advanced patient information systems and medical concept representation medinfo’95 workshop
DESCRIPTION
ADVANCED PATIENT INFORMATION SYSTEMS AND MEDICAL CONCEPT REPRESENTATION MEDINFO’95 WORKSHOP. CHRISTOPHER G. CHUTE MAYO CLINIC, ROCHESTER, MINNESOTA, USA JAMES J. CIMINO COLUMBIA UNIVERSITY, N.Y., N.Y., USA EIKE H.-W. KLUGE VICTORIA UNIVERSITY, VICTORIA, B.C., CANADA YVES LUSSIER - PowerPoint PPT PresentationTRANSCRIPT
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ADVANCED PATIENT INFORMATION SYSTEMSAND MEDICAL CONCEPT
REPRESENTATION
MEDINFO’95 WORKSHOP
ADVANCED PATIENT INFORMATION SYSTEMSAND MEDICAL CONCEPT
REPRESENTATION
MEDINFO’95 WORKSHOP
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CHRISTOPHER G. CHUTECHRISTOPHER G. CHUTE
MAYO CLINIC, ROCHESTER, MINNESOTA, USAMAYO CLINIC, ROCHESTER, MINNESOTA, USA
JAMES J. CIMINOJAMES J. CIMINO
COLUMBIA UNIVERSITY, N.Y., N.Y., USACOLUMBIA UNIVERSITY, N.Y., N.Y., USA
EIKE H.-W. KLUGEEIKE H.-W. KLUGE
VICTORIA UNIVERSITY, VICTORIA, B.C., CANADAVICTORIA UNIVERSITY, VICTORIA, B.C., CANADA
YVES LUSSIERYVES LUSSIER
UNIVERSITY OF SHERBROOKE, SHERBROOKE, QUEBEC, UNIVERSITY OF SHERBROOKE, SHERBROOKE, QUEBEC, CANADACANADA
JOCHEN R. MOEHRJOCHEN R. MOEHR
VICTORIA UNIVERSITY, VICTORIA, B.C., CANADAVICTORIA UNIVERSITY, VICTORIA, B.C., CANADA
VIMLA L. PATELVIMLA L. PATEL
MCGILL UNIVERSITY, MONTREAL, QUEBEC, CANADAMCGILL UNIVERSITY, MONTREAL, QUEBEC, CANADA
ANGELO ROSSI MORIANGELO ROSSI MORI
NATIONAL RESEARCH COUNCIL, ROME, ITALYNATIONAL RESEARCH COUNCIL, ROME, ITALY
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ADVANCED PATIENT INFORMATION SYSTEMS AND MEDICAL CONCEPT REPRESENTATION
MEDINFO’95 WORKSHOP
ADVANCED PATIENT INFORMATION SYSTEMS AND MEDICAL CONCEPT REPRESENTATION
MEDINFO’95 WORKSHOP
History of the WorkshopHistory of the Workshop Purpose of the WorkshopPurpose of the Workshop Goal: Goal:
Explore characteristics and requirements of advanced Explore characteristics and requirements of advanced patient records (APR).patient records (APR).
Identify need for improved medical concept representation Identify need for improved medical concept representation in APR.in APR.
Review current status of medical concept Review current status of medical concept representation and identify challenges and necessary representation and identify challenges and necessary improvementsimprovements
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ADVANCED PATIENT INFORMATION SYSTEMS AND MEDICAL CONCEPT REPRESENTATION
MEDINFO’95 WORKSHOP
ADVANCED PATIENT INFORMATION SYSTEMS AND MEDICAL CONCEPT REPRESENTATION
MEDINFO’95 WORKSHOP
I Issues:I Issues: 9:00-10:00 9:00-10:00
Advanced Patient Records: Characteristics (Jochen R. Moehr)Advanced Patient Records: Characteristics (Jochen R. Moehr)
Clinical Perspective (James Cimino)Clinical Perspective (James Cimino)
Ethico Legal Perspective (Eike H.-W. Kluge)Ethico Legal Perspective (Eike H.-W. Kluge)
Cognitive Science Perspective (Vimla L. Patel)Cognitive Science Perspective (Vimla L. Patel)
II Current Status and LimitationsII Current Status and Limitations 10:00-11:0010:00-11:00
of Medical Concept Representation:of Medical Concept Representation:
IMIA WG 2 Initiatives/Activities (Christopher G. Chute)IMIA WG 2 Initiatives/Activities (Christopher G. Chute)
Semantic Concept Representation Work (James Cimino, C. G. Chute)Semantic Concept Representation Work (James Cimino, C. G. Chute)
Controlled Vocabularies (Yves Lussier)Controlled Vocabularies (Yves Lussier)
Galen Project (Angelo Rossi Mori)Galen Project (Angelo Rossi Mori)
Standardization Initiatives (Angelo Rossi Mori)Standardization Initiatives (Angelo Rossi Mori)
BreakBreak 11:00-11:3011:00-11:30
III Discussion: Requirements for Improvement:III Discussion: Requirements for Improvement: 11:30-12:3011:30-12:30
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IntroductionIntroduction
Advanced Patient RecordsAdvanced Patient Records CharacteristicsCharacteristics ImplicationsImplications
Proposal for SolutionProposal for Solution
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Advanced Patient RecordsAdvanced Patient Records CharacteristicsCharacteristics
UbiquitousUbiquitous Multi-InstitutionalMulti-Institutional NetworkedNetworked Multi MedialMulti Medial VoluminousVoluminous Virtual Patient RecordVirtual Patient Record
Implications:Implications: Information ProblemsInformation Problems Recall & PrecisionRecall & Precision Ethical Problems (Kluge) Ethical Problems (Kluge)
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Recall and precision problems are compounded in the networked virtual health record.
