Transcript ECO R European Centre for Ontological Research Practical implementations of realism-based ontologies: Referent Tracking in Electronic Health Records MIE 2005 tutorial #35 on Ontology Design (part 4) Geneva, Switzerland,

ECO
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European Centre for
Ontological Research
Practical implementations of
realism-based ontologies:
Referent Tracking in
Electronic Health Records
MIE 2005 tutorial #35 on Ontology Design (part 4)
Geneva, Switzerland, August 28, 2005
Dr. W. Ceusters
European Centre for Ontological Research
Saarland University
Saarbrücken - Germany
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Three models for a
Comprehensive Patient Care
Information System *
Information model of
the medical record:
What can be said ?
requirements
Process model of
clinical care: What
ought to occur ?
?
inferences
Inferred model of the
state of the patient:
modification What actually occurs.
* Rector AL, Nolan WA, and Kay S. Foundations for an Electronic Medical Record.
Methods of Information in Medicine 30: 179-86, 1991. (Figure 1)
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An event model of medical
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information representation *
• ‘The real world consist of objects (or entities)’
• ‘Objects interact with other objects and can be associated with
other objects by relationships’
• ‘When two or more objects interact in the real world, an ‘event’
is said to have occurred’
Is ‘saying that an event has occurred’ a requirement
for the event to have occurred ?
What ‘event’ occurred in my left hand being a part
of my left arm ?
* Huff SM, Rocha RA, Bray BE, Warner HR, and Haug PJ. An Event Model of Medical
Information Representation. J Am Med Informatics Assoc. 1995;2:116-134.
?
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Observation Event Instance Created from the Statement
R ‘Surgical clips are again seen along the right mediastinum’ *
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?
Are the clips there
because they have
been observed ?
Is the observation
located in the
mediastinum ?
* Huff SM, Rocha RA, Bray BE, Warner HR, and Haug PJ. An Event Model of Medical
Information Representation. J Am Med Informatics Assoc. 1995;2:116-134.
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What is wrong in both cases
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(and so many others) ?
• Further clues to the answer:
– Huff SM, Rocha RA, Bray BE, Warner HR, and Haug
PJ. An Event Model of Medical Information
Information
Representation. JJAm
Representation.
AmMed
MedInformatics
InformaticsAssoc.
Assoc.
1995;2:116-134.
– Rector et al.’s paper: Many of the difficulties
experienced in attempting to generalize existing [patient
record] systems stem from the fact that they have preselected and distorted information in order to fit into
particular applications, usually clinical research and
epidemiology. The models emit much of the information
actually used in clinical care and do not accurately
reflect the
the real
real status
statusofofthe
thedata
data
they
they
record.
record.
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What is wrong (continued) ?
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•
An overemphasis on data and information
and too little attention to reality:
–
–
•
“data modelling”
“information modelling”
Is the “Object Oriented” model approach any
better, since, after all, objects are said to be
those things that exist in reality ?
–
The object-oriented model is based on a collection of
objects
–
–
An object contains values stored in instance variables within the
object.
Unlike the record-oriented models, these values are themselves
objects.
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The story of
Jane Smith
an old case, well
known in the
literature ...
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July 4th, 1990:
Jane goes shopping:
Jane’s favourite supermarket
The freezer section of
Jane’s favourite
supermarket
The only available
warning sign used
outside
A very suspiciously
shaped upper leg
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A visit to the hospital
City Health Centre
(City HC)
Dr. Peters
Dr. Longley
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Diagnosis: a severe spiral fracture
of the femur
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The City HC’s medical record
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• Main principles:
– a faithful record of the clinicians’ observations:
what they have heard, seen, thought and done.
– captures in a structured form all of the ‘clinically
significant’ information in the narrative notes,
where by clinically significant they mean the
information which is within the medical domain
rather than the domain of everyday life.
Rector AL, Nowlan WA, Kay S, Goble CA, Howkins TJ. A framework for modelling the
electronic medical record. Methods Inf Med. 1993 Apr;32(2):109-19.
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City HC’s EHR model
Rector AL, Nowlan WA, Kay S, Goble CA, Howkins TJ.
