One-Way and Round-Trip Analysis Demonstrates Surprising Limitations of Standards-Based Terminology Maps.

The informatics community has a long-standing vision of freely flowing and highly re-usable patient-specific clinical data that improves care quality and safety. We sought to evaluate the extent to which a standards-based mapping approach is sufficient to support semantic interoperability. We simulated large-scale clinical data transmission and measured semantic success between VA and DoD systems via one-way testing (OWT) and round-trip testing (RTT).

Interoperability of Medication Classification Systems: Lessons Learned Mapping Established Pharmacologic Classes (EPCs) to SNOMED CT.

Interoperability among medication classification systems is known to be limited. We investigated the mapping of the Established Pharmacologic Classes (EPCs) to SNOMED CT. We compared lexical and instance-based methods to an expert-reviewed reference standard to evaluate contributions of these methods.

Drug knowledge expressed as computable semantic triples.

The majority of questions that arise in the practice of medicine relate to drug information. Additionally, adverse reactions account for as many as 98,000 deaths per year in the United States. Adverse drug reactions account for a significant portion of those errors.

Role of the odontologist in the investigation of domestic violence, neglect of the vulnerable, and institutional violence and torture.

Dentists have a significant role to identify and intervene in domestic abuse, violence, and neglect of the vulnerable. Over 75% of abuse victims have injuries to the head, face, mouth, and neck and so dentists are often first responders. However, under recognition and under reporting of domestic abuse and violence is a particular problem among health care providers, including dentists.

Model-driven CDA Clinical Document Development Framework.

The Health Level 7 (HL7) Clinical Document Architecture, Release 2 (CDA R2) standardizes the structure and semantics of clinical documents in order to permit interchange. We have applied this standard to generate a platform independent CDA model and write a toolset that permits model specialization, generation of XML implementation artifacts, and provides an interface for clinical data managers. The resulting work was tested using US Department of Veterans Affairs Operative Note templates.

Use of RxNorm to exchange codified drug allergy information between Department of Veterans Affairs (VA) and Department of Defense (DoD).

Under a congressional mandate, VA and DoD have built a framework to exchange standardized, codified patient drug allergy information through a mediation terminology. Initially, the Unified Medical Language System (UMLS) was deemed to be the most appropriate translator. After both agency files were mapped to UMLS, DoD could understand 45 percent of VA's mapped terms and VA could understand 26 percent of DoD's mapped terms.

Direct comparison of MEDCIN and SNOMED CT for representation of a general medical evaluation template.

Background: Two candidate terminologies to support entry of general medical data are SNOMED CT and MEDCIN. We compare the ability of SNOMED CT and MEDCIN to represent concepts and interface terms from a VA general medical examination template.

Methods: We parsed the VA general medical evaluation template and mapped the resulting expressions into SNOMED CT and MEDCIN.

Exchange of computable patient data between the Department of Veterans Affairs (VA) and the Department of Defense (DoD): terminology mediation strategy.

Complete patient health information that is available where and when it is needed is essential to providers and patients and improves healthcare quality and patient safety. VA and DoD have built on their previous experience in patient data exchange to establish data standards and terminology services to enable real-time bi-directional computable (i.e.

Categorical information in pharmaceutical terminologies.

Drug information sources use category labels to assist in navigating and organizing information. Some category labels describe drugs from multiple perspectives (e.g.

A simple strategy for implementing standard reference terminologies in a distributed healthcare delivery system with minimal impact to existing applications.

The Veterans Administration (VA) has adopted an ambitious program to standardize its clinical terminology to comply with industry-wide standards. The VA is using commercially available tools and in-house software to create a high-quality reference terminology system. The terminology will be used by current and future applications with no planned disruption to operational systems.

Evaluation of SNOMED coverage of Veterans Health Administration terms.

Veterans Health Administration (VHA) is now evaluating use of SNOMED-CT. This paper reports the first phase of this evaluation, which examines the coverage of SNOMED-CT for problem list entries. Clinician expressions in VA problem lists are quite diverse compared to the content of the current VA terminology Lexicon.

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 Terminology's (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.

U.S. Department of Veterans Affairs Enterprise Reference Terminology strategic overview.

The Veterans Health Affairs (VHA) branch of the Department of Veterans Affairs has undertaken an Enterprise Reference Terminology (ERT). VHA, arguably the largest integrated healthcare provider in the United States, has completely computerized virtually all clinical transactions, including physician orders and documentation. The VA is now integrating its clinical records across hundreds of sites of care by means of a Health Data Repository (HDR) project.

Adequacy of representation of the National Drug File Reference Terminology Physiologic Effects reference hierarchy for commonly prescribed medications.

The National Drug File Reference Terminology contains a novel reference hierarchy to describe physiologic effects (PE) of drugs. The PE reference hierarchy contains 1697 concepts arranged into two broad categories; organ specific and generalized systemic effects. This investigation evaluated the appropriateness of the PE concepts for classifying a random selection of commonly prescribed medications.

Data representation in healthcare: a design for a freely-available openly-developed international reference terminology for healthcare.

The importance of data representation in healthcare has been of concern for centuries. In the last fifty years there has been an increasing awareness of the need for formal representations of terminological systems. We propose that terminological system development should be consensus driven and the product of iterative open refinement in order to practically serve the needs of the healthcare community.

Dentists' qualifications affect the accuracy of radiographic identification.

This study assessed the effects of forensic odontologists' training and experience upon the accuracy of their dental radiographic identifications. Forty participating odontologists with various levels of training and experience completed a Web-based survey of their qualifications and then completed nine Web-based radiographic identification cases. They made their identifications using the American Board of Forensic Odontology Categories and Terminology for Body Identification.

A formal representation for messages containing compositional expressions.

Clinically useful controlled vocabularies should represent healthcare concepts completely and with high reliability. Anticipating and pre-coordinating all possible expressions (e.g.

VistA--U.S. Department of Veterans Affairs national-scale HIS.

The Veterans Health Administration of the U.S. Department of Veterans Affairs has a long, successful, and interesting history of using information technology to meet its mission.

Reliability and validity of eight dental age estimation methods for adults.

This paper evaluates the reliability and validity of eight published dental age estimation methods for adults that may aid in victim identification. Age was calculated on 20 Caucasian teeth of known age according to the methods of Kvaal (for in situ and extracted teeth), Solheim (for in situ and sectioned teeth), Lamendin (for extracted teeth), Johanson (for sectioned teeth) and Bang (for extracted and sectioned teeth) by one independent observer. For each method, mean age error and standard error were assessed as the measures of accuracy and precision.