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Beyond Interoperability: What Ontology Can Do for the EHR

Beyond Interoperability: What Ontology Can Do for the EHR. William R. Hogan, MD, MS July 30 th , 2011 International Conference on Biomedical Ontology. Beyond Interoperability. We all understand the importance of ontology for interoperability But, ontology may also:

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Beyond Interoperability: What Ontology Can Do for the EHR

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  1. Beyond Interoperability: What Ontology Can Do for the EHR William R. Hogan, MD, MS July 30th, 2011 International Conference on Biomedical Ontology

  2. Beyond Interoperability • We all understand the importance of ontology for interoperability • But, ontology may also: • Help our information technology departments get dates correct • Improve the science and practice of diagnosis • Enable healthcare reform

  3. Definitions • Disease* A disposition (i) to undergo pathological processes that (ii) exists in an organism because of one or more disorders in that organism. • Diagnosis* A conclusion of an interpretive process that has as input a clinical picture of a given patient and as output an assertion to the effect that the patient has a disease of such and such a type. • Diagnostic process – the interpretive process… * Scheuermann RH, Ceusters W, and Smith B. Toward an ontological treatment of disease and diagnosis. Proceedings, AMIA Translational Summit, 2009.

  4. Definitions The key point is to distinguish clearly among: The entity observed A record of the observation The process of observing • Disease* A disposition (i) to undergo pathological processes that (ii) exists in an organism because of one or more disorders in that organism. • Diagnosis* A conclusion of an interpretive process that has as input a clinical picture of a given patient and as output an assertion to the effect that the patient has a disease of such and such a type. • Diagnostic process/act – the interpretive process… * Scheuermann RH, Ceusters W, and Smith B. Toward an ontological treatment of disease and diagnosis. Proceedings, AMIA Translational Summit, 2009.

  5. Why Distinguishing Thing vs. Record of Thing Matters What does “effective” date mean? Date record of allergy started to exist in source system (first row)? Or date allergy started to exist (second row)?

  6. Another Example At 6:02p, we got a measurement of TSH concentration as it existed at 2p. We sort by “collected” to see state of patient evolve over time. We sort by “resulted” to see what results came back recently. Some results take days or weeks after collection!

  7. The Problem of Diagnostic Error • According to one review*, rate is 2-15% • Varies by specialty, care setting, and disease • Significant cause of adverse events (~8-17%) • Leading or 2nd leading cause of malpractice claims • Diagnosticians are overconfident in wrong diagnoses* *Berner ES, Graber ML. Overconfidence as a cause of diagnostic error in medicine. Am J Med. 2008;121(5A):S2-S23.

  8. Current EHR Support for Diagnosis • Retrieval and display of data/information about the patient • Capture output of diagnostic process as: • Narrative text • Billing ICD codes • “Problem list”

  9. Current EHR Support for Diagnosis • Retrieval and display of data/information about the patient • Capture output of diagnostic process as: • Narrative text • Billing ICD codes • “Problem list” In other words, the EHR supplies input to, and captures the output of, the diagnostic process, but leaves out everything in between!

  10. No Tracking of Diseases

  11. No Tracking of Diseases All three diagnoses refer to the same disease, but there are no links! No disease gets a unique identifier, only records of diseases (diagnoses)

  12. Referent Tracking, Diseases, and Diagnoses

  13. Referent Tracking, Diseases, and Diagnoses Aha! A misdiagnosis? Or a different disease (which needs a new id)?

  14. Healthcare Reform: Episodes of Care With thanks to Werner Ceusters, University at Buffalo PtID Date SNOMED CT code Narrative 5572 07/04/2011 26442006 closed fracture of shaft of femur IUI-001 IUI-001 5572 07/04/2011 81134009 Fracture, closed, spiral IUI-001 5572 07/21/2011 26442006 closed fracture of shaft of femur Previous fracture, or new fracture? A new fracture would mean we start another episode of care, if we are to count fractures and the outcomes of treating them appropriately!!!

  15. Acknowledgements • The Referent Tracking Team Ceusters, Manzoor, Tariq, Garimalla, et al. • OGMS Community • Award numbers 1UL1RR029884 and 3 P20 RR016460-08S1 from the National Center for Research Resources The content is solely the responsibility of the author and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health.

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