The ICPS process:Typology of a novel
terminological system
Stefan SCHULZ IMBI, University Medical Center, Freiburg, Germany
Daniel KARLSSON Department of Medical Informatics, Linköping University, Sweden
Christel DANIEL INSERM, UMR_S 872, eq.20, Descartes University, Paris, France
Hans COOLS AGFA Healthcare, Gent, Belgium
Christian LOVIS Medical Informatics Service, University Hospitals of Geneva, Switzerland
Detecting and Eliminating Bacteria UsinG Information Technology
Background
Background
• Patient safety: Increased attention and awareness on a global scale
• WHO is developing the International Classification for Patient Safety
(ICPS) together with the World Alliance for Patient Safety
• to represent patient safety workflows
• to facilitate international reporting and data exchange
• to facilitate international research collaboration
• Novel, ontology-based methodology
• Current state of ICPS:
– conceptual framework
– field testing, but not yet released
– available at http://www.who.int/patientsafety/taxonomy/en/
Structure of the Talk
• ICPS: How does it look like?
• ICPS: What it isn’t
• ICPS: What it is now
• ICPS: What it may be in the future
ICPS: Architecture
ICPS Architecture Critique Typology Outlook
Three components of ICPS
9. Hazard: a circumstance, agent or action with the potential to cause harm.
10. Circumstance: a situation or factor that may influence an event, agent or person(s).
11. Event: something that happens to or involves a patient.
12. Agent: a substance, object or system which acts to produce change.
13. Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum.
14. Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury.
15. Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient.
informsActionsT
akenT
o R
edu
ceR
isk
Contributing Factors/ Hazards
Incident
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcomes
Ameliorating Actions
ActionsT
akenT
o R
edu
ceR
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcomes
informs
informs
influences informs
informsActionsT
akenT
o R
edu
ceR
isk
Contributing Factors/ Hazards
Incident
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcomes
Ameliorating Actions
ActionsT
akenT
o R
edu
ceR
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcomes
informs
informs
influences informs
“Conceptual Framework”
“Key Concepts”
ICPS "taxonomy"
ICPS Architecture Critique Typology Outlook
Three components of ICPS
9. Hazard: a circumstance, agent or action with the potential to cause harm.
10. Circumstance: a situation or factor that may influence an event, agent or person(s).
11. Event: something that happens to or involves a patient.
12. Agent: a substance, object or system which acts to produce change.
13. Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum.
14. Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury.
15. Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient.
informsActionsT
akenT
o R
edu
ceR
isk
Contributing Factors/ Hazards
Incident
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcomes
Ameliorating Actions
ActionsT
akenT
o R
edu
ceR
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcomes
informs
informs
influences informs
informsActionsT
akenT
o R
edu
ceR
isk
Contributing Factors/ Hazards
Incident
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcomes
Ameliorating Actions
ActionsT
akenT
o R
edu
ceR
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcomes
informs
informs
influences informs
“Conceptual Framework”
“Key Concepts”
ICPS Architecture Critique Typology Outlook
ICPS "taxonomy"
ICPS Conceptual Framework
ICPS Major Class Subdivisions Example Leaf Concepts
Incident Type Medication/IV Fluids Problem: Wrong Drug Type of Harm: Pathophysiology: Diseases of the Nervous
System Patient Outcome Degree of harm: Severe Reason for encounter: Procedure Surgical Procedure Patient
Characteristics Demographics: Age Treatment status: Inpatient:
Immediate Post-OP or ICU/HDU Care
Discipline Involved: Intensive Care People Involved: Healthcare Professional:
Nurse Practitioner Incident Characteristics
Person Reporting: Healthcare Professional:
Doctor
Staff Factors: Performance Factors: Distraction/Inattention Contributing Factors / Hazards
Patient Factors: Communication Factors: With Whom:
With Staff
