Toward a Harmonized WHO Family of International Classifications Content Model.

An overarching WHO-FIC Content Model will allow uniform modeling of classifications in the WHO Family of International Classifications (WHO-FIC) and promote their joint use. We provide an initial conceptualization of such a model.

An ontology-driven tool for structured data acquisition using Web forms.

BACKGROUND: Structured data acquisition is a common task that is widely performed in biomedicine. However, current solutions for this task are far from providing a means to structure data in such a way that it can be automatically employed in decision making (e.g., in our example application domain of clinical functional assessment, for determining eligibility for disability benefits) based on conclusions derived from acquired data (e.g., assessment of impaired motor function). To use data in these settings, we need it structured in a way that can be exploited by automated reasoning systems, for instance, in the Web Ontology Language (OWL); the de facto ontology language for the Web. RESULTS: We tackle the problem of generating Web-based assessment forms from OWL ontologies, and aggregating input gathered through these forms as an ontology of "semantically-enriched" form data that can be queried using an RDF query language, such as SPARQL. We developed an ontology-based structured data acquisition system, which we present through its specific application to the clinical functional assessment domain. We found that data gathered through our system is highly amenable to automatic analysis using queries. CONCLUSIONS: We demonstrated how ontologies can be used to help structuring Web-based forms and to semantically enrich the data elements of the acquired structured data. The ontologies associated with the enriched data elements enable automated inferences and provide a rich vocabulary for performing queries.

Use of ontology structure and Bayesian models to aid the crowdsourcing of ICD-11 sanctioning rules.

The International Classification of Diseases (ICD) is the de facto standard international classification for mortality reporting and for many epidemiological, clinical, and financial use cases. The next version of ICD, ICD-11, will be submitted for approval by the World Health Assembly in 2018. Unlike previous versions of ICD, where coders mostly select single codes from pre-enumerated disease and disorder codes, ICD-11 coding will allow extensive use of multiple codes to give more detailed disease descriptions. For example, "severe malignant neoplasms of left breast" may be coded using the combination of a "stem code" (e.g., code for malignant neoplasms of breast) with a variety of "extension codes" (e.g., codes for laterality and severity). The use of multiple codes (a process called post-coordination), while avoiding the pitfall of having to pre-enumerate vast number of possible disease and qualifier combinations, risks the creation of meaningless expressions that combine stem codes with inappropriate qualifiers. To prevent that from happening, "sanctioning rules" that define legal combinations are necessary. In this work, we developed a crowdsourcing method for obtaining sanctioning rules for the post-coordination of concepts in ICD-11. Our method utilized the hierarchical structures in the domain to improve the accuracy of the sanctioning rules and to lower the crowdsourcing cost. We used Bayesian networks to model crowd workers' skills, the accuracy of their responses, and our confidence in the acquired sanctioning rules. We applied reinforcement learning to develop an agent that constantly adjusted the confidence cutoffs during the crowdsourcing process to maximize the overall quality of sanctioning rules under a fixed budget. Finally, we performed formative evaluations using a skin-disease branch of the draft ICD-11 and demonstrated that the crowd-sourced sanctioning rules replicated those defined by an expert dermatologist with high precision and recall. This work demonstrated that a crowdsourcing approach could offer a reasonably efficient method for generating a first draft of sanctioning rules that subject matter experts could verify and edit, thus relieving them of the tedium and cost of formulating the initial set of rules.

Using ontologies to model human navigation behavior in information networks: A study based on Wikipedia.

The need to examine the behavior of different user groups is a fundamental requirement when building information systems. In this paper, we present Ontology-based Decentralized Search (OBDS), a novel method to model the navigation behavior of users equipped with different types of background knowledge. Ontology-based Decentralized Search combines decentralized search, an established method for navigation in social networks, and ontologies to model navigation behavior in information networks. The method uses ontologies as an explicit representation of background knowledge to inform the navigation process and guide it towards navigation targets. By using different ontologies, users equipped with different types of background knowledge can be represented. We demonstrate our method using four biomedical ontologies and their associated Wikipedia articles. We compare our simulation results with base line approaches and with results obtained from a user study. We find that our method produces click paths that have properties similar to those originating from human navigators. The results suggest that our method can be used to model human navigation behavior in systems that are based on information networks, such as Wikipedia. This paper makes the following contributions: (i) To the best of our knowledge, this is the first work to demonstrate the utility of ontologies in modeling human navigation and (ii) it yields new insights and understanding about the mechanisms of human navigation in information networks.