Recall and precision problems are compounded in the networked virtual health record.
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Recall Problem Recall Problem
The location of relevant data is not The location of relevant data is not necessarily known, making it hard to necessarily known, making it hard to retrieve themretrieve them
Increasing recall decreases precisionIncreasing recall decreases precision
Increasing precision decreases recallIncreasing precision decreases recall
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Precision Problem Precision Problem
Data relevant for a defined decision are Data relevant for a defined decision are usually mixed with data that do not usually mixed with data that do not contribute to that decisioncontribute to that decision
Caused by:Caused by: VolumeVolume TimeTime SourceSource
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VolumeVolume
medical records are voluminousmedical records are voluminous no upper boundary exists, such as a no upper boundary exists, such as a
criterion for ‘completeness’criterion for ‘completeness’ hence it is difficult to find relevant data hence it is difficult to find relevant data
among the masses of dataamong the masses of data the need to find relevant data and the size the need to find relevant data and the size
of the record increase in problem patientsof the record increase in problem patients where precision matters most precision is where precision matters most precision is
leastleast
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TimeTime
medical data become quickly obsolete for medical data become quickly obsolete for medical care decisionsmedical care decisions
relevance of data, i.e., precision, decreases relevance of data, i.e., precision, decreases over timeover time
the older the data the less relevant the older the data the less relevant (precise)(precise)
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SourceSource
medical data quality depends on their medical data quality depends on their source, e.g.:source, e.g.: laboratorylaboratory clinicalclinical subjective impressionsubjective impression
the more valid the source, the higher the the more valid the source, the higher the precisionprecision
data validity is not source specific but data validity is not source specific but context specificcontext specific
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Semantic Indexing as a Solution -Alternatives
Semantic Indexing as a Solution -Alternatives
a) Retrieval of “complete” virtual recorda) Retrieval of “complete” virtual record
b) Retrieval by imposed structure, e.g., SOAP, b) Retrieval by imposed structure, e.g., SOAP, Time and SourceTime and Source
c) Retrieval by automated semantic indexingc) Retrieval by automated semantic indexing
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Semantic Indexing as a Solution -Alternatives
Semantic Indexing as a Solution -Alternatives
a) Retrieval of “complete” virtual recorda) Retrieval of “complete” virtual record““all data available on John Doe”all data available on John Doe” potentially boundlesspotentially boundless costly (time, $$)costly (time, $$) very low precisionvery low precision high recallhigh recall little valuelittle value
b) Retrieval by imposed structure, e.g., b) Retrieval by imposed structure, e.g., SOAP, Time and SourceSOAP, Time and Source
c) Retrieval by automated semantic indexingc) Retrieval by automated semantic indexing
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Semantic Indexing as a Solution -Alternatives
Semantic Indexing as a Solution -Alternatives
a) Retrieval of “complete” virtual recorda) Retrieval of “complete” virtual record b) Retrieval by imposed structure, e.g., b) Retrieval by imposed structure, e.g.,
SOAP, Time and Source:SOAP, Time and Source:““all radiographs and lab data obtained March and all radiographs and lab data obtained March and
April ‘95 at xyz hospital”April ‘95 at xyz hospital” improved precisionimproved precision reduced recallreduced recall P&R limited by original structureP&R limited by original structure feasiblefeasible improved benefit/cost ratioimproved benefit/cost ratio
c) Retrieval by automated semantic indexingc) Retrieval by automated semantic indexing
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Semantic Indexing as a Solution -Alternatives
Semantic Indexing as a Solution -Alternatives
a) Retrieval of “complete” virtual recorda) Retrieval of “complete” virtual record b) Retrieval by imposed structure, e.g., SOAP, Time and b) Retrieval by imposed structure, e.g., SOAP, Time and
SourceSource c) Retrieval by automated semantic indexingc) Retrieval by automated semantic indexing
““all data of John Doe pertinent to chronic pulmonary all data of John Doe pertinent to chronic pulmonary hypertension”hypertension”
instantiation meta data baseinstantiation meta data base need for representation of deep knowledge need for representation of deep knowledge potentially high precision and recallpotentially high precision and recall P&R not limited by imposed structureP&R not limited by imposed structure potential for solution also of ethical problemspotential for solution also of ethical problems cost benefit ratio and feasibility unknowncost benefit ratio and feasibility unknown
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Clinical Perspective
James J. Cimino, M.D.Department of Medical Informatics
Columbia UniversityNew York, New York, USA
Clinical Perspective
James J. Cimino, M.D.Department of Medical Informatics
Columbia UniversityNew York, New York, USA
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ClinicalClinicalPerspectivePerspective
DataDataCaptureCapture
ClinicalClinicalComputingComputingPerspectivePerspective
