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ECOREuropean Centre forOntological Research
Practical implementations of realism-based ontologies:
Referent Tracking in Electronic Health Records
MIE 2005 tutorial #35 on Ontology Design (part 4)Geneva, Switzerland, August 28, 2005
Dr. W. CeustersEuropean Centre for Ontological Research
Saarland University
Saarbrücken - Germany
ECOREuropean Centre forOntological Research
Three models for a Comprehensive Patient Care
Information System *
Information model of the medical record: What can be said ?
Process model of clinical care: What
ought to occur ?
Inferred model of the state of the patient:
What actually occurs.
* Rector AL, Nolan WA, and Kay S. Foundations for an Electronic Medical Record. Methods of Information in Medicine 30: 179-86, 1991. (Figure 1)
requirements inferences
modification
Inferred model of the state of the patient:
What actually occurs.
?
ECOREuropean Centre forOntological Research
What ‘event’ occurred in my left hand being a part of my left arm ?
Is ‘saying that an event has occurred’ a requirement for the event to have occurred ?
An event model of medicalinformation representation *
• ‘The real world consist of objects (or entities)’ • ‘Objects interact with other objects and can be associated with
other objects by relationships’ • ‘When two or more objects interact in the real world, an ‘event’
is said to have occurred’
* Huff SM, Rocha RA, Bray BE, Warner HR, and Haug PJ. An Event Model of Medical Information Representation. J Am Med Informatics Assoc. 1995;2:116-134.
?
ECOREuropean Centre forOntological Research
Observation Event Instance Created from the Statement
‘Surgical clips are again seen along the right mediastinum’ *
* Huff SM, Rocha RA, Bray BE, Warner HR, and Haug PJ. An Event Model of Medical Information Representation. J Am Med Informatics Assoc. 1995;2:116-134.
?Are the clips there because they have been observed ?
Is the observation located in the mediastinum ?
ECOREuropean Centre forOntological Research
What is wrong in both cases(and so many others) ?
• Further clues to the answer:– Huff SM, Rocha RA, Bray BE, Warner HR, and Haug
PJ. An Event Model of Medical Information Representation. J Am Med Informatics Assoc. 1995;2:116-134.
– Rector et al.’s paper: Many of the difficulties experienced in attempting to generalize existing [patient record] systems stem from the fact that they have pre-selected and distorted information in order to fit into particular applications, usually clinical research and epidemiology. The models emit much of the information actually used in clinical care and do not accurately reflect the real status of the data they record.
• Further clues to the answer:– Huff SM, Rocha RA, Bray BE, Warner HR, and Haug
PJ. An Event Model of Medical Information Representation. J Am Med Informatics Assoc. 1995;2:116-134.
– Rector et al.’s paper: Many of the difficulties experienced in attempting to generalize existing [patient record] systems stem from the fact that they have pre-selected and distorted information in order to fit into particular applications, usually clinical research and epidemiology. The models emit much of the information actually used in clinical care and do not accurately reflect the real status of the data they record.
ECOREuropean Centre forOntological Research
What is wrong (continued) ?
• An overemphasis on data and information and too little attention to reality:
– “data modelling”– “information modelling”
• Is the “Object Oriented” model approach any better, since, after all, objects are said to be those things that exist in reality ?
– The object-oriented model is based on a collection of objects
– An object contains values stored in instance variables within the object.
– Unlike the record-oriented models, these values are themselves objects.
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The story of Jane Smith
an old case, well known in the literature ...
ECOREuropean Centre forOntological Research
Jane’s favourite supermarket
July 4th, 1990: Jane goes shopping:
The freezer section of Jane’s favourite supermarket
The only available warning sign used outside
A very suspiciously shaped upper leg
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A visit to the hospital
City Health Centre Dr. Peters
(City HC) Dr. Longley
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Diagnosis: a severe spiral fracture of the femur
ECOREuropean Centre forOntological Research
The City HC’s medical record
• Main principles:– a faithful record of the clinicians’ observations:
what they have heard, seen, thought and done.– captures in a structured form all of the ‘clinically
significant’ information in the narrative notes, where by clinically significant they mean the information which is within the medical domain rather than the domain of everyday life.
