On beyond Gruber: "Ontologies" in today's biomedical information systems and the limits of OWL.

The word "ontology" was introduced to information systems when only closed-world reasoning systems were available. It was "borrowed" from philosophy, but literal links to its philosophical meaning were explicitly disavowed. Since then, open-world reasoning systems based on description logics have been developed, OWL has become a standard, and philosophical issues have been raised. The result has too often been confusion. The question "What statements are ontological" receives a variety of answers. A clearer vocabulary that is better suited to today's information systems is needed. The project to base ICD-11 on a "Common Ontology" required addressing this confusion. This paper sets out to systematise the lessons of that experience and subsequent discussions. We explore the semantics of open-world and closed-world systems. For specifying knowledge bases and software, we propose "invariants" or, more fully, "the first order invariant part of the background domain knowledge base" as an alternative to the words "ontology" and "ontological." We discuss the role and limitations of OWL and description logics and how they are complementary to closed world systems such as frames and to less formal "knowledge organisation systems". We illustrate why the conventions of classifications such as ICD cannot be formulated directly in OWL, but can be linked to OWL knowledge bases by queries. We contend that while OWL and description logics are major advances for representing invariants and terminologies, they must be combined with other technologies to represent broader background knowledge faithfully. The ICD-11 architecture is one approach. We argue that such hybrid architectures can and should be developed further.

Method for mapping the French CCAM terminology to the UMLS metathesaurus.

The French coding system of surgical procedures, the Classification Commune des Actes Médicaux (CCAM), is used in France for DRG databases and fee for services payment. Mapping between CCAM and other clinical procedures terminologies by the means of UMLS metathesaurus is essential in order to increase semantic interoperability between different healthcare terminologies and between different case mix systems. In a previous work the CISMeF team used an automatic approach to map CCAM descriptors to the French part of the UMLS metathesaurus. In another way for the French funded research project InterSTIS, we performed a mapping using MetaMap based on the top level semantic structure descriptors of anatomy and action of CCAM translated from French to English. This paper aims to present this new approach and to compare the results with the previous one. The combination of both approaches significantly improved the coverage of the mapping to 68 % for both descriptors and 95 % for at least one descriptor.

Development of a new international classification of health interventions based on an ontology framework.

: The WHO International Classification of Diseases is used in many national applications to plan, manage and fund through case mix health care systems and allows international comparisons of the performance of these systems. There is no such measuring tool for health interventions or procedures. To fulfil this requirement the WHO-FIC Network recommended in 2006 to develop an International Classification of Health Interventions (ICHI). This initiative is aimed to harmonise the existing national classifications and to provide a basic system for the countries which have not developed their own classification systems. It is based on the CEN/ISO ontology framework standard named Categorial Structure defined from a non formal bottom up ontology approach. The process of populating the framework is ongoing to start from a common model structure encompassing the ICD 9CM Volume 3 granularity.

The revision of the Korean classifications of health interventions based on the proposed ICHI semantic model and lessons learned.

The Korean Medical Association and the Health Information Review Agency have decided to re-engineer the different Korean coding systems of health interventions based on a proposed ontology framework defined in 2010 for the prospective International Classification of Health Interventions (ICHI). The authors present the interim report of the project focused on this model: 5,338 procedures of the Korean version of ICD9-CM 5,150 procedures covered by Korean health insurance and 6,619 uncovered procedure labels were processed with the participation of 8 coders and 310 medical doctors. As of 28th January 61.8% of data was processed. The ontology framework model itself was not enough to represent all the labels when the preliminary data from obstetrics and gynecology was explored. However, when modified with 7 notations, it was possible to assign each label of ICD 9 CM Volume 3 and 30 % to 57 % of specific Korean interventions to the semantic model.

An automated approach to map a French terminology to UMLS.

BACKGROUND: CCAM is a French terminology for coding clinical procedures. CCAM is a multi-hierarchical structured classification for procedures used in France for reimbursement in health care, which is external to UMLS. OBJECTIVE: The objective of this work is to describe a French lexical approach allowing mapping CCAM procedures to the UMLS Metathesaurus to achieve interoperability to multiple international terminologies. This approach used a preliminary step intended to take only the significant characters used to code CCAM corresponding to anatomical and actions axes. RESULTS: According to the 7,926 CCAM codes used in this study, 5,212 possible matches (exact matching, single to multiple matching, partial matching) are found using the French CCAM to UMLS based mapping, 65% of the corresponding anatomical terms in the CCAM code are mapped to at least one UMLS Concept and 37% of the corresponding action terms in the CCAM code are mapped to at least one UMLS Concept. For all the exact matches found (n=200), 91% were rated by a human expert as narrower than the mapped UMLS Concepts, while only 3% were irrelevant.

Ontological representation of adverse drug reactions using the Foundational Model of Anatomy.

