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is hard to do (Why?)

Sharing healthcare meaning. is hard to do (Why?). John Madden SNOMED/Duke University. A big, recurring mistake. … you ’ re unlikely to come up with a good language for saying it. If you can ’ t specify what sorts of things you ’ ll be wanting to say …. What do M.D. ’ s want to do/say?.

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is hard to do (Why?)

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  1. Sharing healthcare meaning is hard to do (Why?) John Madden SNOMED/Duke University

  2. A big, recurring mistake …you’re unlikely to come up with a good language for saying it. If you can’t specify what sorts of things you’ll be wanting to say…

  3. What do M.D.’s want to do/say? • Store records retrievably • Ad hoc search • Explore/mine records • Support M.D.-machine interaction (structured reporting, templates) • Decision support • Artificial medical intelligence Okay Oy vay

  4. Germ Theory of Disease “Hmm, odd combination of symptoms!” “Which facts belong in discharge plan?” “Which facts belong in an eye exam note?” “The Facts” We constantly and unconsciously hop heterogeneous levels of abstraction !

  5. Why is this a problem? • Specific, relatively tractable notion of semantics underlies many very successful knowledge representation formalisms • “The existence and non-existence of atomic facts is Reality.…A proposition presents the existence and non-existence of atomic facts.” • “Of what we cannot speak, we must remain silent.”

  6. But what’s missing? • Context • Relevance • Agendas • Workflow embedding • Paraconsistency

  7. 3 Three topologies for “semantic interoperability”

  8. Central semantic authority

  9. What happens? “If you would just our controlled vocabulary (damn it), we wouldn’t have all these interoperability issues. Spheres of Influence

  10. De facto interoperabiltiy Inferencing is tractable Maintenance is conceptually simple Terminological complexity scales poorly Inferencing is brittle Restricts speech Maintenance (in practice) incredibly laborious Pro and con

  11. Hierachical semantics Devoid of specifics but very sharable Very specific but poorly sharable

  12. What happens? • Centralized terminologies ‘lose weight” • Users take on more responsibility • “Weakest link” phenomenon

  13. What happens? Registries Ontology rconciliation

  14. Unrecoverable loss of information Inconsistencies still break inferences And now they might be harder to pinpoint Can still reason And maybe the size of the fact base is smaller and more manageable Pro and con

  15. Federated semantics

  16. Mapping Responsibility is finely divided Quality depends on peer-to-peer collaboration “Map-to-play” Few global guarantees Need to support a “market” in ontology fragments What happens?

  17. Nirvana • Locally consistent • Globally tolerant of inconsistency • Finely granular in either case

  18. Germ Theory of Disease “Unusual combination of symptoms!” “Which facts belong in discharge plan?” “Which facts belong in my exam note?” “The Facts” At what level are we non-interoperable?

  19. Technology fit to use case Very contextual Heavy search Heavy inferencing Very non-contextual

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