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

Integration approaches Translating to OWL Applications (reusing rules) Conclusions

Archetypes are formal clinical specifications, expressed in terms of constraints on a reference model.

clinical archetypes (OpenEHR)

ReferenceModel

They are combined together through templates, and used at runtime to

extract data, to enable querying, and to support legacy data

transformation.

coded texts, quantities, measures, date/times,

booleans,

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}

… state matches { … ELEMENT[at0013] occurrences matches {0..1} matches { -- Position value matches { DV_CODED_TEXT matches { at1000 – Lying; at1001 – Sitting; at1002 – Reclining; … etc} … protocol matches { … ELEMENT[at0011] occurrences matches {0..1} matches { -- Device DV_TEXT matches {*}

ontologyterminologies_available = <"SNOMED-CT", ...>

items = < ["at0000"] = < description = <"The rate the heart is beating - either mechanically or electrically"> text = <"Heart rate">

Classification of types ofClinical Information (Beale & Heard)

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

ACTION: a record of intervention actions that have occurred, due to the execution of an Instruction by some agent:• Medication action• Transfusion

EVALUATION: inferences of the investigator using the personal and published knowledge base about what the observations mean, and what to do about them.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);

about the past about the present about the future

RMAM

Information & reality

Information model (OpenEHR) models of reality

domain content models(variable)

Archetypes

Information models(stable)

Reference Model & Service Model

classifications processdescriptionICDx, ICPC,

LOINC guidelines

descriptiveterminologiesSNOMED-CT

OGMS ontology

Information aboutContinuant & 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).

As pieces of information, archetypes instances are all Continuant entities. However, they contain information about clinical statements that represent both Continuant and Occurrent entities.

Information aboutContinuant & Occurrent entities

Info about

Info aboutOccurrents

Conti-nuants

Initiation, Realization, Recognition and Representation of Disease I

The clinical investigator model (OpenEHR) Physical Examinations, Signs,

Symptoms, Clinical History, Lab Tests & Findings.

Clinical Picture, Diagnosis Plan development

Treatment & Therapeutic

response

Initiation, Realization, Recognition and Representation of Disease II (Scheuermann & Smith)

CLUS.symptomCLUS.health_event

CLUS.issue

CLUS.symptomCLUS.health_event

CLUS.issue

OBS.examCLUS.inspection

OBS.examCLUS.inspection

EVAL.diagnosisEVAL.problem

EVAL.diagnosisEVAL.problem ACT.follow_upACT.follow_up

OBS.lab_testCLUS.specimenOBS.lab_testCLUS.specimen

OBS.storyOBS.story

INS.follow_upINS.follow_up