A framework for modelling the electronic medical record.
Methods Inf Med. 1993 Apr;32(2):109-19.
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CityHC’s representation formalism
(for statements in records)
Categories: “represent
concepts and are analogous to
classes in other formalisms”
Individuals:
“concrete instances
of categories which
persist in space and
time”
Occurrences: “are
Rector AL, Nowlan WA, Kay S, Goble CA,
Howkins TJ.
A framework for modelling the electronic
medical record.
Methods Inf Med. 1993 Apr;32(2):109-19.
specific occurrences of
individuals and must be
situated in space and time.
The most important
group of occurrences are
observations — i.e. agents’
observations of individuals.”
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Note:
Mixing statements and entities
• “Every occurrence level statement
concerning the Jane Smith’s Fracture of the
Femur is an observation of the
corresponding individual.”
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A look at the database:
R Use of SNOMED codes for ‘unambiguous’
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understanding
PtID
Date
ObsCode
Narrative
How
many
closed
fracture
of shaft numerically
of femur
different
disorders are
Fracture,
closed, spiral
closed
fracture
of shaft?of femur
listed
here
5572
04/07/1990
26442006
5572
04/07/1990
81134009
5572
12/07/1990
26442006
5572
12/07/1990
9001224
5572
04/07/1990
79001
0939
24/12/1991
255174002
2309
21/03/1992
26442006
2309
21/03/1992
9001224
47804
03/04/1993
58298795
Other lesion on other specified region
5572
17/05/1993
79001
Essential hypertension
298
22/08/1993
2909872
298
22/08/1993
9001224
5572
01/04/1997
26442006
How many disorders
have
patients
5572, 2309
Closed
fracture
of radial head
and in298
thus
Accident
publiceach
buildinghad
(supermarket)
closed
of shaftlifetime
of femur
farfracture
in their
?
5572
01/04/1997
79001
Essential hypertension
0939
20/12/1998
255087006
malignant polyp of biliary tract
*
Accident in public building (supermarket)
How many different
benign
polypof
of biliary
tract
types
disorders
are
closed fracture of shaft of femur
listed here ?
Essential hypertension
*
*
Accident in public building (supermarket)
* cause, not disorder
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PtID
Different
patients.
Same?
supermarket?
Would the
terms
help
Maybe the same (irrelevant ?) freezer
Date
section ?
Narrative
Or different
supermarkets,
but always
26442006
closed
fracture of shaft of femur
Same patient,
same
hypertension
code:
81134009
Fracture,
closed, spiral
in the freezer
sections
?
Same (numerically
identical)
hypertension
?
ObsCode
5572
04/07/1990
5572
04/07/1990
5572
12/07/1990
26442006
closed fracture of shaft of femur
5572
12/07/1990
9001224
Accident in public building (supermarket)
5572
04/07/1990
79001
Essential hypertension
0939
24/12/1991
255174002
benign polyp of biliary tract
298
Same patient, different
21/03/1992
26442006
closed fracturedates,
of shaft ofsame
femur fracture
Same
patient,
21/03/1992
9001224
Accident
in publicsame
buildingdate,
(supermarket)
codes:
same
03/04/1993patient,
58298795
Other lesion
on other specified
region
2patients,
different
fracture
codes:
Same
different
Differentdates,
same
fracture
codes:
(numerically
identical)
17/05/1993
79001
Essential
hypertension
same (numerically
Different codes.Same
Same(numerically
(numerically
identical)headfracture
? ?
22/08/1993
2909872
Closed fracture of radialfracture
identical) fracture ?
identical)
polyp
?
22/08/1993
9001224
Accident in public building (supermarket)
5572
01/04/1997
26442006
closed fracture of shaft of femur
5572
01/04/1997
79001
Essential hypertension
0939
20/12/1998
255087006
malignant polyp of biliary tract
2309
2309
47804
5572
298
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Main problem areas
for CityHC’s EHR
• Statements refer only very implicitly to the
concrete entities about which they give
information.