Directed to Patient: Patient Referred Mitigating Factors Directed to Staff: Relevant Persons Educated
Detection Healthcare Professional: Doctor Increase in Required Resource Allocation:
Increased Length of Stay Organizational Outcome
Legal Ramifications Patient Related: Compensation Ameliorating Actions Patient Related: Management of Disability Staff Factors: Staff Supervision/Assistance Actions Taken to
Reduce Risk Organizational Factors: Matching of Staff to Tasks/Skills
informs
Act
ions
Tak
en T
o R
educ
e R
isk
Contributing Factors / Hazards
IncidentType
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcome
Ameliorating Actions
Act
ions
Tak
en T
o R
educ
e R
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcome
informs
informs
influences informs
ICPS Architecture Critique Typology Outlook
ICPS Conceptual Framework
ICPS Major Class Subdivisions Example Leaf Concepts
Incident Type Medication/IV Fluids Problem: Wrong Drug Type of Harm: Pathophysiology: Diseases of the Nervous
System Patient Outcome Degree of harm: Severe Reason for encounter: Procedure Surgical Procedure Patient
Characteristics Demographics: Age Treatment status: Inpatient:
Immediate Post-OP or ICU/HDU Care
Discipline Involved: Intensive Care People Involved: Healthcare Professional:
Nurse Practitioner Incident Characteristics
Person Reporting: Healthcare Professional:
Doctor
Staff Factors: Performance Factors: Distraction/Inattention Contributing Factors / Hazards
Patient Factors: Communication Factors: With Whom:
With Staff
Directed to Patient: Patient Referred Mitigating Factors Directed to Staff: Relevant Persons Educated
Detection Healthcare Professional: Doctor Increase in Required Resource Allocation:
Increased Length of Stay Organizational Outcome
Legal Ramifications Patient Related: Compensation Ameliorating Actions Patient Related: Management of Disability Staff Factors: Staff Supervision/Assistance Actions Taken to
Reduce Risk Organizational Factors: Matching of Staff to Tasks/Skills
informs
Act
ions
Tak
en T
o R
educ
e R
isk
Contributing Factors / Hazards
IncidentType
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcome
Ameliorating Actions
Act
ions
Tak
en T
o R
educ
e R
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcome
informs
informs
influences informs
ICPS Architecture Critique Typology Outlook
ICPS Conceptual Framework
ICPS Major Class Subdivisions Example Leaf Concepts
Incident Type Medication/IV Fluids Problem: Wrong Drug Type of Harm: Pathophysiology: Diseases of the Nervous
System Patient Outcome Degree of harm: Severe Reason for encounter: Procedure Surgical Procedure Patient
Characteristics Demographics: Age Treatment status: Inpatient:
Immediate Post-OP or ICU/HDU Care
Discipline Involved: Intensive Care People Involved: Healthcare Professional:
Nurse Practitioner Incident Characteristics
Person Reporting: Healthcare Professional:
Doctor
Staff Factors: Performance Factors: Distraction/Inattention Contributing Factors / Hazards
Patient Factors: Communication Factors: With Whom:
With Staff
Directed to Patient: Patient Referred Mitigating Factors Directed to Staff: Relevant Persons Educated
Detection Healthcare Professional: Doctor Increase in Required Resource Allocation:
Increased Length of Stay Organizational Outcome
Legal Ramifications Patient Related: Compensation Ameliorating Actions Patient Related: Management of Disability Staff Factors: Staff Supervision/Assistance Actions Taken to
Reduce Risk Organizational Factors: Matching of Staff to Tasks/Skills
informs
Act
ions
Tak
en T
o R
educ
e R
isk
Contributing Factors / Hazards
IncidentType
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcome
Ameliorating Actions
Act
ions
Tak
en T
o R
educ
e R
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcome
informs
informs
influences informs
ICPS Architecture Critique Typology Outlook
ICPS Conceptual Framework
ICPS Major Class Subdivisions Example Leaf Concepts
Incident Type Medication/IV Fluids Problem: Wrong Drug Type of Harm: Pathophysiology: Diseases of the Nervous
System Patient Outcome Degree of harm: Severe Reason for encounter: Procedure Surgical Procedure Patient
Characteristics Demographics: Age Treatment status: Inpatient:
Immediate Post-OP or ICU/HDU Care
Discipline Involved: Intensive Care People Involved: Healthcare Professional:
