Introduction

Introduction

What CIEL is

CIEL is a clinical interface terminology: it represents clinical concepts in language close to everyday practice and links each concept to international reference terminologies such as SNOMED CT, ICD, ATC, RxNorm and LOINC.

History

CIEL grew out of Columbia University's global health work in low- and middle-income countries, especially the Millennium Villages Project (MVP), which ran from 2005 to 2015 in ten communities across sub-Saharan Africa. The project needed an information system that connected care delivered in communities to district, regional and national levels, and produced structured data for management and research. Between 2007 and 2012, work supported by the Rockefeller Foundation and the IDRC led, among other results, to the Millennium Villages Global Network (MVG-Net). The CIEL laboratory itself was formed in 2010.

That system had to work with limited resources. OpenMRS, an open source electronic medical record designed for such settings, became a central component. OpenMRS structures clinical data around a centrally managed Concept Dictionary: diagnoses, symptoms, procedures, tests and medications are stored as shared, reusable concepts rather than being defined separately by each implementation.

This exposed a problem that went beyond software:

• Implementations in different countries needed to record similar clinical ideas, but clinicians used different expressions, languages and levels of detail.
• The data also had to be related to standard terminologies for interoperability, indicators and analysis. MVP needed to be able to analyze the data from all of the Millennium Villages and determine what interventions were working and which weren't so that lessons could be shared across MVP to achieve the Millennium Development Goals.
• Using reference terminologies directly did not solve it, because the language needed at the point of care does not always match the structure of classifications built for other purposes.

The answer was a shared layer between what the clinician wants to record and the standards needed to exchange its meaning. That is the CIEL Concept Dictionary: concepts written for clinical use, with relationships to reference terminologies. Instead of each organization rebuilding its own dictionary, implementations start from a common, already mapped core.

After MVP ended in 2015, CIEL focused on the OpenMRS community, expanding the multilingual, multinational dictionary to the world. It took requests from implementers such as Partners in Health, iTECH and Médecins Sans Frontières, and published a release every month. The dictionary is now used by implementations in more than 40 countries.

Three needs, one terminology

CIEL's origin is the meeting of three needs seen in real global health projects:

1. Open source clinical systems that fit low-resource settings.
2. Shared terminology content reused across implementations.
3. A bridge between local clinical language and international standards.

Today

CIEL is now managed entirely in Open Concept Lab (OCL), from authoring to publication. See Release Process and Use Cases.