• Idiosyncracies of concept-based terminologies
– tell us only that some instance of the class the codes
refer to, is refered to in the statement, but not what
instance precisely.
– Are usually confused about classes and individuals.
• “Country” and “Belgium”.
• Mixing up the act of observation and the thing
observed.
• Mixing up statements and the entities these
statements refer to.
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Consequences
• Very difficult to:
– Count the number of (numerically) different
diseases
• Bad statistics on incidence, prevalence, ...
• Bad basis for health cost containment
– Relate (numerically same or different) causal
factors to disorders:
– Dangerous public places (specific work floors, swimming
pools), dogs with rabies, HIV contaminated blood from
donors, food from unhygienic source, ...
• Hampers prevention
– ...
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Proposed solution:
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Referent Tracking
• Purpose:
– explicit reference to the concrete individual entities
relevant to the accurate description of each patient’s
condition, therapies, outcomes, ...
• Method:
– Introduce an Instance Unique Identifier (IUI) for each
relevant individual (= particular, = instance).
– Distinguish between
• IUI assignment: for instances that do exist
• IUI reservation: for entities expected to come into existence in
the future
ECO
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Ontology
• ‘An ontology’ is a representation of some preexisting domain of reality which
– (1) reflects the properties of the objects within its
domain in such a way that there obtains a systematic
correlation between reality and the representation itself,
– (2) is intelligible to a domain expert
– (3) is formalized in a way that allows it to support
automatic information processing
• ‘ontological’ (as adjective):
– Within an ontology.
– Derived by applying the methodology of ontology
– ...
ECO An ontological analysis
R Universals
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EHR system
HC
Freezer section
continuants
City HC’s EHR system
City HC
The freezer section of Jane’s favourite supermarket
Jane Smith
Person
Dr. Peters
Dr. Longley
Femur
Jane’s left femur
Jane’s left femur
Jane’s left femur fracture
Fracture
Jane’s fracture’s image
Image
t
occurrents
Jane’s fracture as seen by Dr. Peters
Jane’s fracture as seen by Dr. Longley
Jane’s falling
Jane’s femur breaking
Dr. Peter’s examination of Jane’s fracture
Dr. Peter’s ordering of an X-ray
Shooting the pictures of Jane’s leg
Jane’s fracture’s healing
Dr. Peter’s diagnosis making
Dr. Longley’s examination of Jane’ s fracture
Freezer section dismantled
Jane dies
Instances of
Jane’s fracture
ECO
Ontological recategorisation
R
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Fracture
Of Femur
CityHC
Dr. Peters
City HC
exists on
4th July
1990
Dr. Peters
located at
City HC on
4th July
1990
Jane
Smith
Jane Smith’s
consultation
with
Dr. Peters at
City HC on
4th July
1990
Jane
Smith’s
Fracture
Of Femur
Dr. Peters’
assessment of
Jane Smith’s
fracture of
femur
at
City HC on
4th July
1990
Severe
Jane
Smith’s
Fracture
Of Femur’s
severity
Spiral
Jane
Smith’s
Fracture
Of Femur’s
shape
ECO
R Essentials of Referent Tracking
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Ontological Research
• Generation of universally unique identifiers;
• deciding what particulars should receive a IUI;
• finding out whether or not a particular has already
been assigned a IUI (each particular should
receive maximally one IUI);
• using IUIs in the EHR, i.e. issues concerning the
syntax and semantics of statements containing
IUIs;
• determining the truth values of statements in
which IUIs are used;
• correcting errors in the assignment of IUIs.
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Architecture of a
Referent Tracking System (RTS)
• RTS: system in which all statements referring to
particulars contain the IUIs for those particulars
judged to be relevant.
