Semantic Engineering Notation

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From Terminologies to Classifications The
Challenge of Information Reduction Hans Rudolf
Straub Kreuzlingen, Switzerland
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Reality Instances
Classes
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Reality Instances
? Free Text ? Terminologies ? Codes ? DRGs
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Reality Instances
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Simplification is intended!
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Reality Instances
? Free Text ? Terminologies ? Codes ? DRGs
Information Reduction
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Simplification is intended!
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Reality Instances
Information Content
? Free Text ? Terminologies ? Codes ? DRGs
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106 (1015)
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104 (108)
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Reality Instances
Granularity
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Classes
Hierarchy
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deductionspossible
Conditions for true hierarchies -
Disjunctivity - Unidirectionality
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(No Transcript)
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Natural hierarchy of Diseases? -
Multidimensionality - Sum/summands Problem
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Division of arterial hypertension
- by malignancy and crisis - malignant /
benign - with crisis / without crisis - by
cause - endocrinous phaeochromocytoma, cushing,
... - renal renovascular, renoparenchymatous -
by organic complications - without organic
complications - with cardiopathy - with
nephropathy - with encephalopathy
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Division by causes
granularity
HT caused byrenal arterystenosis
HT caused byrenal arterystenosis
HT caused byrenal arterystenosis
HT caused byrenal arterystenosis
HT caused byglomerulo- nephritis
HT caused byrenal arterystenosis
hypertension caused by phaeochromocytoma
hypertension caused by phaeochromocytoma
renovascular hypertension
renoparenchymatoushypertension
hypertension caused by phaeochromocytoma
renal hypertension
endocrinous hypertension
arterial hypertension
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Division by organic complications
granularity
hypertension with renal insufficiency
hypertension with cardiac insufficiency
hypertension without organic complications
hypertension w. nephropathy
hypertension w.cerebral bleeding
hypertension w.cardiopathy
arterial hypertonsion
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Multidimensional representation
organic complications
nephro- pathy
complicated
cardio- pathy
hypertension
x
without complications
causes
reno- vascular
reno- parench.
renal
endocrine
primary
secundary
Hypertonie
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ICD-10 several dimensions in 1 hierarchy
organic complications
causes
I10 primary hypertension
I11 hypertensive cardiopathy
I12 hypertensive nephropathy
I13 hypertensive cardiop. nephrop.
I15 secondary hypertension
3-digits
I10 I15 arterial hypertension
group
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ICD-10 several dimensions in 1 hierarchy
Organic Insufficiencies
I11.0with cardiac insufficiency
I11.9without card. Insuff.
I12.0with renal insufficiency
I12.9without ren. insuff.
.. H
.. N
I13.2 HN
.. -
4-digits
I15.0reno- vasc.
I15.1reno- paren.
I15.2 endo- krin
I10.0benign
I10.1malignant
I10 primary hypertension
I11 hypertensive cardiopathy
I12 hypertensive nephropathy
I13 hypertensive cardiop. nephrop.
I15 secondary hypertension
3-digits
I10 I15 arterial hypertension
group
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ICD-10 several dimensions in 1 hierarchy
5-digits
I11.00without crisis
I11.01with crisis
I15.20without crisis
I15.21with Krise
...
...
...
I11.0with cardiac insufficiency
I11.9without card. Insuff.
I12.0with renal insufficiency
I12.9without ren. insuff.
.. H
.. N
I13.2 HN
.. -
4-digits
I15.0reno- vasc.
I15.1reno- paren.
I15.2 endo- krin
I10.0benign
I10.1malignant
I10 primary hypertension
I11 hypertensive cardiopathy
I12 hypertensive nephropathy
I13 hypertensive cardiop. nephrop.
I15 secondary hypertension
3-digits
I10 I15 arterial hypertension
group
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ICD-10 several dimensions in 1 hierarchy
5-digits
I11.00without crisis
I11.01with crisis
I15.20without crisis
I15.21with Krise
...
...
...
I11.0with cardiac insufficiency
I11.9without card. Insuff.
I12.0with renal insufficiency
I12.9without ren. insuff.
.. H
.. N
I13.2 HN
.. -
4-digits
I15.0reno- vasc.
I15.1reno- paren.
I15.2 endo- krin
I10.0benign
I10.1malignant
I10 primary hypertension
I11 hypertensive cardiopathy
I12 hypertensive nephropathy
I13 hypertensive cardiop. nephrop.
I15 secondary hypertension
3-digits
I10 I15 arterial hypertension
Not a problem of ICD-10 But of all diagnoses
systems
group
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Sum/summands problem
diagnosis of its own
I11.0with cardiac insufficiency
I11.9without card. Insuff.
I12.0with renal insufficiency
I12.9without ren. insuff.
.. H
.. N
I13.2 HN
.. -
4-digits
I15.0reno- vasc.
I15.1reno- paren.
I15.2 endo- krin
I10.0benign
I10.1malignant
I10 primary hypertension
I11 hypertensive cardiopathy
I12 hypertensive nephropathy
I13 hypertensive cardiop. nephrop.
I15 secondary hypertension
3-digits
I10 I15 arterial hypertension
group
attribute of a diagnosis
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Sum/summands problem
diagnosis of its own
? I50.00 I50.19
I11.0with cardiac insufficiency
I11.9without card. Insuff.
I12.0with renal insufficiency
I12.9without ren. insuff.
.. H
.. N
I13.2 HN
.. -
4-digits
I15.0reno- vasc.
I15.1reno- paren.
I15.2 endo- krin
I10.0benign
I10.1malignant
I10 primary hypertension
I11 hypertensive cardiopathy
I12 hypertensive nephropathy
I13 hypertensive cardiop. nephrop.
I15 secondary hypertension
3-digits
I10 I15 arterial hypertension
group
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Sum/summands problem

