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Unified Medical Language System® (UMLS®)

New and Updated Sources (Expanded Representation Information) - 2013AA Release

General Information:

What's New to the Metathesaurus

For 2013AA, there are 4 new sources (LNC_ASQ_3, LNC_NPUAP, LNC_VR_12, SOP) and 66 updated sources (including subsources and translation sources).

LNC_ASQ_3 represents The Ages & Stages Questionnaire, an assessment questionnaire designed to screen the developmental performance of children in the areas of communication, gross motor skills, fine motor skills, problem solving, and personal-social skills. The target population is children between the ages of 4 months and 60 months. Users of this questionnaire are early childhood educators, social workers, nurses, pediatricians, and other early childhood professionals.

LNC_NPUAP represents the staging system of pressure ulcers designed by the National Pressure Ulcer Advisory Panel which is dedicated to the prevention and management of pressure ulcers.

LNC_VR_12 represents The Veterans RAND 12 Item Health Survey (VR-12). A self-administered survey used to measure health related quality of life, to estimate disease burden and to evaluate disease-specific benchmarks with other populations. The items in the questionnaire correspond to eight principal physical and mental health domains including general health perceptions; physical functioning; role limitations due to physical and emotional problems; bodily pain; energy-fatigue, social functioning and mental health.

SOP represents the Source of Payment Typology developed by The PHDSC Payer Typology Committee. The goal is to empower the healthcare and public health communities with health information technology standards.

For detailed information about sources that are new or have had changes made (e.g. new term types, new attribute names, etc.):

Current Procedural Terminology, CPT2013
Healthcare Common Procedure Coding System, HCPCS2013
International Classification of Diseases, Ninth Revision, Clinical Modification, ICD9CM_2013_2012_08_06
International Classification of Diseases, Tenth Revision, Clinical Modification, ICD10CM_2013
Logical Observation Identifiers Names and Codes (LOINC), LNC242
Medicomp Systems, MEDCIN [terminology files], MEDCIN3_2012_12_14
MedlinePlus Health Topics, MEDLINEPLUS_20130221
Descritores em Ciencias da Saude (Portuguese translation of the Medical Subject Headings), MSHPOR2013
Descritores en Ciencias de la Salud (Spanish translation of the Medical Subject Headings), MSHSPA2013
NeuroNames, NEU2012_08_23
RXNORM Vocabulary, RXNORM_12AB_130304F
US Extension to SNOMED CT, SCTUSX_2013_03_01
Source of Payment Typology, SOP5


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What's New to the Metathesaurus:

Attribute name (ATN):
      BRAININFO_URL
      CNID
      CNIDTYPE
      CPT_CLINICIAN_DESC_ID
      CPTDTK_CONCEPT_ID
      HL7_ATTACHMENT_STRUCTURE
      IMPRINT_CODE
      MP_GROUP_URL
      MP_HEALTH_TOPIC_URL
      MP_OTHER_LANGUAGE_URL
      MP_PRIMARY_INSTITUTE_URL
     
Relationship attribute(RELA)| RELA inverse:
      has_clinician_form|clinician_form_of
      has_consumer_friendly_form|consumer_friendly_form_of
     
Term type (TTY):
      CHISY
      ETCF
      ETCLIN
      FRESY
      GERSY
      INDSY
      ITASY
      KORSY
      LATSY
      RUSSY
      SPASY
      TURSY

------------------------------------------
Source: Current Procedural Terminology
SAB: CPT2013

This version includes:
      MTHCH2013

1. New term type (TTY) | Suppressible value | Source(s):
      ETCF|N|CPT2013
      ETCLIN|N|CPT2013

2. New relationship | relationship attribute(RELA) | RELA inverse | Source(s):
      RO|has_clinician_form|clinician_form_of|CPT2013
      RO|has_consumer_friendly_form|consumer_friendly_form_of|CPT2013

3. New attribute name (ATN) | Source(s):
      CPT_CLINICIAN_DESC_ID|CPT2013
      GENE_FAM_DESC

Discussion:

1. Two new categories of descriptions were processed for inclusion in the Metathesaurus:
      a. pub_clinician_descriptor_ids.txt - clinicial descriptors (CDs) that describe a procedure or service performed by a physician or qualified healthcare professional at the point of care.
      b. pub_consumer_friendly_descriptor_terms.txt - consumer friendly descriptors which translate each code descriptor from the official CPT code set into language that is easily understood by the average patient and/or his or her caregiver.