• Ideally set up as broad as possible:
– some metrics:
• % of particulars referred to by means of IUI
• % of HCs active in a region
– Geographic region
– functional region: defined by contacts amongst patients
• % of patients referred to within a region
• Services:
– IUI generator
– IUI repository: statements about assignments and reservations
– Referent Tracking ‘Database’ (RTDB): index (LSID) to statements
relating instances to instances and classes
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IUI generation
• Universally Unique IDs:
– recently standardized through ISO/IEC 98348:2004,
– specifies format and generation rules enabling
users to produce 128-bit identifiers that are
either guaranteed or have a high probability of
being globally unique
– Meaningless strings
– Central management or certification not needed
to guarantee uniqueness
• (But use as IUI requires this)
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IUI assignment
• = an act carried out by the first ‘cognitive
agent’ feeling the need to acknowledge the
existence of a particular it has information
about by labelling it with a UUID.
• ‘cognitive agent’:
– A person;
– An organisation;
– A device or software agent, e.g.
• Bank note printer,
• Image analysis software.
ECO
R Criteria for IUI assignment (1)
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Ontological Research
1. The particular’s existence must be determined:
–
–
Easy for persons in front of you, body parts, ...
Easy for ‘planned acts’: they do not exist before the
plan is executed !
•
–
More difficult: subjective symptoms
•
–
Only the plan exists and possibly the statements made about
the future execution of the plan
But the statements the patient makes about them do exist !
However:
•
•
no need to know what the particular exactly is, i.e. which
universal it instantiates
No need to be able to point to it precisely
–
–
One bee out of a particular swarm that stung the patient, one
pain out of a series of pain attacks that made the patient
worried.
But: this is not a matter of choice, not ‘any’ out of ...
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R Criteria for IUI assignment (2)
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Ontological Research
2. The particular’s existence ‘may not already have
been determined as the existence of something
else’:
•
•
•
Morning star and evening star
Himalaya
Multiple sclerosis
3. May not have already been assigned a IUI.
4. It must be relevant to do so:
•
•
•
Personal decision, (scientific) community guideline, ...
Possibilities offered by the EHR system
If a IUI has been assigned by somebody, everybody else
making statements about the particular should use it
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Assertion of assignments
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• IUI assignment is an act of which the execution
has to be asserted in the IUI-repository:
– Di = <IUId, Ai, td>
• IUId
IUI of the registering agent
• Ai
the assertion of the assignment < IUIp, IUIa, tap>
• td
» IUIa
» IUIp
IUI of the author of the assertion
» tap
time of the assignment
IUI of the particular
time of registering Ai in the IUI-repository
• Neither td or tap give any information about when
# IUIp started to exist ! That might be asserted in
statements providing information about # IUIp .
ECO
R Management of the IUI-repository
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• Adequate safety and security provisions
– Access authorisation, control, read/write, ...
– Pseudonymisation
• Deletionless but facilities for correcting
mistakes.
• Registration of assertion ASAP after IUI
assignment
• (virtual, e.g. LSID) central management with
adequate search facilities.
ECO
Representation in the EHR
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European Centre for
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Fracture
Of Femur
Severe
CityHC
Dr. Peters
Jane
Smith
Jane Smith’s
consultation
with
Dr. Peters at
City HC on
4th July
1990
4th July 1990
Jane
Smith’s
Fracture
Of Femur
Dr. Peters’
assessment of
Jane Smith’s
fracture of
femur
at
City HC on
4th July
1990
Jane
Smith’s
Fracture
Of Femur’s
severity
Spiral
Jane
Smith’s
Fracture
Of Femur’s
shape
particulars
• Relevant particulars
referred to using IUIs
• Relationships that obtain
between particulars at time t
expressed using relations
from an ontology (type OBO)
• Statements describing for
each particular, at time t:
– Of what universal from an
ontology it is an instance of
– AND/OR (if one insists):
– By means of what concept from
a concept-based system it can
sensibly be described
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•
PtoP statements particular to particular
ordered sextuples of the form
Ri = <IUIa, ta, r, o, P, tr>
IUIa is the IUI of the author of the statement,
ta
a reference to the time when the statement is made,
r
a reference to a relationship (available in o) obtaining between the
particulars referred to in P,
o
a reference to the ontology from which r is taken,
P
an ordered list of IUIs referring to the particulars between which
r obtains, and,
tr
a reference to the time at which the relationship obtains.
• P contains as much IUIs as required by the arity of r. In most cases, P will
be an ordered pair such that r obtains between the particular represented by the
first IUI and the one referred to by the second IUI.
