Utility and Added Value of Classifications in Health Information Systems
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Health Information Systems; ICD, ICD11, SNOMED-CT, Use Cases showing benefits of use of classification- terminology systems; avoid and e-tower of Babel; electronic health record, Enhance Patient Care, Decision Support, Safety & Quality
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Utility and Added Value of Classifications in Health Information Systems
- 1. Utility & Added-value of Classifications in Health Information Systems Tevfik Bedirhan Üstün Classifications, Terminologies, Standards Team World Health Organization
- 2. A Web of Collaborators
- 3. “Key” in the keynote
- 4. CLASSIFICATIONS TERMINOLOGIES & standards … BUILDING BLOCKS OF HEALTH INFORMATION …
- 5. Sharing Meaning YOU • Think • wish to express • think you have just expressed • you expressed • … OTHER ONE • wants to hear • Actually hears • wishes to understand • understands • …
- 6. Genealogy of ICD 1664 350 years
- 7. ICD Revisions 139 161 179 189 205 214 200 954 965 1,040 1,164 8,173 1,967 14,473 1 10 100 1000 10000 100000 Farr/d'Espine Bertillon ICD 1 ICD 2 ICD 3 ICD 4 ICD 5 ICD 6 ICD 7 ICD 8 ICD 9 ICD-9-M ICD 10 ICD-10-M 1853 1893 1900 1909 1920 1929 1938 1948 1955 1968 1975 1979 1990 1993
- 8. Placing WHO Classifications in HIS & IT Population Health • Births • Deaths • Diseases • Disability • Risk factors ICD ICF ICHI Classifications Clinical • Decision Support • Integration of care • Outcome Administration • Scheduling • Resources • Billing Reporting • Cost • Needs • Outcome
- 11. Placing WHO Classifications in HIS & IT Population Health • Births • Deaths • Diseases • Disability • Risk factors e-Health Record Systems ICD ICF ICHI Classifications Linkages KRs Terminologies Clinical • Decision Support • Integration of care • Outcome Administration • Scheduling • Resources • Billing Reporting • Cost • Needs • Outcome
- 12. ICD-11 Revision Goals 1. Evolve a multi-purpose and coherent classification – Mortality, morbidity, primary care, clinical care, research, public health… – Consistency & interoperability across different uses 2. Serve as an international and multilingual reference standard for scientific comparability and communication purposes 3. Ensure that ICD-11 will function in an electronic environment. • ICD-11 will be a digital product • Support electronic health records and information systems • Link ICD logically to underpinning terminologies and ontologies (e.g. SNOMED, GO, …) • ICD Categories “defined” by "logical operational rules" on their associations and details
- 13. • Essential for EHR • Enhance Care • Decision Support • Safety & Quality • Better Collaboration • Monitoring & Evaluation • Better Health Information • Less Administration
- 14. Why is this Sooooo important ?
- 15. Health Information Systems: Analog to Digital How do we optimize our health services
- 16. Digital Models New business models e-health Existing business models New products Existing products e-bay e-trade e-banking e-media (music/video)
- 18. Computers are S T U P I D ? They cannot ask questions ¿ They may –if you enable them - only give you answers. Pablo Picasso
- 19. What is “NOntology” ? Ontology (philosophy) the Organization of Reality !!! Ontology (computer science) – the explicit – operational description of the conceptualization of a domain • Entities • Atributes • Values • An ontology defines: – a common vocabulary – a shared understanding/exchange: • among people • among software agents • between people and software – to reuse data - information – to introduce standards to allow interoperability
- 20. THE CONTENT MODEL Any Category in ICD is represented by: 1. ICD Concept Title 1.1. Fully Specified Name 2. Classification Properties 2.1. Parents 2.2 Type 2.3. Use and Linearization(s) 3. Textual Definition(s) 4. Terms 4.1. Base Index Terms 4.2. Inclusion Terms 4.3. Exclusions 5. Body Structure Description 5.1. Body System(s) 5.2. Body Part(s) [Anatomical Site(s)] 5.3. Morphological Properties 6. Manifestation Properties 6.1. Signs & Symptoms 6.2. Investigation findings 7. Causal Properties 7.1. Etiology Type 7.2. Causal Properties - Agents 7.3. Causal Properties - Causal Mechanisms 7.4. Genomic Linkages 7.5. Risk Factors 8. Temporal Properties 8.1. Age of Occurrence & Occurrence Frequency 8.2. Development Course/Stage 9. Severity of Subtypes Properties 10. Functioning Properties 10.1. Impact on Activities and Participation 10.2. Contextual factors 10.3. Body functions 11. Specific Condition Properties 11.1 Biological Sex 11.2. Life-Cycle Properties 12.Treatment Properties 13. Diagnostic Criteria 20
