Ontology Manager

The Ontology Manager is where you create and maintain reusable rule snippets for complex clinical concepts, define custom LOINC codes, and adopt pre-built ontology rules and custom LOINC codes from the Ethicos library.

Accessing the Ontology Manager

From the Settings gear menu in the top navigation, select Ontology Manager.

The page has up to three tabs: Ontology Rules, Custom LOINC codes, and Library. The Library tab is only shown to tenant administrators on non-global tenants.

Ontology Rules tab

Viewing and searching rules

The Ontology Rules tab lists all rule snippets available in your tenant. Each row shows the rule Name and its Scope (Global rules are built-in platform rules; Tenant rules are ones your organization has created or adopted).

Use the search field at the top left to filter the list by name.

Adding a rule

Select Add Rule to open the rule editor dialog. Enter a name and define the rule using the rule builder. For a demographics gender condition, choose Male or Female from the value list rather than typing a code. If you set the operator to is one of or is not one of, the value list lets you pick more than one. Select Create Rule when done. The new rule appears in the list and is immediately available to reference in guidelines.

If the rule cannot be saved, the dialog stays open with a red message at the top explaining why, and your name, description, and rule builder work are preserved so you can correct the problem and try again.

The rule builder tabs

The rule editor has three tabs:

• Builder — add and arrange rules visually.
• JSON — view and edit the rule definition in this tab.
• Describe — write a plain-language description (for example, a list of drugs or clinical criteria), then select Generate Rules. The generated rules appear in the Builder tab.

When Describe Rules is not enabled for your tenant, the Describe tab appears greyed out and Generate Rules is disabled. The Builder and JSON tabs keep working. A global administrator can turn this on in Tenant Details, in the Guideline Settings card (Enable Describe Rules (AI rule generation)).

If the AI cannot produce any rules from your description, you see: The AI could not generate rules from this description. Try rephrasing or shortening it. Existing rules in the builder are left unchanged.

Editing a rule

Click any rule row (or select the pencil icon) to open the rule editor with that rule’s current definition loaded. Make your changes and select Update Rule. As with adding a rule, a failed save leaves the dialog open with an explanation rather than discarding your edits.

Deleting a rule

Select the delete icon on any tenant-scoped rule. A confirmation dialog asks you to confirm before the rule is removed. Global rules cannot be deleted.

Building observation rules

When you add or edit a rule leaf and set Field Type to Observations, the rule builder shows how to pick the lab or vital sign you mean, how to choose which reading to compare, and the threshold itself.

Picking groups and codes together

The Observations panel has two areas:

• LOINC groups — official Regenstrief rollups for a clinical concept (for example, an LDL cholesterol group). Select Add group, search by name or group ID, and choose one or more groups. Each group chip shows the group name.
• Individual LOINC codes — specific observation codes that are not covered by your selected groups, or codes you want to include explicitly. Select Add code and search by code or test name. Custom organization codes (GEMA codes) appear here the same way as standard LOINC codes.

You can use groups only, codes only, or both on the same rule. One Selection Rule, Max Age (days), Operator, and Value apply to every group and code you selected — you do not need separate rules for each variant of the same test.

Example: To require LDL cholesterol, add the official LDL group and add calculated LDL as an individual code if your members sometimes have that result under a code the group does not include. The patient satisfies the rule if they have a qualifying reading under any member of a selected group or under any explicit code you added.

Selection, age, and threshold

On the first row of the observation rule:

• Selection Rule — choose which reading to evaluate (for example Use latest value or Baseline value). Comparison options such as month-over-month change appear here when relevant.
• Max Age (days) — optional freshness limit. Leave blank to consider any observation on the chart.

On the second row, set Operator and Value (and Units when more than one unit is valid for the test). These apply to the combined set of groups and codes.

When Use latest value is selected, the system treats the most recent reading across all selected groups and codes as the value to compare — not the latest per code separately.

Mixed scale warning

If the tests you selected use incompatible result scales (for example ordinal vs numeric), a warning appears under the observation picker. You can still save the rule, but review that your threshold still makes clinical sense for every code in the set.

About official LOINC groups

LOINC groups are maintained by Regenstrief and marked as Beta reference rollups. Membership can change when LOINC releases a new version — a group you selected may gain or lose member codes over time without you editing the rule. If you need a fixed, frozen set of codes, add those codes individually under Individual LOINC codes and omit the group.

