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Affiliations of the authors: Stanford University, Stanford, California (KEC, DEO, EHS); Oregon Health Sciences University, Portland, Oregon and College of American Pathologists, Northfield, Illinois (KAS); Veterans Administration Health Care System, Palo Alto, California (DEO).
Correspondence and reprints: Keith E. Campbell, MD, PhD, Section on Medical Informatics, Stanford University School of Medicine, Stanford, CA 94305-5479.
Abstract The authors describe a framework, based on the Ogden-Richards semiotic triangle, for understanding the relationship between the Unified Medical Language System (UMLS) and the source terminologies from which the UMLS derives its content. They pay particular attention to UMLS's Concept Unique Identifier (CUI) and the sense of "meaning" it represents as contrasted with the sense of "meaning" represented by the source terminologies. The CUI takes on emergent meaning through linkage to terms in different terminology systems. In some cases, a CUI's emergent meaning can differ significantly from the original sources' intended meanings of terms linked by that CUI. Identification of these different senses of meaning within the UMLS is consistent with historical themes of semantic interpretation of language. Examination of the UMLS within such a historical framework makes it possible to better understand the strengths and limitations of the UMLS approach for integrating disparate terminologic systems and to provide a model, or theoretic foundation, for evaluating the UMLS as a Possible World—that is, as a mathematical formalism that represents propositions about some perspective or interpretation of the physical world.
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