TITLE NATU

Reporters:

Kyle Gonzaga
Geomar Lim
Michael Natad
Andre Osayan

Advanced Terminology Systems

Background and Definitions

• Primary motivation for standardized terms: need for valid, comparable data that
can be used across information system applications to support clinical decision-
making and evaluation of processes and outcomes of care

• Secondary uses include purposes such as clinical research, development of

practice-based nursing knowledge and generation of healthcare policy

• Terminology: “set of terms representing a system of concepts”

Vocabulary Problem

• Refers to the failure to achieve a single, integrated terminology with broad

coverage of the healthcare domain

• Several reasons include:

o Development of multiple specialized terminologies- results to overlapping,

undistributed content

o Existing terminologies are developed to provide sets of terms and

definitions of concepts for human interpretation, with computer
interpretation merely a secondary goal

Concept Orientation

• What does it mean for a terminology to be concept-oriented?

• Criteria r/t concept-oriented approaches

Atomic-based concepts must be separable into constituent components

Compositionality ability to combine simple concepts into composed concepts
Concept permanence once a concept is defined it should not be deleted from a
terminology
Language independence support for multiple linguistic expressions
Multiple hierarchy accessibility of concepts through all reasonable hierarchical
paths with consistency of views
Nonambiguity explicit definition for each term
Nonredundancy one preferred way of representing a concept or idea
Synonymy support for synonyms and consistent mapping of synonyms
within and among terminologies
• Some terminologies do not meet criteria

• It is important for us to understand the relationships among objects, concepts, and

terms (refer to pg. 280)

• ISO 1087-1:2000- provided definitions for elements mentioned above

o Concept (thought, reference): unit of knowledge created by a unique

 combination of characteristics- a characteristic is an abstract of a property
of an object or a set of objects

o Object (referent): anything perceivable or conceivable

o Term (symbol): verbal designation of a general concept in a specific

subject field- a general concept corresponds to two or more objects which
form a group by reason of common properties

Components of Advanced Terminology Systems

• Within the context of high-level information model provided by Nursing Minimum

Data Set (NMDS), there has been extensive development and refinement of
terminologies for describing patient problems, nsg interventions, and nsg-sensitive
patient outcomes

Terminology Model

• Concept based presentation of a collection of domain-specific terms optimized for

management of terminological definitions

• Encompasses both schemata and type definitions

o Schemata- incorporate domain-specific knowledge about typical

constellations of entities, attributes and events in real world and reflect
plausible combinations of concepts, and may be supported by either formal
or informal composition rules

o Type definitions- obligatory conditions that state only the essential

properties of a concept

Representation Language

• Terminology models may be formulated and elucidated in an ontology language

• Ontology languages represent classes and their properties

• Thus they are able to support, through explicit semantics, the formal definition of
concepts in terms of their relationships with other concepts

Computer-Based Tools

• A representation language may be implemented using description logic within a

software system or by a suite of software tools

• Functionality of these tools vary

• Software may facilitate transformation of concept representations into canonical

form or support a set of sanctions that test whether a propsed composed concept
is sensible

Generations of terminologies

• 1st generation terminology systems

o consist of a list of enumerated terms, possibly arranged as a single

hierarchy

o Serve a single purpose or a group of closely related purposes and allow

minimal computer processing

• 2nd generation systems

 o include an abstract terminology model or terminology model schema that
describes the organization of the main categories used in a particular
terminology or set of terminologies

o abstract terminology model is usually accompanied by a thesaurus of

elementary descriptors and a template of rules

o can be used for a limited range of purposes

• 3rd generation language systems

o support sufficient formalisms to enable computer-based processing

o also referred to as formal concept representation systems or reference

terminologies

Advantages of Advanced Terminology Systems

• Computer-based systems that support clinical uses such as EHRs and decision
support require more granular (less abstract) data than that typically contained in
terminologies designed primarily for manual use or for classification

• Advanced concept-oriented terminology systems allow much greater granularity

• They facilitate two important facets of knowledge representation for a computer-

based system:

o Describing concepts

 Advantages in this facet include:

• Nonambiguous representation of concepts

• Facilitation of data abstraction or de-abstraction without

loss of original data

• Nonambiguous mapping among terminologies

• Data reuse in different contexts

o Manipulating and reasoning about those concepts using computer-based

tools

 Advantages include:

• Automated classification of new concepts and ability to

support multiple inheritance of defining characteristics

Advanced Terminological Approaches in Nursing

ISO 18104:2003

• An international standard covering reference terminology modesl for nursing

diagnoses was approved in 2003

• Developed by experts within ISO Technical Committee 215 (Health Informatics)

Working Group 3 (Health Concept Representation) under the collaborative
leadership of the International Medical Informatics Association- Nursing Special
Interest Group (IMIA-NI) and the International Council of Nurses (ICN)

• Motivated in part by desire to harmonize the plethora of nursing terminologies in

 use around the world

• Potential uses include:

o Facilitate representation of nsg dx and nsg axn concepts and their

relationships in a manner suitable for computer processing

o Provide a framework for generation of compositional expressions from

atomic concepts within a reference terminology

o Facilitate mapping among nursing diagnosis and nursing action concepts

from various terminologies

o Enable the systematic evaluation of terminologies and associated

terminology models for purposes of harmonization

o Provide a language to describe the structure of nursing diagnosis and

nursing action concepts in order to enable appropriate integration with
information models

GALEN

• concept-oriented approach has been developed within the GALEN program

• can be used in a range of ways, from directly supporting clinical applications to

support authoring, maintenance and quality assurance of other kinds of
terminologies

• GRAIL: an ontology language for representing concepts and their interrelationships

o Two integrated sets of tools used in development of GRAIL model

 Computer based modeling environment

• Facilitates collaborative formulation of models

• Allows authoring of clinical knowledge at different levels of

abstraction

 Terminology server

• A software system that implements GRAIL

• Performs functions such as:

o Internally managing and representing the model

o Testing validity of combinations of concepts

o Constructing valid composed concepts

o Transforming composed concepts into canonical

form

o Automatically classifying composed concepts into

hierarchy

• Has been successfully applied in other areas of healthcare

o Does not seek to replace existing nsg terminologies, but to contribute,

supplement their development and allow comparisons among them

SNOMED RT

• Developed through collaboration between College of American Pathologists and

Kaiser Permanente based on SNOMED International
• A reference terminology optimized for clinical data retrieval and analysis

• Concepts are presented using modified KRSS rather than GRAIL

• Concept definition and manipulation are supported through a set of tools with
functionality such as:

o Acronym resolution, word completion, term completion, spelling correction,

display of authoritative from of the term entered by the user and
decomposition of unrecognized input

o Automated classification

o Conflict management, detection and resolution