Tuttle M S, Nelson S J
Methods Inf Med. 1996 Sep;35(3):211-7.
The single greatest impediment to the successful leveraging of computer-based patient records (CPRs) is the difficulty of creating and maintaining comparable patient descriptions. Specifically, it will be hard to justify the investment required to deploy CPRs widely if the patient descriptions they store are not comparable across successive releases of controlled health-care vocabularies. Thus, it is necessary to solve the controlled health-care vocabulary update problem for CPRs before the comparability of patient descriptions can be sustained. What may seem to be a narrow technical problem of interest only to maintainers of health-care enterprise systems is, instead, a central problem of medical informatics. Cimino's "Formal descriptions and adaptive mechanisms for changes in controlled medical vocabularies" describes a classification of the changes appearing in the 1994 Edition of the International Classification of Diseases (ICD-9-CM). His paper describes the conversion of differences detected between the 1993 and 1994 releases of ICD-9-CM and a conversion of the elements of the classification into the required formal changes to the Medical Entities Dictionary (MED), part of the CPR in use at Columbia Presbyterian Medical Center. Because the process of detecting differences begins with an empirical analysis of the ASCII representations of the 1993 and 1994 releases of ICD-9-CM, it is impossible for a computer program to infer the intent of the changes that caused the differences; instead, a content expert must infer the intent and then update the MED accordingly. A typical task is to infer whether a change in naming also reflects a change in the meaning named. While Cimino's methods and their execution are exemplary in every respect, they nevertheless constitute a kind of "reverse engineering"-an ad hoc attempt to infer intent from details. Reverse engineering of changes to controlled medical vocabularies is a poor precedent. Such methods should be viewed as necessary short-term expedients only, and all parties concerned should work toward an incremental plan by which the intent of changes to controlled health-care vocabularies can be made both explicit and machine processible. Only then can the comparability of patient descriptions be sustained.
成功利用基于计算机的患者记录（CPR）的最大障碍是创建和维护可比患者描述的困难。具体而言，如果它们存储的患者描述在受控医疗保健词汇表的连续版本之间不可比，那么广泛部署CPR所需的投资将很难说得过去。因此，在维持患者描述的可比性之前，有必要解决CPR的受控医疗保健词汇更新问题。这看似只是医疗保健企业系统维护人员感兴趣的一个狭隘技术问题，实则是医学信息学的核心问题。西米诺的《受控医学词汇变化的形式描述与自适应机制》描述了1994年版《国际疾病分类》（ICD - 9 - CM）中出现的变化分类。他的论文描述了在ICD - 9 - CM的1993年版和1994年版之间检测到的差异的转换，以及将分类元素转换为对哥伦比亚长老会医学中心正在使用的CPR的一部分——医学实体词典（MED）所需的形式变化。由于检测差异的过程始于对ICD - 9 - CM的1993年版和1994年版的ASCII表示的实证分析，计算机程序无法推断导致差异的变化意图；相反，内容专家必须推断意图，然后相应地更新MED。一个典型任务是推断名称的变化是否也反映了所命名含义的变化。虽然西米诺的方法及其执行在各方面都堪称典范，但它们仍然构成了一种“逆向工程”——一种从细节推断意图的临时尝试。对受控医学词汇变化进行逆向工程是一个不良先例。此类方法应仅被视为必要的短期权宜之计，所有相关方都应朝着一个渐进计划努力，通过该计划，受控医疗保健词汇变化的意图能够变得明确且可由机器处理。只有这样，患者描述的可比性才能得以维持。
