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Complex Occurrents in Clinical Terminologies Stefan Schulz, Kornél Markó Department of Medical Informatics, Freiburg University Hospital, Germany Boontawee.

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Presentation on theme: "Complex Occurrents in Clinical Terminologies Stefan Schulz, Kornél Markó Department of Medical Informatics, Freiburg University Hospital, Germany Boontawee."— Presentation transcript:

1 Complex Occurrents in Clinical Terminologies Stefan Schulz, Kornél Markó Department of Medical Informatics, Freiburg University Hospital, Germany Boontawee Suntisrivaraporn Department of Computer Science, Technical University of Dresden, Germany

2 Understanding Clinical Terminologies from an Ontological Point of View Append- ectomy, open Append- ectomy Append- ectomy, laparo- scopic Terms / Concepts / Nodes represent Types (common properties) used to classify… Taxonomy (subtype hierarchy) …Individual objects (instances) in clinical reality An individual object is instance of one or more concept according to the properties defined for this concept

3 Understanding Clinical Terminologies from an Ontological Point of View Proc. #12345 Proc. #22345 Proc. #24095 Proc. #20095 Proc. #68881 Proc. #63281 Proc. #95541 Proc. #10541 Proc. #15541 Proc. #67599 Proc. #67129 Proc. #69129 Proc. #66629 Proc. #62846 Proc. #68876 Proc. #68816 Proc. #10196 Proc. #81196 Proc. #89006 Proc. #89201 Proc. #87101 Proc. #87877 Proc. #87888 Proc. #87918 Proc. #64518 Append- ectomy, open Append- ectomy Append- ectomy, laparo- scopic Terms / Concepts / Nodes represent Types (common properties) used to classify… Taxonomy (subtype hierarchy) …Individual objects (instances) in clinical reality An individual object is instance of one or more concepts according to the properties defined for this concept

4 Understanding Clinical Terminologies from an Ontological Point of View Proc. #12345 Proc. #22345 Proc. #24095 Proc. #20095 Proc. #68881 Proc. #63281 Proc. #95541 Proc. #10541 Proc. #15541 Proc. #67599 Proc. #67129 Proc. #69129 Proc. #66629 Proc. #62846 Proc. #68876 Proc. #68816 Proc. #10196 Proc. #81196 Proc. #89006 Proc. #89201 Proc. #87101 Proc. #87877 Proc. #87888 Proc. #87918 Proc. #64518 Append- ectomy, open Append- ectomy Append- ectomy, laparo- scopic Taxonomy (subtype hierarchy) T-Box Terminological Level Concepts / Types / Universal Properties General axioms about individuals: A-Box Assertional Level: Assertions about instances (individuals, tokens) = concrete objects in the world All open appendectomies are appendectomies All appendectomies act on some appendix Procedure #67129 is a laparoscopic appendectomy Procedure #67129 is performed by Dr. Petersson Procedure #67129 is complicated by some infection instance-of

5 Understanding Clinical Terminologies from an Ontological Point of View Proc. #12345 Proc. #22345 Proc. #24095 Proc. #20095 Proc. #68881 Proc. #63281 Proc. #95541 Proc. #10541 Proc. #15541 Proc. #67599 Proc. #67129 Proc. #69129 Proc. #66629 Proc. #62846 Proc. #68876 Proc. #68816 Proc. #10196 Proc. #81196 Proc. #89006 Proc. #89201 Proc. #87101 Proc. #87877 Proc. #87888 Proc. #87918 Proc. #64518 Append- ectomy, open Append- ectomy Append- ectomy, laparo- scopic Taxonomy (subtype hierarchy) Clinical Terminology Medical Records instance-of

6 Understanding Clinical Terminologies from an Ontological Point of View Proc. #12345 Proc. #22345 Proc. #24095 Proc. #20095 Proc. #68881 Proc. #63281 Proc. #95541 Proc. #10541 Proc. #15541 Proc. #67599 Proc. #67129 Proc. #69129 Proc. #66629 Proc. #62846 Proc. #68876 Proc. #68816 Proc. #10196 Proc. #81196 Proc. #89006 Proc. #89201 Proc. #87101 Proc. #87877 Proc. #87888 Proc. #87918 Proc. #64518 Append- ectomy, open Append- ectomy Append- ectomy, laparo- scopic Taxonomy (subtype hierarchy) Clinical Terminology Medical Records instance-of

7 Append- ectomy, open Append- ectomy Append- ectomy, laparo- scopic Surgical Procedure Append- ectomy Occurrent Thing Continuant Phys. Object Body Part AppendixHeart Taxonomy (subtype hierarchy, is-a hierarchy): All appendectomies are surgical procedures All surgical procedures are occurrents All appendices are body parts All body parts are physical objects All physical objects are continuants (…) Upper Ontology Domain Ontology

8 Append- ectomy, open Append- ectomy Append- ectomy, laparo- scopic Surgical Procedure Append- ectomy Occurrent Thing Continuant Phys. Object Body Part AppendixHeart Upper Ontology Domain Ontology Taxonomy (subtype hierarchy, is-a hierarchy): All appendectomies are surgical procedures All surgical procedures are occurrents All appendices are body parts All body parts are physical objects All physical objects are continuants (…)

