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10 January 2008 Semantic Interoperability in Health Informatics: Lessons Learned
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Semantic Interoperability in Health Informatics: Lessons Learned
Medical Informatics Lessons Learned
Experiences MHS AHLTA interoperability Private sector SNOMED CT implementation
and legacy migration CPOE implementation
10 January 2008 Semantic Interoperability in Health Informatics: Lessons Learned
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Semantic Interoperability in Health Informatics: Lessons Learned
Medical Informatics Lessons Learned
Lack of definitions Divergent information models Ontologic weakness of reference
terminology Quality assurance Communication across team
10 January 2008 Semantic Interoperability in Health Informatics: Lessons Learned
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Semantic Interoperability in Health Informatics: Lessons Learned
Medical Informatics Lesson Learned
Importance of definitions SNOMED CT and most terminologies in
use lack explicit definitions of concepts and relationships
Meaning may be implied by common usage or position in hierarchy
Domain experts often disagree on meaning
10 January 2008 Semantic Interoperability in Health Informatics: Lessons Learned
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Semantic Interoperability in Health Informatics: Lessons Learned
Medical Informatics Lesson Learned
Description Logic in SNOMED CT Appendicitis (Fully defined by)
Associated morphology Inflammation
Finding site Appendix structure
Fully defined concepts may reduce need for text definition
Up to half of disorders in SNOMED CT lack full Description Logic definition
10 January 2008 Semantic Interoperability in Health Informatics: Lessons Learned
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Semantic Interoperability in Health Informatics: Lessons Learned
Medical Informatics Lesson Learned
Divergent information models SNOMED CT disorder context model
Subject Temporality Assertion/negation Modal status Laterality Severity Acuity Course/stages
10 January 2008 Semantic Interoperability in Health Informatics: Lessons Learned
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Semantic Interoperability in Health Informatics: Lessons Learned
Medical Informatics Lesson Learned
Divergent information models Precoordinated Postcoordinated
SNOMED CT implements context model inconsistently
Similar inconsistencies in other terminologies
10 January 2008 Semantic Interoperability in Health Informatics: Lessons Learned
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Semantic Interoperability in Health Informatics: Lessons Learned
Medical Informatics Lesson Learned
Ontologic weakness of SNOMED CT Confusion in Hierarchy Semantic type confusion IS-A overload SNOMED CT SEP anatomy model
10 January 2008 Semantic Interoperability in Health Informatics: Lessons Learned
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Semantic Interoperability in Health Informatics: Lessons Learned
Medical Informatics Lesson Learned
Confusion in Hierarchy Many use cases rely on subsumption of
clinical disorders Medications are more complicated Ontologic hierarchy may not reflect clinical
view Numerous exceptions to hierarchy
complicate implementation and maintenance
10 January 2008 Semantic Interoperability in Health Informatics: Lessons Learned
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Semantic Interoperability in Health Informatics: Lessons Learned
Medical Informatics Lesson Learned
SNOMED CT Semantic type confusion Disorder vs. morphology Finding vs. observable
Confusion in understanding of intent by implementers
10 January 2008 Semantic Interoperability in Health Informatics: Lessons Learned
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Semantic Interoperability in Health Informatics: Lessons Learned
Medical Informatics Lesson Learned
Is-a Overload Confusion of
Is a subclass of Is a part of Is contained in
10 January 2008 Semantic Interoperability in Health Informatics: Lessons Learned
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Semantic Interoperability in Health Informatics: Lessons Learned
Medical Informatics Lesson Learned
SNOMED CT SEP anatomy model Entire hand Hand structure Hand part Structure of left hand Structure of right hand
Anatomic region vs. anatomic surface area
10 January 2008 Semantic Interoperability in Health Informatics: Lessons Learned
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Semantic Interoperability in Health Informatics: Lessons Learned
Medical Informatics Lesson Learned
Limitations of 1:1 map Equivalent Narrower than Broader than Other relationship
10 January 2008 Semantic Interoperability in Health Informatics: Lessons Learned
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Semantic Interoperability in Health Informatics: Lessons Learned
Medical Informatics Lesson Learned
Quality Assurance burden Difficult without automated tools Full definition in Description Logic
enables automated error checking
10 January 2008 Semantic Interoperability in Health Informatics: Lessons Learned
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Semantic Interoperability in Health Informatics: Lessons Learned
Medical Informatics Lesson Learned
Communication issues Medical informaticist Ontologist Domain expert Software developer
Use and design of tools
10 January 2008 Semantic Interoperability in Health Informatics: Lessons Learned
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Semantic Interoperability in Health Informatics: Lessons Learned
Solutions
Improve the ontological basis of standard terminologies
Educate informaticists and domain experts about ontology practices
Address information model issues Create mapping tools to support
interoperability Semantic type subsets Medical specialty subsets