2. TTY = ETCLIN indicate entry terms for clinician descriptions.

3. TTY = ETCF indicate entry terms for consumer friendly descriptions.

4. RELA = has_clinician_form/clinician_form_of connects the clinican form (TTY = ETCLIN) of the CPT descriptor to the preferred term (TTY = PT).

5. RELA = consumer_friendly_form_of/has_consumer_friendly_form connects the consumer friendly form (TTY = ETCF) of the CPT descriptor to the preferred term (TTY = PT).

6. ATN = CPT_CLINICIAN_DESC_ID represents the CPT clinician descriptor concept identifier.

7. ATN = CPTDTK_CONCEPT_ID represents the CPT DTK concept identifier.

------------------------------------------
Source: Healthcare Common Procedure Coding System
SAB: HCPCS2013

This version includes:
      HCDT2013
      HCPT2013
      MTHHH2013

1. New term type (TTY) | Suppressible value | Source(s):
      MTH_PT|N|HCPCS2013, HCPT2013

2. New relationship | relationship attribute(RELA) | RELA inverse | Source(s):
      SY|mth_plain_text_form_of|mth_has_plain_text_form|HCPCS2013, HCPT2013

Discussion:

1. A new MTH_* term type and mth_* relationship was needed for plain ASCII text strings created during Metathesaurus processing.

2. The version of CDT was updated to HCDT2013.

------------------------------------------
Source: International Classification of Diseases, Ninth Revision, Clinical Modification
SAB: ICD9CM_2013_2012_08_06

This version includes:
      MTHICD9_2013_2012_08_06

Discussion:

On August 8, 2012, CMS issued corrections to full descriptions which affected 41 diagnoses codes. These changes were incorporated into 2013AA.

------------------------------------------
Source: International Classification of Diseases, Tenth Revision, Clinical Modification
SAB: ICD10CM_2013

1. New term types (TTY) | Suppressible value:
      MTH_AB|N

Discussion:

New TTY = MTH_AB for plain text version of short descriptions.

------------------------------------------
Source: Logical Observation Identifiers Names and Codes (LOINC)
SAB: LNC242

This version includes:
      LNC242_AD8_2005
      LNC242_ASQ_3_2009 (new)
      LNC242_BRADEN_1988
      LNC242_CAM_2003
      LNC242_FACIT
      LNC242_FLACC_1997
      LNC242_MDS20
      LNC242_MDS30
      LNC242_MLHFQ_1986
      LNC242_NEUROQOL_2010
      LNC242_NPUAP_2012 (new)
      LNC242_OASIS_2002
      LNC242_OPTIMAL_2005
      LNC242_PHQ_9_1999
      LNC242_RHO_2008
      LNC242_SPERTUS_2005
      LNC242_VR_12_2004 (new)
      LNC242_WHO_2006

1) New term type (TTY) | Suppressible value | Source(s):
      LC|N|LNC242_ASQ_3_2009, LNC242_NPUAP_2012, LNC242_VR_12_2004
      LN|N|LNC242_ASQ_3_2009, LNC242_NPUAP_2012, LNC242_VR_12_2004
      MTH_LN|N|LNC242_ASQ_3_2009, LNC242_NPUAP_2012, LNC242_VR_12_2004

2) New relationship | relationship attribute (RELA) | RELA inverse | Source(s):
      RO|has_class|class_of|LNC242_ASQ_3_2009, LNC242_NPUAP_2012, LNC242_VR_12_2004
      RO|has_component|component_of|LNC242_ASQ_3_2009, LNC242_VR_12_2004
      RO|has_evaluation|evaluation_of|LNC242_ASQ_3_2009, LNC242_VR_12_2004
      RO|has_fragments_for_synonyms|fragments_for_synonyms_of|LNC242_VR_12_2004
      RO|has_method|method_of|LNC242_ASQ_3_2009, LNC242_NPUAP_2012, LNC242_VR_12_2004
      RO|has_property|property_of|LNC242_NPUAP_2012, LNC242_VR_12_2004
      RO|has_scale|scale_of|LNC242_NPUAP_2012, LNC242_VR_12_2004
      RO|has_supersystem|supersystem_of|LNC242_ASQ_3_2009, LNC242_NPUAP_2012, LNC242_VR_12_2004
      RO|has_time_aspect|time_aspect_of|LNC242_ASQ_3_2009, LNC242_NPUAP_2012, LNC242_VR_12_2004
      RO|measured_by|measures|LNC242_NPUAP_2012
      SY|common_name_of|has_common_name|LNC242_ASQ_3_2009, LNC242_NPUAP_2012, LNC242_VR_12_2004
      SY|has_expanded_form|expanded_form_of|LNC242_NPUAP_2012
      SY|mth_expanded_form_of|mth_has_expanded_form|LNC242_ASQ_3_2009, LNC242_NPUAP_2012, LNC242_VR_12_2004