Rector AL, Nowlan WA, Kay S, Goble CA, Howkins TJ. A framework for modelling the electronic medical record. Methods Inf Med. 1993 Apr;32(2):109-19.
ECOREuropean Centre forOntological Research City HC’s EHR model
Rector AL, Nowlan WA, Kay S, Goble CA, Howkins TJ.A framework for modelling the electronic medical record.Methods Inf Med. 1993 Apr;32(2):109-19.
ECOREuropean Centre forOntological Research
CityHC’s representation formalism(for statements in records)
Rector AL, Nowlan WA, Kay S, Goble CA, Howkins TJ.A framework for modelling the electronic medical record.Methods Inf Med. 1993 Apr;32(2):109-19.
Categories: “represent concepts and are analogous to classes in other formalisms”
Individuals: “concrete instances of categories which persist in space and time”Occurrences: “are
specific occurrences of individuals and must be situated in space and time. The most importantgroup of occurrences are observations — i.e. agents’ observations of individuals.”
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Note:Mixing statements and entities
• “Every occurrence level statement concerning the Jane Smith’s Fracture of the Femur is an observation of the corresponding individual.”
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5572 04/07/1990 26442006 closed fracture of shaft of femur
5572 04/07/1990 81134009 Fracture, closed, spiral
5572 12/07/1990 26442006 closed fracture of shaft of femur
5572 12/07/1990 9001224 Accident in public building (supermarket)
5572 04/07/1990 79001 Essential hypertension
0939 24/12/1991 255174002 benign polyp of biliary tract
2309 21/03/1992 26442006 closed fracture of shaft of femur
2309 21/03/1992 9001224 Accident in public building (supermarket)
47804 03/04/1993 58298795 Other lesion on other specified region
5572 17/05/1993 79001 Essential hypertension
298 22/08/1993 2909872 Closed fracture of radial head
298 22/08/1993 9001224 Accident in public building (supermarket)
5572 01/04/1997 26442006 closed fracture of shaft of femur
5572 01/04/1997 79001 Essential hypertension
PtID Date ObsCode Narrative
0939 20/12/1998 255087006 malignant polyp of biliary tract
A look at the database:Use of SNOMED codes for ‘unambiguous’
understanding
*
*
*
* cause, not disorder
How many disorders have patients 5572, 2309 and 298 each had thus far in their lifetime ?
How many numerically different disorders are listed here ?
How many different types of disorders are listed here ?
ECOREuropean Centre forOntological Research
5572 04/07/1990 26442006 closed fracture of shaft of femur
5572 04/07/1990 81134009 Fracture, closed, spiral
5572 12/07/1990 26442006 closed fracture of shaft of femur
5572 12/07/1990 9001224 Accident in public building (supermarket)
5572 04/07/1990 79001 Essential hypertension
0939 24/12/1991 255174002 benign polyp of biliary tract
2309 21/03/1992 26442006 closed fracture of shaft of femur
2309 21/03/1992 9001224 Accident in public building (supermarket)
47804 03/04/1993 58298795 Other lesion on other specified region
5572 17/05/1993 79001 Essential hypertension
298 22/08/1993 2909872 Closed fracture of radial head
298 22/08/1993 9001224 Accident in public building (supermarket)
5572 01/04/1997 26442006 closed fracture of shaft of femur
5572 01/04/1997 79001 Essential hypertension
PtID Date ObsCode Narrative
0939 20/12/1998 255087006 malignant polyp of biliary tract
Same patient, same hypertension code:Same (numerically identical) hypertension ?
Different patients, same fracture codes:Same (numerically identical) fracture ?
Same patient, different dates, same fracture
codes: same (numerically identical)
fracture ?
Same patient, same date,2 different fracture codes:
same (numerically identical) fracture ?
Would the terms help ?Different patients. Same supermarket? Maybe the same (irrelevant ?) freezer section ?Or different supermarkets, but always in the freezer sections ?
Same patient, different dates, Different codes. Same (numericallyidentical) polyp ?
ECOREuropean Centre forOntological Research Main problem areas
for CityHC’s EHR• Statements refer only very implicitly to the concrete
entities about which they give information.• Idiosyncracies of concept-based terminologies
– tell us only that some instance of the class the codes refer to, is refered to in the statement, but not what instance precisely.