9 Partonomies (Compositional Hierarchies) of Continuants Digestive Tract Large Intestine Small Intestine Ileum Jejunum Appendix Colon part-of some General axioms about parts and holes All appendices are part of some large intestine All colons are part of some large intestine All large intestines are part of some digestive tract (…)

10 Partonomies (Compositional Hierarchies) of Continuants Removal of Foreign Body from Stomach by Gastrotomy Removal of Foreign Body from Stomach has-part some Every instance of Removal of Foreign Body from Stomach by Gastrotomy has as parts: some Gastrotomy some Removal of Foreign Body from Stomach has-part some in SNOMED CT expressed as Role Groups (Schulz et al, Meth Inf Med 2006)

11 Problems with Complex Occurrents in Clinical Terminologies Brain Concussion ( ) With Loss Of Consciousness ( ) = BCLOC accident admission Running Example:

12 Brain Concussion With Loss Of Consciousness (BCLOC): Different interpretations 1.BCLOC: One complex event which is the sum of two simple events, a BC and a LOC 2.BC LOC : One (simple) BC event which is followed by a LOC event 3. BC LOC : One (simple) LOC event which is preceded by a BC event Instances of BC LOC are not instances of BCLOC, they are BCs ontologically dependent on LOCs Instances of BC LOC are not instances of BCLOC, they are LOCs ontologically dependent on BCs

13 BC LOC Occurrent BCLOC has-part some BC LOC part-of some subtype-of Brain Concussion With Loss Of Consciousness (BCLOC) and related types

14 Analogy: Sums are not subtypes of their summands + = Bride Groom Couple An instance of Bride is not an instance of Couple, but for every instance of Bride there is some instance of Couple and some instance of Groom An instance of Groom is not an instance of Couple, but for every instance of Groom there is a some instance of Couple and some instance of Bride summands sum* *cf. Straub et al. From Terminologies to Classifications – FCTC 2006

15 Couple, Woman, Man, Bride, Groom Man Woman Continuant Couple has-part some GroomBride part-of some subtype-of

16 Man Woman Continuant Couple has-part some GroomBride part-of some subtype-of BC LOC Occurrent BCLOC has-part some BC LOC part-of some subtype-of

17 BC LOC Occurrent BCLOC has-part some BC LOC part-of some subtype-of Patient #1 Patient #2 A-Box T-Box

18 Brain Concussion With Loss Of Consciousness (BCLOC): More interpretations

19 BC LOC: complex event constituted by a BC being followed by a LOC LOC BC: complex event constituted by a LOC followed by a BC Analogously: BC LOC, LOC BC, BC LOC,, LOC BC Brain Concussion With Loss Of Consciousness (BCLOC): More interpretations

20 BC LOC Occurrent BCLOC has-part some LOC BC part-of some BC LOCLOC BC BC LOC part-of some

21 BC LOC Occurrent BCLOC has-part some LOC BC BC LOC LOC BC BC LOC LOC BC precedes some follows some follows some precedes some

22 Brain Concussion ( ) With Period Without Loss Of Consciousness ( ) Brain Concussion Without Loss Of Consciousness (BC-LOC) accident admission

23 Brain Concussion ( ) With Period Without Loss Of Consciousness ( ) accident admission ? ? Brain Concussion Without Loss Of Consciousness (BC-LOC)

24 BC LOC Occurrent BC-LOC has-part some all has-part not BC - LOC part-of some subtype-of Brain Concussion Without Loss Of Conscious- ness (BC-LOC) and related types Problems: - Temporal Context must be considered -Negation or at least disjointness must be supported

25 BC ALOC BTEE Occurrent BC-LOC has-part some BC - LOC part-of some subtype-of Workaround Without Negation has-part some absence of loss of consciousness between traumatic event and examination

26 How Complex Occurrents can be expressed in SNOMED CT SNOMED supports –by underlying description logics : ontological dependence by existential quantified roles (exists some…) complex definitions by implicit conjunction (RG) –context dependence by context model SNOMED does not support –temporal reasoning –temporal relations such as follows, precedes –negations

27 How Complex Occurrents are currently expressed in SNOMED CT heterogeneous picture: –some are represented as sums (BCLOC) –some are represented specialized concepts (BC LOC ) –post-coordination does not always allow to infer the pre-coordinated concept –Definitions of simple occurrents exhibit unnecessary complexity (RG nesting) Conclusion: –Revision necessary ! Examples:

28 Removal of Foreign Body from Stomach by Gastrotomy (Group) has-part some Occurrent Gastrotomy Removal of Foreign Body from Stomach

29 BC LOC Occurrent BCLOC has-part some BC LOC part-of some subtype-of

30 Complex Occurrents in Clinical Terminologies… …and their Representation in a Formal Language Stefan Schulz, Kornél Markó Department of Medical Informatics, Freiburg University Hospital, Germany Boontawee Suntisrivaraporn Department of Computer Science, Technical University of Dresden, Germany

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