3. Dropped relationship | relationship attribute (RELA):
      RQ|mapped_from

4. New attribute name (ATN) | Source(s):
      COMMON_ORDER_RANK|LNC242_ASQ_3_2009, LNC242_NPUAP_2012, LNC242_VR_12_2004
      COMMON_SI_TEST_RANK|LNC242_ASQ_3_2009, LNC242_NPUAP_2012, LNC242_VR_12_2004
      COMMON_TEST_RANK|LNC242_ASQ_3_2009, LNC242_NPUAP_2012, LNC242_VR_12_2004
      COPYRIGHT|LNC242_ASQ_3_2009, LNC242_NPUAP_2012, LNC242_VR_12_2004
      EXAMPLE_UCUM_UNITS|LNC242_VR_12_2004
      EXAMPLE_UNITS|LNC242_VR_12_2004
      HL7_ATTACHMENT_STRUCTURE|LNC242
      HL7_V2_DATATYPE|LNC242_VR_12_2004
      LCL|LNC242_ASQ_3_2009, LNC242_NPUAP_2012, LNC242_VR_12_2004
      LCN|LNC242_ASQ_3_2009, LNC242_NPUAP_2012, LNC242_VR_12_2004
      LCS|LNC242_ASQ_3_2009, LNC242_NPUAP_2012, LNC242_VR_12_2004
      LCT|LNC242_ASQ_3_2009, LNC242_NPUAP_2012, LNC242_VR_12_2004
      LLR|LNC242_ASQ_3_2009, LNC242_NPUAP_2012, LNC242_VR_12_2004/>       LOINC_COMPONENT|LNC242_ASQ_3_2009, LNC242_NPUAP_2012, LNC242_VR_12_2004
      LOINC_METHOD_TYP|LNC242_ASQ_3_2009, LNC242_NPUAP_2012, LNC242_VR_12_2004
      LOINC_PROPERTY|LNC242_ASQ_3_2009, LNC242_NPUAP_2012, LNC242_VR_12_2004
      LOINC_SCALE_TYP|LNC242_ASQ_3_2009, LNC242_NPUAP_2012, LNC242_VR_12_2004
      LOINC_SYSTEM|LNC242_ASQ_3_2009, LNC242_NPUAP_2012, LNC242_VR_12_2004
      LOINC_TIME_ASPECT|LNC242_ASQ_3_2009, LNC242_NPUAP_2012, LNC242_VR_12_2004
      LOR|LNC242_NPUAP_2012
      LQS|LNC242_VR_12_2004
      LQT|LNC242_ASQ_3_2009, LNC242_VR_12_2004
      LRN2|LNC242_ASQ_3_2009, LNC242_NPUAP_2012, LNC242_VR_12_2004
      SOS|LNC242_ASQ_3_2009, LNC242_VR_12_2004

5. Dropped attribute name (ATN):
      LMP

Discussion:

1. Three new subsources: LNC242_ASQ_3_2009, LNC242_NPUAP_2012, LNC242_VR_12_2004.

2. New ATN = HL7_ATTACHMENT_STRUCTURE. Valid values are STRUCTURED or UNSTRUCTURED. STRUCTURED terms are the allowed document type codes in the Consolidated CDA Implementation guide. UNSTRUCTURED terms are based on the PIUC guide.

3. New MTH_* term types are due to the creation of plain ASCII text strings during Metathesaurus processing.

4. Five subsources within the LNC source data are not included in the Metathesaurus:
      a. Borderline Symptom List - 23 Item
      b. Borderline Symptom List - Supplement
      c. Edinburgh Postnatal Depression Scale
      d. Patient Reported Outcomes Measurement (PROMIS)
      e. Test of Infant Motor Performance (TIMP)

5. The 'MAP_TO' field in the source data was deprecated. The information in this field supplied the value for the dropped ATN=LMP.

