Modeling patient safety incidents knowledge with the Categorial Structure method.

Following the WHO initiative named World Alliance for Patient Safety (PS) launched in 2004 a conceptual framework developed by PS national reporting experts has summarized the knowledge available. As a second step, the Department of Public Health of the University of Saint Etienne team elaborated a Categorial Structure (a semi formal structure not related to an upper level ontology) identifying the elements of the semantic structure underpinning the broad concepts contained in the framework for patient safety. This knowledge engineering method has been developed to enable modeling patient safety information as a prerequisite for subsequent full ontology development. The present article describes the semantic dissection of the concepts, the elicitation of the ontology requirements and the domain constraints of the conceptual framework. This ontology includes 134 concepts and 25 distinct relations and will serve as basis for an Information Model for Patient Safety.

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.

Comparing existing national and international classification systems of surgical procedures with the CEN/ISO 1828 ontology framework standard.

Among different standardization strategies for biomedical terminologies the European Standard Body CEN TC 251 followed by ISO TC 215 have stated that it was not possible to convince the different European or international member states using different national languages to agree on a reference clinical terminology or to standardize a detailed language independent biomedical ontology. Since 1990 they have developed since an approach named the Categorial Structure that standardises only the terminologies' model structure. The methodology for the Categorial Structure development and a comparison of the different existing classification systems based on this ontology framework is presented as a step towards increased interoperability between biomedical terminologies through conformity to a minimum set of ontological requirements.

Tracing the foundations of a conceptual framework for a patient safety ontology.

BACKGROUND: In work for the World Alliance for Patient Safety on research methods and measures and on defining key concepts for an International Patient Safety Classification (ICPS), it became apparent that there was a need to try to understand how the meaning of patient safety and underlying concepts relate to the existing safety and quality frameworks commonly used in healthcare. OBJECTIVES: To unfold the concept of patient safety and how it relates to safety and quality frameworks commonly used in healthcare and to trace the evolution of the ICPS framework as a basis of the electronic capture of the component elements of patient safety. CONCLUSION: The ICPS conceptual framework for patient safety has its origins in existing frameworks and an international consultation process. Although its 10 classes and their semantic relationships may be used as a reference model for different disciplines, it must remain dynamic in the ever-changing world of healthcare. By expanding the ICPS by examining data from all available sources, and ensuring rigorous compliance with the latest principles of informatics, a deeper interdisciplinary approach will progressively be developed to address the complex, refractory problem of reducing healthcare-associated harm.

Towards an International Classification for Patient Safety: the conceptual framework.

Global advances in patient safety have been hampered by the lack of a uniform classification of patient safety concepts. This is a significant barrier to developing strategies to reduce risk, performing evidence-based research and evaluating existing healthcare policies relevant to patient safety. Since 2005, the World Health Organization's World Alliance for Patient Safety has undertaken the Project to Develop an International Classification for Patient Safety (ICPS) to devise a classification which transforms patient safety information collected from disparate systems into a common format to facilitate aggregation, analysis and learning across disciplines, borders and time. A drafting group, comprised of experts from the fields of patient safety, classification theory, health informatics, consumer/patient advocacy, law and medicine, identified and defined key patient safety concepts and developed an internationally agreed conceptual framework for the ICPS based upon existing patient safety classifications. The conceptual framework was iteratively improved through technical expert meetings and a two-stage web-based modified Delphi survey of over 250 international experts. This work culminated in a conceptual framework consisting of ten high level classes: incident type, patient outcomes, patient characteristics, incident characteristics, contributing factors/hazards, organizational outcomes, detection, mitigating factors, ameliorating actions and actions taken to reduce risk. While the framework for the ICPS is in place, several challenges remain. Concepts need to be defined, guidance for using the classification needs to be provided, and further real-world testing needs to occur to progressively refine the ICPS to ensure it is fit for purpose.

Towards an International Classification for Patient Safety: a Delphi survey.

OBJECTIVE: Interpretation and comparison of patient safety information have been compromised by the lack of a common understanding of the concepts involved. The World Alliance set out to develop an International Classification for Patient Safety (ICPS) to address this, and to test the relevance and acceptability of the draft ICPS and progressively refine it prior to field testing. DESIGN: Two-stage Delphi survey. Quantitative and qualitative analyses informed the review of the ICPS. SETTING: International web-based survey of expert opinion. PARTICIPANTS: Experts in the fields of patient safety, health policy, reporting systems, safety and quality control, classification theory and development, health informatics, consumer advocacy, law and medicine; 253 responded to the first round survey, 30% of whom responded to the second round. RESULTS: In the first round, 14% felt that the conceptual framework was missing at least one class, although it was apparent that most respondents were actually referring to concepts they felt should be included within the classes rather than the classes themselves. There was a need for clarification of several components of the classification, particularly its purpose, structure and depth. After revision and feedback, round 2 results were more positive, but further significant changes were made to the conceptual framework and to the major classes in response to concerns about terminology and relationships between classes. CONCLUSIONS: The Delphi approach proved invaluable, as both a consensus-building exercise and consultation process, in engaging stakeholders to support completion of the final draft version of the ICPS. Further refinement will occur.

Towards an International Classification for Patient Safety: key concepts and terms.

BACKGROUND: Understanding the patient safety literature has been compromised by the inconsistent use of language. OBJECTIVE: To identify key concepts of relevance to the International Patient Safety Classification (ICPS) proposed by the World Alliance For Patient Safety of the World Health Organization (WHO), and agree on definitions and preferred terms. METHODS: Six principles were agreed upon-that the concepts and terms should: be applicable across the full spectrum of healthcare; be consistent with concepts from other WHO Classifications; have meanings as close as possible to those in colloquial use; convey the appropriate meanings with respect to patient safety; be brief and clear, without unnecessary or redundant qualifiers; be fit-for-purpose for the ICPS. RESULTS: Definitions and preferred terms were agreed for 48 concepts of relevance to the ICPS; these were described and the relationships between them and the ICPS were outlined. CONCLUSIONS: The consistent use of key concepts, definitions and preferred terms should pave the way for better understanding, for comparisons between facilities and jurisdictions, and for trends to be tracked over time. Changes and improvements, translation into other languages and alignment with other sets of patient safety definitions will be necessary. This work represents the start of an ongoing process of progressively improving a common international understanding of terms and concepts relevant to patient safety.

A deployment and Research Roadmap for Semantic Interoperability: the EU semantic health project.

The purpose of this EU funded project is to describe a short and medium term Research and Deployment Roadmap for Semantic Interoperability in e-health. It started by defining 4 levels and 3 dimensions for Semantic Interoperability. The vision is to reconcile the needs for the direct patient care safety, biomedical and clinical research and for public health by the reuse of direct care data: from gene to individuals and populations. The methodology is presented and preliminary results and milestones for the short and the long term are set. We conclude by statements on the main characteristics and needs of the roadmap to sustain better health for individual and populations in the changing EU health care systems.