The same observation picker appears anywhere the shared rule builder is used (ontology rules, guideline initiation and continuation rules, interchange conversion rules, legacy therapy discontinuation rules, and GoldCard matching rules).

Custom LOINC codes tab

The Custom LOINC codes tab lists observation codes your organization has defined outside the standard LOINC catalog. Each entry shows an auto-assigned GEMA-NNN code (for example, GEMA-001), a name, description, scale type, and active status.

Adding a custom LOINC code

Select Add Custom LOINC Code to open the editor. Enter a name and description, choose a scale type (quantitative or ordinal), and configure the related fields (units for quantitative codes, or answer options for ordinal picklists). Select Create when done. GEMA assigns the next available GEMA-NNN code automatically — you do not enter the code yourself.

Editing a custom LOINC code

Select the pencil icon on any row to open the editor with the existing values. The code is shown read-only. Update the other fields and select Update.

Deactivating a custom LOINC code

Select the delete icon on a row. A confirmation dialog asks you to confirm before the custom LOINC code is deactivated.

Library tab

The Library tab lists Ethicos-provided content your tenant can adopt: Ontology Rules and Custom LOINC Codes. This tab is only visible to tenant administrators on non-global tenants.

The page has two sections. Use the search field in each section to filter that list.

Adopting a rule from the library

In the Ontology Rules section, browse or search for the rule you need. Select the adopt icon on a rule row. A dialog confirms the rule name and asks you to confirm adoption. Select Adopt Rule to copy the rule into your tenant’s Ontology Rules tab. Once adopted, you can edit the rule to customize it for your organization’s needs.

If the rule has already been adopted, the dialog tells you and the adopt action is disabled.

Adopting a custom LOINC code from the library

In the Custom LOINC Codes section, browse or search for the code you need. Each row shows the GEMA-NNN code, name, scale type, and status. Select the adopt icon on a row. A dialog confirms the code name and shows the GEMA-NNN code that will be copied. Select Adopt Code to add it to your tenant’s Custom LOINC codes tab with the same GEMA-NNN identifier.

Once adopted, open the Custom LOINC codes tab to view or edit the copy (name, description, scale type, units or answer list, and active status). The code itself stays fixed.

If the code has already been adopted, the dialog tells you and the adopt action is disabled.

When you adopt a guideline from the Guideline Manager Library, any ontology rules that guideline references are also added to your Ontology Rules list automatically. Rules your tenant already has are reused, not duplicated. See Configuring Guidelines for library adoption and Adopt Update.

Using ontology rules in guidelines

Reference an ontology rule from a guideline’s rule builder when you want to reuse a named clinical concept (a bundled set of diagnoses, drugs, procedures, or other criteria) across multiple guidelines.

Wherever that guideline is shown to staff or prescribers, the ontology rule’s name is displayed alongside the expanded criteria:

• Guideline detail page — the Rules section summary names the ontology rule (for example, Patient matches ontology rule: Type 2 Diabetes).
• PA Determination Review — the clinical criteria tree shows the ontology rule as its own row that names the rule and states whether the patient must match or must not match it (for example The patient must not match ontology rule Diagnosis, Pancreatitis). The row’s status is the result for the whole ontology rule; the expanded diagnosis, drug, or procedure checks are listed beneath it as supporting detail. Very long flat diagnosis lists start collapsed with Show N diagnoses, and a group or ontology with six or more requirements starts collapsed with Show N requirements under its row, so the tree stays readable; expand to see every line.
• Evaluation Audit on the patient chart — the criteria tree shows the same ontology row, with its checks beneath it. Long diagnosis and requirement lists start collapsed with Show N diagnoses and Show N requirements, like Determination Review.
• Determination and data-request letters — letters and PDFs state the ontology rule by name and whether the patient must match or must not match it, with its result, and list the underlying codes beneath.

Give each ontology rule a clear, descriptive name in the Ontology Manager — that name is what readers see in these surfaces.

On a standard guideline detail page, you may also see a separate Matching Rules summary. Those rules can restrict by prescriber taxonomy, route of administration, dosage form, or any combination — for example oral tablet only, or every form except injectable. They are an applicability gate rather than a reusable clinical ontology rule, so you manage them in the guideline’s own configuration, not in the Ontology Manager. Leaving matching rules empty means no restriction. When a patient’s data does not satisfy them, the guideline is skipped without a data request. Each matching-rule group must contain a rule, and a not group must contain exactly one rule before you can save.