Terminology servers

eHealth Summer University

3 July 2014

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Essential tools to normalize medical vocabulary in healthcare organizations

Index

• The Speakers

• Who and why

• Controlled vocabularies

• Terminology servers

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The speakers

• Dr. Léonard Janer

– Technological Transfer Centre Manager

– TecnoCampus Mataró-Maresme (CCI-TCM)

• Ariadna Rius

– Terminology expert CCI(TCM), OFSTI, Catalan Healthcare Department

• Jacob Boye Hansen

– CEO CareCom A/S, Virum, Denmark

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Who and why

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National Healthcare System

Clinicians

Managers

Documentalists

Researchers

BI

Big Data

R+D

Controlled vocabularies

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Index

• Types of language

• Semantic resources

• How to deal with this semantic ecosystem?

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Types of language

• There are different types of language according to their use in Information Systems (IS):

– Natural language (can rises up to 90%).

– Controlled vocabularies (the remaining 10%):

• Interface (input) vocabularies.

• Reference vocabularies.

• Aggregation (output) vocabularies.

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Types of language

• Natural language

– It refers to both oral and written language used by professionals to communicate with patients and other physicians:

• It is the most friendly, it is natural.

– Depends on the context and interlocutors.

– It includes jargon, acronyms, homonyms, etc.

– Being very reach and flexible.

– It can be very specialized but also very ambiguous.

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Types of language• Natural language is human oriented:

– It is not the best choice for IS to advice and support healthcare professionals.

• It is necessary to normalize the relevant information according to our objective:– PHR interoperability: Exchange and query?

– Big Data analysis: Plan and discover?

– Healthcare System: Control, make recommendations and prevention?

– Upcoming: Research and Innovation?

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Types of language• Controlled vocabularies are normalized

languages that can be understand by IS, as they can:– Identify, localize and differentiate its elements.

– Automatically process it.

– Have a representation of the meanings without ambiguity and using different levels of detail.

• This normalization involves using codes and attributes to represent specific ideas or units of meaning.

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Types of language• There are 3 types of controlled vocabulary:

– Interface (input): • Vocabulary used directly by healthcare professionals to

record the information of patients in IS.• It represents the first level of formalization and concretion.

– Reference:• It allows relating the vocabularies in order to compare and

consider information from different sources.• It is granular and presents the maximum level of detail.

– Aggregation (output):• Objective: exploiting different kind of information like:

statistics, plan, reimbursement, population analysis, etc.• Interpretation from different points of view is allowed

(manager and financial).

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Semantic resources• Semantic resources are controlled vocabularies

used to represent, to codify, to index and/or to mark data, information or content.

• There are many types of resources according to their structure and objectives:– Catalogues– Thesaurus– Classifications– Terminologies– Ontologies– …

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Semantic resources

• Catalogues

– Being plain lists of codes and descriptions normally close to a limited domain.

– They can also have other few attributes.

– Having usually ONE description per code.

– They are often local but they can be international as well.

– Objective: to facilitate the identification and localization of their already sorted elements.

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Semantic resources• Catalogues

– Example: UCUM (Unified Code for Units of Measure)

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Semantic resources

• Thesaurus

– They are formalized lists of terms related to each other through hierarchy, equivalency or associative links:

• For example synonyms of the same idea.

– Objective: to index or mark content in order to facilitate the recovery of documents, articles or other publications in databases of documentation.

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• Thesaurus– Example: COSTART (The Coding Symbols for a

Thesaurus of Adverse Reaction Terms)

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Semantic resources

Semantic resources• Classifications

– They are made of elements with codes and descriptions that can be grouped in chapters of content.

– Having concepts organized by classes and subclasses, following a tree structure (modelled by codes).

– They have different levels of detail (that can include miscellaneous and unspecific concepts).

– They tend to be international but also can be local.

– Normally they are closed to only one single domain.

– Objective: To classify certain information of patients (for example diagnosis or procedures).

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Semantic resources• Classifications

– Example: ICD-10 (International Classification of Diseases 10 revision)

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Semantic resources• Terminologies

– They are made of terms related to each other through hierarchy and other kind of relationships.

– Their elements can have more than one description and many other attributes.

– Normally they are international and provide a standard to achieve semantic interoperability.

– Having high level of detail and granularity in the representation of its elements.

– Objective: to relate concepts from different sources and controlled vocabularies that represent the same idea, using the maximum level of detail.

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Semantic resources• Terminologies

– Example: SNOMED CT (Systematized Nomenclature of Medicine – Clinical Terms)

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Semantic resources• Ontologies

– Being semantic networks of related concepts through many different kinds of associations.

– They have elements that can have many descriptions and attributes.

– Representing one single domain normally.

– They have concepts with a high level of abstraction:• Each of them can be codified by a terminology.

– Objective: to represent meanings to allow its automatic processing in IS.

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Semantic resources

• Ontologies

– Example: GO (Gene Ontology)

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Semantic resources

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Interface vocabularies

Reference vocabularies

Aggregation vocabularies

Semantic resources

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Classifications, catalogues and terminologies

Terminologies and ontologies

Classifications, terminologies and thesaurus

Semantic resources

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ICDs, SNOMED CT, ICPC, ATC, NANDA, NIC, NOC, LOINC, etc.

SNOMED CT, LOINC, GO, etc.

ICDs, SNOMED CT, ICPC, ATC, NANDA, NIC, NOC, LOINC, etc.

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• Healthcare centres have multiple semantic resources for each domain:– Medicines, active ingredients, dose forms, routes of

administration, etc.– Diagnosis, morphology, findings, topologies, etc.– Other master data like genders, types of address, types of

professionals for roles, etc.

