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This blog written by Dr. Andrew Kanter, an Asst. Prof. of Clinical Biomedical Informatics and Epidemiology at Columbia University. He directs the Columbia International eHealth Laboratory. He is also a senior advisor and former Chief Medical Officer for Intelligent Medical Objects, the premier clinical interface terminology company.


CIEL: Bridging Terminology for the Global Community

What is the CIEL Concept Dictionary?

The CIEL concept dictionary is a dictionary of over 53 thousand concepts relevant to health information systems in low and middle income countries (LMICs). Those concepts include diagnoses, procedures, medications, labs and observables (answers to questions) all mapped to international standard coding systems such as ICD-10-WHO, SNOMED CT, LOINC, RxNORM, and many others. It is used by electronic health records and other health information systems in more than 40 countries.

Origin of CIEL

Schematic of the Millennium Villages Global Network.

Figure 1: Schematic of the Millennium Villages Global Network.

The Columbia International eHealth Laboratory (CIEL), directed by Dr. Andrew Kanter, was formed in 2010 as a joint effort of the Earth Institute, Columbia University Department of Biomedical Informatics and Engineering department with support from the Canadian International Development Research Centre (IDRC) and the Rockefeller Foundation. CIEL’s initial role was to support the health information system needs of the Millennium Villages Project (MVP) in ten sub-Saharan African countries. Creating the Millennium Villages Global Network (MVG-Net), CIEL tied together several different open source packages to create a village-to-Ministry information system. MVG-Net consisted of a community health worker application (ChildCount followed by CommCare), a clinic-based application (OpenMRS), a health information management application (DHIS2) and a de-identified research database at Columbia. It also included a pilot application of Telehealth in Ghana (see Figure 1).

With the completion of MVP in 2015, CIEL focused the majority of its resources on continuing to support the OpenMRS community, in particular, by expanding the multilingual, multinational standardized concept dictionary from MVP to the global community. MVP required interoperable data collected from the ten different countries in Africa, and CIEL managed this dictionary for the duration of the project. Prior to MVP, OpenMRS had access to a starter dictionary created by Regenstrief and AMPATH, but this dictionary was not being updated. CIEL took in requests for additional concepts from many in the OpenMRS community including Partners in Health, iTECH, Médecins sans Frontières (MSF), and then made the dictionary available to everyone on a monthly basis via a modified Creative Commons license.

The CIEL concept dictionary was originally provided to the OpenMRS community via a flat file distributed by Dropbox in multiple different versions for the different OpenMRS databases. This required a complete overwriting of the concept tables within the OpenMRS application. This limited the utility of the shared dictionary and created complex implementation pathways. OpenMRS provided a metadata sharing module which allowed packages of concepts to be added to existing implementations, but this too was not ideal.

A Collaboration between CIEL and OCL

Dr. Kanter and CIEL collaborated with Jonathan Payne and the Open Concept Lab (OCL) to develop an alternative distribution platform which would allow for cloud-based collaboration on dictionaries, including the CIEL dictionary, and a method of subscribing and updating of a server such as OpenMRS. OCL has now grown to become a multi-purpose terminology management system that many organizations use to publish structured metadata to support health data exchange.

The CIEL dictionary home in the Open Concept Lab TermBrowser.

Figure 2: The CIEL dictionary home in the Open Concept Lab TermBrowser.

The OpenMRS community has committed to work together with tools, like CIEL, to ensure they have great tooling and great documentation to unlock scale to:

  • Ensure patients get the right, timely, and appropriate care; 
  • Provide health workers with timely, accurate, and complete information; and, 
  • Give organizations data to improve the efficiency and quality of care delivery.

To make implementations easier to build and deploy, OpenMRS supports the ability to copy and customize a CIEL concept instead of recreating it manually. Additionally, OpenMRS has developed the OpenMRS dictionary manager application to give implementers a single place to manage codes. For more details and how to engage more in the OpenMRS Dictionary Manager, checkout the OpenMRS squad that supports the application.

Visit CIEL on OCL Online to see the latest release: 

Get connected with CIEL

The CIEL concepts are constantly being updated, including addition of new maps to ICD-11-WHO and language translations for a subset of concepts. 

To help implementers and designers better understand concept management and curated dictionaries like CIEL in particular, Dr. Kanter hosts an open CIEL Office Hours on alternating Wednesdays and Thursdays at 8:30pm IST | 6pm Nairobi | 5pm Cape Town | 1pm UTC | 10am Boston | 7am Seattle. See this talk post for details on how to join: