The ICPS process: Typology of a novel terminological system

1. The ICPS process:Typology of a novel terminological system Stefan SCHULZ IMBI, University Medical Center, Freiburg, Germany Daniel KARLSSON Department of Medical Informatics, Linköping University, Sweden Christel DANIEL INSERM, UMR_S 872, eq.20, Descartes University, Paris, France Hans COOLS AGFA Healthcare, Gent, Belgium Christian LOVIS Medical Informatics Service, University Hospitals of Geneva, Switzerland Detecting and Eliminating Bacteria UsinG Information Technology

2. Background

3. Background • Patient safety: Increased attention and awareness on a global scale • WHO is developing the International Classification for Patient Safety (ICPS) together with the World Alliance for Patient Safety • to represent patient safety workflows • to facilitate international reporting and data exchange • to facilitate international research collaboration • Novel, ontology-based methodology • Current state of ICPS: • conceptual framework • field testing, but not yet released • available at http://www.who.int/patientsafety/taxonomy/en/

4. Structure of the Talk • ICPS: How does it look like? • ICPS: What it isn’t • ICPS: What it is now • ICPS: What it may be in the future

5. ICPS Architecture Critique Typology Outlook ICPS: Architecture

6. ICPS Architecture Critique Typology Outlook Three components of ICPS ICPS "taxonomy" “Conceptual Framework” • Hazard: a circumstance, agent or action with the potential to cause harm. • Circumstance: a situation or factor that may influence an event, agent or person(s). • Event: something that happens to or involves a patient. • Agent: a substance, object or system which acts to produce change. • Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum. • Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury. • Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient. “Key Concepts”

7. ICPS Architecture Critique Typology Outlook Three components of ICPS ICPS "taxonomy" “Conceptual Framework” • Hazard: a circumstance, agent or action with the potential to cause harm. • Circumstance: a situation or factor that may influence an event, agent or person(s). • Event: something that happens to or involves a patient. • Agent: a substance, object or system which acts to produce change. • Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum. • Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury. • Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient. “Key Concepts”

8. ICPS Architecture Critique Typology Outlook ICPS Conceptual Framework Contributing Factors / Hazards influences informs PatientCharacteristics IncidentCharacteristics IncidentType Actions Taken To Reduce Risk Actions Taken To Reduce Risk influences Detection informs informs influences Mitigating Factors informs Organi-zationalOutcome informs PatientOutcome influences informs Ameliorating Actions

9. ICPS Architecture Critique Typology Outlook ICPS Conceptual Framework Contributing Factors / Hazards influences informs PatientCharacteristics IncidentCharacteristics IncidentType Actions Taken To Reduce Risk Actions Taken To Reduce Risk influences Detection informs informs influences Mitigating Factors informs Organi-zationalOutcome informs PatientOutcome influences informs Ameliorating Actions

10. ICPS Architecture Critique Typology Outlook ICPS Conceptual Framework Contributing Factors / Hazards influences informs PatientCharacteristics IncidentCharacteristics IncidentType Actions Taken To Reduce Risk Actions Taken To Reduce Risk influences Detection informs informs influences Mitigating Factors informs Organi-zationalOutcome informs PatientOutcome influences informs Ameliorating Actions

11. ICPS Architecture Critique Typology Outlook ICPS Conceptual Framework Contributing Factors / Hazards influences informs PatientCharacteristics IncidentCharacteristics IncidentType Actions Taken To Reduce Risk Actions Taken To Reduce Risk influences Detection informs informs influences Mitigating Factors informs Organi-zationalOutcome informs PatientOutcome influences informs Ameliorating Actions

12. ICPS Architecture Critique Typology Outlook ICPS Conceptual Framework Contributing Factors / Hazards influences informs PatientCharacteristics IncidentCharacteristics IncidentType Actions Taken To Reduce Risk Actions Taken To Reduce Risk influences Detection informs informs influences Mitigating Factors informs Organi-zationalOutcome informs PatientOutcome influences informs Ameliorating Actions

13. ICPS Architecture Critique Typology Outlook ICPS Conceptual Framework Contributing Factors / Hazards influences informs PatientCharacteristics IncidentCharacteristics IncidentType Actions Taken To Reduce Risk Actions Taken To Reduce Risk influences Detection informs informs influences Mitigating Factors informs Organi-zationalOutcome informs PatientOutcome influences informs Ameliorating Actions