– Are usually confused about classes and individuals.• “Country” and “Belgium”.
• Mixing up the act of observation and the thing observed.
• Mixing up statements and the entities these statements refer to.
ECOREuropean Centre forOntological Research
Consequences
• Very difficult to:– Count the number of (numerically) different
diseases • Bad statistics on incidence, prevalence, ...• Bad basis for health cost containment
– Relate (numerically same or different) causal factors to disorders:
– Dangerous public places (specific work floors, swimming pools), dogs with rabies, HIV contaminated blood from donors, food from unhygienic source, ...
• Hampers prevention
– ...
ECOREuropean Centre forOntological Research Proposed solution:
Referent Tracking
• Purpose:– explicit reference to the concrete individual entities
relevant to the accurate description of each patient’s condition, therapies, outcomes, ...
• Method:– Introduce an Instance Unique Identifier (IUI) for each
relevant individual (= particular, = instance).– Distinguish between
• IUI assignment: for instances that do exist• IUI reservation: for entities expected to come into existence in
the future
ECOREuropean Centre forOntological Research Ontology
• ‘An ontology’ is a representation of some pre-existing domain of reality which– (1) reflects the properties of the objects within its
domain in such a way that there obtains a systematic correlation between reality and the representation itself,
– (2) is intelligible to a domain expert– (3) is formalized in a way that allows it to support
automatic information processing
• ‘ontological’ (as adjective):– Within an ontology.– Derived by applying the methodology of ontology– ...
ECOREuropean Centre forOntological Research
An ontological analysis
continuantsCity HC
The freezer section of Jane’s favourite supermarket
Jane’s left femur
Jane’s left femur fracture
Jane Smith
Dr. Peters
Jane’s left femur
Jane’s fracture’s image
Dr. Longley
City HC’s EHR system
t Jane’s fallingJane’s femur breakingDr. Peter’s examination of Jane’s fractureDr. Peter’s ordering of an X-rayShooting the pictures of Jane’s leg
occurrents
Jane’s fracture’s healingDr. Peter’s diagnosis making
Jane diesFreezer section dismantledDr. Longley’s examination of Jane’ s fracture
Jane’s fracture as seen by Dr. PetersJane’s fracture as seen by Dr.
Longley
Instances of
Jane’s fracture
UniversalsEHR system
HC
Freezer section
Person
Femur
Fracture
Image
ECOREuropean Centre forOntological Research Ontological recategorisation
CityHC Dr. PetersJane
Smith
JaneSmith’sFractureOf Femur
FractureOf Femur
Severe Spiral
City HCexists on 4th July1990
Dr. Peterslocated atCity HC on 4th July1990
Jane Smith’sconsultation withDr. Peters atCity HC on 4th July1990
Dr. Peters’assessment ofJane Smith’sfracture offemur atCity HC on 4th July1990
JaneSmith’sFracture
Of Femur’sseverity
JaneSmith’sFracture
Of Femur’sshape
ECOREuropean Centre forOntological Research
Essentials of Referent Tracking
• Generation of universally unique identifiers;• deciding what particulars should receive a IUI;• finding out whether or not a particular has already
been assigned a IUI (each particular should receive maximally one IUI);
• using IUIs in the EHR, i.e. issues concerning the syntax and semantics of statements containing IUIs;
• determining the truth values of statements in which IUIs are used;
• correcting errors in the assignment of IUIs.
ECOREuropean Centre forOntological Research
Architecture of aReferent Tracking System (RTS)
• RTS: system in which all statements referring to particulars contain the IUIs for those particulars judged to be relevant.
• Ideally set up as broad as possible:– some metrics:
• % of particulars referred to by means of IUI• % of HCs active in a region
– Geographic region– functional region: defined by contacts amongst patients
• % of patients referred to within a region
• Services:– IUI generator– IUI repository: statements about assignments and reservations– Referent Tracking ‘Database’ (RTDB): index (LSID) to statements relating
instances to instances and classes
ECOREuropean Centre forOntological Research
IUI generation
• Universally Unique IDs: – recently standardized through ISO/IEC 9834-
8:2004, – specifies format and generation rules enabling
users to produce 128-bit identifiers that are either guaranteed or have a high probability of being globally unique
– Meaningless strings– Central management or certification not needed
to guarantee uniqueness• (But use as IUI requires this)
ECOREuropean Centre forOntological Research
IUI assignment
• = an act carried out by the first ‘cognitive agent’ feeling the need to acknowledge the existence of a particular it has information about by labelling it with a UUID.
