The Columbia International eHealth Laboratory (CIEL) concept dictionary is a comprehensive, multi-lingual clinical terminology developed to support electronic health record systems, particularly in resource-limited settings. It provides a standardized set of medical concepts that cover a wide range of clinical domains, making it especially valuable for global health initiatives and implementations of OpenMRS, a popular open-source electronic medical record system.
Structure of CIEL
The CIEL dictionary is organized as a collection of concepts, each representing a unique clinical idea. The structure includes:
Concepts
Each concept in CIEL is identified by a unique numeric identifier and includes:
- Concept Name: The primary name of the concept
- Concept Class: The category or type of the concept (e.g., diagnosis, drug, test)
- Datatype: The type of data associated with the concept (e.g., numeric, coded, text)
Example:
- Concept ID: 5085
- Name: Systolic blood pressure
- Class: Test
- Datatype: Numeric
Descriptions
Concepts can have multiple descriptions, including:
- Fully Specified Name: A unique, unambiguous description of the concept
- Short Name: A concise version of the name for use in user interfaces
- Synonyms: Alternative terms for the same concept
Mappings
CIEL provides mappings to other standard terminologies, including:
Relationships
CIEL defines relationships between concepts, such as:
- Is-a relationships (hierarchical)
- Part-of relationships
- Has-a relationships
Key Features of CIEL
- Comprehensiveness: Covers a wide range of clinical domains including diagnoses, medications, lab tests, and procedures.
- Multilingual Support: Includes translations in multiple languages, facilitating global use.
- Regular Updates: Frequent releases to keep up with advances in medical knowledge and user needs.
- Open Source: Freely available for use and distribution.
- Integration with OpenMRS: Designed to work seamlessly with the OpenMRS platform.
- Concept Mappings: Provides mappings to other major terminologies to support interoperability.
CIEL Components
1. Concept Hierarchy
CIEL organizes concepts into a hierarchical structure, allowing for navigation from broad categories to specific clinical terms.
2. Metadata
Each concept includes metadata such as:
- Date created
- Creator
- Date last changed
- Retired status (for outdated concepts)
3. Answers and Sets
CIEL defines answer lists for coded concepts and sets of related concepts, facilitating the creation of structured data entry forms.
Use Cases for CIEL
- Electronic Health Records: Providing a standardized terminology for clinical documentation.
- Clinical Decision Support: Enabling the creation of rules and alerts based on standardized concepts.
- Data Exchange: Facilitating the sharing of clinical data between different systems and organizations.
- Research: Supporting the aggregation and analysis of clinical data across multiple sites.
- Global Health Initiatives: Providing a common terminology for health programs in diverse settings.
Benefits of Using CIEL
- Standardization: Promotes consistent documentation and data collection across different healthcare providers and settings.
- Interoperability: Facilitates data exchange between different health information systems.
- Multilingual Support: Enables use in diverse linguistic contexts.
- Cost-Effective: Free to use, reducing implementation costs for health information systems.
- Comprehensive Coverage: Includes terms relevant to both primary care and specialty practice.
Challenges in CIEL Implementation
- Maintenance: Keeping local implementations up-to-date with new CIEL releases.
- Customization: Balancing the need for local customization with maintaining standardization.
- Training: Educating healthcare providers on the use of standardized terminology.
- Integration: Incorporating CIEL into existing health information systems and workflows.
CIEL in Health Information Exchange
CIEL plays a significant role in health information exchange, particularly in implementations of OpenMRS:
- Facilitates data sharing between different OpenMRS implementations
- Supports the creation of standardized clinical forms and reports
- Enables the aggregation of data for population health management and research
Tools and Resources
- OpenMRS Concept Dictionary Manager: A tool for managing CIEL concepts within OpenMRS.
- CIEL CSV Files: Downloadable files containing the full CIEL dictionary for offline use or import into other systems.
- OCL (Open Concept Lab): An online platform for browsing and managing CIEL concepts.
Future Developments
Ongoing development of CIEL focuses on:
- Expanding coverage of concepts relevant to emerging health challenges
- Improving alignment with other international terminologies
- Enhancing support for multilingual implementations
- Developing tools to facilitate the use of CIEL in diverse health information systems
The CIEL concept dictionary serves as a crucial resource for standardizing clinical terminology, particularly in global health contexts and OpenMRS implementations. Its comprehensive coverage, multilingual support, and integration with other terminologies make it a valuable tool for promoting interoperability and standardization in health information systems. While implementation can present challenges, the benefits in terms of data quality, research capabilities, and support for global health initiatives make CIEL an important component of modern health informatics infrastructure.
