use a standard terminology directly or do you require a layer of abstraction to insulate from potential semantic shift or drift in the standard?
- Will you have a need to author new content?
- What standard terminologies do you require?
- How does your use of terminology fit into your organizations overall data governance strategy?
Answering these types of questions will help ensure that you don’t spend a lot of time, money, and effort building something you can’t use or something that requires an unnecessarily large team of individuals to maintain and enhance.
Here are some basic capabilities you should look for in your terminology management environment:
- Obtaining and updating content – process and tools for acquiring, transforming, and loading both initial and ongoing updates of terminology content
- Content distribution – delivering content to other vocabulary servers or applications
- Batch and computer assisted Term Mapping – integration of local terminologies and standards
- Browsing, authoring, subsetting and extending content
- Deploying content to a runtime environment
- Monitoring the performance of the content in runtime
- Versioning capability
Implementing capabilities such as these requires resources that are supported by tooling and processes. It is important to note that the degree to which these capabilities are automated (how good your tools and processes are) will have significant impact on the resources needed to implement and maintain content and the quality/consistency of the work product. Investments in this solution (total cost of ownership) will come in the form of time (content creation, management, mapping and maintenance) and money (content and software licensing).
Finally, since the architecture you put in place and content you create will be foundational, it is important to address current needs effectively while allowing for future enhancements and growth. This means that the ideal “Fit-For-Purpose” solution must also be flexible and extensible. It must scale with your future needs.
These are just some of things to consider, the key message is don’t let the tail wag the dog. Let your purpose drive your approach to clinical terminology.