• autom. included?
• additional item?
• sequence?

diagnosis of its own
? I50.00 I50.19
I11.0with cardiac insufficiency
I11.9without card. Insuff.
I12.0with renal insufficiency
I12.9without ren. insuff.
.. H
.. N
I13.2 HN
.. -
4-digits
I15.0reno- vasc.
I15.1reno- paren.
I15.2 endo- krin
I10.0benign
I10.1malignant
I10 primary hypertension
I11 hypertensive cardiopathy
I12 hypertensive nephropathy
I13 hypertensive cardiop. nephrop.
I15 secondary hypertension
3-digits
I10 I15 arterial hypertension
group
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Sum/summands problem
diagnoses of its own
I11.0with cardiac insufficiency
I11.9without card. Insuff.
I12.0with renal insufficiency
I12.9without ren. insuff.
.. H
.. N
I13.2 HN
.. -
4-digits
I15.0reno- vasc.
I15.1reno- paren.
I15.2 endo- krin
I10.0benign
I10.1malignant
I10 primary hypertension
I11 hypertensive cardiopathy
I12 hypertensive nephropathy
I13 hypertensive cardiop. nephrop.
I15 secondary hypertension
3-digits
I10 I15 arterial hypertension
group
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Sum/summands problem
diagnoses of its own
I11.0with cardiac insufficiency
I11.9without card. Insuff.
I12.0with renal insufficiency
I12.9without ren. insuff.
.. H
.. N
I13.2 HN
.. -
4-digits
I15.0reno- vasc.
I15.1reno- paren.
I15.2 endo- crinous
I10.0benign
I10.1malignant
I10 primary hypertension
I11 hypertensive cardiopathy
I12 hypertensive nephropathy
I13 hypertensive cardiop. nephrop.
I15 secondary hypertension
3-digits
I10 I15 arterial hypertension
group
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Sum/summands problem

• autom. included?
• additional item?
• sequence?

diagnoses of its own
I11.0with cardiac insufficiency
I11.9without card. Insuff.
I12.0with renal insufficiency
I12.9without ren. insuff.
.. H
.. N
I13.2 HN
.. -
4-digits
I15.0reno- vasc.
I15.1reno- paren.
I15.2 endo- krin
I10.0benign
I10.1malignant
I10 primary hypertension
I11 hypertensive cardiopathy
I12 hypertensive nephropathy
I13 hypertensive cardiop. nephrop.
I15 secondary hypertension
3-digits
I10 I15 arterial hypertension
group
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Sum/summands problem

• autom. included?
• additional item?
• sequence?

