ICBO 2011 Chutex

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2 Οκτ 2013 (πριν από 3 χρόνια και 10 μήνες)

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Biomedical Informatics

Some Observations on

Clinical Data Representation in EHRs



Christopher G. Chute, MD
DrPH
, Mayo Clinic


Chair, ICD11 Revision, World Health Organization


Chair, ISO Tech. Comm. TC215 Health Informatics


International Conference on Biomedical Ontology

Buffalo, 30 July 2011

Biomedical Informatics

© 2007 Mayo Clinic College of Medicine

2

From Practice
-
based Evidence

to Evidence
-
based Practice

Patient

Encounters

Clinical

Databases

Registries
et al.

Clinical

Guidelines

Medical Knowledge

Expert

Systems

Data

Inference

Knowledge

Management

Decision

support

Ontology

Shared Semantics

Vocabularies & Terminologies


Biomedical Informatics

© 2007 Mayo Clinic College of Medicine

3

Blois, 1988

Medicine and the nature of vertical reasoning


Molecular: receptors, enzymes, vitamins, drugs


Genes, SNPs, gene regulation


Physiologic pathways, regulatory changes


Cellular metabolism, interaction, meiosis,…


Tissue function, integrity


Organ function, pathology


Organism (Human), disease


Sociology, environment, nutrition, mental health…

Biomedical Informatics

© 2007 Mayo Clinic College of Medicine

4

The Continuum Of Biomedical Informatics

Bioinformatics meets Medical Informatics

Chasm of Semantic Despair

Biomedical Informatics

© 2007 Mayo Clinic College of Medicine

5

The Historical Center of the

Health Data Universe

Clinical Data

Billable Diagnoses

Billable Diagnoses

Biomedical Informatics

© 2007 Mayo Clinic College of Medicine

6

Copernican Healthcare


Billable Diagnoses

Clinical Data

(Niklas Koppernigk)

Clinical Guidelines

Scientific Literature


Medical Literature

Clinical Data

Biomedical Informatics

World Health Organization; ICD
-
11

7

Biomedical Informatics

World Health Organization; ICD
-
11

8

Biomedical Informatics

© 2007 Mayo Clinic College of Medicine

9

Familiar Points Along Continuum

Modern Health Vocabularies


Nomenclature


Highly Detailed Descriptions (SNOMED)


Classification


Organized Aggregation of Descriptions into a Rubric
(ICDs)


Groupings


High Level Categories of Rubrics (DRGs)

Detailed

Grouped

Nomenclature

Classification

Groups

Groupers

Aggregation

Biomedical Informatics

© 2007 Mayo Clinic College of Medicine

10

Aggregation Logics by domain

rule
-
based aggregations

Decision Support
and Error Detection

Public Health and

Surveillance

Reimbursement
and Management

Outcome Research
and Epidemiology

Findings

Interventions

Events

Biomedical Informatics

© 2007 Mayo Clinic College of Medicine

11

ICD11 Use Cases


Scientific consensus of clinical
phenotype


Public Health Surveillance


Mortality


Public Health Morbidity


Clinical data aggregation


Metrics of clinical activity


Quality management


Patient Safety


Financial administration


Case mix


Resource allocation

Biomedical Informatics

© 2007 Mayo Clinic College of Medicine

12

Traditional Hierarchical System

ICD
-
10 and family

Biomedical Informatics

© 2007 Mayo Clinic College of Medicine

13

Addition of semantic arcs
-

Ontology

Relationships


Logical Definitions


Etiology


Genomic


Location


Laterality


Histology


Severity


Acuity

Biomedical Informatics

© 2007 Mayo Clinic College of Medicine

14

Linear views may serve multiple use
-
cases

Morbidity, Mortality, Quality, …

Biomedical Informatics

ICD11
Content Model

Descriptive characteristics

1.
Type

Disease
, disorder, syndrome, injury,
sign/symptom, external cause, reason for
encounter

2.
Body System(s)

(
pathophysiology)

3.
Body Part(s)

(
anatomical site)

4.
Manifestation Attributes


a.
Signs & Symptoms

b.
Diagnostic Findings

5.
Causal Properties

(etiology)


a.
Causal Mechanisms /Agents

b.
Genomic characteristics

6.
Temporal Properties

7.
Severity and/or Extent

8.
Functional Impact

9.
Treatment

TITLE
:

Name of disease, disorder, or syndrome…

1.
Textual
definition 2.
Synonyms
-

Inclusion


Exclusion
-

Index terms

Maintenance attributes


A.
Unique identifier


B.
Subset, adaptation, and
special view flag


1. Primary Care

2. Clinical Care

3. Research

4. Special indices (e.g. Public Health
Indices or Resource Groupings)


C.
Hierarchical relationships



parents and children in ICD
structure

D.
Mapping
relationships


Linkages
to other systems like
SNOMED etc
.

A.
Other rules

Biomedical Informatics

ICD11 and SNOMED

16

Relationship with IHTSDO

SNOMED content


IHT (SNOMED) will require high
-
level nodes that
aggregate more granular data


Use
-
cases include mutually exclusive, exhaustive,…


Sounds a lot like ICD


ICD
-
11 will require lower level terminology for
value sets which populate content model


Detailed terminological underpinning


Sounds a lot like
SNOMED


Memorandum of Agreement


July 2010!


WHO right to use for authoring and interpretation

Biomedical Informatics

© 2007 Mayo Clinic College of Medicine

17

Potential Future States

ICD
-
11

SNOMED

Ghost SNOMED

Ghost ICD

Biomedical Informatics

© 2007 Mayo Clinic College of Medicine

18

Alternate Future

ICD
-
11

SNOMED

Joint

ICD
-
IHTSDO

Effort