In a previous work we proposed a categorial structure for the representation of adverse drug reactions consisting of 16 semantic categories and 20 relations. We present an implementation of this categorial structure in Protégé based on four WHO-ART system organ classes: Gastro-intestinal system disorders, Liver and biliary system disorders, Central & peripheric nervous system disorders, and Psychiatric disorders. We compared classification according to anatomy using SNOMED CT within the PharmARTS tool and the FMA with the Pellet reasoner. This ontology contains 210 concepts for Gastroenterology, 66 concepts for Psychiatry and 85 concepts for Neurology. Classification of disorders located in the upper gastro intestinal tract was similar using both SNOMED CT and the FMA. This work is a first step towards the comparison of two models of anatomy within a common ontology of adverse drug reactions.

Scrutinizing SNOMED CT's Ability to Reconcile Clinical Language Ambiguities with an Ontology Representation.

An important SNOMED CT use case is to support semantic interoperability between electronic health records and aggregation terminologies such as ICD. From the ongoing alignment exercise between SNOMED CT and the new version of ICD, now in its pre-final form, we studied whether the ambiguity of clinical language as displayed by SNOMED CT synonyms hampers the quality of SNOMED CT axioms following the SNOMED CT "concept model". We measure the rate of synonyms in the semantic misalignment between classes from the chapter on circulatory diseases of the ICD-11 beta version and SNOMED CT concepts with the same description names. Our study confirms that SNOMED CT synonyms are ambiguous and that there is a need to increase the number of SNOMED CT fully defined representations of Fully Specified Names (FSN), and of synonyms independently of their relations.

Coupling ontology driven semantic representation with multilingual natural language generation for tuning international terminologies.

OBJECTIVES: The importance of clinical communication between providers, consumers and others, as well as the requisite for computer interoperability, strengthens the need for sharing common accepted terminologies. Under the directives of the World Health Organization (WHO), an approach is currently being conducted in Australia to adopt a standardized terminology for medical procedures that is intended to become an international reference. METHOD: In order to achieve such a standard, a collaborative approach is adopted, in line with the successful experiment conducted for the development of the new French coding system CCAM. Different coding centres are involved in setting up a semantic representation of each term using a formal ontological structure expressed through a logic-based representation language. From this language-independent representation, multilingual natural language generation (NLG) is performed to produce noun phrases in various languages that are further compared for consistency with the original terms. RESULTS: Outcomes are presented for the assessment of the International Classification of Health Interventions (ICHI) and its translation into Portuguese. The initial results clearly emphasize the feasibility and cost-effectiveness of the proposed method for handling both a different classification and an additional language. CONCLUSION: NLG tools, based on ontology driven semantic representation, facilitate the discovery of ambiguous and inconsistent terms, and, as such, should be promoted for establishing coherent international terminologies.

[Specialist hospitals' management of care for cardiovascular in-patients]. / Les prises en charge hospitalières de référence des affections cardiovasculaires.

In order to identify and describe the organisation of specialist hospitals' technical services and activities for patients with cardiovascular disease, we applied the classification method of Barrubes et al. to their in-patients' hospitalisation period for a duration of 24 hours or more. Technical activities are defined as the state-of-the-art medicine for extremely complex diseases requiring specifically skilled attention. This simple method enabled the identification of specialist technical activities for treating patients with cardiovascular disease and to learn more about the role of the public and private providers of hospital care, roles which vary according to French geographic areas and regions.

Interface Terminologies, Reference Terminologies and Aggregation Terminologies: A Strategy for Better Integration.

The time has come to end unproductive competitions among different types of biomedical terminology artefacts. Tools and strategies to create the foundation of a seamless environment covering clinical jargon, clinical terminologies, and classifications are necessary. Whereas language processing relies on human interface terminologies, which represent clinical jargon, their link to reference terminologies such as SNOMED CT is essential to guarantee semantic interoperability. There is also a need for interoperation between reference and aggregation terminologies. Simple mappings between nodes are not enough, because the three kinds of terminology systems represent different things: reference terminologies focus on context-free descriptions of classes of entities of a domain; aggregation terminologies contain rules that enforce the principle of single hierarchies and disjoint classes; interface terminologies represent the language used in a domain. We propose a model that aims at providing a better flow of standardized information, addressing multiple use cases in health care including clinical research, epidemiology, care management, and reimbursement.

How to Link SNOMED CT Procedure and WHO International Classification of Health Interventions (ICHI).

Among different used healthcare terminology resources there is a need to link them to ease their interoperability. SNOMED CT is the most detailed clinical reference terminology for procedure used in the Electronic Health Record (EHR). WHO developed since 2006 an aggregated classification named ICHI required for statistics and resource allocation. It is based on an ontology framework defined in ISO 1828 named Categorial Structure (CAST) for surgical procedures. We present ICHI coding structure, ISO 1828 CAST standard for surgical procedures and SNOMED CT procedures hierarchy concept model and their relations. We demonstrate the obstacles to align ICHI coding structure with ISO 1828 CAST which can be linked with SNOMED CT procedures hierarchy concept model. We recommend to update ICHI coding structure to decrease the gap with ISO 1828 CAST and SNOMED CT concept model for procedures hierarchy to allow users to share the different terminology resources.

Coding acute stroke care and telestroke with the International Classification of Health Interventions (ICHI).