• As with A statements, these statements must also be accompanied by a
meta-statement capturing when the sextuple became available to the referent
tracking system.
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PtoU statements –
particular to universal
Ui = <IUIa, ta, inst, o, IUIp, u, tr>
IUIa
ta
inst
o
IUIp
u
tr
is the IUI of the author of the statement,
a reference to the time when the statement is made,
a reference to an instance relationship available in o
obtaining between p and cl,
a reference to the ontology from which inst and u are
taken,
the IUI referring to the particular whose inst
relationship with u is asserted,
the universal in o to which p enjoys the inst relationship,
and,
a reference to the time at which the relationship obtains.
ECO
PtoCO statements
R
particular to concept code
European Centre for
Ontological Research
Coi = <IUIa, ta, cbs, IUIp, co, tr>
IUIa
ta
cbs
IUIp
co
tr
is the IUI of the author of the statement,
a reference to the time when the statement is made,
a reference to the concept-based system from which co
is taken,
the IUI referring to the particular which the author
associates with co,
the concept-code in cbs which the author associates with
p, and,
a reference to the time at which the author considers the
association appropriate,
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Interpretation of
PtoCO statements
• must be interpreted as simple indexes to
terms in a dictionary.
• All that such a statement tells us, is that
within the linguistic and scientific community
in which cbs is used, the terms associated
with co may - i.e. are acceptable to - be
used to denote p in their determinative
version.
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A SNOMED-CT example
• <IUI-0945, 18/04/2005, SNOMED-CT v0301, IUI1921, 367720001, forever>
• #IUI-0945: author of the statement
• #IUI-1921: the left testicle of patient #IUI-78127
• 367720001: the SNOMED concept-code to which “left testis” is
(in SNOMED) attached as term
• So we can denote #IUI-1921 by means of
• that left testis
• that entire left testis
• that testicle, that male gonad, that testis
•
that genital structure
•
that physical anatomical entity
• BUT NOT: that SNOMED-CT concept
ECO
Pragmatics of IUIs in EHRs
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European Centre for
Ontological Research
• IUI assignment requires an additional effort
• In principle no difference qua (or just a little bit more) effort
compared to using directly codes from concept-based
systems
– A search for concept-codes is replaced by a search for the
appropriate IUI using exactly the same mechanisms
• Browsing
• Code-finder software
• Auto-coding software (CLEF NLP software Andrea Setzer)
– With that IUI comes a wealth of already registered
information
– If for the same patient different IUIs apply, the user must
make the decision which one is the one under scrutiny, or
whether it is again a new instance
• A tranfert or reference mechanism makes the statements
visible through the RTDB
ECO
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PtID
Advantage: better
reality representation
Date
ObsCode
Narrative
5572
04/07/1990
26442006
IUI-001
closed fracture of shaft of femur
5572
04/07/1990
81134009
IUI-001
Fracture, closed, spiral
5572
12/07/1990
26442006
IUI-001
closed fracture of shaft of femur
5572
12/07/1990
9001224
5572
04/07/1990
79001
IUI-005
Essential hypertension
0939
24/12/1991
255174002
IUI-004
benign polyp of biliary tract
2309
21/03/1992
26442006
IUI-002
closed fracture of shaft of femur
2309
21/03/1992
9001224
IUI-007
Accident in public building (supermarket)
47804
03/04/1993
58298795
Other lesion on other specified region
5572
17/05/1993
79001
IUI-005
Essential hypertension
298
22/08/1993
2909872
IUI-003
Closed fracture of radial head
298
22/08/1993
9001224
5572
01/04/1997
26442006
IUI-012
closed fracture of shaft of femur
5572
01/04/1997
79001
IUI-005
Essential hypertension
0939
20/12/1998
255087006
IUI-004
malignant polyp of biliary tract
IUI-007
Accident in public building (supermarket)
IUI-007
Accident in public building (supermarket)
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Other Advantages
• mapping as by-product of tracking
– Descriptions about the same particular using
different ontologies/concept-based systems
• Quality control of ontologies and cbs
– Systematic “inconsistent” descriptions in or
cross terminologies may indicate poor definition
of the respective terms
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R
European Centre for
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A case study
• Double goal:
– Application of referent tracking to a concrete
patient story
– Ontological analysis of what is involved
• The latter is NOT to be performed to the
same extent when referent tracking is used
as an alternative to coding using conceptbased systems.