Nurse Practitioner Incident Characteristics
Person Reporting: Healthcare Professional:
Doctor
Staff Factors: Performance Factors: Distraction/Inattention Contributing Factors / Hazards
Patient Factors: Communication Factors: With Whom:
With Staff
Directed to Patient: Patient Referred Mitigating Factors Directed to Staff: Relevant Persons Educated
Detection Healthcare Professional: Doctor Increase in Required Resource Allocation:
Increased Length of Stay Organizational Outcome
Legal Ramifications Patient Related: Compensation Ameliorating Actions Patient Related: Management of Disability Staff Factors: Staff Supervision/Assistance Actions Taken to
Reduce Risk Organizational Factors: Matching of Staff to Tasks/Skills
informs
Act
ions
Tak
en T
o R
educ
e R
isk
Contributing Factors / Hazards
IncidentType
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcome
Ameliorating Actions
Act
ions
Tak
en T
o R
educ
e R
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcome
informs
informs
influences informs
ICPS Architecture Critique Typology Outlook
ICPS Conceptual Framework
ICPS Major Class Subdivisions Example Leaf Concepts
Incident Type Medication/IV Fluids Problem: Wrong Drug Type of Harm: Pathophysiology: Diseases of the Nervous
System Patient Outcome Degree of harm: Severe Reason for encounter: Procedure Surgical Procedure Patient
Characteristics Demographics: Age Treatment status: Inpatient:
Immediate Post-OP or ICU/HDU Care
Discipline Involved: Intensive Care People Involved: Healthcare Professional:
Nurse Practitioner Incident Characteristics
Person Reporting: Healthcare Professional:
Doctor
Staff Factors: Performance Factors: Distraction/Inattention Contributing Factors / Hazards
Patient Factors: Communication Factors: With Whom:
With Staff
Directed to Patient: Patient Referred Mitigating Factors Directed to Staff: Relevant Persons Educated
Detection Healthcare Professional: Doctor Increase in Required Resource Allocation:
Increased Length of Stay Organizational Outcome
Legal Ramifications Patient Related: Compensation Ameliorating Actions Patient Related: Management of Disability Staff Factors: Staff Supervision/Assistance Actions Taken to
Reduce Risk Organizational Factors: Matching of Staff to Tasks/Skills
informs
Act
ions
Tak
en T
o R
educ
e R
isk
Contributing Factors / Hazards
IncidentType
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcome
Ameliorating Actions
Act
ions
Tak
en T
o R
educ
e R
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcome
informs
informs
influences informs
ICPS Architecture Critique Typology Outlook
ICPS Conceptual Framework
ICPS Major Class Subdivisions Example Leaf Concepts
Incident Type Medication/IV Fluids Problem: Wrong Drug Type of Harm: Pathophysiology: Diseases of the Nervous
System Patient Outcome Degree of harm: Severe Reason for encounter: Procedure Surgical Procedure Patient
Characteristics Demographics: Age Treatment status: Inpatient:
Immediate Post-OP or ICU/HDU Care
Discipline Involved: Intensive Care People Involved: Healthcare Professional:
Nurse Practitioner Incident Characteristics
Person Reporting: Healthcare Professional:
Doctor
Staff Factors: Performance Factors: Distraction/Inattention Contributing Factors / Hazards
Patient Factors: Communication Factors: With Whom:
With Staff
Directed to Patient: Patient Referred Mitigating Factors Directed to Staff: Relevant Persons Educated
Detection Healthcare Professional: Doctor Increase in Required Resource Allocation:
Increased Length of Stay Organizational Outcome
Legal Ramifications Patient Related: Compensation Ameliorating Actions Patient Related: Management of Disability Staff Factors: Staff Supervision/Assistance Actions Taken to
Reduce Risk Organizational Factors: Matching of Staff to Tasks/Skills
informs
Act
ions
Tak
en T
o R
educ
e R
isk
Contributing Factors / Hazards
IncidentType
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcome
Ameliorating Actions
Act
ions
Tak
en T
o R
educ
e R
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcome
informs
informs
influences informs
ICPS Architecture Critique Typology Outlook
ICPS Conceptual Framework
ICPS Major Class Subdivisions Example Leaf Concepts
Incident Type Medication/IV Fluids Problem: Wrong Drug Type of Harm: Pathophysiology: Diseases of the Nervous