• ‘cognitive agent’:– A person;– An organisation;– A device or software agent, e.g.
• Bank note printer,• Image analysis software.
ECOREuropean Centre forOntological Research
Criteria for IUI assignment (1)1. The particular’s existence must be determined:
– Easy for persons in front of you, body parts, ...– Easy for ‘planned acts’: they do not exist before the
plan is executed !• Only the plan exists and possibly the statements made about
the future execution of the plan
– More difficult: subjective symptoms• But the statements the patient makes about them do exist !
– However: • no need to know what the particular exactly is, i.e. which
universal it instantiates• No need to be able to point to it precisely
– One bee out of a particular swarm that stung the patient, one pain out of a series of pain attacks that made the patient worried.
– But: this is not a matter of choice, not ‘any’ out of ...
ECOREuropean Centre forOntological Research
Criteria for IUI assignment (2)
2. The particular’s existence ‘may not already have been determined as the existence of something else’:
• Morning star and evening star• Himalaya• Multiple sclerosis
3. May not have already been assigned a IUI.
4. It must be relevant to do so:• Personal decision, (scientific) community guideline, ... • Possibilities offered by the EHR system• If a IUI has been assigned by somebody, everybody else
making statements about the particular should use it
ECOREuropean Centre forOntological Research Assertion of assignments
• IUI assignment is an act of which the execution has to be asserted in the IUI-repository:– Di = <IUId, Ai, td>
• IUId IUI of the registering agent
• Ai the assertion of the assignment < IUIp, IUIa, tap>
» IUIa IUI of the author of the assertion
» IUIp IUI of the particular
» tap time of the assignment
• td time of registering Ai in the IUI-repository
• Neither td or tap give any information about when # IUIp
started to exist ! That might be asserted in statements
providing information about # IUIp .
ECOREuropean Centre forOntological Research
Management of the IUI-repository
• Adequate safety and security provisions– Access authorisation, control, read/write, ...– Pseudonymisation
• Deletionless but facilities for correcting mistakes.
• Registration of assertion ASAP after IUI assignment
• (virtual, e.g. LSID) central management with adequate search facilities.
ECOREuropean Centre forOntological Research Representation in the EHR
• Relevant particulars referred to using IUIs
• Relationships that obtain between particulars at time t expressed using relations from an ontology (type OBO)
• Statements describing for each particular, at time t:– Of what universal from an
ontology it is an instance of– AND/OR (if one insists):– By means of what concept from
a concept-based system it can sensibly be described
CityHC Dr. PetersJane
Smith
JaneSmith’s
FractureOf Femur
FractureOf Femur
SevereSpiral
Jane Smith’sconsultation withDr. Peters atCity HC on 4th July1990
Dr. Peters’assessment ofJane Smith’sfracture offemur atCity HC on 4th July1990
JaneSmith’s
FractureOf Femur’s
severity
JaneSmith’s
FractureOf Femur’s
shape
4th July 1990
particulars
ECOREuropean Centre forOntological Research PtoP statements -
particular to particular • ordered sextuples of the form Ri = <IUIa, ta, r, o, P, tr>
IUIa is the IUI of the author of the statement,
ta a reference to the time when the statement is made,
r a reference to a relationship (available in o) obtaining between the particulars referred to in P,o a reference to the ontology from which r is taken,P an ordered list of IUIs referring to the particulars between which
r obtains, and,tr a reference to the time at which the relationship obtains.
• P contains as much IUIs as required by the arity of r. In most cases, P will be an ordered pair such that r obtains between the particular represented by the first IUI and the one referred to by the second IUI. • As with A statements, these statements must also be accompanied by a meta-statement capturing when the sextuple became available to the referent tracking system.
