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The
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National
...
Cancer
...
Institute
...
has
...
long
...
been
...
a
...
leader
...
in
...
terminology
...
related
...
services
...
and
...
has
...
provided
...
the
...
cancer
...
community
...
with
...
structured
...
terminology
...
through
...
the
...
NCI
...
Enterprise
...
Vocabulary
...
Services
...
for
...
several
...
years.
...
There
...
is
...
now
...
a
...
much
...
wider
...
range
...
of
...
terminology
...
use
...
cases
...
for
...
the
...
needs
...
from
...
bedside
...
to
...
bench
...
and
...
back
...
and
...
Semantic
...
Infrastructure
...
2.0
...
is
...
being
...
designed
...
to
...
address
...
all
...
of
...
these
...
use
...
cases.
...
The
...
use
...
cases
...
require
...
thinking
...
beyond
...
the
...
capabilities
...
of
...
the
...
existing
...
metadata
...
repository
...
as
...
demonstrated
...
in
...
the
...
Cancer
...
Data
...
Standards
...
Registry
...
and
...
Repository
...
(caDSR)
...
and
...
supporting
...
semantic
...
representations
...
of
...
concepts
...
as
...
they
...
are
...
used
...
in
...
clinical
...
information
...
exchange
...
using
...
structured
...
documents.
...
Requirements
...
are
...
also
...
recognized
...
for
...
binding
...
concepts
...
to
...
information
...
models
...
in
...
the
...
abstract
...
as
...
domain
...
values,
...
for
...
use
...
in
...
models
...
such
...
as
...
the
...
BRIDG
...
(Biomedical
...
Research
...
Integrated
...
Domain
...
Group)
...
domain
...
analysis
...
model
...
(DAM)
...
or
...
the
...
life
...
sciences
...
DAM.
...
As
...
NCI
...
supports
...
these
...
new
...
information
...
models,
...
a
...
fundamental
...
requirement
...
is
...
recognized
...
to
...
continue
...
to
...
support
...
customers
...
who
...
have
...
invested
...
in
...
the
...
common
...
data
...
element
...
capabilities
...
of
...
NCI
...
over
...
the
...
last
...
several
...
years
...
and
...
to
...
provide
...
for
...
customers
...
to
...
continue
...
to
...
use
...
those
...
elements
...
while
...
making
...
the
...
transition
...
to
...
Semantic
...
Infrastructure
...
2.0.
...
The
...
NCI
...
also
...
needs
...
to
...
continue
...
to
...
support
...
the
...
needs
...
of
...
new
...
customers
...
who
...
are
...
creating
...
information
...
and
...
services
...
that
...
use
...
terminology
...
and
...
structures
...
that
...
exist
...
outside
...
of
...
the
...
BRIDG
...
and
...
LS
...
DAM
...
space.
...
The
...
result
...
will
...
be
...
a
...
more
...
robust
...
representation
...
that
...
captures
...
semantics
...
consistent
...
with
...
usage
...
in
...
clinical
...
care
...
and
...
clinical
...
research,
...
and
...
semantics
...
that
...
will
...
provide
...
more
...
nearly
...
full
...
coverage
...
for
...
the
...
life
...
sciences
...
research
...
community.
...
Below
...
are
...
several
...
high-level
...
use
...
cases
...
that
...
highlight
...
some
...
of
...
these
...
demanding
...
requirements.
...
| Table of Contents |
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1 - Translate local codes to standard code systems
A user has a data base that uses a combination of enumerated values (for example, 0: Male, 1: Female, 9: Unknown) and codes drawn from outside code systems such as Hospital International Classification of Diseases Adapted (HICDA) or Medical Dictionary for Regulatory Activities (MedDRA). The user needs to translate these codes into the codes that are adopted by the Vocabulary and Common Data Elements workspace. The user needs to first determine whether there are existing value sets that already represent the same or a broader conceptual space represented in the user's data base. If one exists, the user then needs to determine whether a mapping exists to the corresponding HICDA or MedDRA codes. If a value set does not already exist, the user needs access to a set of tools that will (a) allow the user to upload the code list along with any corresponding descriptive information, (b) determine which code system(s) are appropriate targets, (c) perform the actual mapping, which is described in a separate use case. Note that the user may need to record local mappings (enumerated values that are of no interest to the larger community) locally while recording mappings between external code systems in a fashion that is accessible by the whole community. Once the mappings are recorded, the user needs access the Semantic Infrastructure 2 framework to locate a service that will allow the user to automate the transformations in the target workflow environment, localizing the service if needed to meet performance or confidentiality requirements and connecting the service to the appropriate mapping(s). The user may also need to embed links to this code in the user's local software.
2 - Create nested value sets
The user is building the specifications for a new application to manage follow-up of chemotherapy patients to track the signs and symptoms associated with a clinical trial of certain chemotherapy agents. The user has been given a set of
Common Terminology Criteria for Adverse Events (CTCAE) terms to capture the signs and symptoms but the set of symptoms listed is so large that it does not fit well into a single drop-down menu. The user would like to create subsets of these concepts according related organ systems affected. The user would like to have a unique identifier for each of these sets so they can be reused in future studies. The user has already investigated the available resources and did not find a collection of codes that met these requirements.
3 - Retrieve semantic code system cross-links
A user is constructing a case report form and as part of the form, will have some data entry fields that correspond to laboratory tests that were ordered as part of the study. The user would like to constrain the inputs on the results of these tests to valid possibilities that can be provided via a menu selection. The user would like to submit a list of these laboratory tests to an application that can return an identified value set of possible ranges of answers and associated units of measure for each test. The user realizes that some of the tests will have results that are not available for some reason and would like the appropriate null representations returned as part of the value sets presented by the application.