-----------------------------------------------
Source: Medicomp Systems, MEDCIN [terminology files]
SAB: MEDCIN3_2012_12_14

1) New relationship | relationship attribute(RELA) | RELA inverse:
      RO|has_indirect_morphology|indirect_morphology_of

Discussion:

RELA = has_indirect_morphology indicates a relationship between a SNOMEDCT term and a MEDCIN term.

------------------------------------------------
Source: MedlinePlus Health Topics
SAB: MEDLINEPLUS_20130221

1. New attribute name (ATN):
      MP_GROUP_URL
      MP_HEALTH_TOPIC_URL
      MP_OTHER_LANGUAGE_URL
      MP_PRIMARY_INSTITUTE_URL

2. Dropped attribute name (ATN):
      GROUPURL
      URL

Discussion:

1. The format of the health topics code has changed. The prefix 'T' was deprecated. Previous code format was T3061. Current code format is 3061.

2. Some ATNs have been replaced with more descriptive names.
      ATN = MP_GROUP_URL replaces GROUPURL.
      ATN = MP_HEALTH_TOPIC_URL replaces URL.

3. New ATN = MP_OTHER_LANGUAGE_URL indicates the other language associated with the health topic.

4. New ATN = MP_PRIMARY_INSTITUTE_URL indicates the primary National Institutes of Health Institute assigned to the health topic.

----------------------------------------------
Source: Descritores em Ciencias da Saude (Portuguese translation of the Medical Subject Headings)
SAB: MSHPOR2013

1. New term type (TTY) | Suppressible value:
      EN|N
      PEN|N

Discussion:

1. New TTY = EN indicates entry term.

2. New TTY = PEN indicates preferred entry term.

----------------------------------------------
Source: Descritores en Ciencias de la Salud (Spanish translation of the Medical Subject Headings)
SAB: MSHSPA2013

1. New term type (TTY) | Suppressible value:
      EN|N
      PEN|N

Discussion:

1. New TTY = EN indicates entry term.

2. New TTY = PEN indicates preferred entry term.

----------------------------------------------
Source: NeuroNames
SAB: NEU2012_08_23

1. New term type (TTY) | Suppressible value:
      ACR|Y
      CHISY|N
      FRESY|N
      GERSY|N
      INDSY|N
      ITASY|N
      KORSY|N
      LATSY|N
      PT|N
      RUSSY|N
      SPASY|N
      SY|N
      TURSY|N

2. New relationship | relationship attribute (RELA) | RELA inverse:
      SY|has_expanded_form|expanded_form_of

3. New attribute name (ATN):
      BRAININFO_URL
      CNID
      CNIDTYPE

Discussion:

1. New permanent numeric identifier called brainInfoID. IDs used prior to 2009 are mapped to ATN = CNID.

2. Synonyms are available in several languages (Chinese, Russian, French, etc) and are assigned specific termtypes: CHISY (Chinese), FRESY (French), GERSY (German), etc.

3. Latin atoms were previously assigned TTY=LSY (in NEU99). It is now TTY = LATSY to remain consistent with the 3 code language format of the other languages.

4. ATN = CNIDTYPE identifies whether an item is in the classical hierarchy of brain structures (value = h) or not (value = a for ancillary).

5. ATN = BRAININFO_URL identifies the URL of the central directory page in BrainInfo.

6. New species restrictions: guenon, rodent, mouse, primate, rat.

7. New relationship: SY|expanded_form_of created between the preferred term (TTY=PT) and the acronym (TTY=ACR).

----------------------------------------------
Source: RXNORM Vocabulary
SAB: RXNORM_12AB_130304F

This version includes:
      GS_2013_02_01 (Gold Standard Drug Database)
      MDDB_2013_01_30 (Master Drug Data Base. Medi-Span, a division of Wolters Kluwer Health)
      MMSL_2013_02_01 (Multum MediSource Lexicon)
      MMX_2013_02_04 (Micromedex RED BOOK)
      MTHFDA_2011_06_01_13_03_04 (FDA National Drug Code Directory)
      MTHSPL_2013_02_26 (FDA Structured Product Labels)
      NDDF_2013_02_06 (FDB MedKnowledge)
      NDFRT_2013_02_04 (National Drug File)
      VANDF_2013_01_15 (Veterans Health Administration National Drug File)