BACKGROUND: and purpose: Acute stroke care is to detect, diagnose, and treat patients in the shortest amount of time. Access to acute stroke care may however be limited in some areas and telemedicine has been thus used to increase its access. Coding acute stroke care as a health intervention had limited attention in the past. METHODS: The International Classification of Health Interventions (ICHI) currently under development was used to identify existing codes relevant for coding acute stroke care interventions, including telestroke. A review of the ICHI was conducted to identify codes relevant for acute stroke care by two independent reviewers. RESULTS: A matching ICHI code was found for each of the steps in the acute stroke care process but no ICHI codes were available to specifically capture telestroke. CONCLUSION: As telemedicine intervention is likely to become more common in the future, it will be imperative that the ICHI is able to code such interventions.

From a Categorical Structure to a Concept Model: The International Classification of Health Interventions (ICHI).

The International Classification of Health Interventions (ICHI) alpha2 2016 Section 1 Interventions on Body Systems and Functions is based on ISO 1828 international standard named categorial Structure (CAST). This is not sufficient to represent the meaning of ICD9-CM Volume 3 labels. We propose to modify it by using the SNOMED CT concept model.

A Patient Safety Information Model for Interoperability.

Current systems that target Patient Safety (PS) like mandatory reporting systems and specific vigilance reporting systems share the same information types but are not interoperable. Ten years ago, WHO embarked on an international project to standardize quality management information systems for PS. The goal is to support interoperability between different systems in a country and to expand international sharing of data on quality and safety management particularly for less developed countries. Two approaches have been used: (i) a bottom-up one starting with existing national PS reporting and international or national vigilance systems, and (ii) a top-down approach that uses the Patient Safety Categorial Structure (PS-CAST) and the Basic Formal Ontology (BFO) upper level ontology versions 1 and 2. The output is currently tested as an integrated information system for quality and PS management in four WHO member states.

ICD-11 (JLMMS) and SCT Inter-Operation.

The goal of this work is to contribute to a smooth and semantically sound inter-operability between the ICD-11 (International Classification of Diseases-11th revision Joint Linearization for Mortality, Morbidity and Statistics) and SNOMED CT (SCT). To guarantee such inter-operation between a classification, characterized by a single hierarchy of mutually exclusive and exhaustive classes, as is the JLMMS successor of ICD-10 on the one hand, and the multi-hierarchical, ontology-based clinical terminology SCT on the other hand, we use ontology axioms that logically express generalizable truths. This is expressed by the compositional grammar of SCT, together with queries on axiomsof SCT. We test the feasibility of the method on the circulatory chapter of ICD-11 JLMMS and present limitations and results.

Representing ICD-11 JLMMS Using IHTSDO Representation Formalisms.

It is investigated whether the content of the Joint Linearization for Mortality and Morbidity Statistics of the 11th ICD revision can be semantically represented by formalisms acting on the clinical terminology SNOMED CT, viz. the IHTSDO Compositional Grammar (CG) and the Expression Constraint Language (ECL). Whereas CG provides a composition syntax for building coordinated SNOMED CT expressions, ECL provides a powerful query mechanism. Both formalisms can be leveraged to guarantee inter-operation between an ontology-based terminology like SNOMED CT and a statistical classification like ICD, characterized by single hierarchies and exhaustive, mutually exclusive classes. We test the feasibility of the method on the circulatory chapter of ICD-11 JLMMS.

Toward a patient safety upper level ontology.

Patient Safety (PS) standardization is the key to improve interoperability and expand international share of incident reporting system knowledge. By aligning the Patient Safety Categorial Structure (PS-CAST) to the Basic Formal Ontology version 2 (BFO2) upper level ontology, we aim to provide more rigor on the underlying organization on the one hand, and to share instances of concepts of categorial structure on the other hand. This alignment is a big step in the top-down approach, to build a complete and standardized domain ontology in order to facilitate the basis to a WHO accepted new information model for Patient Safety.

Integrated care: an Information Model for Patient Safety and Vigilance Reporting Systems.

Quality management information systems for safety as a whole or for specific vigilances share the same information types but are not interoperable. An international initiative tries to develop an integrated information model for patient safety and vigilance reporting to support a global approach of heath care quality.

Translating ICD-11 into French using lexical-based approach: a preliminary study.

To translate the 11th edition of the International Classification of Diseases (ICD-11) into French, we proposed a lexical approach using Natural Language Processing techniques. This method relies on the 56 biomedical terminologies and ontologies included in the Cross-lingual Health Multiple Terminologies and Ontologies Portal. From a sample of 336 ICD-11 terms, the algorithm translated 164 (49%) terms into at least one French term each.

ICHI Categorial Structure: a WHO-FIC Tool for Semantic Interoperability of Procedures Classifications.

Casemix grouping using procedures classifications has become an important use case for health care terminologies. There are so many different national procedures classifications used for Casemix grouping that it is not possible to agree on a worldwide standard. ICHI (International Classification of Health Interventions) is proposing an approach that standardises only the terminologies' model structure. The poster shows the use of the ICHI alpha to replace ICD9 CM Volume 3 in the UNU-CBG International Casemix grouper.