1. www.landc.be Language, terminology and ontology in a medical context: theory en reality in industrial applications Werner CEUSTERS CTO Language & Computing nv

2. www.landc.be Presentation overview 1.L&C’s current key application 2.Some problems related to existing medical terminology systems 3.Major reason: a too simplistic interpretation of the semantic/semiotic triangle 4.L&C’s answer: a cognitive approach to terminology connecting Aristotelian Realism with Linguistic Functionalism 5.How this is implemented and used 6.Conclusions and issues for debate

3. www.landc.be Mission of L&C nv To provide users and developers of systems for knowledge management with tools and services for efficient and accurate data-entry and retrieval by exploiting the full power of automated (medical) natural language understanding We hereby declare...

4. www.landc.be AnthemMulti-TaleDomeGIUSelectC-CareLiquid Mobidev R/D ratio Homey Poirot Inface SCOP

5. www.landc.be Most Successful Application Automatic semantic annotation of documents –semantic indexing and retrieval –relevance ranking of in-document semantics –coding towards medical terminologies Often requires formalisation of clients’ proprietary terminologies

6. www.landc.be TeSSI Indexing Service

7. www.landc.be TEX Indexing component

8. www.landc.be Result 1 : Annotated document

9. www.landc.be Result 2 : relevance ranking

10. www.landc.be View on MeSH coding

11. www.landc.be Behind the scene (1): Semantics based shallow processing

12. www.landc.be Behind the scene (2): disambiguation

13. www.landc.be But: this system is NOT perfect ! word not recognised no code found in MeSH missed the large syntactic scope of “infections”

14. www.landc.be Some problems Major problem: most medical terminologies are build following unsound principles

15. www.landc.be ICD-10 “class-of” hierarchy Problem areas: 1 2 3 4 5 6

16. www.landc.be Problems of mapping

17. www.landc.be Problems with naïve merging UMLS semantic drift ISA circles

18. www.landc.be UMLS superficial term analysis

19. www.landc.be Is a “formal” approach better ? SNOMED-RT ISA ?

20. www.landc.be Are these the only problems ? Don’t dream ! The semiotic/semantic triangle

21. www.landc.be Language Term Symbol Reality Object Concept – Model – Mind “prototype” view“characteristics” view

22. www.landc.be Normative interpretation (Wüster, ISO/TC37, prefered terms,...) Too much focus on the concepts Assuming independence amongst the vertices of the triangle Does not survive an intentional framework Where it went wrong...

23. www.landc.be Too much focus on the concepts “conceptualism” versus “realism” “ontology” versus “Ontology” oversimplification of reality –discussions on 3D or 4D, instead of 3D and 4D –limitations of set theory “independence of language” paradigm that does not accept language as a medium of communication

24. www.landc.be Triangular dependencies concept term object Baboons and humans have different cut-off points for discerning "same" objects because our verbal expression for "same" makes the idea of "same" more restrictive.” Fagot and Wasserman (Centre for Research in Cognitive Neuroscience in Marseille) Human observation is determined by the possibilities and restrictions of the human body. Lakoff The structures of language are partially determined by our conceptualisation of the world. Halliday

25. www.landc.be Intentional framework problem “I want to go to...” “Brussels”“capital of Belgium”

26. www.landc.be The basis of L&C’s approach Aristotelian realism Halliday’s systemic functional grammar Natural Language Understanding for (medical) reality the description of

27. www.landc.be LinkBase Formal Domain Ontology Lexicon Grammar Language A Lexicon Grammar Language B Cassandra Linguistic Ontology MEDDRA ICD SNOMED ICPC Others... Proprietary Terminologies

28. www.landc.be Example: joint anatomy joint HAS-HOLE joint space joint capsule IS-OUTER-LAYER-OF joint meniscus –IS-INCOMPLETE-FILLER-OF joint space –IS-TOPO-INSIDE joint capsule –IS-NON-TANGENTIAL-MATERIAL-PART-OF joint joint –IS-CONNECTOR-OF bone X –IS-CONNECTOR-OF bone Y synovia –IS-INCOMPLETE-FILLER-OF joint space synovial membrane IS-BONAFIDE- BOUNDARY-OF joint space

29. www.landc.be Linguistic and domain ontologies Having a healthcare phenomenon Generalised Possession Healthcare phenomenon Human IS-A Has- possessor Has- possessed Patient Is-possessor-of Patient at risk IS-A Has-Healthcare- phenomenon Risk Factor IS-A Is-Risk- Factor-Of Patient at risk for osteoporosis Risk factor for osteoporosis Osteoporosis Has-Healthcare- phenomenon Is-Risk- Factor-Of IS-A 1 1 1 2 2 3 3 4 4

30. www.landc.be The industrial challenge How to set up a profitable business taking into account –the problems intrinsic to medical terminologies the obligation for many clients to use them the existence of many different, incompatible systems often based on a design that is not suited for automatic processing –the problems intrinsic to natural language processing –the business environment in which our applications have to run –the high costs for “doing right what others do wrong”

31. www.landc.be production maintenance research Integration of Research, maintenance and production corrected document gold standard corpus text to analyse client document set candidate knowledge gap WWW “WebAgent” “GapFinder” new-terms various beans candidate classified terms “Model-H1” various beans marked up text Medico-Linguistic Ontology TeSSI,... relevance ranking index uncorrected document

32. www.landc.be A terminological workbench for maintenance AND production! The solution

33. www.landc.be LinkFactory ToolSet

34. www.landc.be Managing different views External ontology Internal ontology Criteria Mappings Definitions Terms

35. www.landc.be Assisted term classification

36. www.landc.be Gap- Finder and Web- Agent 1.concept queried for 2.information used for document relevance assessment 3.new words retrieved 4.context-information for new word 5.relevant pages found 1 2 3 4 5

37. www.landc.be Research:automatic ontology extraction

38. www.landc.be Some details

39. www.landc.be Conclusions (and issues for discussion) 1.Medical natural language understanding (MNLU) is a very complex endeavour; 2.Terminology is a necessary component, though not the most important one; 3.Traditional terminology approaches have less value for MNLU than those that accept a close relationship with language and reality (e.g. the “sociocognitive” approach); 4.Some traditional, authoritative sources in medical terminology follow a wrong approach; 5.Get away with Conceptualism and adopt Realism.

40. www.landc.be Successful industrial application of MNLU requires (amongst other things): 1.Acceptation of the previous points without discussion; 2.200% awareness of the state of the art; 3.the capacity to make valid judgments about the expected outcomes of a (new) theory without requiring full proofs; 4.an integrated service/production and maintenance/ development environment to transform costs into revenue.