14. ICPS Architecture Critique Typology Outlook ICPS Conceptual Framework Contributing Factors / Hazards influences informs PatientCharacteristics IncidentCharacteristics IncidentType Actions Taken To Reduce Risk Actions Taken To Reduce Risk influences Detection informs informs influences Mitigating Factors informs Organi-zationalOutcome informs PatientOutcome influences informs Ameliorating Actions

15. ICPS Architecture Critique Typology Outlook ICPS Conceptual Framework Contributing Factors / Hazards influences informs PatientCharacteristics IncidentCharacteristics IncidentType Actions Taken To Reduce Risk Actions Taken To Reduce Risk influences Detection informs informs influences Mitigating Factors informs Organi-zationalOutcome informs PatientOutcome influences informs Ameliorating Actions

16. ICPS Architecture Critique Typology Outlook ICPS Conceptual Framework Contributing Factors / Hazards influences informs PatientCharacteristics IncidentCharacteristics IncidentType Actions Taken To Reduce Risk Actions Taken To Reduce Risk influences Detection informs informs influences Mitigating Factors informs Organi-zationalOutcome informs PatientOutcome influences informs Ameliorating Actions

17. ICPS Architecture Critique Typology Outlook ICPS Conceptual Framework Contributing Factors / Hazards influences informs PatientCharacteristics IncidentCharacteristics IncidentType Actions Taken To Reduce Risk Actions Taken To Reduce Risk influences Detection informs informs influences Mitigating Factors informs Organi-zationalOutcome informs PatientOutcome influences informs Ameliorating Actions

18. ICPS Architecture Critique Typology Outlook ICPS Conceptual Framework Contributing Factors / Hazards influences informs PatientCharacteristics IncidentCharacteristics IncidentType Actions Taken To Reduce Risk Actions Taken To Reduce Risk influences Detection informs informs influences Mitigating Factors informs Organi-zationalOutcome informs PatientOutcome influences informs Ameliorating Actions

19. ICPS Architecture Critique Typology Outlook ICPS Conceptual Framework

20. ICPS Architecture Critique Typology Outlook ICPS Components ICPS "taxonomy" “Conceptual Framework” • Hazard: a circumstance, agent or action with the potential to cause harm. • Circumstance: a situation or factor that may influence an event, agent or person(s). • Event: something that happens to or involves a patient. • Agent: a substance, object or system which acts to produce change. • Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum. • Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury. • Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient. IncidentCharacteristics IncidentCharacteristics “Key Concepts”

21. ICPS Architecture Critique Typology Outlook ICPS “Taxonomy” IncidentCharacteristics

22. ICPS Architecture Critique Typology Outlook ICPS Conceptual Framework ICPS "taxonomy" “Conceptual Framework” • Hazard: a circumstance, agent or action with the potential to cause harm. • Circumstance: a situation or factor that may influence an event, agent or person(s). • Event: something that happens to or involves a patient. • Agent: a substance, object or system which acts to produce change. • Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum. • Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury. • Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient. “Key Concepts”

23. ICPS Architecture Critique Typology Outlook ICPS Key Concepts • Classification: an arrangement of concepts into classes and their subdivisions, linked so as to express the semantic relationships between them. • Concept: a bearer or embodiment of meaning. • Class: a group or set of like things.Hazard: a circumstance, agent or action with the potential to cause harm. • Healthcare: services received by individuals or communities to promote, maintain, monitor or restore health. • Event: something that happens to or involves a patient. • Patient: a person who is a recipient of healthcare. • Agent: a substance, object or system which acts to produce change. • Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum. • Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury. • Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient.

24. ICPSArchitectureCritique Typology Outlook Structure of the Talk • ICPS: How does it look like? • ICPS: What it isn’t • ICPS: What it is now • ICPS: What it may be in the future

25. ICPSArchitecture Critique Typology Outlook ICPS is not yet…

26. ICPSArchitecture Critique Typology Outlook Analyzing ICPS • target of analysis: the ICPS tree… • graph structure: resemblance with WHO-FIC classifications(4 – 5 levels, single parents) • artifact meant to be used by medical coders • key concepts winscp.exeand conceptual framework: meta information from user’s point of view • Hazard: a circumstance, agent or action with the potential to cause harm. • Circumstance: a situation or factor that may influence an event, agent or person(s). • Event: something that happens to or involves a patient. • Agent: a substance, object or system which acts to produce change. • Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum. • Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury. • Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient.

