Clinical Terminology in Practical Use for Recording and Researching Reasons for Admission in Intensi

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Clinical Terminology in Practical Usefor
Recording and ResearchingReasons for Admission
in Intensive Care

• Ronald Cornet
• Dept. of Medical Informatics
• Academic Medical Center Universiteit van
  Amsterdam

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Overview

• Intensive Care
• DICE Ontology
• Registration of patient data
• Research on patient data

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Practical Use Intensive Care

• Young discipline, large development, expensive
• Need for
• High quality registration of patient information
• Quality assessment and improvement
• Epidemiology of (rare) diseases on ICU

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Terminological System

• Terminology to adequately describe health
  problems of patients in routine patient care
• Structure of the system that supports aggregation
  of homogeneous groups to enable analysis and
  evaluation of care
• ?DICE (Diagnoses for Intensive Care Evaluation)

Recording Researching Reasons for Admission
in Intensive Care
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DICE Ontology
Health Problems
NICE code
ICD-10 code
Is_a
Is_a
Medical Condition
Surgical Condition
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DICE Ontology
Health Problems
NICE code
ICD-10 code
Is_a
Is_a
Medical Condition
Surgical Condition
Causation
Abnormality
System_involvement
Component_involvement
Anatomical components
Dysfunctions/abnormality
Aetiology
Systems
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DICE Ontology
Health Problems
NICE code
ICD-10 code
Is_a
Is_a
Medical Condition
Surgical Condition
Procedure_related
Causation
Abnormality
Surgical Procedure
System_involvement
Component_involvement
OP_System_involvement
OP_Abnormality
OP_Component_involvement
Anatomical components
Aetiology
Dysfunctions /abnormality
Systems
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DICE Characteristics

• Concepts are provided with Dutch and English
  descriptions, allowing preferred and synonymous
  terms
• A concept-refinement mechanism is provided
• Frame-based representation
• 2500 concepts, 1500 Reasons for Adm.

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Integration in PDMS
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Concept Selection in Practice

• CABG
• IsA Bypass, graft, or prothesis of arteries
• IsA Coronary artery procedure
• Involves dysfunction Obstruction
• Location Coronary arteries
• Tract Cardiovascular tract
• Act Bypass / Graft

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Concept Refinement in Practice

• CABG
• Reoperative yes / no
• Type GEA / LIMA / PIMA / RIMA / Venous graft
• Number of bypasses gt 0

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Registration of data (Pilot)

• Short introduction was provided
• Voluntary registration
• Clinicians specify reason for admission for 50
  of admitted patients
• 40 of Reasons for Admission is post-coordinated
  (i.e. further specified)

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Registration of data (Pilot)

• Level of detail is comparable to free text
• Post-coordination resulting in pre-coordinated
  concepts does occur, e.g.
• mitral valve replacement
• valve replacement, involving mitral valve

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Research on data (Pilot)

• DICE is converted to OWL-DL
• Recorded data are converted to RDF

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Research on data (Pilot)

• Querying can be done using off-the-shelf tools
• RDF Stores such as Sesame, InstanceStore
• Reasoners such as RACER, FaCT, Pellet

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Conclusions

• Olivier Bodenreider
• The goal is not to have terminologies in OWL
• But
• Recording
• Post-coordination is used
• and leads to multiple representations of concepts
• Research
• Standardization makes querying easier

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Further work

• Standardization of
• Syntax
• Applications
• Storage
• Assess scalability
• Larger terminologies
• Larger amounts of patient data
• Alternatives for data entry