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1. Maintain all concepts (both locally-created and externally-managed) in a single OpenMRS instance (could be cloud hosted). Use this central concept dictionary server to maintain all of the concepts, make changes and additions, and then push them out to other servers using the MDS module.
2. Import new concepts from the MVP or MCL concept dictionary (the manner of import will depend on where you get the source from). You can use the MCL server with the MDS Module to import a subset of concepts. NOTE: Need to see what happens with MDS in regards to updates to existing concepts such as map changes, etc. The MCL server is updated fairly frequently with the concepts from the CIEL/MVP dictionary. Search for needed concepts and when you have all of them, create an MDS export (zip package) which is imported into your server. The MCL is running OpenMRS Version 1.6.3 with MDS Version 1.0.6.  NOTE: Check on OpenMRS versions compatible with the MCL server. If you get the concept tables directly from CIEL via the dropbox, the SQL files will overwrite all the concept tables in your local implementation.
   

Suggestions for Organizing Local Concepts

1. Include your organization as the concept source for your concepts (ie. AMPATH, PIH, MVP). This will ensure that you know the source of the concepts. Check on this: "and you could export them by selecting the source". Due to synchronization and MDS (and perhaps other factors), the concept IDs are not maintained between servers, but the mappings and the uuids are preserved.
2. You might want to place some identifier (for example the name of your organization) to make them more easily identifiable. For example, in HTML forms, it's easier to read  <obs conceptId="PIH: Malaria" /> or <obs conceptId="ICD-10-WHO: B54" /> than <obs conceptId="123" /> or worse yet, with the uuids <obs conceptId="be3f86fa-1691-11df-97a5-7038c432aabf" />. If you use the concept name in the conceptId (ie. PIH: Malaria), MDS does not convert that mapping when importing the htmlform. However, if it used the concept id (ie. conceptId="123"), MDS converts the concept id to uuid. It makes the htmlform difficult to read and debug.

Adding New Concepts

To add a concept, it's best to search the CIEL/MVP dictionary first to ensure that the concept is not already there by another name, etc. Do this by going to the MCL server http://maternalconceptlab.com. Concepts can be search by the concept name or by relevant maps (such as the SNOMED CT code or ICD-10 code, if you know it). If there is ANY REASON why the concept could be used by others, the it should be included in the CIEL/MVP dictionary. Do not assume that a concept would only be used by you. Email Andy (at akanter@ei.columbia.edu) if you have any questions. If you cannot find the concept that you want in the dictionary, it could be because it is in the dictionary and you can't find it, or because it is a new concept and is not there. If you are SURE that the concept would only be used locally then add it to your local server.

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Which concepts to select

One way to do this is to only get the concepts from the external dictionary that you need.  The benefit of that is you maintain a usable set of concepts, because it get difficult to manage if there are too many concepts. Of note, managing a concept dictionary is extremely complicated and requires a significant time commitment to do properly. It is frequently seen that locally-managed concept dictionaries become corrupted, lead to duplication of data, or otherwise make it difficult to analyse data previously collected. Currently, the CIEL/MVP dictionary has over 60,000 concepts. The disadvantage of that is it requires someone to pull concepts every time you want to add additional forms or programs.

It might be helpful to use MDS to select all concepts with a particular map and export those to another server.

Automatically updating Dictionary and MDS Module

When thinking about getting the automatic updates from either the MVP/MCL dictionary or MDS updates, always make sure to test them out in the concept server before going into production and always backup the concept tables on the server before doing any updates. You probably want to update the concept dictionary when there are new concepts that you want to use. If you rely on maps to reference terminologies such as SNOMED or ICD-10, you probably should make sure that you update your concept tables at least once or twice a year at a minimum.

Updating/Synchronizing many servers

If you have multiple servers who are going to be using the same concepts, there seem to be 2 ways to keep them updated with the central concept server

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