• So, don’t go home with the idea: “that’s all
too cumbersome and time cosuming”
ECO
Jim Cimino’s Woods Hole case
R Jane Smith is a 30 year old, Native American female who presents to the
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emergency room with the chief complaint of cough and chest pain.The
patient reports that she has had a productive cough for three days but
that chest pain developed one hour ago. She gives a history of
hypertension. She also reports that she was treated in the past for
tuberculosis while she was pregnant. The patient reports an allergy to
Bufferin.
Physical examination revealed a well-developed, well-nourished female
in moderate respiratory distress. Vital signs showed a pulse of 90, a
respiratory rate of 22, an oral temperature of 100.3, and a blood pressure
of 150/100. Examination revealed rales and rhonchi in the left upper
chest. Abdominal exam revealed a tender, palpable liver edge.
Labs:
Chem7 (serum): Glucose 100 (70-105) Chem7 (plasma): Glucose 150
(75-110)
CBC: Hgb 15 (12.0-15.8), Hct 45 (42.4-48.0), WBC 11,000 (3,5409,060), Platelets 145,000 (165,000-415,000)
A fingerstick blood sugar was 80
Urinalysis showed protein of 1+ and glucose of 0.
A blood culture was positive for methicillin-resistant Staphylococcus
aureus (MRSA)
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case study continued ...
• ECG - Sinus Rhythm, 74BPM, Axis -30 degrees, ST segment
2mm elevated andT-waves down in leads I, L, V5 and V6
Chest X-ray Left upper lobe infiltrate, left ventricular
hypertrophy
The patients nurse reported that the patient seemed depressed
about her condition. On questioning, the nurse found that the
patient was caringfor her elderly father and was concerned that
she would no longer be able to manage caring for herself and
him. The nurse asked the patients physician to consider an
antidepressant and a social work consult.
A medical student reviewing the case is concerned about the
risk of MRSA in patients with pneumonia and a recent
myocardial infarction. She decides to do a literature search.
ECO Step 1: identify the phrases
R
referring to particulars
European Centre for
Ontological Research
Jane Smith
is
Native American
to
with
of
the
the
cough
a
50
female
year
who
old ,
presents
Question:
What if the patient
emergency
roomis not telling
the truth ?
chief
and
complaint
chest
pain.
ECO Step 2: indentify to what
R particulars these phrases refer
European Centre for
Ontological Research
Jane Smith
is
a
50
old ,
Jane Smith’s age
Jane Smith
Native American
Jane Smith’s race
to
year
the
female
Jane Smith’s gender
who
Jane Smith
emergency
room
presents
Jane Smith’s
showing up at ...
A specific emergency room of health facility XYZ
with
the
chief
complaint
Jane Smith’s complaining primarily about ...
of
cough
and
A temporal part of Jane Smith’s
life marked by happenings of coughs
chest
Jane Smith’s chest
pain.
A specific
pain
experienced
by Jane
Smith
ECO Compare with simple clinical
R
coding in juxtaposition
European Centre for
Ontological Research
Jane Smith
is
a
50
“Jane Smith”
female
who
presents
CS1-femaleCS2-woman
gender
CS1-native-american
the
old ,
CS1-age
Native American
to
year
emergency
room
CS1-emergency room
with
the
chief
complaint
CS1-chief-complaint
of
cough
CS1-coughing
and
chest
pain.
CS2-chest
CS1-chest-pain CS2-pain
ECO Compare
Comparewith
withthe
theoutput
outputofofthe
theNAIVE
perfect!!!