• guidelines
• - ICD-10 (excl./incl.)
• DKR (german guidelines)

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Sum/summands problem

• autom. included?
• additional item?
• sequence?

• guidelines
• - ICD-10 (excl./incl.)
• DKR (german guidlines)

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Sum/summands problem




I10
N28.9
I12
Give Sum
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Sum/summands problem




I10
N28.9
I10 N28.9
Give Summands
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Sum/summands problem




I12
N19
N19 I12
Give Summands
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Sum/summands problem




I11
I12
I13
Give Sum
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Sum/summands problem




I13
I50
I50 I13
Give Summands
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Which summand is stronger?
Fine granularity (summands)
coarse granularity (sum)
Diagnoses Terminologies Classifications
classification funnel
(hierarchy)
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Which summand is stronger?

hypertension
nephropathy
summands
classification funnel
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Which summand is stronger?

hypertension
nephropathy
summands
hypertensive nephropathy
sum
classification funnel
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Which summand is stronger?

hypertension
nephropathy
summands
diabetic Nethie
athero- Nepthie
hypertensive nephropathy
sum
classification funnel
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Which summand is stronger?

hypertension
nephropathy
summands
diabetic Nethie
athero- Nepthie
sum with full information
hypertensive nephropathy
sum with reduced information
nephropathy
classification funnel
N
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Which summand is stronger?

hypertension
nephropathy
summands
Hypertonie mit Kardiopathie
Hypertonie mit Kardiopathie
sum with full information
hypertension with nephropathy
classification funnel
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Which summand is stronger?

hypertension
nephropathy
summands
Hypertonie mit Kardiopathie
Hypertonie mit Kardiopathie
sum with full information
hypertension with nephropathy
sum with reduced information
hypertension
classification funnel
I
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Which summand is stronger?

hypertension
nephropathy
summands
sum with full information
hypertensive nephropathy
hypertension with nephropathy
sum with reduced information
hypertension
nephropathy
classification funnel
I
N
Disjunction
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Sum/summands normal part_of relation?
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Sum/summands normal part_of relation?
finger part_of hand ? never on same
level (finger cannot stand alone)
hypertension part_of (hypertensive)
cardiopathy ? possibly on same level!
(hypertension can stand alone)
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Sum/summands normal part_of relation?
finger part_of hand (always) finger without
hand (not possible)
hypertension part_of hypertens. cardiop.
(sometimes) hypertension without hypertens.
cardiop. (well possible)
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Sum/summands normal part_of relation?
finger part_of hand (always) finger without
hand (not possible)
hypertension part_of hypertens. cardiop.
(sometimes) hypertension without hypertens.
cardiop. (well possible)
? mandatory part_of ?
contingent part_of
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Sum/summands normal part_of relation?
? mandatory part_of ?
contingent part_of
hand
palm
thumb
...
deductions possible
hypertensive cardiopathy
hypertension
cardiopathy
deductions NOT possible
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The sum/summands problem is frequent
- duodenal ulcer with gastrointestinal
bleeding - diabetes with complications -
diabetic nephropathy - diabetic foot - cardiac
lung oedema ( symptom cardiac insufficiency) - ce
rebral aneurysm with subarachnoidal bleeding and
coma- monteggia-fracture ( fracture of ulna und
luxation of radius) - Weber fracture (tibia
fibula ligaments) - unhappy triad (meniscus 2
ligaments) - appendicitis mit perforation und
peritonitis
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Reality Instances
? Free Text ? Terminologies ? Codes ? DRGs
Sum/Summands Problem
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many points
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one point
Simplification is intended!
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• It makes sense to arrange clinical diagnoses in
  the structure of a hierarchy, but its always
  arbitrary due to
• multidimensionality
• sum/summands problem

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Summary
A description of a coarser granularity cannot
automatically be obtained from a description with
finer granularity The sum/summands problem is
frequent and inescapable Simplifying/grouping/cla
ssification of medical diagnosis will always be
necessary in practice
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(No Transcript)
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Computer assisted coding
Input
The user is guided by the knowledge based coding
system
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Computer assisted coding
.. Until the complete sum/summands coding
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Objects versus model elements