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This is a general overview of clinical application development at Columbia-Presbyterian Medical Center (CPMC). On the left, we see the ancillary systems such as laboratory, radiology and pharmacy. On the right, we application developers involved in building systems for use in patient care, education and research. The ancillary systems dump their data into the large central clinical database. They also provide, depicted by the broken lines, their controlled vocabularies which are stored in a second central database called the Medical Entities Dictionary, or MED. The application developers can retrieve clinical information from the central database and decode the information using the MED.