6. Index
⢠Types of language
⢠Semantic resources
⢠How to deal with this semantic ecosystem?
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7. Types of language
⢠There are different types of language
according to their use in Information Systems
(IS):
â Natural language (can rises up to 90%).
â Controlled vocabularies (the remaining 10%):
⢠Interface (input) vocabularies.
⢠Reference vocabularies.
⢠Aggregation (output) vocabularies.
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8. Types of language
⢠Natural language
â It refers to both oral and written language used by
professionals to communicate with patients and
other physicians:
⢠It is the most friendly, it is natural.
â Depends on the context and interlocutors.
â It includes jargon, acronyms, homonyms, etc.
â Being very reach and flexible.
â It can be very specialized but also very ambiguous.
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9. Types of language
⢠Natural language is human oriented:
â It is not the best choice for IS to advice and
support healthcare professionals.
⢠It is necessary to normalize the relevant
information according to our objective:
â PHR interoperability: Exchange and query?
â Big Data analysis: Plan and discover?
â Healthcare System: Control, make
recommendations and prevention?
â Upcoming: Research and Innovation?
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10. Types of language
⢠Controlled vocabularies are normalized
languages that can be understand by IS, as they
can:
â Identify, localize and differentiate its elements.
â Automatically process it.
â Have a representation of the meanings without
ambiguity and using different levels of detail.
⢠This normalization involves using codes and
attributes to represent specific ideas or units of
meaning.
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11. Types of language
⢠There are 3 types of controlled vocabulary:
â Interface (input):
⢠Vocabulary used directly by healthcare professionals to
record the information of patients in IS.
⢠It represents the first level of formalization and concretion.
â Reference:
⢠It allows relating the vocabularies in order to compare and
consider information from different sources.
⢠It is granular and presents the maximum level of detail.
â Aggregation (output):
⢠Objective: exploiting different kind of information like:
statistics, plan, reimbursement, population analysis, etc.
⢠Interpretation from different points of view is allowed
(manager and financial).
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12. Semantic resources
⢠Semantic resources are controlled vocabularies
used to represent, to codify, to index and/or to
mark data, information or content.
⢠There are many types of resources according to
their structure and objectives:
â Catalogues
â Thesaurus
â Classifications
â Terminologies
â Ontologies
â âŚ
1203/07/2014
13. Semantic resources
⢠Catalogues
â Being plain lists of codes and descriptions
normally close to a limited domain.
â They can also have other few attributes.
â Having usually ONE description per code.
â They are often local but they can be international
as well.
â Objective: to facilitate the identification and
localization of their already sorted elements.
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15. Semantic resources
⢠Thesaurus
â They are formalized lists of terms related to each
other through hierarchy, equivalency or
associative links:
⢠For example synonyms of the same idea.
â Objective: to index or mark content in order to
facilitate the recovery of documents, articles or
other publications in databases of documentation.
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16. ⢠Thesaurus
â Example: COSTART (The Coding Symbols for a
Thesaurus of Adverse Reaction Terms)
1603/07/2014
Semantic resources
17. Semantic resources
⢠Classifications
â They are made of elements with codes and
descriptions that can be grouped in chapters of
content.
â Having concepts organized by classes and subclasses,
following a tree structure (modelled by codes).
â They have different levels of detail (that can include
miscellaneous and unspecific concepts).
â They tend to be international but also can be local.
â Normally they are closed to only one single domain.
â Objective: To classify certain information of patients
(for example diagnosis or procedures).
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19. Semantic resources
⢠Terminologies
â They are made of terms related to each other through
hierarchy and other kind of relationships.
â Their elements can have more than one description
and many other attributes.
â Normally they are international and provide a
standard to achieve semantic interoperability.
â Having high level of detail and granularity in the
representation of its elements.
â Objective: to relate concepts from different sources
and controlled vocabularies that represent the same
idea, using the maximum level of detail.
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21. Semantic resources
⢠Ontologies
â Being semantic networks of related concepts
through many different kinds of associations.
â They have elements that can have many
descriptions and attributes.
â Representing one single domain normally.
â They have concepts with a high level of
abstraction:
⢠Each of them can be codified by a terminology.
â Objective: to represent meanings to allow its
automatic processing in IS.
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26. 2603/07/2014
⢠Healthcare centres have multiple semantic resources for
each domain:
â Medicines, active ingredients, dose forms, routes of
administration, etc.
â Diagnosis, morphology, findings, topologies, etc.
â Other master data like genders, types of address, types of
professionals for roles, etc.
⢠And they need to map vocabularies to represent the
information using the maximum level of detail and to
communicate with other centres and organizations.
⢠Additionally, all these resources need to be maintained and
distributed to all the clinical work stations.
Semantic resources
28. How to deal with this semantic ecosystem?
2803/07/2014
⢠Using tools that have been specifically
designed to manage, distribute, develop and
explore controlled vocabularies:
â Terminology servers (for example HealthTerm and
ITServer).
