Acceptability of Unified Medical Language System terms as substitute for natural language general medicine clinic diagnoses

Abstract

The acceptability of using the Unified Medical Language System (UMLS) concept phrases to substitute for physicians' diagnosis statements was investigated. Physician diagnosis statements recorded in the University of New Mexico's General Medicine Clinic were input into a computer program that automatically finds the best matching UMLS concept phrases. The computer program written in C++ integrates UMLS searching and browsing with a graphical user interface. Five attending physicians in the Department of Internal Medicine rated the acceptability of the UMLS concept phrase as a substitute for the original physician statement. One hundred and ninety-five patients' notes were examined with 447 diagnosis statements recorded of which 271 statements were unique. Attending physicians rated their satisfaction with the automated UMLS substitutes on a scale of 1 (extremely dissatisfied) to 5 (extremely satisfied). Intrarater (mean 0.94) and interrater correlations (mean 0.75) were high. The mean rating was 4.0 (quite satisfied). Most (73%) of the substitution were satisfactory (rating of 4 or 5), 16% were neutral (rating of 3), and 21% were unsatisfactory (rating of 1 or 2). A review of the substitutions showed a frequent lack of clinical modifier terms in UMLS as has been previously described. Comparison to a previous study shows the broader term coverage of UMLS to be a more acceptable source of diagnosis codes than using International Classification of Diseases revision 9 alone. These results suggest that UMLS can be an effective tool for coding unconstrained physician diagnoses.