...
There is much work going on in ontologies around the world, including in biomedical ontologies. Most of the work is designed with the following purposes in mind:
- computer-based reasoning on facts e.g.
...
- determining from a health record that a patient is at risk of a heart problem, or a candidate for a certain medication;
- aggregation, search and retrieval of data from diverse original source systems, which necessitates rationalisation / mapping of vocabularies used in the original data.
One of the challenges of ontological models is that to work, the data on which inferencing is to be done using the ontology must themselves have a meaning consistent with the ontology. In practical terms this means that the information model(s) of the data must be consistent with or mappable to the ontologies, in other words, ; it also means that the data themselves are likely to be tagged with terms from an ontology. For example, if the data record a 'allergy' for a patient, this has must have the same meaning as 'allergy' does in the ontology. However, this is often not the case due to poorly defined terms; 'allergy' might have been used to mean 'an allergic reaction' or 'a diagnosed allergy. Ontologies also exist in software, although most software developers have no idea of this, due to the failure so far of mainstream ICT education to Ontologies can help here by allowing the detection of such ambiguities see http://ontology.buffalo.edu/medo/Cologne.pdfand by providing well-tested guidelines for how to deal with the corresponding distinctions
Ontologies also exist in software, although most software developers have no idea of this, due to the failure so far of mainstream ICT education to take account of semantics within technical models (i.e. 'class', 'object' or E-R models in the programming sense). Nevertheless, everytime any 'modeller' or programmer creates code, a UML model or an information schema, they are creating some kind of ontology, usually of informational concepts. Software models should be understood as ontologies, because they make commitments to certain flavours particular notions of the concepts they model - including for example, the base data types (Integer, Boolean etc) of programming languages.
...
- 'ontologies of reality' - ontologies whose subject matter is real things, processes or events, rather than information
- 'ontologies of information' - ontologies whose subject matter is information of any kind - i.e. utterances committed to a medium. Concepts undelying such an ontology are likely to have to do with the process of investigating, recording, reporting or similar ideas.
We draw this distinction Obviously 'information' is part of reality, just like everything else, so this distinction needs to be made with care. Nevertheless, we make the distinction because as soon as something s is recorded, there is a question of what the recorded form looks like:
...
- Theoretical approaches
o 1968: Weed's POMR defined a problem/SOAP model of clinical information #Weed1968
o 1978: Elstein described a hypothetico-deductive model of clinical reasoning (mainly diagnosis) #Elstein1978
o 1992: Rector, Nowlan and Kay described an approach in which EHR information included (paraphrasing) 'what can be said, thought and done for the patient' #Rector1991
o 1994: GEHR (Good European Health Record) an EU-funded project that developed requirements for an EHR and an information model #Ingram1995
o 2003: Tange et al proposed a synthesis of the POMR, Elstein and 'conversation for action;' theory #Tange2003 - Practical approaches:
o 1998- : the Danish G-EPJ ('EPJ' = 'EHR'), which described a cycle very similar to the one used in openEHR #Bruun2005
o 2001-3: the Australian GeHR (Good electronic Health Record) project, an approach that introduced formal 'archetypes' #Beale2000
o 2005- : the Swedish Samba project distinguished 3 kinds of interlinked process: clinical, management and communication #Areblad2005 - Act-based approaches:
o 1992: RICHE consortium devised a method of representing health information in terms of acts carried out in the care delivery process #Riche1992
o 1993- : The HL7v3 RIM (reference information model) is a current approach that attempts to represent health information as acts. #hl7org - Medical terminologies: all medical terminologies with any structure whatever are ontologies of some kind, whether they think they are or not, including:
o MeSH
o ICDx
o Read codes
o SNOMED CT
o LOINC
o and many others
Success Criteria
If we are to take an ontological analysis of openEHR seriously, we need There are also approaches not yet included in engineered systems, but most likely essential for the proper semantics of systems in the future. One such concept is 'reference tracking'.
Referent tracking is a variant of the Meed problem-based approach, but better.
Success Criteria
If we are to take an ontological analysis of openEHR seriously, we need to establish success criteria. These might include:
...
- Rector A L, Nowlan W A, Kay S. Foundations for an Electronic Medical Record. Methods of Information in Medicine, 1991, 30:179-186. citeseer
- Austin JL. How to Do Things With Words. Cambridge (Mass.) 1962 - Paperback: Harvard University Press, 2nd edition, 2005. amazon
- HL7 International. Reference Information Model (RIM). See http://www.hl7.org.
- Weed LL. Medical Records, Medical Education and Patient Care. The Problem Oriented Medical Record as a Basic Tool. Cleveland: Case Western Reserve University press, 1968. google scholar amazon
| Anchor |
|---|
| ceusters_smith_2006 |
|---|
| ceusters_smith_2006 |
|---|
|
Ceusters W, Smith B. Strategies for Referent Tracking in Electronic Health Records. J Biomed Inform. 2006 Jun;39(3):362-78. (ePub 2005 Sep 9, draft, slides presented during the IMIA WG6 workshop Ontology and Biomedical Informatics, Rome, Italy, April 29 - Mai 1, 2005)| Anchor |
|---|
| rudnicki_et_al_2007 |
|---|
| rudnicki_et_al_2007 |
|---|
|
Rudnicki R, Ceusters W, Manzoor S, Smith B. What Particulars are Referred to in EHR Data? A Case Study in Integrating Referent Tracking into an Electronic Health Record Application. In Teich JM, Suermondt J, Hripcsak C. (eds.), American Medical Informatics Association 2007 Annual Symposium Proceedings, Biomedical and Health Informatics: From Foundations to Applications to Policy, Chicago IL, 2007;:630-634. (abstract, draft)- Elstein AS, Shulman LS, Sprafka SA. Medical problem solving: an analysis of clinical reasoning. Cambridge, MA: Harvard University Press 1978. amazon
- Tange HJ, Dietz JLG, Hasman A, de Vries Robbé PF. A Generic Model of Clinical Practice - A Common View of Individual and Collaborative Care. Methods of Information in Medicine 3/2003. Schattauer GmbH. complete article
- Bruun-Rasmussen M, Bernstein K, Vingtoft S, Nøhr C, Andersen SK. Quality labelling and certification of Electronic Health Record Systems. Studies in Health Technology and Informatics 2005; 116: p47-52. pubmed
- Areblad M, Fogelberg M, Karlsson D, Åhlfeldt H. SAMBA - Structured Architecture for Medical Business Activities. In: Engelbrecht R, et al. (editors) Connecting Medical Informatics and Bio-Informatics. MIE 2005: Proceedings of Medical Informatics Europe; 2005 Aug 28-31; Geneva, Switzerland. p. 1225-30.
- Beale T, Heard S. The GEHR Object Model - Technical Requirements. 2000. complete document.
- RICHE Consortium. RICHE ESPRIT Project. Final Report. Nov 30 1992.
- Ingram D, Lloyd D, Kalra D, Beale T, Heard S, Grubb, P, Dixon R, Camplin D, Ellis J, Maskens A. Deliverable 19,20,24: GEHR Architecture. GEHR Project 30/6/1995. complete document.
- Pierre GRENON, Barry SMITH and Louis GOLDBERG. Biodynamic Ontology: Applying BFO in the Biomedical Domain. From D. M. Pisanelli (ed.), Ontologies in Medicine, Amsterdam: IOS Press, 2004, 20-38. complete article
- Thomas Beale, Sam Heard. An Ontology-based Model of Clinical Information. pp760-764 Proceedings MedInfo 2007, K. Kuhn et al. (Eds), IOS Publishing 2007.