The language of skin: Lexicon project codifies dermatology’s terminology for digital age

National report - The Dermatology Lexicon Project (DLP) promises to provide the specialty with the foundation it needs to enter an age of computerized medical information. The multi-year project, taken over by the American Academy of Dermatology a few years ago, is the first-of-its-kind comprehensive dermatology terminology lexicon, created to support dermatology research, medical informatics and clinical care.

Building the foundation

A driving force behind the DLP’s computerized creation, Art Papier, M.D., associate professor of dermatology and medical informatics, University of Rochester School of Medicine and Dentistry, Rochester, N.Y., says the DLP started with four years of funding from the government’s National Institute of Arthritis and Musculoskeletal and Skin Diseases.

The National Institutes of Health arm funded the project because it became clear that the terminology for dermatology that existed was inadequate in a computerized age of electronic health records, digital image databases, decision support tools and more. Dermatology lagged in building the lexicon, while other specialties, including radiology, ophthalmology and pathology, had theirs in place, according to Dr. Papier.

"Many doctors use the ICD-9 system to code images or cases. But ICD-9 is really a nomenclature for all of medicine and does not have a richness of terminology to fit all the dermatology diagnoses," Dr. Papier says."The NIAMS branch approved this Dermatology Lexicon Project to work collaboratively with dermatologists across the country to create a comprehensive set of diagnostic terms and all their synonyms, with the idea that set could then be used to enhance research, education, medical care, telemedicine and decision support systems."

Dr. Papier did just that, working collaboratively with an impressive group of academic and private practice dermatologists in the United States. Their charge, according to Dr. Papier, was to review the terminology and come to a consensus of which diagnoses and synonyms should be included.

"We also had a very productive cooperative relationship with a doctor in the UK. It is part of the British Association of Dermatology’s effort to create a lexicon … and Dr. Robert Chalmers was very cooperative and helpful in terms of guiding us and helping us," Dr. Papier says.

A resource; not a product

What exists today is not a piece of software but rather the brains, or words, that go into software, according to Dr. Papier.

"This terminology could be inserted, for instance, as a base for diagnoses in an electronic health record. Or it could be inserted into a program that somebody develops to convert diagnoses to the correct ICD-9," he says.

Dr. Papier says the information would help a software program find the closest ICD-9 code to use when an exact diagnosis does not exist.

The end users of the information could be any kind of physician, but the data is of particular interest to dermatologists, including those who are labeling their cases.

"Dermatologists take lots of pictures, so one use of the system is to have a much better terminology to label and retrieve their cases, whether it is for education or research," he says.

The DLP is a rich resource of 6,147 diagnostic concepts and 4,067 synonyms, which are organized into 15 pathophysiologic categories. Also included: 185 precisely defined morphologic terms.

The lexicon’s terminology will be ultimately built into medical information technology products, Dr. Papier says.

Changing hands

Dr. Papier and colleagues released the first version of the lexicon and presented the DLP to the board of directors of the American Academy of Dermatology about two years ago.

"[We presented it] as an opportunity to move dermatology into the digital age and have the lexicon database housed on the academy Web site as a benefit to the members," Dr. Papier says.

The AAD board approved the project and took over the lexicon in 2006. Mark Pittlekow, M.D., chair of the academy’s medical informatics committee, is overseeing the project, and the AAD hired a medical informatics specialist to move the initiative forward.

The academy has since invited academy members to participate, asking that they review and contribute to the ever-evolving database.

According to Mark Pittelkow, M.D., professor, department of dermatology, Mayo Clinic College of Medicine, Rochester, Minn., and chair of the AAD’s Medical Informatics Committee, the hope is that the lexicon will be live for AAD members to use at the end of this year.

"Part of [the goal] is to have it specific and detailed enough for all the needs of the specialty … including common terms, definitions and a nice display of graphic display and tools to explain [the terms]," Dr. Pittelkow says. "There is the intent or plan to try and merge it with the other large lexicon that had been developed by the British Association of Dermatologists."

In the short term, the AAD is looking at the top 100 dermatology terms in the DLP and mapping those to ICD-9 codes, so that dermatologists can easily code their diagnoses. The data for the 100 terms may be available to members by October 2008, according to Dr. Pittelkow.

The long-term goal, according to a January 2008 article in the AAD’s magazine, Dermatology World, is to use the DLP to develop efficient patient care tools. Members’ continued contributions, according to the article, "will help streamline the database of the regional and dialectical disparities that can obscure diagnostics." DT