ADVANCED TERMINOLOGY SYSTEMS

1. ADVANCED TERMINOLOGY SYSTEMS Nicholas R. Hardiker Suzanne Bakken Amy Coenen

2. VOCABULARY PROBLEM -the failure to achieve a single, integrated terminology with broad coverage of the healthcare domain. Evolving criteria for healthcare terminologies for implementation in computer-based systems suggest that concept-oriented approaches are needed to support the data needs of today’s complex, knowledge-driven healthcare and health management environment.

3. BACKGROUND AND DEFINITION The primary motivation for standardized terms in nursing is the need for valid, comparable data that can be used across information system applications to support clinical decision-making and the evaluation of processes and outcomes of care. Secondary uses of the data for the purposes such as clinical research, development of practice-based nursing knowledge, and generation of healthcare policy are dependent on the initial collection and representation of the data.

4. THE VOCABULARY PROBLEM Reasons: The development of multiple specialized terminologies has resulted in areas of overlapping content, areas for which no content exists, and large number of codes and terms Existing terminologies are most often developed to provide sets of terms and definitions of concepts for human interpretation, with computer interpretation as only a secondary goal -this is true for nursing terminology that nurses use in clinical care. Unfortunately, knowledge that is eminently understandable to humans is often confusing, ambiguous, or opaque to computers, and, consequently, current efforts have been resulted in terminologies that are inadequate in meeting the data needs of today’s healthcare systems.

5. CONCEPT ORIENTATION The health informatics literature provides an evolving framework that enumerates the criteria that render healthcare terminologies suitable for implementation in computer-based systems. In particular, it is clear that such terminologies must be concept-oriented (with explicit semantics), rather than based on surface linguistics. Several studies have reported that existing nursing terminologies do not meet the criteria related to concept orientation. In order to appreciate the significance of this approach, it is important to understand first the definitions of and relationships among things in the world (object), our thoughts about the things in the world (concepts), and the labels we used to represent and communicate our thoughts about things in the world (terms). The International Standardization Organization (ISO) provides the definitions for the elements that correspond to each vertex of the triangle.

6. SEMIOTIC TRIANGLE Concept – unit of knowledge created by a unique combination of characteristics (abstraction of a property of an object or of a set of objects) Term – 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 Object – anything perceivable or conceivable

7. COMPONENTS OF ADVANCED TERMINOLOGY SYSTEMS • Terminology Model – concept-based representation of a collection of domain-specific terms that is optimized for the management of terminological definitions. It encompasses both schemata and type definitions. • Schemata incorporate domain - specific knowledge about the typical constellations of entities, attributes, and events in the real world and, as such, reflect plausible combinations of concepts. • Type Definitions – obligatory conditions that state only the essential properties of a concept • Representation Language – terminology models maybe formulated and elucidated in an ontology language. In this way, ontology languages are able to support, thru explicit semantics, the formal definition of concepts in terms of their relationships with the other concepts. • Computer-based Tools – representation language may be implemented using description logic within a software system or by a suite of software tools. The functionality of these tools varies but may include among the other things, management and internal organization of the model, and the reasoning on the model, such as automatic classification of composed concepts based on their formal definition.

8. SUITABILITY FOR COMPUTER PROCESSING as characterized in terms of “generation”: • First-generation Terminology Systems consist of a list of enumerated terms, possibly arranged as a single hierarchy. • - serve as single purpose or a group of closely related purposes and allow minimal computer processing • Second-generation Systems – 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. • - can be used for a range of purposes, but they allow only limited computer processing, automatic classification of composed concept is not possible. • Third-generation Language System – supports sufficient formalisms to enable computer- based processing, they include a grammar that defines the rules of automated generation and classification of new concepts. • - also referred to as formal concept representation systems or reference technology • Majority of existing nursing terminologies can be characterized as first-generation systems because they were designed primarily for direct manual use in the process of care. E.g., NANDA • The beta 2 version of the ICNP is an example of a second-generation system

9. ADVANTAGES OF ADVANCED TERMINOLOGY SYSTEMS • allow much greater granularity thru controlled composition, while avoiding a combinatorial explosion of precoordinated terms. • facilitate 2 important facets of knowledge representation for computer-based systems that support clinical care: • a.) describing concepts • advantages: • -nonambiguous representation of concepts • -facilitation of data abstraction or de-abstraction without loss of original data • -nonambiguous mapping among terminologies • -date reuse in different contexts • b.) manipulating and reasoning about those concepts using computer- based tools. • advantages: • -automated classification of new concepts • -ability to support multiple inheritance of defining characteristics

10. ADVANCE TERMINOLOGICAL APPROACHES IN NURSING • ISO 18104:2003 • An International Standard (ISO 18104:2003) covering reference terminology models for nursing diagnoses and nursing actions was approved in 2003. The development of ISO 18104:2003 was motivated in part by a desire to harmonize the plethora of nursing terminologies in use around the world. It’s development was intended to “be consistent with the goals and objectives of other specific health terminology models in order to provide a more unified reference health model.” • POTENTIAL USES: • 1. Facilitate the representation of nsg. diagnosis and nsg. action concepts and their relationships • 2. Provide a framework for the generation of compositional expressions from anatomic concepts within a reference terminology • 3. Facilitate the mapping among nsg. diagnosis and nsg. action concepts from various terminologies • 4. Enable the systematic evaluation of terminlologies and associated terminology models for purposes of harmonization • 5. Provide a language to describe the structure of nsg. diagnosis and nsg. action.

11. GALEN • A concept-oriented approach has been developed within the GALEN Program. • Used in supporting clinical applications • Support the authoring, maintenance, and quality assurance of other kinds of terminologies • GRAIL – ontology language for representing concepts and their interrelationships • 2 Integrated Sets of Tools Used in GRAIL: • Computer-based modeling environment – facilitates the collaborative formulation of models. It allows authoring of clinical knowledge at different levels of abstraction. • Terminology server – a software system that implements GRAIL. It is also used to deliver the model for use by clinical applications and other kinds of authoring environments • Performs the ff functions: • 1. internally managing and representing the model • 2. testing the validity of combinations of concepts • 3. constructing valid composed concepts • 4. transforming composed concept into canonical form • 5. automatically classifying composed concepts into the hierarchy

12. SNOMED RT (Reference Technology) • Is a reference terminology optimized for clinical data retrieval and analysis. Concepts and relationships in SNOMED RT are represented using modified KRSS rather than GRAIL. • More recently, along with the U.K. Clinical Terms, SNOMED RT has been used as a foundation for a new terminology system, SNOMED CT (Clinical Terms), which has been developed collaboratively by the College of American Pathologists and the U.K. National Health Service. • SNOMED CT possesses both reference terminology properties and user interface terms.

13. OWL Standard Ontology Language - intended for use where applications, rather than humans, are to process information.

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