System Patient Outcome Degree of harm: Severe Reason for encounter: Procedure Surgical Procedure Patient
Characteristics Demographics: Age Treatment status: Inpatient:
Immediate Post-OP or ICU/HDU Care
Discipline Involved: Intensive Care People Involved: Healthcare Professional:
Nurse Practitioner Incident Characteristics
Person Reporting: Healthcare Professional:
Doctor
Staff Factors: Performance Factors: Distraction/Inattention Contributing Factors / Hazards
Patient Factors: Communication Factors: With Whom:
With Staff
Directed to Patient: Patient Referred Mitigating Factors Directed to Staff: Relevant Persons Educated
Detection Healthcare Professional: Doctor Increase in Required Resource Allocation:
Increased Length of Stay Organizational Outcome
Legal Ramifications Patient Related: Compensation Ameliorating Actions Patient Related: Management of Disability Staff Factors: Staff Supervision/Assistance Actions Taken to
Reduce Risk Organizational Factors: Matching of Staff to Tasks/Skills
informs
Act
ions
Tak
en T
o R
educ
e R
isk
Contributing Factors / Hazards
IncidentType
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcome
Ameliorating Actions
Act
ions
Tak
en T
o R
educ
e R
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcome
informs
informs
influences informs
ICPS Architecture Critique Typology Outlook
ICPS Conceptual Framework
ICPS Major Class Subdivisions Example Leaf Concepts
Incident Type Medication/IV Fluids Problem: Wrong Drug Type of Harm: Pathophysiology: Diseases of the Nervous
System Patient Outcome Degree of harm: Severe Reason for encounter: Procedure Surgical Procedure Patient
Characteristics Demographics: Age Treatment status: Inpatient:
Immediate Post-OP or ICU/HDU Care
Discipline Involved: Intensive Care People Involved: Healthcare Professional:
Nurse Practitioner Incident Characteristics
Person Reporting: Healthcare Professional:
Doctor
Staff Factors: Performance Factors: Distraction/Inattention Contributing Factors / Hazards
Patient Factors: Communication Factors: With Whom:
With Staff
Directed to Patient: Patient Referred Mitigating Factors Directed to Staff: Relevant Persons Educated
Detection Healthcare Professional: Doctor Increase in Required Resource Allocation:
Increased Length of Stay Organizational Outcome
Legal Ramifications Patient Related: Compensation Ameliorating Actions Patient Related: Management of Disability Staff Factors: Staff Supervision/Assistance Actions Taken to
Reduce Risk Organizational Factors: Matching of Staff to Tasks/Skills
informs
Act
ions
Tak
en T
o R
educ
e R
isk
Contributing Factors / Hazards
IncidentType
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcome
Ameliorating Actions
Act
ions
Tak
en T
o R
educ
e R
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcome
informs
informs
influences informs
ICPS Architecture Critique Typology Outlook
ICPS Conceptual Framework
ICPS Major Class Subdivisions Example Leaf Concepts
Incident Type Medication/IV Fluids Problem: Wrong Drug Type of Harm: Pathophysiology: Diseases of the Nervous
System Patient Outcome Degree of harm: Severe Reason for encounter: Procedure Surgical Procedure Patient
Characteristics Demographics: Age Treatment status: Inpatient:
Immediate Post-OP or ICU/HDU Care
Discipline Involved: Intensive Care People Involved: Healthcare Professional:
Nurse Practitioner Incident Characteristics
Person Reporting: Healthcare Professional:
Doctor
Staff Factors: Performance Factors: Distraction/Inattention Contributing Factors / Hazards
Patient Factors: Communication Factors: With Whom:
With Staff
Directed to Patient: Patient Referred Mitigating Factors Directed to Staff: Relevant Persons Educated
Detection Healthcare Professional: Doctor Increase in Required Resource Allocation:
Increased Length of Stay Organizational Outcome
Legal Ramifications Patient Related: Compensation Ameliorating Actions Patient Related: Management of Disability Staff Factors: Staff Supervision/Assistance Actions Taken to
Reduce Risk Organizational Factors: Matching of Staff to Tasks/Skills
informs
Act
ions
Tak
en T
o R
educ
e R
isk
Contributing Factors / Hazards
IncidentType
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcome
Ameliorating Actions
Act
ions
Tak
en T
o R
educ
e R
