Transcript No Slide Title

GALEN
Where we started
Building Classifications with GALEN
A look into the future…?
Key Questions
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GALEN-IN-USE Partners
University of Manchester, VAMP Health, UK
University of Nijmegen, Holland
EFCC and its affiliates:
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WCC, NOMESCO, CNR Rome, U St Etienne
IASIST, IDGmbH, CMITD, STAKE, U Louvain
University Hospital of Geneva, LNAT, Switzerland
OLE, RAMIT, Datasoft, Belgium
GSF Medis, U Hildesheim, Germany
CNR, Rome, Italy
SPRI, U Linköping, Sweden
VTT, Oulu Univ Hospital, Medici Data, Finland
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Where we started
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Clinical
Terminology
Data
Entry
Clinical
Record
Decision
Support
Best
Practice
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Clinical
Terminology
Data
Entry
Clinical
Record
Decision
Support
Best
Practice
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Choose terms from a coding scheme
enter search:
cystitis
Cholecystitis,
Cystitis,
Iatrogenic
NOS
cystitis
NOS
Acute
Chronic
Chemical
cystitis
cholecystitis
cystitis
Subacute
Acute
Postoperative
cholecystitis
cystitis,
cystitis
NOS
Follicular
Bacterial
Drug induced
cystitis
Cholecystitis
cystitis
Idiopathic
Bacterial
Radiation
cystitis
cystitis
cystitis
etc
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Too Big
...picking lists
too long
Too Small
...not enough
clinical detail
GALEN
A new clinician-friendly option:
structured data entry
severity
mild
cystitis
moderate severe
onset
gradual
sudden
chronicity
acute sub-acute chronic
Assemble a phrase...
…from a set of useful
pieces...
…displayed on the screen.
“moderately severe, acute cystitis of sudden onset”
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Only one problem:
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How can the computer know in advance what are the sensible
pieces to display?
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Traditional coding schemes do not have the information
required
cystitis
?
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A new resource
What is cystitis combined
with ‘acute and mild?
how would you like
the answer ?
... a resource that can cope with arbitrarily complex
clinical concepts ...
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A new resource
as an English phrase and as
an ICD Code
<“mild, acute cystitis”,
D595.0 >
... and cope with different natural languages and
coding schemes.
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Computer knows ‘rules’ for:
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how do you classify things?
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when are two things the same ?
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‘fractured eyebrow causing donkey’
are any combinations redundant?
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‘Inflammation of Liver’ vs ‘Hepatitis’
are there any illegal combinations?
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Fractures of femur, and of femoral neck
‘finger which is part of hand’
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Building Classifications with GALEN
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Manual Classifications
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Most medical ‘classifications’ are really ‘thesauri’
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Thesauri have mixed hierarchies
– kind, part, cause, modified,...
heart
heart valve
aortic valve
cusp of aortic valve
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For interpretation by people
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Only people can reorganise (and that isn’t easy or quick)
 Must read rubrics
Model of use implicit and fixed
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‘Computed’ Classifications
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Strict hierarchies using ‘kind of’
‘Disorder of heart’
‘Disorder of valve in heart’
‘Disorder of valve in left ventricle in heart’
‘Disorder of cusp in valve in left ventricle in heart’
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Computable
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People can understand (but don’t have to)
Computers can reorganise
– because all meaning is explicit in formal expression
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Bridges from patient data to classifications
Coding &
Classification
Decision
support
UMLS
Clinical Applications
MeSH
SNOMED
Axes
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Medical
Records
MEGATERM
ICPC
ACRNEMA
Data entry
READ
OPCS
ICD-9
ICD-10
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Added value of Computed
Classifications
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Hide the complexity
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Let the computer do the work
Small on the outside, huge on the inside
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Reorganise classifications when needed
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More complete, consistent and automatic indexing
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Automatic cross mapping/merging
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Quicker to update - worry about what, not where
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‘Coherence without Uniformity’
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Issues to consider
Can not prove result is complete or correct
(but can’t do that with manual result either)
Initially expensive to build
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A look into the future…?
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What will the classifications of today
look like in the future?
They won’t exist
Each will be replaced by several different views
on something else, each serving individually
the specific (conflicting) functions which
were formerly tortured out of the one
classification
NOT a book
NOT a picking list
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What will these ‘views’ be like ?
Each view is like a classification, but...
Multiaxial (very)
One, single clear purpose
Humans say what terms are included and what they mean
Computers decide how to arrange them
Not fixed in stone - malleable, customisable, localisable but always coherent
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‘Views’ of what ?
‘Clinical Terminology’
Something clinicians use to record information about real,
individual patients
Somebody else’s problem
..as long as the bridge to classification views exists
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Key Questions
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Key Questions
(for users of terminology systems)
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What do you want it to do?
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Clinical systems are the end
 terminology the means
– Don’t get the cart before the horse
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Can it do it?
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Can anything do it?
A universal coding scheme for everything is implausible
Coherence without Uniformity
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Key Questions
(for builders of terminology systems)
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Can it be built? implemented? maintained?
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Will it scale?
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Quickly enough?
Are there short-term milestones and a migration pathway?
Organisationally? Technically?
Can applications use it?
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Can we maintain them? Can vendors sell them
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Warnings
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Be cautious of hype
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It’s not as easy as it looks
Beware scaling
It’s not how big it is that counts - it’s what you can do with it
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Don’t reinvent the wheel
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Simple to understand doesn’t mean simple to use
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Coding systems are now software
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GALEN-IN-USE
Advanced terminological services to support
integrated clinical information systems
[email protected]
http://www.cs.man.ac.uk/mig/galen/
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