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Integrating disease and diagnosis semantics in clinical archetypes

Integrating disease and diagnosis semantics in clinical archetypes. Leonardo Lezcano Miguel-Ángel Sicilia { leonardo.lezcano , msicilia }@ uah.es University of Alcalá. Contents. Clinical archetypes Initiation, Realization, Recognition and Representation of Disease in clinical archetypes

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Integrating disease and diagnosis semantics in clinical archetypes

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  1. Integrating disease and diagnosis semantics in clinical archetypes Leonardo Lezcano Miguel-Ángel Sicilia {leonardo.lezcano, msicilia}@uah.es University of Alcalá

  2. Contents • Clinical archetypes • Initiation, Realization, Recognition and Representation of Disease in clinical archetypes • Integration approaches • Translating to OWL • Applications (reusing rules) • Conclusions

  3. clinical archetypes (OpenEHR) Archetypes are formal clinical specifications, expressed in terms of constraints on a reference model. Knowledge Managment Platform Application Development Platform They are combined together through templates, and used at runtime to extract data, to enable querying, and to support legacy data transformation. Health Integration Platform Terminology Interface Queries Templates Archetypes Reference Model Blood Pressure, Pregnancy, Symptom, Diagnosis coded texts, quantities, measures, date/times, booleans,

  4. The Heart Rate archetype (ADL) archetype (adl_version=1.4) - concept [at0000] -- Heart rate … definition OBSERVATION[at0000] matches { -- Heart rate data matches { … ELEMENT[at0004] occurrences matches {0..1} matches { -- Rate value matches {C_DV_QUANTITY <…units …magnitude…precision …> … ELEMENT[at0005] occurrences matches {0..1} matches { -- Rhythm value matches { DV_CODED_TEXT matches {at0006 – Regular; at0007 – Irregular; at0008 - Irregularly irregular} … statematches { … ELEMENT[at0013] occurrences matches {0..1} matches { -- Position valuematches { DV_CODED_TEXT matches { at1000 – Lying; at1001 – Sitting; at1002 – Reclining; … etc} … protocolmatches { … ELEMENT[at0011] occurrences matches {0..1} matches { -- Device DV_TEXT matches {*} ontology terminologies_available = <"SNOMED-CT", ...> items = < ["at0000"] = < description = <"The rate the heart is beating - either mechanically or electrically"> text = <"Heartrate">

  5. Classification of types ofClinical Information (Beale & Heard) EVALUATION: inferences of the investigator using the personal and published knowledge base about what the observations mean, and what to do about them. • ACTION: a record of intervention actions that have occurred, due to the execution of an Instruction by some agent: • Medication action • Transfusion about the past about the present about the future RM Instruction: opinion-based instructions sufficiently detailed so as to be directly executable by investigator agents (people or machines), in order to effect a desired intervention (including obtaining a sample for further investigation, as in a biopsy); • OBSERVATION: the entire stream of information captured by the investigator, used to characterize the patient system. Created by an act of observation, measurement, questioning, or testing of the patient: • pathology results, • blood pressure readings, • patient answers during a physical examination AM

  6. Information & reality Information model (OpenEHR) models of reality domain content models (variable) classifications process description ICDx, ICPC, LOINC guidelines Archetypes Information models (stable) descriptive terminologies OGMS ontology Reference Model & Service Model SNOMED-CT

  7. Information aboutContinuant & Occurrent entities As pieces of information, archetypes instances are all Continuant entities. However, they contain information about clinical statements that represent both Continuant and Occurrent entities. • Protocol: Description of the method for arriving to the information in this entry. For OBSERVATIONs, this is a description of the method or instrument used. For EVALUATIONs, how the evaluation was arrived at. For INSTRUCTIONs, how to execute the Instruction. • Guideline_id: External identifier of the guideline creating this action, if relevant. • Data: The actual datum being recorded; expressed through data structures such as a List, Table, Single (value), Tree, etc. • Observation state: Any particular information about the state of the subject of the Entry necessary to correctly interpret the data, (e.g. the patient being female, pregnant, or currently undergoing chemotherapy).

  8. Information aboutContinuant & Occurrent entities Info about Conti- nuants Info about Occurrents

  9. Initiation, Realization, Recognition and Representation of Disease I The clinical investigator model (OpenEHR) Physical Examinations, Signs, Symptoms, Clinical History, Lab Tests & Findings. Treatment & Therapeutic response Clinical Picture, Diagnosis Plan development

  10. Initiation, Realization, Recognition and Representation of Disease II (Scheuermann & Smith) EVAL.diagnosis EVAL.problem INS.follow_up ACT.follow_up CLUS.symptom CLUS.health_event CLUS.issue OBS.lab_test CLUS.specimen OBS.exam CLUS.inspection OBS.story

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