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcome
informs
informs
influences informs
ICPS Architecture Critique Typology Outlook
ICPS Conceptual Framework
ICPS Major Class Subdivisions Example Leaf Concepts
Incident Type Medication/IV Fluids Problem: Wrong Drug Type of Harm: Pathophysiology: Diseases of the Nervous
System Patient Outcome Degree of harm: Severe Reason for encounter: Procedure Surgical Procedure Patient
Characteristics Demographics: Age Treatment status: Inpatient:
Immediate Post-OP or ICU/HDU Care
Discipline Involved: Intensive Care People Involved: Healthcare Professional:
Nurse Practitioner Incident Characteristics
Person Reporting: Healthcare Professional:
Doctor
Staff Factors: Performance Factors: Distraction/Inattention Contributing Factors / Hazards
Patient Factors: Communication Factors: With Whom:
With Staff
Directed to Patient: Patient Referred Mitigating Factors Directed to Staff: Relevant Persons Educated
Detection Healthcare Professional: Doctor Increase in Required Resource Allocation:
Increased Length of Stay Organizational Outcome
Legal Ramifications Patient Related: Compensation Ameliorating Actions Patient Related: Management of Disability Staff Factors: Staff Supervision/Assistance Actions Taken to
Reduce Risk Organizational Factors: Matching of Staff to Tasks/Skills
informs
Act
ions
Tak
en T
o R
educ
e R
isk
Contributing Factors / Hazards
IncidentType
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcome
Ameliorating Actions
Act
ions
Tak
en T
o R
educ
e R
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcome
informs
informs
influences informs
ICPS Architecture Critique Typology Outlook
ICPS Conceptual Framework
ICPS Major Class Subdivisions Example Leaf Concepts
Incident Type Medication/IV Fluids Problem: Wrong Drug Type of Harm: Pathophysiology: Diseases of the Nervous
System Patient Outcome Degree of harm: Severe Reason for encounter: Procedure Surgical Procedure Patient
Characteristics Demographics: Age Treatment status: Inpatient:
Immediate Post-OP or ICU/HDU Care
Discipline Involved: Intensive Care People Involved: Healthcare Professional:
Nurse Practitioner Incident Characteristics
Person Reporting: Healthcare Professional:
Doctor
Staff Factors: Performance Factors: Distraction/Inattention Contributing Factors / Hazards
Patient Factors: Communication Factors: With Whom:
With Staff
Directed to Patient: Patient Referred Mitigating Factors Directed to Staff: Relevant Persons Educated
Detection Healthcare Professional: Doctor Increase in Required Resource Allocation:
Increased Length of Stay Organizational Outcome
Legal Ramifications Patient Related: Compensation Ameliorating Actions Patient Related: Management of Disability Staff Factors: Staff Supervision/Assistance Actions Taken to
Reduce Risk Organizational Factors: Matching of Staff to Tasks/Skills
informs
Act
ions
Tak
en T
o R
educ
e R
isk
Contributing Factors / Hazards
IncidentType
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcome
Ameliorating Actions
Act
ions
Tak
en T
o R
educ
e R
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcome
informs
informs
influences informs
ICPS Architecture Critique Typology Outlook
ICPS Conceptual Framework
ICPS Major Class Subdivisions Example Leaf Concepts
Incident Type Medication/IV Fluids Problem: Wrong Drug Type of Harm: Pathophysiology: Diseases of the Nervous
System Patient Outcome Degree of harm: Severe Reason for encounter: Procedure Surgical Procedure Patient
Characteristics Demographics: Age Treatment status: Inpatient:
Immediate Post-OP or ICU/HDU Care
Discipline Involved: Intensive Care People Involved: Healthcare Professional:
Nurse Practitioner Incident Characteristics
Person Reporting: Healthcare Professional:
Doctor
Staff Factors: Performance Factors: Distraction/Inattention Contributing Factors / Hazards
Patient Factors: Communication Factors: With Whom:
With Staff
Directed to Patient: Patient Referred Mitigating Factors Directed to Staff: Relevant Persons Educated
Detection Healthcare Professional: Doctor Increase in Required Resource Allocation:
Increased Length of Stay Organizational Outcome
Legal Ramifications Patient Related: Compensation Ameliorating Actions Patient Related: Management of Disability Staff Factors: Staff Supervision/Assistance Actions Taken to