ECOREuropean Centre forOntological Research
PtoU statements – particular to universal
Ui = <IUIa, ta, inst, o, IUIp, u, tr>
IUIa is the IUI of the author of the statement,
ta a reference to the time when the statement is made,
inst a reference to an instance relationship available in o obtaining between p and cl,
o a reference to the ontology from which inst and u are taken,
IUIp the IUI referring to the particular whose inst
relationship with u is asserted,u the universal in o to which p enjoys the inst relationship, and,tr a reference to the time at which the relationship obtains.
ECOREuropean Centre forOntological Research
PtoCO statements particular to concept code
Coi = <IUIa, ta, cbs, IUIp, co, tr>
IUIa is the IUI of the author of the statement,
ta a reference to the time when the statement is made,
cbs a reference to the concept-based system from which co is taken,
IUIp the IUI referring to the particular which the author
associates with co,co the concept-code in cbs which the author associates with p, and,tr a reference to the time at which the author considers the
association appropriate,
ECOREuropean Centre forOntological Research
Interpretation ofPtoCO statements
• must be interpreted as simple indexes to terms in a dictionary.
• All that such a statement tells us, is that within the linguistic and scientific community in which cbs is used, the terms associated with co may - i.e. are acceptable to - be used to denote p in their determinative version.
ECOREuropean Centre forOntological Research A SNOMED-CT example
• <IUI-0945, 18/04/2005, SNOMED-CT v0301, IUI-1921, 367720001, forever>
• #IUI-0945: author of the statement• #IUI-1921: the left testicle of patient #IUI-78127• 367720001: the SNOMED concept-code to which “left testis” is
(in SNOMED) attached as term
• So we can denote #IUI-1921 by means of• that left testis• that entire left testis• that testicle, that male gonad, that testis• that genital structure• that physical anatomical entity• BUT NOT: that SNOMED-CT concept
ECOREuropean Centre forOntological Research Pragmatics of IUIs in EHRs
• IUI assignment requires an additional effort• In principle no difference qua (or just a little bit more) effort
compared to using directly codes from concept-based systems– A search for concept-codes is replaced by a search for the
appropriate IUI using exactly the same mechanisms• Browsing• Code-finder software• Auto-coding software (CLEF NLP software Andrea Setzer)
– With that IUI comes a wealth of already registered information– If for the same patient different IUIs apply, the user must make
the decision which one is the one under scrutiny, or whether it is again a new instance
• A tranfert or reference mechanism makes the statements visible through the RTDB
ECOREuropean Centre forOntological Research Advantage: better
reality representation
5572 04/07/1990 26442006 closed fracture of shaft of femur
5572 04/07/1990 81134009 Fracture, closed, spiral
5572 12/07/1990 26442006 closed fracture of shaft of femur
5572 12/07/1990 9001224 Accident in public building (supermarket)
5572 04/07/1990 79001 Essential hypertension
0939 24/12/1991 255174002 benign polyp of biliary tract
2309 21/03/1992 26442006 closed fracture of shaft of femur
2309 21/03/1992 9001224 Accident in public building (supermarket)
47804 03/04/1993 58298795 Other lesion on other specified region
5572 17/05/1993 79001 Essential hypertension
298 22/08/1993 2909872 Closed fracture of radial head
298 22/08/1993 9001224 Accident in public building (supermarket)
5572 01/04/1997 26442006 closed fracture of shaft of femur
5572 01/04/1997 79001 Essential hypertension
PtID Date ObsCode Narrative
0939 20/12/1998 255087006 malignant polyp of biliary tract
IUI-001
IUI-001
IUI-001
IUI-003
IUI-004
IUI-004
IUI-005
IUI-005
IUI-005
IUI-007
IUI-007
IUI-007
IUI-002
IUI-012
ECOREuropean Centre forOntological Research
Other Advantages
• mapping as by-product of tracking– Descriptions about the same particular using
different ontologies/concept-based systems
• Quality control of ontologies and cbs– Systematic “inconsistent” descriptions in or
cross terminologies may indicate poor definition of the respective terms
ECOREuropean Centre forOntological Research
A case study
• Double goal:– Application of referent tracking to a concrete
patient story– Ontological analysis of what is involved
• The latter is NOT to be performed to the same extent when referent tracking is used as an alternative to coding using concept-based systems.