A Method to Compare ICF and SNOMED CT for Coverage of U.S. Social Security Administration's Disability Listing Criteria.

We developed a method to evaluate the extent to which the International Classification of Function, Disability, and Health (ICF) and SNOMED CT cover concepts used in the disability listing criteria of the U.S. Social Security Administration's "Blue Book." First we decomposed the criteria into their constituent concepts and relationships. We defined different types of mappings and manually mapped the recognized concepts and relationships to either ICF or SNOMED CT. We defined various metrics for measuring the coverage of each terminology, taking into account the effects of inexact matches and frequency of occurrence. We validated our method by mapping the terms in the disability criteria of Adult Listings, Chapter 12 (Mental Disorders). SNOMED CT dominates ICF in almost all the metrics that we have computed. The method is applicable for determining any terminology's coverage of eligibility criteria.

How Ontologies are Made: Studying the Hidden Social Dynamics Behind Collaborative Ontology Engineering Projects.

Traditionally, evaluation methods in the field of semantic technologies have focused on the end result of ontology engineering efforts, mainly, on evaluating ontologies and their corresponding qualities and characteristics. This focus has led to the development of a whole arsenal of ontology-evaluation techniques that investigate the quality of ontologies as a product. In this paper, we aim to shed light on the process of ontology engineering construction by introducing and applying a set of measures to analyze hidden social dynamics. We argue that especially for ontologies which are constructed collaboratively, understanding the social processes that have led to its construction is critical not only in understanding but consequently also in evaluating the ontology. With the work presented in this paper, we aim to expose the texture of collaborative ontology engineering processes that is otherwise left invisible. Using historical change-log data, we unveil qualitative differences and commonalities between different collaborative ontology engineering projects. Explaining and understanding these differences will help us to better comprehend the role and importance of social factors in collaborative ontology engineering projects. We hope that our analysis will spur a new line of evaluation techniques that view ontologies not as the static result of deliberations among domain experts, but as a dynamic, collaborative and iterative process that needs to be understood, evaluated and managed in itself. We believe that advances in this direction would help our community to expand the existing arsenal of ontology evaluation techniques towards more holistic approaches.

WebProtégé: A Collaborative Ontology Editor and Knowledge Acquisition Tool for the Web.

In this paper, we present WebProtégé-a lightweight ontology editor and knowledge acquisition tool for the Web. With the wide adoption of Web 2.0 platforms and the gradual adoption of ontologies and Semantic Web technologies in the real world, we need ontology-development tools that are better suited for the novel ways of interacting, constructing and consuming knowledge. Users today take Web-based content creation and online collaboration for granted. WebProtégé integrates these features as part of the ontology development process itself. We tried to lower the entry barrier to ontology development by providing a tool that is accessible from any Web browser, has extensive support for collaboration, and a highly customizable and pluggable user interface that can be adapted to any level of user expertise. The declarative user interface enabled us to create custom knowledge-acquisition forms tailored for domain experts. We built WebProtégé using the existing Protégé infrastructure, which supports collaboration on the back end side, and the Google Web Toolkit for the front end. The generic and extensible infrastructure allowed us to easily deploy WebProtégé in production settings for several projects. We present the main features of WebProtégé and its architecture and describe briefly some of its uses for real-world projects. WebProtégé is free and open source. An online demo is available at http://webprotege.stanford.edu.

PragmatiX: An Interactive Tool for Visualizing the Creation Process Behind Collaboratively Engineered Ontologies.

With the emergence of tools for collaborative ontology engineering, more and more data about the creation process behind collaborative construction of ontologies is becoming available. Today, collaborative ontology engineering tools such as Collaborative Protégé offer rich and structured logs of changes, thereby opening up new challenges and opportunities to study and analyze the creation of collaboratively constructed ontologies. While there exists a plethora of visualization tools for ontologies, they have primarily been built to visualize aspects of the final product (the ontology) and not the collaborative processes behind construction (e.g. the changes made by contributors over time). To the best of our knowledge, there exists no ontology visualization tool today that focuses primarily on visualizing the history behind collaboratively constructed ontologies. Since the ontology engineering processes can influence the quality of the final ontology, we believe that visualizing process data represents an important stepping-stone towards better understanding of managing the collaborative construction of ontologies in the future. In this application paper, we present a tool - PragmatiX - which taps into structured change logs provided by tools such as Collaborative Protégé to visualize various pragmatic aspects of collaborative ontology engineering. The tool is aimed at managers and leaders of collaborative ontology engineering projects to help them in monitoring progress, in exploring issues and problems, and in tracking quality-related issues such as overrides and coordination among contributors. The paper makes the following contributions: (i) we present PragmatiX, a tool for visualizing the creation process behind collaboratively constructed ontologies (ii) we illustrate the functionality and generality of the tool by applying it to structured logs of changes of two large collaborative ontology-engineering projects and (iii) we conduct a heuristic evaluation of the tool with domain experts to uncover early design challenges and opportunities for improvement. Finally, we hope that this work sparks a new line of research on visualization tools for collaborative ontology engineering projects.