27. ICPSArchitecture Critique Typology Outlook ICPS is not… … a taxonomy (ENV 12264:2005, Cornet 2006) • Semantic nature of hierarchic links are not specified • Subclass or is-a relation:a class B is a subclass of a class Aif and only if all members of B are also members of A(ENV 12264:2005, Horrocks 2003)

28. ICPSArchitecture Critique Typology Outlook ICPS is not yet… … a classification (ISO 17115:2007, Ingenerf MIM 1998, Madden [WHO-FIC] 2007) • Criterion of mutually disjoint,exhaustive classes not fulfilled • more than hundred ICPS concepts occur more than once in different hierarchies • Healthcare Professional occurs both as a child of People Involved and Person Reporting

29. ICPSArchitectureCritique Typology Outlook Structure of the Talk • ICPS: How does it look like? • ICPS: What it isn’t • ICPS: What it is now • ICPS: What it may be in the future

30. ICPSArchitectureCritique Typology Outlook ICPS: What it is now ICPS "taxonomy" “Conceptual Framework” • Hazard: a circumstance, agent or action with the potential to cause harm. • Circumstance: a situation or factor that may influence an event, agent or person(s). • Event: something that happens to or involves a patient. • Agent: a substance, object or system which acts to produce change. • Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum. • Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury. • Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient. “Key Concepts”

31. ICPSArchitectureCritique Typology Outlook ICPS: What it is now • This is a rudimentary, informal ontology • describes terms by their generic properties • close to upper-level ontologies (e.g. BioTop): “state”, “substance”, “event”, “agent”, “object”, “action”, “quality”. “Concepts by Class” “Conceptual Framework” • Hazard: a circumstance, agent or action with the potential to cause harm. • Circumstance: a situation or factor that may influence an event, agent or person(s). • Event: something that happens to or involves a patient. • Agent: a substance, object or system which acts to produce change. • Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum. • Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury. • Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient. “Key Concepts”

32. ICPSArchitectureCritique Typology Outlook ICPS: What it is now ICPS "taxonomy" “Conceptual Framework” • Hazard: a circumstance, agent or action with the potential to cause harm. • Circumstance: a situation or factor that may influence an event, agent or person(s). • Event: something that happens to or involves a patient. • Agent: a substance, object or system which acts to produce change. • Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum. • Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury. • Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient. • This is a complex patient safety model • Similarity with • - workflows • business models • Ontologically: • complex event type “Key Concepts”

33. ICPSArchitectureCritique Typology Outlook ICPS: What it is now This is a structured data acquisition template consisting of (mostly) binary fields Can be described as information model Hierarchical parents provide context information for fields(but are not superclasses) ICPS "taxonomy" “Conceptual Framework” • Hazard: a circumstance, agent or action with the potential to cause harm. • Circumstance: a situation or factor that may influence an event, agent or person(s). • Event: something that happens to or involves a patient. • Agent: a substance, object or system which acts to produce change. • Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum. • Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury. • Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient. “Key Concepts”

34. Structure of the Talk • ICPS: How does it look like? • ICPS: What it isn’t • ICPS: What it is now • ICPS: What it may be in the future

35. ICPSArchitectureCritique Typology Outlook What ICPS may be in the future • After finishing, ICPS has the potential to be universally accepted as a reporting standard • The ICPS “key concepts” may become a fully-fledged formal ontology rooted in existing upper-level ontologies and using Semantic Web standards, e.g. OWL • The ICPS “conceptual framework” can be ontologized in the same line • The ICPS reporting template ("taxonomy") may be fully described in terms of ICPS’s ontological core • but…

36. ICPSArchitectureCritique Typology Outlook Open issues • The needs for semantically interoperable patient-safety relevant event reporting is essentially different from the reporting of diseases • For the latter, the format of a statistical classification is adequate (ICD-10) • Is the format of a reporting template adequate for the purpose ICPS is devised for? • Is it necessary to transform the ICPS tree into a real taxonomy or classification structure? • Terms like “taxonomy”, “classification” should be used thoughtfully

37. Acknowledgements Is the “International Classification for Patient Safety” (ICPS) a Classification? Stefan SCHULZ, Daniel KARLSSON, Christel DANIEL, Hans COOLS, Christian LOVIS Thanks for discussions: Pierre Lewalle (WHO) Jean-Marie Rodrigues Cédric Bousquet (Université de St.Etienne)