4 - Transform CTS 2 value set export to an HL7V3 coded data type
A user is building a form that will correspond to a clinical document recording for a pathology report. The user would like the vocabulary drop-down lists to be derived from a CTS 2 value set but would like this value set to be delivered to the document in the syntactical structure required for validation against the CDA schema. In other words, the user would like to submit a list of concepts and have the concepts structured with metadata in a HL7V3 CD data type. The structure that the user anticipates would be delivered as an XML blob with the following structure:
<code xsi:type="CD" code="784.0" codeSystem="2.16.840.1.113883.6.42
...
">
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<displayName
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value="
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Headache
...
"
...
/>
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</code>
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5
...
-
...
Transform
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an
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ISO-11179
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common
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data
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element
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to
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an
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HL7
...
V3
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class
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object
...
A
...
user
...
has
...
a
...
group
...
of
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caDSR
...
common
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data
...
elements
...
which
...
have
...
been
...
used
...
in
...
form
...
construction
...
in
...
the
...
past.
...
Now
...
the
...
user
...
would
...
like
...
to
...
move
...
these
...
forms
...
to
...
the
...
HL7
...
CDA
...
structure.
...
The
...
user
...
finds
...
it
...
possible
...
to
...
represent
...
a
...
portion
...
but
...
not
...
all
...
of
...
the
...
contextual
...
meaning
...
of
...
the
...
data
...
elements
...
in
...
11179.
...
The
...
user
...
would
...
like
...
to
...
transform
...
the
...
CDEs
...
to
...
HL7
...
V3
...
class
...
structures
...
in
...
order
...
to
...
get
...
the
...
full
...
contextual
...
meaning
...
as
...
used
...
in
...
the
...
CDA
...
document.
...
The
...
user
...
would
...
like
...
to
...
submit
...
the
...
list
...
of
...
CDEs
...
to
...
the
...
Enterprise
...
Conformance
...
and
...
Compliance
...
Framework
...
(ECCF)
...
registry
...
transformer
...
and
...
have
...
a
...
set
...
of
...
V3
...
object
...
classes
...
returned.
...
6
...
-
...
Creation
...
of
...
Value
...
Sets
...
and
...
Value
...
Set
...
Mappings
...
A
...
user
...
has
...
identified
...
one
...
or
...
more
...
sets
...
of
...
permissible
...
values
...
that
...
need
...
to
...
be
...
mapped
...
to
...
standard
...
codes
...
used
...
by
...
the
...
Vocabulary
...
and
...
Common
...
Data
...
Elements
...
workspace.
...
These
...
values
...
need
...
to
...
be
...
assembled
...
in
...
a
...
format
...
such
...
as
...
Excel,
...
XML
...
or
...
simple
...
tab
...
separated
...
values
...
and
...
then
...
be
...
uploaded
...
to
...
a
...
service
...
that
...
will
...
allow
...
them
...
to
...
be
...
mapped
...
to
...
the
...
codes
...
that
...
are
...
endorsed
...
for
...
interchange
...
on
...
the
...
grid.
...
The
...
user
...
must
...
be
...
able
...
to
...
locate
...
existing
...
value
...
sets
...
and
...
to
...
construct
...
new
...
ones
...
where
...
appropriate
...
targets
...
do
...
not
...
exist.
...
The
...
user
...
needs
...
to
...
be
...
able
...
to
...
instruct
...
the
...
service
...
to
...
do
...
automatic
...
first
...
approximation
...
at
...
a
...
mapping,
...
and
...
then
...
needs
...
to
...
be
...
able
...
to
...
search,
...
refine
...
and
...
validate
...
mapping,
...
and
...
to
...
be
...
able
...
to
...
record
...
a
...
"quality"
...
metric
...
that
...
states
...
how
...
closely
...
the
...
mapping
...
actually
...
approximates
...
the
...
intent
...
of
...
the
...
original
...
value.
...
The
...
user
...
may
...
encounter
...
potential
...
problems
...
and
...
omissions
...
during
...
this
...
process
...
and
...
will
...
need
...
to
...
submit
...
suggested
...
changes
...
and
...
enhancements
...
to
...
the
...
appropriate
...
oversight
...
body
...
for
...
potential
...
enhancement.
...
Once
...
the
...
mappings
...
are
...
created,
...
the
...
user
...
needs
...
to
...
be
...
able
...
to
...
download
...
the
...
resulting
...
mappings
...
in
...
an
...
electronic
...
format
...
such
...
as
...
Excel
...
or
...
XML,
...
as
...
well
...
as
...
be
...
able
...
to
...
submit
...
the
...
mappings
...
to
...
a
...
service,
...
either
...
local
...
or
...
centralized,
...
that
...
will
...
represent
...
the
...
mappings
...
via
...
a
...
standardized
...
API.
...
7
...
-
...
NCI
...
Enterprise
...
Vocabulary
...
Services
...
The
...
NCI
...
Enterprise
...
Vocabulary
...
Services
...
(EVS)
...
will
...
provide
...
terminology
...
content
...
and
...
technical
...
support
...
for
...
the
...
Semantic
...
Infrastructure
...
2.0,
...
and
...
has
...
an
...
extensive
...
user
...
community
...
with
...
use
...
cases
...
and
...
requirements
...
that
...
will
...
help
...
shape
...
development
...
of
...
the
...
new
...
infrastructure.
...
Further
...
details
...
are
...
available
...
on
...
the
...
...
...
...
and
...
...
...
...
...
...
...
Collaborations pages.
| Wiki Markup |
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|EVS:EVS - Overview of Use and Collaborations] pages.
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