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Comment by chintan | Hacker News Reader

> This is so impossible!

This is exactly why I feel we need more such start-ups in this space - Naive but Bold that have a "Stay hungry Stay foolish" mentality.

Having said that, I pretty much agree with all what you said. The core problem is that few years working in health IT, most people (myself included) start thinking this way. And thats why I feel we need such bold visions, which may sound stupid or "impossible" at this point but can potentially change the status quo. Its very hard to predict when, how and who will bring the change but I know it ll happen, sooner or later.

PS: I disagree about the UMLS part - I don't think any company in their right mind would use Metathesaurus as their base vocabulary, may be synonyms, mappings etc but not as a coding vocabulary.

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> The core problem is that few years working in health IT, most people (myself included) start thinking this way.

You hit the nail on the head, here. There's a fine line between "bold, fearless, and usefully foolish" and "too ignorant of an extremely complicated domain to accomplish anything useful", and in medical informatics that line is even finer than in many other fields.

> I don't think any company in their right mind would use Metathesaurus as their base vocabulary, may be synonyms, mappings etc but not as a coding vocabulary.

Just to chime in (in case anybody reading this comment thread is thinking about getting into this stuff), you're 100% correct: the UMLS is in no way supposed to be used as a coding vocabulary. If you try and use it as such, you're Doing It Wrong(tm). That's what clinical terminologies e.g. SNOMED-CT are for.

Of course, that doesn't mean that plenty of people haven't tried- it's just such a tempting-looking resource...

That said, I certainly wouldn't want to dissuade anybody from learning how to use the UMLS, or from using it for its intended purposes. It's a really valuable (and easily accessible) vocabulary resource.

Yes, UMLS is indeed a great resource! I do think one could use UMLS as a core vocabulary but with specific application context. At my company, we use it for information retrieval of clinical trials. NIH itself uses it in several of their services (MedlinePlus, ClinicalTrials.gov, etc)

In the context of EHR data-entry/documentation, using UMLS would not make sense just because of the inherent noisiness/granularity differences that come about due to the integrated view of the world. With terminologies like SNOMED-CT, you run into coverage issues and end up pre/post coordinating lot of knowledge.

Good point; I've used it as language resource for IR applications many times. What sort of clinical trial IR are you guys doing- storing and retrieving trial protocols themselves? Or is it about managing ongoing trials? Or something else entirely?

> With terminologies like SNOMED-CT, you run into coverage issues and end up pre/post coordinating lot of knowledge.

Well, yes, SNOMED is a post-coordinated vocabulary, so that's sort of the point- it's a feature, not a bug. Of course, there are so many ways to do post-coordination that you can easily end up in trouble when you try to exchange data with somebody else...

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