R
semantic analyser we all would dream of
European Centre for
Ontological Research
“Jane Smith”
Has-Age
CS3-50 years old
Is-A
Has-Sayer
CS3-woman
CS3-complaining
Hasparticipant
Is-A
CS3-native american
Has-Saying
CS3-chest pain
Hashappeningduring
CS3-consultation
Has-Saying
CS3-coughing
Has-Loc
CS3-Em.Room
ECO
R
European Centre for
Ontological Research
What it (more or less)
should be
CS3-complaining
Has-Saying
“chest-pain”
Has-’referent’
Has-Saying
CS3-chest pain
“coughing”
Has-’referent’
CS3-coughing
ECO
Most important difference:
R
European Centre for
Ontological Research
Use of generic terms
Jane Smith
is
a
50
year
“Jane Smith”
the
who
Has-Sayer
emergency
CS3-woman
presents
CS3-complaining
CS1-femaleCS2-woman
gender
CS1-native-american
to
female
CS3-50 years old
Is-A
CS1-age
Native American
Has-Age
“Jane Smith”
old ,
room
Is-A
CS3-native american
Has-Saying
Hasparticipant
CS1-emergency room
with
the
chief
CS3-chest pain
complaint
Hashappeningduring
CS1-chief-complaint
of
cough
CS1-coughing
and
chest
Has-Saying
CS3-coughing
pain.
CS3-consultation
CS2-chest
CS1-chest-pain CS2-pain
Jane Smith
is
a
50
Jane Smith
year
old ,
Jane Smith’s age
Native American
Use of concrete particulars
CS3-Em.Room
Has-Loc
female
Jane Smith’s race
Jane Smith’s gender
to
emergency
the
who
Jane Smith
room
presents
Jane Smith’s
showing up at ...
A specific emergency room of health facility XYZ
with
the
chief
complaint
Jane Smith’s complaining primarily about ...
of
cough
and
A temporal part of Jane Smith’s
life marked by happenings of coughs
chest
Jane Smith’s chest
pain.
A specific
pain
experienced
by Jane
Smith
ECO
Step 3: are relevant and
R
necessary particulars missing ?
European Centre for
Ontological Research
• Referred to:
–
–
–
–
–
–
–
–
–
–
Jane Smith
Jane Smith’s age
Jane Smith’s race
Jane Smith’s gender
Jane Smith’s showing up at ...
The specific emergency room in the health facility
Jane Smith’s primarily complaining ...
The temporal part ... coughs
Jane Smith’s chest
Jane Smith’s particular pain
• Missing:
–
–
–
–
The health facility
The healthcare worker she consulted
The particular coughs (under the condition she tells the objective truth)
The underlying disorder (under whatever state of affairs)
ECO
R
Step 4: IUI assignment
European Centre for
Ontological Research
• Assumptions:
– the RTS contains already:
• IUI-1
Jane Smith
Coi = <IUIa, ta, CS3, IUI-1, woman, tr>
• IUI-1.1
Ri = <IUIa, ta, depends-on, BFO, {IUI-1.1, IUI-1}, tr>
Coi = <IUIa, ta, CS1, IUI-1.1, age, tr>
• IUI-1.2
• IUI-1.3
Coi = <IUIa, ta, CS1, IUI-1.2, cherokee, tr>
Ri = <IUIa, ta, depends-on, BFO, {IUI-1.2, IUI-1}, tr>
Coi = <IUIa, ta, CS3, IUI-1.3, chest pain, tr>
Ri = <IUIa, ta, is-located-in, BFO, {IUI-1.3, IUI-1}, tr>
– All dates in the statements are 2 years earlier than now
• What to do with:
•
•
•
•
•
Jane Smith
Jane Smith’s race (CS1: native American)
Jane Smith’s gender (CS1: female)
Jane Smith’s chest pain (CS3: chest pain)
Jane Smith’s age (50)
ECO
R
European Centre for
Ontological Research
Conclusion
• Referent tracking can solve a number of problems
in an elegant way.
• Existing (or emerging) technologies can be used
for the implementation.
• Old technologies (cbs) can play an interesting
role.
• Big Brother feeling is to be expected but with
adequate measures easy to fight.
• The proof of the pudding is in the eating
– Pilote is going to be set up