• And they need to map vocabularies to represent the information using the maximum level of detail and to communicate with other centres and organizations.

• Additionally, all these resources need to be maintained and distributed to all the clinical work stations.

Semantic resources

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Semantic resources

How to deal with this semantic ecosystem?

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• Using tools that have been specifically designed to manage, distribute, develop and explore controlled vocabularies:– Terminology servers (for example HealthTerm and

ITServer).

• And using this tools directly at the clinical work stations in the point of care by healthcare professionals that is assisting a patient:– And recording directly the information using

standards.

How to deal with this semantic ecosystem?

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https://www.youtube.com/watch?v=6v48LqvMk9c

Terminology Servers

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Index

• SNOMED CT as reference terminology

• Introduction

• Functionalities

• Commercial Tools

– HealthTerm

– ITServer

• Clinical Work Station

• References

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SNOMED CT• SNOMED CT is a multilingual and international terminology.

• SNOMED CT is a semantic standard that can represent elements of many healthcare domains:– Diseases, pharmaceutical products, routes of administration,

substances, procedures, etc.

• SNOMED CT uses concepts to represent ideas:– Each concept has more than one description.– Each concept is related to other concepts trough relationships

performed by many kind of associations (not only hierarchy).

• SNOMED CT also includes extensions that can be viewed as local versions of the terminology but respecting and following the standard.

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SNOMED CT

• SNOMED CT can be used as an interface and aggregation vocabulary:

– It has accessible descriptions made BY and FOR healthcare professionals.

– It includes the subset mechanism to facilitate its use in/with IS and by clinicians:

• Capacity to group concepts, descriptions or relationships in order to use only those we really need.

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SNOMED CT

• BUT… the real strength comes when we use SNOMED CT as a reference terminology:

– It has relationships of many kinds:

• Has a multi-hierarchy structure that relates concepts of different domains.

– It is granular and allows representation of concepts using the maximum level of detail.

– And it includes a mapping mechanism used to relate their concepts with elements of other controlled vocabularies.

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Introduction

• We can found 3 types of tools that work with controlled vocabularies:

– Browsers.

– Terminology servers.

– Exploiting tools.

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Introduction

• Browsers

– They allow us to explore the content of controlled vocabularies through:

• Searches: simple and advance.

• Navigation: plain list or hierarchy discovery.

– They display all the information about controlled vocabularies: common name, version, edition, author, etc.

• And also about its content, for each element they show: ID or CODE, description(s), relationships and any other attribute.

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Introduction

• Terminology servers

– Tools specially designed to allow users and systems to work with controlled vocabularies:

• Maintenance, distribution, development, etc.

– That allow “terminology (to be used) as a service”.

– They are not databases managers.

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Introduction• Exploiting tools

– They use controlled vocabularies with other main proposes:• Like to prescribe a medicine, to report a discharge of a

patient or to order laboratory test analysis.

– Clinical Work Stations of points of care are exploiting tools.

– Healthcare professionals uses these tools to record information in the IS of their centre:• This information ideally will be stored in a structured format

and using standards…– But professionals don’t need to see any code.

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Introduction

• These tools are not mutually exclusive:

– A terminology server should have a browser.

– And most of the exploiting tools have a (partial) browser to help users to find terms.

• And can be used by persons and systems:

– Browsers and exploiting tools are used by persons.

– Terminology servers are used by persons and systems.

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Functionalities

• Related to controlled vocabularies, their components, subsets and mappings:

– Import in a standard or common format:

• First release and historical mechanism.

• Other metadata.

– Representation.

– Exploration with searches and navigation.

• Including queries.

– Export in a standard or common format.

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Functionalities

• Related to controlled vocabularies, their components, subsets and mappings:

– Creation:

• Including translation.

– Edition.

– Inactivation.

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Functionalities

• Additional functionalities for SNOMED CT:

– Management of extensions:

• Includes operations to create, modify and translate components of SNOMED CT.

– Support to post-coordination and management of clinical expressions:

• Using more than one concept to represent an idea.

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Functionalities• Terminology servers can offer these

functionalities in 2 modes:– Through a user interface: for persons (terminology

managers).

– As a (web) service: for systems.

• And they have other functionalities as management systems like:– Control of versions.

– Management of users, rolls and profiles.

– …

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Functionalities

• The main functionalities of terminology servers are described in CTS2 standard of HL7:

– Common Terminology Services Release 2.

– Its definition is at a functional level and establish profiles and criteria of accomplishment.

– Its specification is independent of controlled vocabularies, languages, systems and technologies:

• Allowing different implementations approaches.

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HealthTerm

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http://www.healthterm.com/

HealthTerm

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http://vimeo.com/99705476

ITServer

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http://www.itserver.es/ITServer/common/index.faces

Clinical Work Station

• How can we use controlled vocabularies stored and managed from terminology servers in Clinical Work Stations?

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Clinical Work Station

• Simulated CWS environment:

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Clinical Work Station

• Simulated CWS environment:

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References• CTS 2:

http://wiki.hl7.org/index.php?title=Common_Terminology_Services_-_Release_2_(Normative).

• HealthTerm: http://www.healthterm.com/

• HL7 INT: http://www.hl7.org/.

• IHTSDO (SNOMED CT): http://www.ihtsdo.org/.

• ITServer: http://www.itserver.es/ITServer/common/index.faces.

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Thank you

leonard@tecnocampus.cat

arius@tecnocampus.cat

jbh@carecom.eu

CCI_TCM

Centre de Competències d’Integració

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