Biomedical Informatics Some Observations on Clinical Data Representation in EHRs Christopher G....
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Biomedical Informatics
Some Observations on Clinical Data Representation in EHRs
Christopher G. Chute, MD DrPH, Mayo Clinic Chair, ICD11 Revision, World Health Organization Chair, ISO Tech. Comm. TC215 Health Informatics
International Conference on Biomedical OntologyBuffalo, 30 July 2011
Biomedical Informatics
© 2007 Mayo Clinic College of Medicine 2
From Practice-based Evidenceto Evidence-based Practice
PatientEncounters
ClinicalDatabases Registries et al.
ClinicalGuidelines
Medical Knowledge
ExpertSystems
Data Inference
KnowledgeManagement
Decisionsupport
OntologyShared Semantics
Vocabularies & Terminologies
Biomedical Informatics
© 2007 Mayo Clinic College of Medicine 3
Blois, 1988Medicine and the nature of vertical reasoning •Molecular: receptors, enzymes, vitamins, drugs•Genes, SNPs, gene regulation•Physiologic pathways, regulatory changes•Cellular metabolism, interaction, meiosis,…•Tissue function, integrity•Organ function, pathology•Organism (Human), disease•Sociology, environment, nutrition, mental health…
Biomedical Informatics
© 2007 Mayo Clinic College of Medicine 4
The Continuum Of Biomedical InformaticsBioinformatics meets Medical Informatics
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Biology Medicine
Chasm of Semantic Despair
Biomedical Informatics
© 2007 Mayo Clinic College of Medicine 5
The Historical Center of theHealth Data Universe
Clinical Data
Billable Diagnoses
Billable Diagnoses
Biomedical Informatics
© 2007 Mayo Clinic College of Medicine 6
Copernican Healthcare
Billable Diagnoses
Clinical Data(Niklas Koppernigk)
Clinical Guidelines
Scientific Literature
Medical Literature
Clinical Data
Biomedical Informatics
© 2007 Mayo Clinic College of Medicine 9
Familiar Points Along Continuum Modern Health Vocabularies
• Nomenclature – Highly Detailed Descriptions (SNOMED)• Classification – Organized Aggregation of Descriptions into a Rubric
(ICDs)• Groupings – High Level Categories of Rubrics (DRGs)
Detailed GroupedNomenclature Classification Groups
GroupersAggregation
Biomedical Informatics
© 2007 Mayo Clinic College of Medicine 10
Aggregation Logics by domainrule-based aggregations
Decision Support and Error Detection
Public Health andSurveillance
Reimbursement and Management
Outcome Research and EpidemiologyFindings InterventionsEvents
Biomedical Informatics
© 2007 Mayo Clinic College of Medicine 11
ICD11 Use Cases• Scientific consensus of clinical phenotype
• Public Health Surveillance• Mortality• Public Health Morbidity
• Clinical data aggregation• Metrics of clinical activity • Quality management
• Patient Safety• Financial administration
• Case mix• Resource allocation
Biomedical Informatics
© 2007 Mayo Clinic College of Medicine 12
Traditional Hierarchical SystemICD-10 and family
Biomedical Informatics
© 2007 Mayo Clinic College of Medicine 13
Addition of semantic arcs - Ontology
Relationships Logical Definitions Etiology Genomic Location
Laterality Histology Severity Acuity
Biomedical Informatics
© 2007 Mayo Clinic College of Medicine 14
Linear views may serve multiple use-casesMorbidity, Mortality, Quality, …
Biomedical Informatics
ICD11 Content Model
Descriptive characteristics1. Type Disease, disorder, syndrome, injury,
sign/symptom, external cause, reason for encounter
2. Body System(s) (pathophysiology)
3. Body Part(s) (anatomical site)4. Manifestation Attributes
a. Signs & Symptomsb. Diagnostic Findings
5. Causal Properties (etiology) a. Causal Mechanisms /Agentsb. Genomic characteristics
6. Temporal Properties7. Severity and/or Extent 8. Functional Impact9. Treatment
TITLE : Name of disease, disorder, or syndrome…1. Textual definition 2. Synonyms - Inclusion – Exclusion - Index terms
Maintenance attributesA. Unique identifierB. Subset, adaptation, and
special view flag1. Primary Care
2. Clinical Care 3. Research4. Special indices (e.g. Public Health
Indices or Resource Groupings)
C. Hierarchical relationships parents and children in
ICD structure
D. Mapping relationships• Linkages to other systems like
SNOMED etc.
A. Other rules
Biomedical Informatics
ICD11 and SNOMED16
Relationship with IHTSDOSNOMED content
• IHT (SNOMED) will require high-level nodes that aggregate more granular data•Use-cases include mutually exclusive, exhaustive,…•Sounds a lot like ICD
• ICD-11 will require lower level terminology for value sets which populate content model•Detailed terminological underpinning•Sounds a lot like SNOMED
•Memorandum of Agreement – July 2010!•WHO right to use for authoring and interpretation
Biomedical Informatics
© 2007 Mayo Clinic College of Medicine 17
Potential Future States
ICD-11SNOMED
Ghost SNOMED
Ghost ICD