Representing the ICF in silico: From Terminology Systems to Clinical Information Systems

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Representing the ICF in silico From Terminology
Systems to Clinical Information Systems

• Marcy Harris
• July 11, 2007

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Objectives

• Briefly discuss the role of standards as
  infrastructure for shareable and interoperable
  data within clinical information systems
• Describe types of terminology systems in relation
  to shareable and interoperable data
• Briefly describe Mayo Clinic local global
  efforts related to shareable and interoperable
  data including the ICF

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The Big Picture Clinical Perspective
Practice Based Evidence
Transactional Databases
Analytic Data Repositories
Replication modeling
Storage and Processing
Research, evaluation, performance measurement
Shareable Data, Information Knowledge
Patient Focused Data Capture
Consolidate with other evidence, other
knowledgebases
Point of care knowledge execution
Clinical Guidelines
Expert Systems
Inform
Evidence Based Practice
Chute Harris
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Shareable Implies Standards

• Need to share and reuse data
• Data are of many types and forms and will be used
  for multiple purposes
• Need to preserve information about data
• At least 3 types of metadata are critical
  (content, business use, technical)
• Need to share and reuse knowledge
• Sharing Integration or interoperability?
• Economically feasible only if interoperability
• Interoperability requires a full set of standards

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Interoperability

• Definition The ability of two or more systems,
  or components, to exchange information and to use
  the information that has been exchanged (IEEE)
• Types of interoperability and representations
• Syntactic interoperability
• (e.g., Relational databases)
• Structural interoperability
• (e.g., DB schemas, XML)
• Semantic interoperability
• (e.g., formalisms RDF, OWL, logics)

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How Do We Achieve Interoperability?

• Standards, standards, standards!
• Standards around data representations
• Structure, process, outcomes
• Evidence
• Patient observations and findings
• Standards around information representations
• Messaging
• Context
• Standards around knowledge representations
• Representation and execution

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Interoperability StandardsSupport from Federal
Government

• Office of the National Coordinator
• Health IT Strategic Framework
• Approved and Adopted CHI Standards
• http//www.hhs.gov/healthit/attachment_3/v.html

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Real Challenges R/T Standards

• Ongoing decisions needed about which standards
  and why
• Endorsement and promotion of standards
• Requirements and rewards
• Education and testing of software

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Terminology Systems in Relation to
Interoperability

• What are types of terminology systems?
• How do they enable interoperability?

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Types of Terminology Systems

• ISO 17117 (current revision)
• Terminology
• Coding system
• Interface terminology
• Reference terminology
• Ontology
• Classification

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Types of Terminologies for Different Goals (ISO
11117)
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Terminology Systems VaryExpressiveness and
Interoperability
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The GAP(H. Solbrig Slide)
Taxonomies and Classification
Many, many more exist
ICD-10
ICD-9-CM
ICD-11
ICF
SNOMED CT
CPT-4
MESH
GO
FMA
LOINC
Many, many more to come
GMOD
Ontologies Computable DL Frameworks
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Bridging the Gap

• Requires community access to content, use,
  validity testing, development opportunities
• Requires standards
• Readily available services and tools

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Mayo Clinic RD Focus

• Multiple terminology systems required to meet
  clinical and business needs
• Embrace standards initiatives
• Need to bridge the gap from local to external
  data, information and knowledge representations

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MANY Terminology Systems in MANY Formats

• Terminology Systems
• WHO Family
• ICD
• ICF
• Others
• UMLS terminologies
• Proprietary terminologies (vended systems)
• Local terminology
• Formats
• Unstructured Structured
• Word documents Formal Models

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MANY Sources of Knowledge and MANY Formats

• Many sources of knowledge content, e.g.
• Current applications and databases
• Business process descriptions
• Practice, research, education and administrative
  processes
• Clinical and other documentation systems
• Best practices (expertise, order sets, protocols,
  etc.)
• And more
• Many ways of organizing/formatting that content
• Lists ? Ontologies

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Need Functional Services Common Model

• Current set of services based on best of breed
  (probably not a complete list)
• Authoring and Editing
• Modeling
• Inferencing and quality control
• Multilanguage support
• Versioning
• Publishing and Distribution
• Browsing
• Query
• Import/Export
• Common model
• Normal form for terminology systems that services
  can act on

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Terminology Tools Meet Models Services
Common model/Normal form Distribution
mechanism Import/Export Browsing across
terminologies Query across terminologies
Terminology Resources
e.g., LexGrid
Formal modeling Quality control Inferencing
Community Input
Knowledge Reps
Authoring Editing
e.g., Protege
e.g., Semantic Wiki
Change Mgmt
Versioning
TBD
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Tools ServicesMeet Terminology Systems
SNOMED CT
Common model/Normal form Distribution
mechanism Import/Export Browsing across
terminologies Query across terminologies
ICF
Table 22
Terminology Resources
Table 61
ICD x
e.g., LexGrid
Formal modeling Quality control Inferencing
Community Input
Knowledge Modeler/Editor
Authoring Editing
Governance
e.g., Protege
e.g., Semantic Wiki
Change Modeler?
Versioning
TBD
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MANY Ways to Represent Information

• Alternatives include
• Templates (HL7)
• Archetypes (OpenEHR)
• Detailed clinical models variants (Vendors)

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Representing Domain KnowledgeBinding Terminology
and Value Sets

Value Sets
Terminologies
Detailed Clinical Models
Governance
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Governed/Managed Repositories
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To Achieve this Vision for Mayo

• Engagement in solving the interoperability
  challenges
• Many people involved in standards development
  communities
• Commitment to developing tools and other
  shareable resources in open environments
• Working with software engineers
• Internal and vended

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Mayo Clinic R/T ICF

• ICF is a target terminology resource
• We are committed to participating in development
  via WHO mechanism
• We are freely sharing tools and terminology
  resources with WHO
• We are actively working to enhance content,
  structure and use of ICF