• So, don’t go home with the idea: “that’s all too cumbersome and time cosuming”
ECOREuropean Centre forOntological Research
Jim Cimino’s Woods Hole caseJane Smith is a 30 year old, Native American female who presents to the emergency room with the chief complaint of cough and chest pain.The patient reports that she has had a productive cough for three days but that chest pain developed one hour ago. She gives a history of hypertension. She also reports that she was treated in the past for tuberculosis while she was pregnant. The patient reports an allergy to Bufferin.Physical examination revealed a well-developed, well-nourished female in moderate respiratory distress. Vital signs showed a pulse of 90, a respiratory rate of 22, an oral temperature of 100.3, and a blood pressure of 150/100. Examination revealed rales and rhonchi in the left upper chest. Abdominal exam revealed a tender, palpable liver edge.Labs:Chem7 (serum): Glucose 100 (70-105) Chem7 (plasma): Glucose 150 (75-110)CBC: Hgb 15 (12.0-15.8), Hct 45 (42.4-48.0), WBC 11,000 (3,540-9,060), Platelets 145,000 (165,000-415,000)A fingerstick blood sugar was 80Urinalysis showed protein of 1+ and glucose of 0.A blood culture was positive for methicillin-resistant Staphylococcusaureus (MRSA)
ECOREuropean Centre forOntological Research case study continued ...
• ECG - Sinus Rhythm, 74BPM, Axis -30 degrees, ST segment 2mm elevated andT-waves down in leads I, L, V5 and V6
Chest X-ray Left upper lobe infiltrate, left ventricular hypertrophy
The patients nurse reported that the patient seemed depressed about her condition. On questioning, the nurse found that the patient was caringfor her elderly father and was concerned that she would no longer be able to manage caring for herself and him. The nurse asked the patients physician to consider an antidepressant and a social work consult.
A medical student reviewing the case is concerned about the risk of MRSA in patients with pneumonia and a recent myocardial infarction. She decides to do a literature search.
ECOREuropean Centre forOntological Research
Step 1: identify the phrases referring to particulars
Jane Smith is a 50 year old ,
Native American female who presents
to the emergency room
with the chief complaint
of cough and chest pain.
Question:What if the patient is not tellingthe truth ?
ECOREuropean Centre forOntological Research
Jane Smith is a 50 year old ,
Native American female who presents
to the emergency room
with the chief complaint
of cough and chest pain.
Step 2: indentify to what particulars these phrases refer
Jane Smith Jane Smith’s age
Jane Smith’s race Jane SmithJane Smith’s gender Jane Smith’s showing up at ...
A specific emergency room of health facility XYZ
Jane Smith’s complaining primarily about ...
A temporal part of Jane Smith’slife marked by happenings of coughs
Jane Smith’s chest
A specific pain experienced by Jane Smith
ECOREuropean Centre forOntological Research
Compare with simple clinical coding in juxtaposition
Jane Smith is a 50 year old ,
Native American female who presents
to the emergency room
with the chief complaint
of cough and chest pain.
“Jane Smith” CS1-age
CS1-native-americanCS1-female-gender
CS1-emergency room
CS1-chief-complaint
CS1-coughing CS1-chest-pain
CS2-woman
CS2-painCS2-chest
ECOREuropean Centre forOntological Research
Compare with the output of the perfect semantic analyser we all would dream of
CS3-50 years oldHas-Age
CS3-woman
Is-A
CS3-native american
Is-ACS3-complaining
“Jane Smith”
Has-Sayer
CS3-chest pain
Has-Saying
CS3-coughing
Has-Saying
CS3-consultation
Has-happening-during
CS3-Em.RoomHas-Loc
Has-participant
Compare with the output of the NAIVE !!! semantic analyser we all would dream of
ECOREuropean Centre forOntological Research
What it (more or less) should be
CS3-complaining
CS3-chest pain
Has-Saying
CS3-coughing
Has-Saying
“chest-pain”
Has-’referent’
“coughing”
Has-’referent’
ECOREuropean Centre forOntological Research Most important difference:
Use of generic terms
Use of concrete particulars
Jane Smith is a 50 year old ,
Native American female who presents
to the emergency room
with the chief complaint
of cough and chest pain.