Reduce Risk Organizational Factors: Matching of Staff to Tasks/Skills
ICPS Architecture Critique Typology Outlook
ICPS Components
9. Hazard: a circumstance, agent or action with the potential to cause harm.
10. Circumstance: a situation or factor that may influence an event, agent or person(s).
11. Event: something that happens to or involves a patient.
12. Agent: a substance, object or system which acts to produce change.
13. Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum.
14. Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury.
15. Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient.
informsActionsT
akenT
o R
edu
ceR
isk
Contributing Factors/ Hazards
Incident
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcomes
Ameliorating Actions
ActionsT
akenT
o R
edu
ceR
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcomes
informs
informs
influences informs
informsActionsT
akenT
o R
edu
ceR
isk
Contributing Factors/ Hazards
Incident
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcomes
Ameliorating Actions
ActionsT
akenT
o R
edu
ceR
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcomes
informs
informs
influences informs
“Conceptual Framework”
“Key Concepts”
IncidentCharacteristics
IncidentCharacteristics
ICPS Architecture Critique Typology Outlook
ICPS "taxonomy"
ICPS Architecture Critique Typology Outlook
informsActionsT
akenT
o R
educeR
isk
Contributing Factors/ Hazards
Incident
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcomes
Ameliorating Actions
ActionsT
akenT
o R
educeR
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcomes
informs
informs
influences informs
informsActionsT
akenT
o R
educeR
isk
Contributing Factors/ Hazards
Incident
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcomes
Ameliorating Actions
ActionsT
akenT
o R
educeR
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcomes
informs
informs
influences informs
IncidentCharacteristics
ICPS “Taxonomy”
ICPS Conceptual Framework
9. Hazard: a circumstance, agent or action with the potential to cause harm.
10. Circumstance: a situation or factor that may influence an event, agent or person(s).
11. Event: something that happens to or involves a patient.
12. Agent: a substance, object or system which acts to produce change.
13. Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum.
14. Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury.
15. Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient.
informsActionsT
akenT
o R
edu
ceR
isk
Contributing Factors/ Hazards
Incident
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcomes
Ameliorating Actions
ActionsT
akenT
o R
edu
ceR
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcomes
informs
informs
influences informs
informsActionsT
akenT
o R
edu
ceR
isk
Contributing Factors/ Hazards
Incident
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcomes
Ameliorating Actions
ActionsT
akenT
o R
edu
ceR
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcomes
informs
informs
influences informs
“Conceptual Framework”
“Key Concepts”
ICPS Architecture Critique Typology Outlook
ICPS "taxonomy"
ICPS Key Concepts
• Classification: an arrangement of concepts into classes and their subdivisions, linked so as to express the semantic relationships between them.
• Concept: a bearer or embodiment of meaning.
• Class: a group or set of like things.Hazard: a circumstance, agent or action with the potential to cause harm.
• Healthcare: services received by individuals or communities to promote, maintain, monitor or restore health.
• Event: something that happens to or involves a patient.
• Patient: a person who is a recipient of healthcare.
• Agent: a substance, object or system which acts to produce change.
• Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum.
• Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury.
• Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient.
ICPS Architecture Critique Typology Outlook
Structure of the Talk
• ICPS: How does it look like?
• ICPS: What it isn’t
• ICPS: What it is now
• ICPS: What it may be in the future
ICPS Architecture Critique Typology Outlook
ICPS is not yet…
ICPS Architecture Critique Typology Outlook
Analyzing ICPS
ICPS Architecture Critique Typology Outlook
• target of analysis: the ICPS tree…
– graph structure: resemblance with WHO-FIC classifications(4 – 5 levels, single parents)
– artifact meant to be used by medical coders
• key concepts winscp.exeand conceptual framework: meta information from user’s point of view
9. Hazard: a circumstance, agent or action with the potential to cause harm.
10. Circumstance: a situation or factor that may influence an event, agent or person(s).
11. Event: something that happens to or involves a patient.
12. Agent: a substance, object or system which acts to produce change.
13. Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum.
14. Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury.
15. Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient.
informsActionsTakenT
o R
educeR
isk
Contributing Factors/ Hazards
Incident
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcomes
Ameliorating Actions
ActionsTakenT
o R
educeR
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcomes
informs
informs
influences informs
informsActionsTakenT
o R
educeR
isk
Contributing Factors/ Hazards
Incident
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcomes
Ameliorating Actions
ActionsTakenT
o R
educeR
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcomes
informs
informs
influences informs
ICPS is not…
… a taxonomy (ENV 12264:2005, Cornet 2006)
• Semantic nature of hierarchic
links are not specified
• Subclass or is-a relation:
a class B is a subclass
of a class A
if and only if
all members of B are
also members of A
(ENV 12264:2005, Horrocks 2003)
ICPS Architecture Critique Typology Outlook
ICPS is not yet…
… a classification (ISO 17115:2007, Ingenerf MIM 1998, Madden [WHO-FIC] 2007)
• Criterion of mutually disjoint,
exhaustive classes not fulfilled
• more than hundred
ICPS concepts occur
more than once in different
hierarchies
– Healthcare Professional occurs both as
a child of People Involved and Person
Reporting
ICPS Architecture Critique Typology Outlook
Structure of the Talk
• ICPS: How does it look like?
• ICPS: What it isn’t
• ICPS: What it is now
• ICPS: What it may be in the future
ICPS Architecture Critique Typology Outlook
ICPS: What it is now
9. Hazard: a circumstance, agent or action with the potential to cause harm.
10. Circumstance: a situation or factor that may influence an event, agent or person(s).
11. Event: something that happens to or involves a patient.
12. Agent: a substance, object or system which acts to produce change.
13. Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum.
14. Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury.
15. Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient.
informsActionsT
akenT
o R
edu
ceR
isk
Contributing Factors/ Hazards
Incident
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcomes
Ameliorating Actions
ActionsT
akenT
o R
edu
ceR
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcomes
informs
informs
influences informs
informsActionsT
akenT
o R
edu
ceR
isk
Contributing Factors/ Hazards
Incident
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcomes
Ameliorating Actions
ActionsT
akenT
o R
edu
ceR
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcomes
informs
informs
influences informs
“Conceptual Framework”
“Key Concepts”
ICPS Architecture Critique Typology Outlook
ICPS "taxonomy"
ICPS: What it is now
9. Hazard: a circumstance, agent or action with the potential to cause harm.
10. Circumstance: a situation or factor that may influence an event, agent or person(s).
11. Event: something that happens to or involves a patient.
12. Agent: a substance, object or system which acts to produce change.
13. Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum.
14. Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury.
15. Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient.
informsActionsT
akenT
o R
edu
ceR
isk
Contributing Factors/ Hazards
Incident
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcomes
Ameliorating Actions
ActionsT
akenT
o R
edu
ceR
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcomes
informs
informs
influences informs
informsActionsT
akenT
o R
edu
ceR
isk
Contributing Factors/ Hazards
Incident
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcomes
Ameliorating Actions
ActionsT
akenT
o R
edu
ceR
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcomes
informs
informs
influences informs
“Concepts by Class” “Conceptual Framework”
“Key Concepts”
This is a rudimentary, informal ontology• describes terms by their generic properties• close to upper-level ontologies (e.g.
