Title: Building an Ontology of Adverse Event and Near Miss Data: Information Gleaned from The Patient Safet
1Building an Ontology of Adverse Event and Near
Miss Data Information Gleaned from The Patient
Safety Event Taxonomy (PSET) Project
- Mariana Casella dos Santos, MD
- Language and Computing. Inc
2PRESENTATION OVERVIEW
- Incident Reporting Today
- The intent of PSET
- HIRO
- What is it and why?
- Reconciling the data
- Enabling PSET classification
- Towards a HIRO powered reporting system
3Incident Reporting Today
Passed into law on July 29, 2005, the Patient
Safety and Quality Improvement Act stipulates
that the Department of Health and Human Services
(DHHS) will develop a process for the voluntary
and confidential reporting of health care related
errors by health care organizations to Patient
Safety Organizations (PSOs) which will develop
ways to improve patient safety and reduce
medical errors.A network of patient safety
databases is to be developed that can accept,
aggregate and analyze non-identifiable patient
safety data. Voluntary use of national standards
to promote electronic exchange of healthcare
information will be developed or adopted. Use of
data standards would provide a common reporting
format for the network of patient safety
databases that will be developed, and will allow
for the comparison of data across multiple health
information technology systems (incident
reporting systems).
4Incident Reporting Today
- Laborious Processes leading to non-compliance
Low Quality of Data Captured
5Project Overview
- This project is premised on the notion that a
centralized, standardized national reporting
system for adverse events will be highly valuable
in promoting quality improvement, and in reducing
medical errors.
6Project Overview
- This project will provide answers to many
questions surrounding the feasibility and
clinical utility of combining, and analyzing data
from across the many reporting systems that
collect adverse events, near misses, and other
patient safety-related information. -
7CF Causal or Contributing Factor
8Making Systems Interoperable
Incident Reporting System C
Incident Reporting System B
Incident Reporting System A
Patient Safety Event Taxonomy
Standardized Data
9(No Transcript)
10Analysis of Taxonomic Relationships
- Hypothetical relationships that exist between
nodes of the taxonomy - Event type to Cause
- Cause to Impact
11The Hospital Incident Reporting Ontology (HIRO)
- What is it? And what for?
12- Research Questions
- Does deconstructing data using the PSET/HIRO
provide a hospital with more useful information
than it could obtain using its own pre-existing
system?
13Hospital Data, PSET HIRO
Making Systems Interoperable
Hospital C Incident Data
Hospital A Incident Data
Hospital B Incident Data
Standardization
Perspective
Patient Safety Event Taxonomy
14Hypothesis
- The aggregate data provided to hospitals after
deconstruction with PSET and analysis with the
ontology is more useful than data aggregated
using existing resources
153 Components of the HIRO project
- HIRO ontology
- Formal ontology
- Re-Built from scratch
- Populated with incidence report observables
- View independent representation of reality
- Hospital incidence report terminologies
- An aid to integrating patient data into the HIRO
ontology - PSET Definitions
- Patient Safety Event Taxonomy delivered by JCAHO
- View application perspective reality in terms
of incidence reporting
16The Basic Terminology
Hierarchical relationship Denoted also by is
subsumed by or inherits from or
is-subclass-of (OWL)
TELEPHONE
Horizontal relationship Also called property
(OWL) or predicate (FO)
IS-A
HAS-PROPERTY
BLACK TELEPHONE
BLACK
Concepts also called entity or type (FO) or Class
(OWL)
Zwarte telefoon
Black phone
Terms also called description or name Not
supported by OWL
17 Scope scale of HIRO
INCIDENT
Horizontal relationship
IS-A
HIRO 37 relationship types, 1879
Non-hierarchical relations
HAS-NON-INSTANTIATION
INCIDENT WITHOUT HARM
HARM
Concepts HIRO Originally 400 concepts, now
4053. PSET 162 Concepts
Incident, no harm
Terms HIRO 4561 English terms PSET Hospital
terminologies 5910
18Alternate Views granular partitions
Ontology Ontology is the science of what is, of
the kinds and structures of objects, properties,
events, processes and relations in every area of
reality.
Taxonomy A specific partition of reality
(incidence reporting) A drawing of a boundary
over a certain domain An artifact of our
cognition
Think of it as Albertis grid...
19HIRO PSET
HIRO Formal Ontology
REALITY
Bridging Horizontal relationships
PSET Taxonomy (original structure)
INCIDENCE REPORTING PERSPECTIVE
20Differences in structuring
Taxonomy
Purpose Classification a given defined
portion of reality according to a specific
perspective
Drawbacks Rigid structure No possibility for
expansion Example Loading/merging of other
classifications is impossible Financial
Impact on Hospital Taxonomy
21Differences in structuring example
Expandibility - Neutrality
22Differences in structuring example
23HIRO Framework
DOMAIN-ENTITY
Upper Level Concepts
ENDURANT
PERDURANT
MOTION PROCESS
Mid Level Concepts
FALL
Domain specific Concepts
FALL FROM BEDSIDE COMMODE
FALL CAUSED BY IMPROPER FOOTWEAR
24HIRO concept creation
FALL IN BATHROOM WHILE ASSISTED
HOSPITAL 4
HEALTH CENTER 1
25Interpretation examples
HIRO
Hospital specific terminology
26Hospital
Incident report
Incident
HIRO Ontology
??
JCAHO Incident Data
JCAHO
Analysis
27HIRO terminologies
ENTITY
META-ENTITY
DOMAIN-ENTITY
28HIRO
PSET, CUSTOM Hierarchies..
Hospital Terminology
Instances one Incident Grouped by month /
hospital
29HIRO
Hospital Terminology
Manual Mapping
30HIRO
PSET, CUSTOM Hierarchies..
Hospital Terminology
Manual Mapping
Instances one Incident Grouped by month /
hospital
31- Query the HIRO Ontology
- Straightforward queries
- All dose omissions
- All adverse Drug reactions
- All falls
- All assisted falls
-
HIRO
- NOT straightforward
- All medication errors
Instances one Incident Grouped by month /
hospital
32HIRO
OR Use the ontology
- Query Medication Errors?
- Identify all HIRO concepts denoting a medication
error. - Use the Ontology
- Use a custom made framework (- medication error
portal on HIRO) to ease querying
33HIRO
PSET, CUSTOM Hierarchies..
Instances one Incident Grouped by month /
hospital
PSET Fully developed perspective Analyses HIRO
items in terms of cause, type, domain, etc GI -
GENERAL INCIDENT REPORTING TERMINOLOGY Small
Example framework Analyses HIRO items in terms
of type of incident (one of 6) persons
involved
34Internal report (s)
Incident
- 2. Loss of information
- Attempt to categorize into type / cause / outcome
- Hospitals view on what needs and
- what not needs to be reported
- 1. Loss of information
- Incomplete Reporting
- Very concise terminology
- Data that does not fit goes into narratives
- Primitive terminology
- Might not take into account all necessary
variables
Data sent to JCAHO
3. General Loss of information administration
HIRO
PSET
35A Solution (utopia?) Standardized reporting
terminology system
with
without
HIRO
HIRO
Standardized Terminology software support
Loss of information Level of detail very
variable Effort to map all reports
Loss of information can be prevented Level of
detail customizable Map only standardized
terminology
36Questions?