Jane Smith is a 50 year old ,
Native American female who presents
to the emergency room
with the chief complaint
of cough and chest pain.
Jane Smith Jane Smith’s age
Jane Smith’s race Jane SmithJane Smith’s gender Jane Smith’sshowing up at ...
A specific emergency room of health facility XYZ
Jane Smith’s complaining primarily about ...
A temporal part of Jane Smith’slife marked by happenings of coughs
Jane Smith’s chest
A specific pain experienced by JaneSmith
Jane Smith is a 50 year old ,
Native American female who presents
to the emergency room
with the chief complaint
of cough and chest pain.
“Jane Smith” CS1-age
CS1-native-americanCS1-female-gender
CS1-emergency room
CS1-chief-complaint
CS1-coughing CS1-chest-pain
Jane Smith is a 50 year old ,
Native American female who presents
to the emergency room
with the chief complaint
of cough and chest pain.
Jane Smith is a 50 year old ,
Native American female who presents
to the emergency room
with the chief complaint
of cough and chest pain.
“Jane Smith” CS1-age
CS1-native-americanCS1-female-gender
CS1-emergency room
CS1-chief-complaint
CS1-coughing CS1-chest-pain
CS2-woman
CS2-painCS2-chest
CS2-womanCS2-woman
CS2-painCS2-painCS2-chestCS2-chest
CS3-50 years oldHas-Age
CS3-50 years oldHas-Age
CS3-woman
Is-A
CS3-woman
Is-A
CS3-native american
Is-A
CS3-native american
Is-ACS3-complaining
“Jane Smith”
Has-Sayer
“Jane Smith”
Has-Sayer
CS3-chest pain
Has-Saying
CS3-chest pain
Has-Saying
CS3-coughing
Has-Saying
CS3-coughing
Has-Saying
CS3-consultation
Has-happening-during
CS3-consultation
Has-happening-during
CS3-Em.RoomHas-Loc CS3-Em.RoomHas-Loc
Has-participantHas-participant
ECOREuropean Centre forOntological Research Step 3: are relevant and
necessary particulars missing ?• Referred to:
– Jane Smith– Jane Smith’s age– Jane Smith’s race– Jane Smith’s gender– Jane Smith’s showing up at ...– The specific emergency room in the health facility– Jane Smith’s primarily complaining ...– The temporal part ... coughs– Jane Smith’s chest– Jane Smith’s particular pain
• Missing:– The health facility– The healthcare worker she consulted– The particular coughs (under the condition she tells the objective truth)– The underlying disorder (under whatever state of affairs)
ECOREuropean Centre forOntological Research
Step 4: IUI assignment
• Assumptions: – the RTS contains already:
• IUI-1 Jane Smith
Coi = <IUIa, ta, CS3, IUI-1, woman, tr>
• IUI-1.1 Ri = <IUIa, ta, depends-on, BFO, {IUI-1.1, IUI-1}, tr>
Coi = <IUIa, ta, CS1, IUI-1.1, age, tr>
• IUI-1.2 Coi = <IUIa, ta, CS1, IUI-1.2, cherokee, tr>
Ri = <IUIa, ta, depends-on, BFO, {IUI-1.2, IUI-1}, tr>
• IUI-1.3 Coi = <IUIa, ta, CS3, IUI-1.3, chest pain, tr>
Ri = <IUIa, ta, is-located-in, BFO, {IUI-1.3, IUI-1}, tr>
– All dates in the statements are 2 years earlier than now
• What to do with:• Jane Smith• Jane Smith’s race (CS1: native American)• Jane Smith’s gender (CS1: female)• Jane Smith’s chest pain (CS3: chest pain)• Jane Smith’s age (50)
ECOREuropean Centre forOntological Research
Conclusion
• Referent tracking can solve a number of problems in an elegant way.
• Existing (or emerging) technologies can be used for the implementation.
• Old technologies (cbs) can play an interesting role.
• Big Brother feeling is to be expected but with adequate measures easy to fight.
• The proof of the pudding is in the eating– Pilote is going to be set up