1. Dropped term type (TTY):
      AB
      FN
      HT
      PT

2. Dropped relationship | relationship attribute(RELA):
      RO|active_metabolites_of
      RO|chemical_structure_of
      RO|contraindicated_with_disease
      RO|contraindicating_class_of
      RO|contraindicating_mechanism_of_action_of
      RO|contraindicating_physiologic_effect_of
      RO|effect_may_be_inhibited_by
      RO|has_active_metabolites
      RO|has_chemical_structure
      RO|has_contraindicated_drug
      RO|has_contraindicating_class
      RO|has_contraindicating_mechanism_of_action
      RO|has_contraindicating_physiologic_effect
      RO|has_mechanism_of_action
      RO|has_participant
      RO|has_pharmacokinetics
      RO|has_physiologic_effect
      RO|has_product_component
      RO|has_therapeutic_class
      RO|induced_by
      RO|induced
      RO|induces
      RO|may_be_diagnosed_by
      RO|may_be_prevented_by
      RO|may_be_treated_by
      RO|may_diagnose
      RO|may_inhibit_effect_of
      RO|may_prevent
      RO|may_treat
      RO|mechanism_of_action_of
      RO|metabolic_site_of
      RO|participates_in
      RO|pharmacokinetics_of
      RO|physiologic_effect_of
      RO|product_component_of
      RO|site_of_metabolism
      RO|therapeutic_class_of
      SY|has_print_name
      SY|print_name_of

3. New attribute name (ATN) | Source(s):
      IMPRINT_CODE|MTHSPL_2013_02_26
      NST|MTHFDA_2011_06_01_13_03_04
      RXO|MTHFDA_2011_06_01_13_03_04
      TRN|MTHFDA_2011_06_01_13_03_04

4. Dropped attribute name (ATN):
      APPROVED_DRUG_PRODUCT_MANUFACTURED_EXCLUSIVELY_FOR_PRIVATE_LABEL_DISTRIBUTOR
      DRUG_CLASS_TYPE
      EXCLUDE_DI_CHECK
      FDA_UNII_CODE
      IMPRINT CODE
      LEVEL
      MESH_DEFINITION
      MESH_DUI
      MESH_NAME
      MESH_UI
      NDFRT_KIND
      NDF_UNITS CODE
      NF_INACTIVATE
      NUI
      PARENT_CLASS
      RXN_PRESCRIBABLE
      SEVERITY
      SNOMED_CID
      STRENGTH
      VA_IEN
      VANDF_RECORD
      VUID

Discussion:

1. New ATN = NST indicates the normalized strength and units for drugs with one active ingredient (e.g. 769 MG).

2. New ATN = RXO displays the NDF drug description. Valid values: R for Rx and O for OTC.

3. ATN = IMPRINT_CODE replaces ATN = IMPRINT CODE.

4. New ATN = TRN displays the product trade name.

5. MTHFDA is included in each Metathesaurus release as part of RxNorm, however, it was not updated in this version. MTHFDA was last updated in 2011.

6. Selected portions of MSH and SNOMEDCT are included in the RxNorm release files, however, they are not processed as part of RxNorm for the Metathesaurus except in assigning RXCUI and RXAUI attributes.

------------------------------------------------------------
Source: US Extension to SNOMED CT
SAB: SCTUSX_2013_03_01

1. New relationship | relationship attribute(RELA) | RELA inverse:
      RO|has_finding_informer|finding_informer_of
      RO|has_procedure_morphology|procedure_morphology_of
      RO|has_procedure_site|procedure_site_of
      RO|has_specimen_procedure|specimen_procedure_of
      RO|occurs_after|occurs_before
      RO|uses_energy|energy_used_by
      RO|uses_substance|substance_used_by

Discussion:

1. The relationships while new to SCTUSX are already present in SNOMEDCT.

2. The SCTUSX hierarchy is designed as an extension to the SNOMEDCT hierarchy. Due to complications in representing a mixed-source hierarchy, the SCTUSX hierarchy is not represented in MRHIER.RRF, however, it is represented in MRREL.RRF as follows:

      REL/REL_INVERSE: PAR/CHD
      RELA/RELA_INVERSE: inverse_isa/isa

---------------------------------------------------------------
Source: Source of Payment Typology
SAB: SOP5

1. New term type (TTY) | Suppressible value:
      PT|N

Discussion:

This is a new source.