eco r european centre for ontological research formal ontology and electronic healthcare records:...

ECOREuropean Centre forOntological Research

Formal Ontology andElectronic Healthcare Records:

what exists ...what happened ...

what has been recorded ...

Werner CeustersEuropean Centre for Ontological Research

Universität des Saarlandes

Saarbrücken, Germany


A visit to the operating theatre

Haydom Lutheran Hospital, Tanzania

This surgeon

This amputation stump

A lot ofobjects present

This mask

This hand

with some relations

Part of


A visit to the operating theatre


This wound being closed by holding ...

That wound fluid

drained

A lot ofprocesses going on

This kocher being held in that hand of that surgeon

with some relations

Part of

ECOREuropean Centre forOntological Research “Axiom” 1

• 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 part-relationship between that hand and that surgeon, and the processes going on, are (were) equally real.

epistemology

ontology

ECOREuropean Centre forOntological ResearchBut there is also communication


I must get rid of that

blood

Suction, please !

He wants me to

remove that blood

Fluid being removed


Give me a kocher, please.

= ?

Issues in communication

ECOREuropean Centre forOntological Research Concept-based Terminology

kocher


“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).


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”

• ...


Border’s classification of medicine

• Medicine– Mental health– Internal medicine

• Endocrinology–Oversized endocrinology

• Gastro-enterology• ...

– Pediatrics– ...– Oversized medicine


There is record keeping too

“Cavity drained and wound closed in layers”


“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’s view on reality andthe healthcare record

CEN ENV 13606

“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.”


EHR Extended Architecture

Architectural Component

RootArchitecturalComponent

RecordComponent

OriginalComponent

Complex

SelectedComponent

Complex

Data Item

Link Item

Folder

HeadedSection

Composition

Cluster

Data ItemSpecialisation




Elementary healthcare record entries

CEN ENV 13606


Types of Original Component Complexes

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 RecordInpatient StayDiabetes 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

ConsultationOperation NotesDischarge SummaryVital Signs Chart

Headed Section

Sub-divisions used to group entries with a common theme or derived through a common healthcare process

Past Medical HistoryPresenting SymptomsExamination FindingsTreatment Plan

Cluster Low-level aggregations of elementary entries (Record Items) to represent a compound clinical concept

Heart SoundsDifferential White Cell CountInsulin Schedule

CEN ENV 13606


Architectural Component Attributes

CEN ENV 13606

ArchitecturalComponent

Componentunique identifier

OriginatingHealthcare

agent Originating

date and time

Relatedhealthcare

agent

Relateddate and time

Componentname structure

Subject of careidentifier

ComponentStatus information

DistributionRule Reference

Language

11

10..n

0..n

1

11

0..n

0..1

Refer to situations and statements and rely on terminology


Component Name Structure

• 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.

CEN ENV 13606


Semantic categories

and“fine-graineddescriptors”

clinical situationcondition or state

normal conditionabnormal condition

Illness dialyzedComa cardiopathicDeath carrier of prosthesisDiabetic woundinfection healthy carrier of diseaseallergy statesymptomsigndiseaselesioninjuryimpairment

CEN ENV 13606

To be used in healthcare records as an alternative to terminologies


“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 actor• has qualifier communication modality

– has qualifier relevance– has role role for clinical situation

• Is stated by actor, healthcare organisation• has temporal marker timing marker

CEN ENV 13606

To be used to build terminologies that may be used for the EHR


Reference Information Model

HL7

Entity

LanguageCommunication

CommunicationFunction

Role

Participation

Act

ContextStructure

RoleLink ActLink

Living subject person nonPersonLS Place Organisation Material ManufacteredM Device Container

EmployeePatient

LicensedEntityAccess

ManagedParticipation

PatientEncounterControlActSupply DietWorkingListProcedureObservation PublicHealthcare DiagnosticImage

DeviceTaskSubstanceAdministrationFinancialContractAccountFinancialTransactionInvoiceElement

ECOREuropean Centre forOntological Research “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

ECOREuropean Centre forOntological Research “Axiom” 5: A need for a clean

separation of knowledgeAND ontology

Conceptual knowledge: the knowledge of sensible domain concepts

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

Knowledge of classification and coding systems: how an expression has been classified by such a system

Pragmatic knowledge: what users usually say or think, what they consider important, how to integrate in software

Ala

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Ontology: what exists and how what exists relates to each other

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