Problems with Current Approaches to Clinical Data. William R. Hogan, MD Associate Professor of Biomedical Informatics University of Pittsburgh Director, Medical Vocabulary/Ontology Services UPMC. UPMC Overview. Facilities 20 Hospitals 400 Ambulatory sites with 2300 physicians
William R. Hogan, MD
Associate Professor of Biomedical Informatics
University of Pittsburgh
Director, Medical Vocabulary/Ontology Services
Past history of colon cancer increases one’s risk. Thus, to determine “average risk”, you need to know if this risk factor is present.
Concepts in [the Clinical Finding] hierarchy represent the result of a clinical observation, assessment, or judgment, and include both normal and abnormal clinical states.
Emphasis is mine.
The science of what is, of the kinds and structures of objects, properties, events, processes and relations in every area of reality
*Smith B. Ontology. In: Floridi L, ed. The Blackwell Guide to Philosophy of Computing and Information: Blackwell Publishing 2003.
†Bodenreider O, Smith B, Burgun A. The ontology-epistemology divide: A case study in medical terminology. In: Varzi A, Vieu L, editors. Proceedings of the Formal Ontology in Information Science Conference (FOIS 2004); 2004; Turin; 2004.
IS_A relationships are also known as “Supertype-Subtype relationships”
We gave Chronic hypertension complicating AND/OR reason for care during childbirth every chance. It’s just not a subtype of chronic hypertension.
Will we eventually need: On digital photograph transmitted by a telemedicine device – a rash (finding)?
We also need a coherent, shared representation of disease vs. course of disease
NOT Colitis presumed infectious
NOT presumed infectious
(and then, is it certainly not infectious or certainly infectious, or have we just stopped presuming altogether and chosen instead to remain agnostic about whether the colitis is of infectious origin?)
The diseaseType II diabetes mellitus,and
the diseaseNeuropathy, where the former caused the latter.
Thus this term represents two diagnoses in a set, that are erroneously conjoined with AND.
From: ontology… Fiorillo, Anthony MD Sent: Monday, August 13, 2007 10:20 AMTo: Hogan, William RSubject:
Bill FYI the limits of both ICD and SnowMed; I was unable to find a dx specific to this patients new dx. Submucosal colonic Leiomyoma. Here is a snap shot of the search:
Note that ICD9 assumes Leiomyoma occur only in the uterus when they can occur any where there is smooth muscle!
A problem that the “finer granularity” of ICD-10-CM does not address, incidentally.
53 results in ICD-9-CM and SNOMED-CT combined. Mixture of “Body structure” and “Clinical Finding”.
Although SNOMED does have Leiomyoma of stomach and Leiomyoma of esophagus, it does not have even leiomyoma of colon let alone a submucosal one.
Looks like the best you could do in either case is “Benign tumor of the colon”, which isn’t terribly helpful.
He is asymptomatic; found on screening colonoscopy. I used an annotated SnowMed code 74391019
74391019 is Leiomyoma (body structure)
It was 52nd of 53 search results.