- 21. The ICD Foundation Component • is a collection of ALL ICD entities like diseases, disorders... • It represents the whole ICD universe. • In a simple way, the foundation component is similar to a “store” of books or songs. • From these elements we build a selection as a linearization. • This analogy may however be misleading because there are many links between the ICD entities (like parent-child relations and other). • The ICD entities in the Foundation Component: • are not necessarily mutually exclusive • allow multiple parenting ( i. e. an entity may be in more than one branch, for example tuberculosis meningitis is both an infection and a brain disease)
- 22. The ICD Linearizations • A linearization is a subset of the foundation component, that is: • Fit for a particular purpose: reporting mortality, morbidity, or other uses • Jointly Exhaustive of ICD Universe (Foundation Component) • Composed of entities that are Mutually Exclusive of each other • Each entity is given a single parent
- 23. 23 Foundation: ICD categories with - Definitions, synonyms - Clinical descriptions - Diagnostic criteria - Causal mechanism - Functional Properties Find Term SNOMED-CT, International Classification of Functioning, Disability and Health (ICF)… Linearizations Morbidity Mortality Primary Care
- 24. • Open and Collaborative Platform – Web based – Like WIKIPEDIA • But – by the Content Model • with – by the TAGs , and scientific peers
- 25. ICD11 βeta • http://www.who.int/classifications/icd/revision • Beta – Browser & Print 10 look & feel + descriptions – code structure ! • ICD-11 Beta draft is NOT FINAL • updated on a daily basis •NOT TO BE USED for CODING except for agreed FIELD TRIALS βeta
- 26. ICD-11 Features Internet Based Platform Content Model Multi Lingual Representations Input from all Stakeholders Definitions لعربية Arabic 官话Chinese English English Français French Русский язык Russian Español Spanish Deutsch German Português Portuguese Field Trials for Use Cases Electronic Health Record Ready 26
- 27. Beta • Comments • Proposals • Field Trials • Review Mechanism
- 29. ICD-11 Timeline • 2014 : Beta : Field Trials Version – Systematic/scientific reviews – Vigorous crowdsourcing – Field Trials • 2017 : Final version for WHA Approval – 2018+ implementation Perpetual DIGITAL editing – review cycles
- 30. SNOMED : Old and Current Former SNOMED Enterprise College American Pathologists Network Global Overall Health Care
- 31. Why work together? – WHO & IHTSDO – Coverage & Adequacy – Quality – Reliability - Utility – MultiLingual Applicability – Interoperability – Sustainability – Member States: Enable health care delivery and compile health information SNOMED & WHO Classifications are synergistic and not antagonistic
- 32. The «Common Ontology» Purpose • To provide a common formal knowledge representation structure to enable interoperability between: – ICD-11 and SNOMED CT. – a shared semantics
- 33. Ultimate “Turing-like” Test If common ontology achieved
- 35. Humpty Dumpty Theory • "When I use a word," Humpty Dumpty said, in rather a scornful tone, "it means just what I choose it to mean- neither more nor less."
- 36. Knowledge Representation Grade 3 hypertension Grade 2 hypertension Grade 1 hypertension High normal normal optimal 120 130 140 150 160 170 180 Systolic pressure Diastolic pressure 172 102 110 105 100 95 90 85 80 37
- 37. Rewriting ICD Using SNOMED example of Depressive Disorder F32.0 A. Low mood {41006004} Loss of interest {417523004 } Low energy {248274002} 1. Appetite (decrease, increase) {64379006, 72405004} 2. Body weight (decrease, increase) {89362005, 8943002} 3. Sleep (decrease, increase) {59050008, 77692006} 4. Psychomotor (decrease, increase) {398991009, 47295007} 5. Libido loss {8357008} 6. Low self esteem {286647002, 162220005} 7. Guilt, self blame {7571003} 8. Thoughts of death … 9. Suicide Ideation {102911000, 6471006} B.
- 38. Beyond GoogleTM Semantic Interoperability for HIS • Search using Concepts above Words – How many patients do have diabetes mellitus type II? • Extraction of Concepts from Health Records – Automated extraction of Hb1Ac results of selected patients with DM type II from lab reports within last year • Statistical Index on Community Collections – Calculation of coverage gap for treatment need for diabetes mellitus • Concept Navigation across Collections – Comparison of region A with region B etc 39
- 40. Real Time Public Health Rule-based Aggregation @ Individual, Facility, Population levels Public Health, Epi & Surveillance Findings Events Interventions Reimbursement Resource Management Clinical Information
- 41. Clinical Use Case: Exploration of Cough 386661006 Fever COUGH 49727002 WET COUGH sputum 28743005 Hemoptisia Blood in Sputum 207069003 • X-ray : Tbc? • Culture 399208008 104184002 A 15.0 • Diagnosis: Tuberculosis 154283005 • Treatment: DOTs { 324453004 }
- 42. Interoperability
- 43. Questions & Answers ustunb@who.int @ustunb