BioPortal: enhanced functionality via new Web services from the National Center for Biomedical Ontology to access and use ontologies in software applications.

The National Center for Biomedical Ontology (NCBO) is one of the National Centers for Biomedical Computing funded under the NIH Roadmap Initiative. Contributing to the national computing infrastructure, NCBO has developed BioPortal, a web portal that provides access to a library of biomedical ontologies and terminologies (http://bioportal.bioontology.org) via the NCBO Web services. BioPortal enables community participation in the evaluation and evolution of ontology content by providing features to add mappings between terms, to add comments linked to specific ontology terms and to provide ontology reviews. The NCBO Web services (http://www.bioontology.org/wiki/index.php/NCBO_REST_services) enable this functionality and provide a uniform mechanism to access ontologies from a variety of knowledge representation formats, such as Web Ontology Language (OWL) and Open Biological and Biomedical Ontologies (OBO) format. The Web services provide multi-layered access to the ontology content, from getting all terms in an ontology to retrieving metadata about a term. Users can easily incorporate the NCBO Web services into software applications to generate semantically aware applications and to facilitate structured data collection.

The Biomedical Resource Ontology (BRO) to enable resource discovery in clinical and translational research.

The biomedical research community relies on a diverse set of resources, both within their own institutions and at other research centers. In addition, an increasing number of shared electronic resources have been developed. Without effective means to locate and query these resources, it is challenging, if not impossible, for investigators to be aware of the myriad resources available, or to effectively perform resource discovery when the need arises. In this paper, we describe the development and use of the Biomedical Resource Ontology (BRO) to enable semantic annotation and discovery of biomedical resources. We also describe the Resource Discovery System (RDS) which is a federated, inter-institutional pilot project that uses the BRO to facilitate resource discovery on the Internet. Through the RDS framework and its associated Biositemaps infrastructure, the BRO facilitates semantic search and discovery of biomedical resources, breaking down barriers and streamlining scientific research that will improve human health.

The ontology life cycle: Integrated tools for editing, publishing, peer review, and evolution of ontologies.

Ontologies have become a critical component of many applications in biomedical informatics. However, the landscape of the ontology tools today is largely fragmented, with independent tools for ontology editing, publishing, and peer review: users develop an ontology in an ontology editor, such as Protégé; and publish it on a Web server or in an ontology library, such as BioPortal, in order to share it with the community; they use the tools provided by the library or mailing lists and bug trackers to collect feedback from users. In this paper, we present a set of tools that bring the ontology editing and publishing closer together, in an integrated platform for the entire ontology lifecycle. This integration streamlines the workflow for collaborative development and increases integration between the ontologies themselves through the reuse of terms.

Supporting the Collaborative Authoring of ICD-11 with WebProtégé.

The World Health Organization (WHO) is well under way with the new revision of the International Classification of Diseases (ICD-11). The current revision process is significantly different from past ones: the ICD-11 authoring is now open to a large international community of medical experts, who perform the authoring in a web-based collaborative platform. The classification is also embracing a more formal representation that is suitable for electronic health records. We present the ICD Collaborative Authoring Tool (iCAT), a customization of the WebProtégé editor that supports the community based authoring of ICD-11 on the Web and provides features such as discussion threads integrated in the authoring process, change tracking, content reviewing, and so on. The WHO editors evaluated the initial version of iCAT and found the tool intuitive and easy to learn. They also identified improvement potentials and new requirements for large-scale collaboration support. A demo version of the tool is available at: http://icatdemo.stanford.edu.

Software-engineering challenges of building and deploying reusable problem solvers.

