Transcript Formal Ontology and Electronic Patient Records: what

ECO
R
European Centre for
Ontological Research
Formal Ontology and
Electronic Healthcare Records:
what exists ...
what happened ...
what has been recorded ...
Werner Ceusters
European Centre for Ontological Research
Universität des Saarlandes
Saarbrücken, Germany
ECO
R A visit to the operating theatre
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Ontological Research
A lot of
objects present
This
surgeon
with some relations
Part of
This mask
This
amputatio
n stump
This hand
Haydom Lutheran Hospital, Tanzania
ECO
R A visit to the operating theatre
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Ontological Research
A lot of
processes going on
This wound
being closed
by holding ...
with some relations
Part of
That wound
fluid
drained
This kocher
being held in
that hand of
that surgeon
Haydom Lutheran Hospital, Tanzania
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“Axiom” 1
epistemology
• If the picture is not a fake, we (i.e., me and
this audience) KNOW that that hand, that
surgeon, ... EXIST(ed), i.e. ARE (were)
REAL.
• But importantly: that hand, surgeon, kocher,
mask, ... EXIST(ed) independent of our
knowledge about them and also the partrelationship between that hand and that
surgeon, and the processes going on, are
(were) equally real.
ontology
ECO
R But there is also communication
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He wants
me to
remove
that blood
I must get
rid of that
blood
Suction, please !
Fluid being
removed
Haydom Lutheran Hospital, Tanzania
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Issues in communication
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Ontological Research
=?
Give me a
kocher, please.
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Concept-based Terminology
kocher
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“Axiom” 2
• Concept-based terminology (and
standardisation thereof) is there as a
mechanism to improve understanding of
messages, originally by humans, now also
by machines.
• It is NOT the right device to explain why
reality is what it is, how it is organised, etc.,
(although it is needed to allow us to
communicate on insights thereof).
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European Centre for
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Why not ?
• Does not take care of universals and particulars
appropriately
• Concepts not necessarily correspond to
something that (will) exist(ed)
– Sorcerer, unicorn, leprechaun, ...
• Definitions set the conditions under which terms
may be used, and may not be abused as
conditions an entity must satisfy to be what it is
• Language can make strings of words look as if it
were terms
– “Middle lobe of left lung”
• ...
ECO
R Border’s classification of medicine
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Ontological Research
• Medicine
– Mental health
– Internal medicine
• Endocrinology
–Oversized endocrinology
• Gastro-enterology
• ...
– Pediatrics
– ...
– Oversized medicine
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There is record keeping too
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Ontological Research
“Cavity drained and wound
closed in layers”
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“Axiom 3”
• The health care record is a mixture of
– Statements about portions of reality
•
•
•
•
The person being cared
Activities carried out
Believes, desires, ...
...
– Statements about statements
• When registered
• By whom
• ...
CEN ENV 13606
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CEN’s view on reality and
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Ontological Research
the healthcare record
“The real world of health and health care is
made up of individual clinical situations
(of which the participants are called
“associate topics”), that are described by an
EHCR author as clinical statements.
Within an EHCR system each clinical
statement will be expressed as an
elementary healthcare record entry.”
CEN ENV 13606
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EHR Extended Architecture
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Architectural
Component
Record
Component
Root
Architectural
Component
Selected
Component
Complex
Folder
Original
Component
Complex
Headed
Section
Composition
Cluster
Link Item
Data Item
Elementary healthcare record entries
Data
DataItem
Item
Data
Item
Specialisation
Data
Item
Specialisation
Specialisation
Specialisation
CEN ENV 13606
ECO
R Types of Original Component Complexes
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OCC
specialisation
Description
Examples of Component
Names
Folder
High-level subdivisions of the entire
EHCR for a patient, usually grouping
entries over long time-spans within
one organisation or department, or for
a particular health problem
GP Record
Inpatient Stay
Diabetes Care Record
Composition
A set of record entries relating to one
time and place of care delivery;
grouped contributions to an aspect of
health care activity; composed reports
and overviews of clinical progress
Consultation
Operation Notes
Discharge Summary
Vital Signs Chart
Headed
Section
Sub-divisions used to group entries
with a common theme or derived
through a common healthcare process
Past Medical History
Presenting Symptoms
Examination Findings
Treatment Plan
Cluster
Low-level aggregations of elementary
entries (Record Items) to represent a
compound clinical concept
Heart Sounds
Differential White Cell Count
Insulin Schedule
CEN ENV 13606
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Architectural Component Attributes
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Refer to situations and statements and rely on terminology
Language
Component
unique identifier
0..1
1
Related
date and time
0..n
Component
Status information
1
1
Component
name structure
Architectural
Component
0..n
Related
healthcare
agent
1
Originating
Healthcare
agent
1
1
Originating
date and time
0..n
Distribution
Rule Reference
Subject of care
identifier
CEN ENV 13606
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Component Name Structure
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• Each instance of Architectural Component shall be
associated with a component name. The name may be
expressed as a simple code, a structured set of codes
or, in certain circumstances, as a string.
• NOTES:
– This attribute is used to provide the Architectural Component
with a descriptor, title, heading, label, etc. depending upon the
deployment of the Architectural Component.
– The component name may be a term drawn from a domain
information model.
– Limiting the use of textual names to EHCR Root Architectural
Component, Folder OCCs and SCCs is recommended, although
these too may utilise coded names.
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CEN ENV 13606
European Centre for
Ontological Research
clinical situation
condition or state
normal condition
abnormal condition
Illness
Coma
Death
Diabetic
infection
allergy state
symptom
sign
disease
lesion
injury
impairment
Semantic
categories
and
“fine-grained
descriptors”
dialyzed
cardiopathic
carrier of prosthesis
wound
healthy carrier of disease
To be used in healthcare
records as an alternative to
terminologies
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European Centre for
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CEN ENV 13606
“Archetypes”
• clinical situation
– pertains to body component, product, environment
– has context facet subject of information, process
status, role for dates
– has information qualifier knowing mode
• has information source
• has qualifier
– has qualifier
– has role
• Is stated by
• has temporal marker
actor
communication modality
relevance
role for clinical situation
actor, healthcare organisation
timing marker
To be used to build terminologies that may be used for the EHR
HL7
ECO
R Reference Information Model
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Living subject
person
nonPersonLS
Place
Organisation
Material
ManufacteredM
Device
Container
Managed PatientEncounter
Employee
Participation ControlAct
Patient
LicensedEntity
Supply
Access
Diet
WorkingList
Procedure
Observation
Entity
PublicHealthcare
DiagnosticImage
DeviceTask
SubstanceAdministration
FinancialContract
Account
FinancialTransaction
InvoiceElement
Role
Role
Link
Language
Communication
Participation
ActLink
Communication
Function
Act
Context
Structure
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European Centre for
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“Axiom” 4
• EHR standards should make better
difference between language, terminology
and communication issues on the one
hand, and ontological issues on the other
hand
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“Axiom” 5: A need for a clean
R
European Centre for
Ontological Research
Alan Rector
separation of knowledge
AND ontology
Pragmatic knowledge: what users usually say or think, what they
consider important, how to integrate in software
Knowledge of classification and coding systems: how an expression has
been classified by such a system
Knowledge of definitions and
criteria: how to determine if a
concept applies to a particular instance
Surface linguistic knowledge:
how to express the concepts in
any given language
Conceptual knowledge: the knowledge of sensible domain concepts
Ontology: what exists and how what exists
relates to each other