Harmonization : Brief introduction to CT2M

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• Harmonization Brief introduction to CT2M
• ISO DTS 22789(Patients findings)
• General comments
• (to be continued) Harmonization with TrM
  terminologies WRT. ISO DTS 22789 with TrM

2
Brief introduction to CT2M

• Motivation
• CT2M specification
• Problems
• CT2M DE
• future of CT2M development

Kyungmo ParkKyunghee University, Korea2006. 04.
02
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Motivation of CT2M
China
Integration of Market!

• Now being Developed Independently by China and
  Korea
• Each country has different market structure and
  needs
• Consequently Needs for EHR and fundamentals are
  different from each other
• In future, Market will be integrated, then We
  should have interoperable systems and shared
  fundamentals

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Nation I
Nation II
Market
Market
System
System
IR
IR
EHR
EHR
DB
DB
Fundamentals
Fundamentals
Content standard
Messaging Standard HL7, DICOM
Content standard
Messaging Standard HL7, DICOM
Shared Standards
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The same problem occur!
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Motivation of CT2M

• What is CT2M?
• Ontological Approach for Clinical Terminology
  System of Traditional Medicine
• What is the goal of CT2M?
• Enhancement of EHR Functionality
• Why CT2M?
• Terminology systems in Asian Traditional Medicine
• HIS in CJK Traditional medical Practice (maybe
  including U.S and Europe)
• Clinical Studies and trials
• Evidence Based Medicine in TM
• Sharing of Medical information and patient data
• Bioinformatics research in TM

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Motivation of CT2M

• CT2M makes Machine to Understand Various
  Traditional Medicine written by Chinese,
  Japanese, Korean and other countries
• Building Reference terminology system for various
  Health Record from many counties
• In future, Forward to Unified Clinical
  Terminology including Eastern medicine and
  western medicine

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Ontology Evaluation Acquisition,Discovery,Anal
ysis of knowledge
StructuringDomainKnowledge and Building Ontology
Providing DomainKnowledge Model
UsingApplication

• Electronic Health Record
• Health Data Sharing
• CDSS
• Critical Pathway supporting

• Concept Extraction
• Ontology Editing
• Ontology Integration
• Ontology Mapping

• Information Retrieval API
• Information Extraction API
• Customizing
• Parsing
• NLP
• Validation

• Knowledge Representation Language
• Knowledge Model
• Standard of Data Format

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Beginning 2004, 2005
1st WHO WPRO IST meeting in Beijing, 2004 1st WHO
WPRO information standardization meeting in
Beijing, 2005

• Suggested standardization issues
• IST (International Standard Terminology)
• has 6,000 terms (English, Korea, Japan language)
• Used as basis for CT2M
• MeSH TM(Medical Subject Headings)
• Will be published around 2007
• ICD TM(International Classification of Diseases)
• Will be published around 2007
• CT2M

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Middle of 2005
1st CT2M workshop, Beijing

• Discussed the logical structure of CT2M
• Logical structure Frame System a
• Benchmarked terminologies UMLS, SNOMED,GALEN
  etc
• We have referred to the existing medical
  terminology

2nd WHO WPRO IS meeting, Tsucuba
Beginning of 2006

• Consents on strategy of CT2M development
• Independent Development and then integration into
  international standard
• Satisfying minimum EHR functionality
• Data Entry, Patient data retrieval, Reporting
• common conceptual structure and common developing
  method.
• Sharing development tools and API
• Avoiding overlapped development

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Middle of 2006(Feb-Oct)
2nd 3rd CT2M workshop

• Design, discussion, sample modeling, and
  confirmation
• Logical Problem
• 2nd Detailed Logical Structure discussion and
  confirmation
• Present DL. n, ?, ?, (? not use)
• DL layers(T,A box), Inference
• According to modeling semantic relationships,
  will be fixed
• Content Problem
• 1st High Level Ontology
• Higher level concepts and hierarchy
• Logical status of Semantic type
• Semantic relations
• 1st Selection of 500 concepts from IST
• Include high level, deep hierarchy, and
  application oriented modeling
• For Developing a sample ontology
• 2nd Developing Semantic Relationships between
  500 concepts
• Tool Problem
• 1st Tool development strategy
• Tools should be used for solving content problem
• Tools should be tightly followed by modeling
  methods

Semantic relation attribute(FL), Property(DL),
Predicate Semantic relationship frame,
assertion, triple, sentence
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Discussed issues of 2nd workshop

• Several TRM exclusive concepts can be candidate
  of CT2M higher level conceptsclinical finding,
  procedure, body morphology, drug/instrument,
  theory, prescription, environment, experience,
  measure etc)
• we will make effort to circulate our drafts of
  Relations from each countries before 3rd
  workshop. Japan will investigate the attributes
  of GALEN
• Issue of 500 Term selection from IST will be
  discussed after drafts from each countries are
  circulated before 3rd workshop.
• In future, We hope to develop the common
  Development Environment, jointly.
• China will have English website which can
  facilitate the activity of CT2M after around one
  month.