Problem solving methods (PSMs) are software components that represent and encode reusable algorithms. They can be combined with representations of domain knowledge to produce intelligent application systems. A goal of research on PSMs is to provide principled methods and tools for composing and reusing algorithms in knowledge-based systems. The ultimate objective is to produce libraries of methods that can be easily adapted for use in these systems. Despite the intuitive appeal of PSMs as conceptual building blocks, in practice, these goals are largely unmet. There are no widely available tools for building applications using PSMs and no public libraries of PSMs available for reuse. This paper analyzes some of the reasons for the lack of widespread adoptions of PSM techniques and illustrate our analysis by describing our experiences developing a complex, high-throughput software system based on PSM principles. We conclude that many fundamental principles in PSM research are useful for building knowledge-based systems. In particular, the task-method decomposition process, which provides a means for structuring knowledge-based tasks, is a powerful abstraction for building systems of analytic methods. However, despite the power of PSMs in the conceptual modeling of knowledge-based systems, software engineering challenges have been seriously underestimated. The complexity of integrating control knowledge modeled by developers using PSMs with the domain knowledge that they model using ontologies creates a barrier to widespread use of PSM-based systems. Nevertheless, the surge of recent interest in ontologies has led to the production of comprehensive domain ontologies and of robust ontology-authoring tools. These developments present new opportunities to leverage the PSM approach.

A Bayesian network model for analysis of detection performance in surveillance systems.

Worldwide developments concerning infectious diseases and bioterrorism are driving forces for improving aberrancy detection in public health surveillance. The performance of an aberrancy detection algorithm can be measured in terms of sensitivity, specificity and timeliness. However, these metrics are probabilistically dependent variables and there is always a trade-off between them. This situation raises the question of how to quantify this tradeoff. The answer to this question depends on the characteristics of the specific disease under surveillance, the characteristics of data used for surveillance, and the algorithmic properties of detection methods. In practice, the evidence describing the relative performance of different algorithms remains fragmented and mainly qualitative. In this paper, we consider the development and evaluation of a Bayesian network framework for analysis of performance measures of aberrancy detection algorithms. This framework enables principled comparison of algorithms and identification of suitable algorithms for use in specific public health surveillance settings.

Predicting outbreak detection in public health surveillance: quantitative analysis to enable evidence-based method selection.

Public health surveillance is critical for accurate and timely outbreak detection and effective epidemic control. A wide range of statistical algorithms is used for surveillance, and important differences have been noted in the ability of these algorithms to detect outbreaks. The evidence about the relative performance of these algorithms, however, remains limited and mainly qualitative. Using simulated outbreak data, we developed and validated quantitative models for predicting the ability of commonly used surveillance algorithms to detect different types of outbreaks. The developed models accurately predict the ability of different algorithms to detect different types of outbreaks. These models enable evidence-based algorithm selection and can guide research into algorithm development.

Understanding detection performance in public health surveillance: modeling aberrancy-detection algorithms.

OBJECTIVE: Statistical aberrancy-detection algorithms play a central role in automated public health systems, analyzing large volumes of clinical and administrative data in real-time with the goal of detecting disease outbreaks rapidly and accurately. Not all algorithms perform equally well in terms of sensitivity, specificity, and timeliness in detecting disease outbreaks and the evidence describing the relative performance of different methods is fragmented and mainly qualitative. DESIGN: We developed and evaluated a unified model of aberrancy-detection algorithms and a software infrastructure that uses this model to conduct studies to evaluate detection performance. We used a task-analytic methodology to identify the common features and meaningful distinctions among different algorithms and to provide an extensible framework for gathering evidence about the relative performance of these algorithms using a number of evaluation metrics. We implemented our model as part of a modular software infrastructure (Biological Space-Time Outbreak Reasoning Module, or BioSTORM) that allows configuration, deployment, and evaluation of aberrancy-detection algorithms in a systematic manner. MEASUREMENT: We assessed the ability of our model to encode the commonly used EARS algorithms and the ability of the BioSTORM software to reproduce an existing evaluation study of these algorithms. RESULTS: Using our unified model of aberrancy-detection algorithms, we successfully encoded the EARS algorithms, deployed these algorithms using BioSTORM, and were able to reproduce and extend previously published evaluation results. CONCLUSION: The validated model of aberrancy-detection algorithms and its software implementation will enable principled comparison of algorithms, synthesis of results from evaluation studies, and identification of surveillance algorithms for use in specific public health settings.