⢠And using this tools directly at the clinical
work stations in the point of care by
healthcare professionals that is assisting a
patient:
â And recording directly the information using
standards.
29. How to deal with this semantic ecosystem?
2903/07/2014
https://www.youtube.com/watch?v=6v48LqvMk9c
31. Index
⢠SNOMED CT as reference terminology
⢠Introduction
⢠Functionalities
⢠Commercial Tools
â HealthTerm
â ITServer
⢠Clinical Work Station
⢠References
02/07/2014 31
32. SNOMED CT
⢠SNOMED CT is a multilingual and international terminology.
⢠SNOMED CT is a semantic standard that can represent elements of
many healthcare domains:
â Diseases, pharmaceutical products, routes of administration,
substances, procedures, etc.
⢠SNOMED CT uses concepts to represent ideas:
â Each concept has more than one description.
â Each concept is related to other concepts trough relationships
performed by many kind of associations (not only hierarchy).
⢠SNOMED CT also includes extensions that can be viewed as local
versions of the terminology but respecting and following the
standard.
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33. SNOMED CT
⢠SNOMED CT can be used as an interface and
aggregation vocabulary:
â It has accessible descriptions made BY and FOR
healthcare professionals.
â It includes the subset mechanism to facilitate its
use in/with IS and by clinicians:
⢠Capacity to group concepts, descriptions or
relationships in order to use only those we really need.
02/07/2014 33
34. SNOMED CT
⢠BUT⌠the real strength comes when we use
SNOMED CT as a reference terminology:
â It has relationships of many kinds:
⢠Has a multi-hierarchy structure that relates concepts of
different domains.
â It is granular and allows representation of
concepts using the maximum level of detail.
â And it includes a mapping mechanism used to
relate their concepts with elements of other
controlled vocabularies.
02/07/2014 34
35. Introduction
⢠We can found 3 types of tools that work with
controlled vocabularies:
â Browsers.
â Terminology servers.
â Exploiting tools.
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36. Introduction
⢠Browsers
â They allow us to explore the content of controlled
vocabularies through:
⢠Searches: simple and advance.
⢠Navigation: plain list or hierarchy discovery.
â They display all the information about controlled
vocabularies: common name, version, edition,
author, etc.
⢠And also about its content, for each element they
show: ID or CODE, description(s), relationships and any
other attribute.
02/07/2014 36
37. Introduction
⢠Terminology servers
â Tools specially designed to allow users and
systems to work with controlled vocabularies:
⢠Maintenance, distribution, development, etc.
â That allow âterminology (to be used) as a serviceâ.
â They are not databases managers.
02/07/2014 37
38. Introduction
⢠Exploiting tools
â They use controlled vocabularies with other main
proposes:
⢠Like to prescribe a medicine, to report a discharge of a
patient or to order laboratory test analysis.
â Clinical Work Stations of points of care are exploiting
tools.
â Healthcare professionals uses these tools to record
information in the IS of their centre:
⢠This information ideally will be stored in a structured format
and using standardsâŚ
â But professionals donât need to see any code.
02/07/2014 38
39. Introduction
⢠These tools are not mutually exclusive:
â A terminology server should have a browser.
â And most of the exploiting tools have a (partial)
browser to help users to find terms.
⢠And can be used by persons and systems:
â Browsers and exploiting tools are used by persons.
â Terminology servers are used by persons and
systems.
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40. Functionalities
⢠Related to controlled vocabularies, their
components, subsets and mappings:
â Import in a standard or common format:
⢠First release and historical mechanism.
⢠Other metadata.
â Representation.
â Exploration with searches and navigation.
⢠Including queries.
â Export in a standard or common format.
02/07/2014 40
41. Functionalities
⢠Related to controlled vocabularies, their
components, subsets and mappings:
â Creation:
⢠Including translation.
â Edition.
â Inactivation.
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42. Functionalities
⢠Additional functionalities for SNOMED CT:
â Management of extensions:
⢠Includes operations to create, modify and translate
components of SNOMED CT.
â Support to post-coordination and management of
clinical expressions:
⢠Using more than one concept to represent an idea.
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43. Functionalities
⢠Terminology servers can offer these
functionalities in 2 modes:
â Through a user interface: for persons (terminology
managers).
â As a (web) service: for systems.
⢠And they have other functionalities as
management systems like:
â Control of versions.
â Management of users, rolls and profiles.
â âŚ
02/07/2014 43
44. Functionalities
⢠The main functionalities of terminology
servers are described in CTS2 standard of HL7:
â Common Terminology Services Release 2.
â Its definition is at a functional level and establish
profiles and criteria of accomplishment.
â Its specification is independent of controlled
vocabularies, languages, systems and
technologies:
⢠Allowing different implementations approaches.
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48. Clinical Work Station
⢠How can we use controlled vocabularies
stored and managed from terminology servers
in Clinical Work Stations?
02/07/2014 48