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Coverage of CT2M

• All kinds of Clinical document

Out patient
Physical object
Observable entity
Pharmaceutical biologic product
Clinical finding
Environments/ Geographical locations
Procedure/ Intervention
Staging scales
Social context
In patient
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Framework of Discussion
General concepts
?
CT2M
CTWM
?
?
?
C0003
Concept-Level
Language-Level
Multiple higher-level hierarchy
Chinese
English
D00011
D00127
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• Clinical Terminology in Medical Domain

Strategy
must developing
included
integrated
adoption
CT2M
included
development or adoption
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TRM Exclusive concepts
8.35 ????
12.26 ????
8.36 ??
?? ????
12.27 ????
12.31 ?????
?? ?????
3.46 ?????
8.61 ?????
8.54 ???
8.64 ????
8.67 ??
8.68 ?????
8.70 ?????
8.74 ????
8.76 ??
?? ???
8.78 ???
8.77 ??
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Commonly shared concepts
Is-A
other relation
Is-A
?
cause of
?
associate with
?
location of
?
associate with
?
WM exclusives
TRM exclusives
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SNOMED
CT2M
Is-A
Is-A
Is-A
Is-A
shared concepts
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Distinction of multiple contexts
another perspective
another perspective
a perspective
a perspective
High-level
-Abstract -Theoretical
a perspective
Traditional Medicine
Another perspective
Western Medicine
Low-level
-Concrete
same description but, different context
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What is CT2M DE?
CT2M DE
Terminology Server
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TMLS DE-Architecture
TMLS Ontology (OWL)
B R O W S E R
Extraction
E D I T O R
ManualEditing
Integration
conversion
refering
MetadataKnowledge Base
Mapping
Parser, Validator, Evaluator, Visualizer
Online based, Multi-user, Versioning
supported server
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Functionalities
Edition
Storage
Query

• Query Browser

• Storage

• OWL files
• Database

• Syntax oriented query
• Content oriented query

• Language support

• China, japan
• Korea, english

• OWL-DB converter

• for reasoning
• for version management

• Editing support

• Division of Edition
• Reintegration
• Multiple hierarchy
• Search function

Inference
Evaluation

• Logical operator

• ?, ?, n,

• File version management

• Ontology version
• management

• Consistency check

• Ontology evaluation

• Semantic evaluation

• Syntactic evaluation

• Manual evaluation-work

• Author management

• Validation

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Architecture of System
Client Browser
Mapper
Intermediate Representation
Template Representation
Editor
DB-OWL Converter
Query Browser
Import/Export services
Other Format
Ontology Format
OWL
Excel
XML
RDF(S)
Ontology Manager
Query Engine(DB export retrieval)
Server Access API(JSP, Servlet, JDBC)
Database
Application Server
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CT2M Development Strategy

• Already national standards are being developed by
  China and Korea, independently.
• However, at the beginning stage, we will have the
  common structure and share the developing method.
• And then will be mapped each other and be
  integrated into unified one, CT2M.
• Need labor for implementation of interoperable
  EHR, will be unified or mapped with clinical
  terminology system of western medicine

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CT2M Development Strategy

• the same developing language syntax and
  semantics
• Guarantee of mapping
• the same high level ontology
• Prevention of inferiorization when integration
• Guarantee of high functionality
• Satisfaction of minimum EHR functionality
• Sharing development tools and API
• Sharing terminology server
• Avoiding overlapped development

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Next Meeting Schedule

• Date Oct.-Nov.28-30, 2006
• Venue Seoul, Korea

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3rd WHO WPRO IS meeting
End of 2006(Nov) to Beginning of 2007

• To Confirm modeling method
• To Complete initial tool development
• Clinical Terminologies are already being
  developed independently
• Publication of Recommendation

2007-2008

• Independently Development of Clinical Terminology
  system
• China development of the TCM CTS system
• Korea development of the CT2M korea system
• Japan ?

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End of 2008 or Beginning of 2009

• To integrate the system into CT2M
• System integration TCM CTS, CT2M korea, others

Middle of 2009
Publication of the CT2Ms first version
2009-2010

• Support of CT2M Application development
• CT2Ms second version development
• Enhancing EHR functionality