Building a Hospital Incident Reporting Ontology(HIRO) in the Web Ontology Language (OWL)

using the JCAHO Patient Safety Event Taxonomy (PSET)

presented by Liju Fan, PhD

Senior Scientist

Core Competencies• Health and Science Informatics• Environmental Services • Public Health Outreach

The KEVRIC Company• Founded in 1981• Headquarters in Silver Spring, Maryland• Acquired by Information Management

Consultants (IMC) in February 2003

Health and Science Health and Science Informatics CapabilitiesInformatics Capabilities

• Enterprise Vocabulary System • Ontology Development• Knowledge Management• Patient Safety• Clinical Trial Management• Public Health Statistical Analysis

What is an Ontology?• Tom Gruber -

“An ontology is a specification of a conceptualization” • Stanford Knowledge Systems Lab -

“An ontology is an explicit specification of some topic. Ontologies therefore provide a vocabulary for representing and communicating knowledge about some topic and a set of relationships that hold among the terms in that vocabulary.”

• World Wide Web Consortium (W3C) -“Ontology is about the exact description of things and their relationships.”

What is an Ontology?http://www.w3.org/TR/webont-req/#onto-def

• Ontologies (from simple taxonomies to metadata schemes to logical theories)– defines the terms used to describe and represent

an area of knowledge – is used by people, databases, and applications that

need to share domain information – includes computer-usable definitions of basic

concepts in the domain and the relationships among them

– encodes knowledge in a domain and also knowledge that spans domains

What is an Ontology?http://www.w3.org/TR/webont-req/#onto-def

• Ontologies (from simple taxonomies to metadata schemes to logical theories)

• defines the terms used to describe and represent an area of knowledge

• is used by people, databases, and applications that need to share domain information

• includes computer-usable definitions of basic concepts in the domain and the relationships among them

• encodes knowledge in a domain and also knowledge that spans domains

What is an Ontology?http://www.w3.org/TR/webont-req/#onto-def

• Ontologies figure prominently in the emerging Semantic Web – representing the semantics of documents– enabling the semantics to be used by web

applications and intelligent agents.

• But the Semantic Web needs HIGHLY STURCTURED ontologies with– Classes (general things) in the many domains of

interest– The relationships that can exist among things– The properties (or attributes) those things may have

What is an Ontology?http://www.w3.org/TR/webont-req/#onto-def

• Ontologies figure prominently in the emerging Semantic Web – represent the semantics of documents– enable the semantics to be used by web applications and

intelligent agents

• But the Semantic Web needs HIGHLY STRUCTURED ontologies with– Classes (general things) in the many domains of interest– The relationships that can exist among things– The properties (or attributes) those things may have

Uses of Ontologies

•Ontologies provide controlled vocabularies for a specific domain

•Separate ontologies mapped to one another to form a system-wide ontology

•Accessed through API, ontologies facilitate the integration of archived and external data to the warehouse

What is an Ontology?http://www.w3.org/TR/webont-req/#onto-def

• Ontologies figure prominently in the emerging Semantic Web – representing the semantics of documents– enabling the semantics to be used by web

applications and intelligent agents.

• But the Semantic Web needs HIGHLY STURCTURED ontologies with– Classes (general things) in the many domains of

interest– The relationships that can exist among things– The properties (or attributes) those things may have

Identify Scope

ReviewExisting

Taxonomy/Ontology

KnowledgeAcquisition

Encode

ConceptualizeTest

Iterative Development of Ontologies

Highlighted Project:Highlighted Project:Web Redesign Controlled Health Thesaurus for Web Redesign Controlled Health Thesaurus for

CDC-IRMOCDC-IRMOHighlighted Project:Hospital Incident Reporting Ontology for Joint Commission on Accreditation of Healthcare Organizations (JCAHO-HIRO)

• The KEVRIC team develops the Hospital Incident Reporting Ontology (HIRO) for adverse events and near misses

• Based on the Patient Safety Event Taxonomy (PSET), a common standardized terminology created by JCAHO for different event data collected from dissimilar reporting systems

• Incorporating a sample of de-identified hospital incident reports representative of systems currently in use

• To facilitate data-mining, knowledge sharing, and cooperative problem-solving respecting patient safety in hospitals

• Using Protégé-OWL (open-source ontology editing tool developed by Stanford U.)

Design Specifics of HIRO

• Approach: Integrative• Portability to the web: OWL format• Development environment: Protégé 3.0 release• Hardware: Pentium• Database: MySQL• Consistency and inferencing: Classifiable by Racer• Naming conventions: OWL-compatible and human

friendly

Highlighted Project:Highlighted Project:Web Redesign Controlled Health Thesaurus for Web Redesign Controlled Health Thesaurus for

CDC-IRMOCDC-IRMO

• Evaluate and re-organize PSET in Protégé-OWL for► Concept coverage ► Concept properties ► Concepts relationships

• Incorporate additional concepts and relationships from de-identified individual incident reports using ► Natural Language Processing (NLP) ► Manual editing and modeling by clinical staff who are

subject matter experts in patient safety

Development of HIRO

PSET Terms(xls)

AHRQ Cases(html)

Peer-ReviewedLiterature

(pdf)

Johns HopkinsICUSRSDatabase

(mdb)

HIRO PrototypeConsistency Check

Modeling

Natural LanguageProcessing

Building Methodology

Protégé-OWL

ManualCurating

EvaluationRe-organization

Five Top Nodes of Taxonomic Tree from PSET

• Cause of Occurrence - The factors and agents that bring about a health care error or systems failure

• Domain - Where a health care error or systems failure occurred and the type of individual involved

• Impact - The outcome or effect of a health care error or systems failure, commonly referred to as harm to the recipient of care

• Mitigation Activity - Those activities that an organization undertakes in attempting to lessen the severity and impact of a potential emergency

• Type of Occurrence - The perceptible, outward, or visible process that was in error or failed

PSET in Protégé• True is_a relationship down through each hierarchy where every

X at level n “is a” Y at level n-1Example: Death is a Physical_Impact;

Physical_Impact is a Medical_Impact; Medical_Impact is an Impact

• Non-hierarchical relationships linking concepts (classes) of two trees or within the same tree

Examples: leads to, affects, prevents

• Properties provide additional informationExamples: PSET_ID, Synonym, PSET_Definition

Mapping to major medical vocabularies or classifications (DSM-IV_ID, ICD-9_Code)

Use Caseshttp://www.w3.org/TR/webont-req/

Uses of an ontologyfor patient safety information systems

• Controlled vocabulary for semantic interoperability • Corporate web site management for patient safety• Web portal for patient safety• Design documentation, e.g., incident reports• Data aggregation and retrieval • Query patient safety databases via API

AcknowledgementsKEVRIC / IMCAnnette Smith, MSDouglas Boenning, MDPaul Koch, PhDTodd Grimmett Peg Silloway

JCAHOAndrew Chang, JDGerard Castro, MPHStacey Champagne, MAJerod M. Loeb, PhD

AHRQJames Battles, PhD