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Clinical Computing PerspectiveClinical Computing Perspective
Record StructureRecord Structure Represented by Data DictionaryRepresented by Data Dictionary
Record ContentRecord Content Represented by Content DictionaryRepresented by Content Dictionary
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Same Meaning, Different StructureSame Meaning,
Different Structure
"Family History of Cancer""Family History of Cancer"
Finding + Modifier: Finding + Modifier: "Cancer (Family History of)""Cancer (Family History of)"
Finding + Modifier: Finding + Modifier: "Family History (Cancer)""Family History (Cancer)"
Family History Table: Family History Table: "Cancer""Cancer"
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Content Dictionary - LimitationsContent Dictionary - Limitations
Limited by coding structureLimited by coding structure
Limited by strict hierarchyLimited by strict hierarchy
Limitations on freedom of expressionLimitations on freedom of expression
Must avoid redundant forms of expressionMust avoid redundant forms of expression
Meaning of terms must be clearMeaning of terms must be clear
No one level of granularity is appropriateNo one level of granularity is appropriate
Can't be independent of data dictionaryCan't be independent of data dictionary
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Cognitive Science Perspective
Vimla L. Patel, Ph.D.Centre for Medical Education
McGill UniversityMontreal, Quebec, Canada
Cognitive Science Perspective
Vimla L. Patel, Ph.D.Centre for Medical Education
McGill UniversityMontreal, Quebec, Canada
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Levels of Meaning in Textand Discourse
Levels of Meaning in Textand Discourse
Text-based ModelText-based Model Representation of Textual Material (Syntax/Semantics)Representation of Textual Material (Syntax/Semantics) Generation of Local InferencesGeneration of Local Inferences Propositional RepresentationPropositional Representation
Situational ModelSituational Model Representation of Events, Actions and Persons in Representation of Events, Actions and Persons in
ContextContext Conceptual Representation: Semantic NetworkConceptual Representation: Semantic Network Generation of High-Level InferencesGeneration of High-Level Inferences Pragmatics: Context-bound InferencesPragmatics: Context-bound Inferences
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CLINICAL DATA
Representation ofClinical Information
Interpretation(in Context)
Data-driven Process
PRIORKNOWLEDGE
Interactive Process of Understanding Clinical Problems
Comprehension
New KnowledgeGeneralization
Instantiation
ConceptuallyDriven Process
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Semantic Network(relationships between
propositions)
CONCEPTUALREPRESENTATION
situational model
PROPOSITIONALREPRESENTATION
text-based model
Propositional Analysis(a form of representation of asemantic network in memory)
NATURALLANGUAGE
expressed throughTHOUGHTSAND IDEAS
Semantic Representation of Natural Language Analysis
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Concept Representation WorkConcept Representation Work
Semantic network approachSemantic network approach
Unified Medical Language System (UMLS)Unified Medical Language System (UMLS)
GalenGalen
Canon GroupCanon Group
Electronic Medical Record ProjectElectronic Medical Record Project
SNOMED InternationalSNOMED International
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Content Dictionary - ImplicationsContent Dictionary - Implications
Not limits by coding structureNot limits by coding structure
Multiple hierarchies permittedMultiple hierarchies permitted
Semantic attributes increase expressivenessSemantic attributes increase expressiveness
Redundant forms of expression recognizedRedundant forms of expression recognized
Semantic attributes define meaningSemantic attributes define meaning
Multiple levels of granularityMultiple levels of granularity
Can also model data dictionaryCan also model data dictionary
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Same Meaning, Equivalent Structures
Same Meaning, Equivalent Structures
"Family History of Cancer""Family History of Cancer"
Cancer - has modifier - Family History ofCancer - has modifier - Family History of
Family History - has modifier - CancerFamily History - has modifier - Cancer
Family History - has element - CancerFamily History - has element - Cancer
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US Vocabulary DevelopmentUS Vocabulary Development
Unified Medical Language SystemUnified Medical Language System
SNOMED InternationalSNOMED International
CanonCanon
Electronic Medical Record ProjectElectronic Medical Record Project
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Unified Medical Language System
Unified Medical Language System
National Library of Medicine 10-year effort National Library of Medicine 10-year effort
MetathesaurusMetathesaurus
Semantic NetworkSemantic Network
Information Sources MapInformation Sources Map
Specialist LexiconSpecialist Lexicon
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CanonCanon
Independent researchers with different Independent researchers with different needsneeds
Experiment in collaborative vocabulary Experiment in collaborative vocabulary developmentdevelopment
Representation of chest xray reportsRepresentation of chest xray reports
Development of a "merged model"Development of a "merged model"
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Electronic Medical Record Project
Electronic Medical Record Project
National Library of MedicineNational Library of Medicine
Controlled vocabulary of clinical medicineControlled vocabulary of clinical medicine
Cooperative agreementCooperative agreement
Arden workshop on Patient ProblemsArden workshop on Patient Problems