BioTop): “state”, “substance”, “event”,
“agent”, “object”, “action”, “quality”.
ICPS Architecture Critique Typology Outlook
ICPS: What it is now
9. Hazard: a circumstance, agent or action with the potential to cause harm.
10. Circumstance: a situation or factor that may influence an event, agent or person(s).
11. Event: something that happens to or involves a patient.
12. Agent: a substance, object or system which acts to produce change.
13. Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum.
14. Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury.
15. Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient.
informsActionsT
akenT
o R
edu
ceR
isk
Contributing Factors/ Hazards
Incident
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcomes
Ameliorating Actions
ActionsT
akenT
o R
edu
ceR
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcomes
informs
informs
influences informs
informsActionsT
akenT
o R
edu
ceR
isk
Contributing Factors/ Hazards
Incident
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcomes
Ameliorating Actions
ActionsT
akenT
o R
edu
ceR
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcomes
informs
informs
influences informs
“Conceptual Framework”
“Key Concepts”
ICPS Architecture Critique Typology Outlook
ICPS "taxonomy"
This is a complex patient
safety model• Similarity with
- workflows- business models
- Ontologically:- complex event type
ICPS: What it is now
9. Hazard: a circumstance, agent or action with the potential to cause harm.
10. Circumstance: a situation or factor that may influence an event, agent or person(s).
11. Event: something that happens to or involves a patient.
12. Agent: a substance, object or system which acts to produce change.
13. Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum.
14. Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury.
15. Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient.
informsActionsT
akenT
o R
edu
ceR
isk
Contributing Factors/ Hazards
Incident
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcomes
Ameliorating Actions
ActionsT
akenT
o R
edu
ceR
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcomes
informs
informs
influences informs
informsActionsT
akenT
o R
edu
ceR
isk
Contributing Factors/ Hazards
Incident
IncidentCharacteristics
PatientCharacteristics
Detection
Mitigating Factors
PatientOutcomes
Ameliorating Actions
ActionsT
akenT
o R
edu
ceR
isk
influences
influences
informsinfluences
informsOrgani-zational
Outcomes
informs
informs
influences informs
“Conceptual Framework”
“Key Concepts”
This is a structured data
acquisition template
consisting of (mostly) binary
fields
Can be described as
information model
Hierarchical parents provide
context information for fields
(but are not superclasses)
ICPS Architecture Critique Typology Outlook
ICPS "taxonomy"
Structure of the Talk
• ICPS: How does it look like?
• ICPS: What it isn’t
• ICPS: What it is now
• ICPS: What it may be in the future
What ICPS may be in the future
• After finishing, ICPS has the potential to be universally
accepted as a reporting standard
• The ICPS “key concepts” may become a fully-fledged formal
ontology rooted in existing upper-level ontologies and using
Semantic Web standards, e.g. OWL
• The ICPS “conceptual framework” can be ontologized in the
same line
• The ICPS reporting template ("taxonomy") may be fully
described in terms of ICPS’s ontological core
• but…
ICPS Architecture Critique Typology Outlook
Open issues
• The needs for semantically interoperable
patient-safety relevant event reporting is
essentially different from the reporting of
diseases
• For the latter, the format of a statistical
classification is adequate (ICD-10)
• Is the format of a reporting template adequate
for the purpose ICPS is devised for?
• Is it necessary to transform the ICPS tree into a
real taxonomy or classification structure?
• Terms like “taxonomy”, “classification” should
be used thoughtfully
ICPS Architecture Critique Typology Outlook
Acknowledgements
Is the “International Classification for Patient Safety” (ICPS) a Classification?
Stefan SCHULZ, Daniel KARLSSON, Christel DANIEL, Hans COOLS, Christian LOVIS
Thanks for discussions: Pierre Lewalle (WHO)Jean-Marie RodriguesCédric Bousquet
(Université de St.Etienne)