1. Concept Model for observables, investigations, and observation results For the IHTSDO Observables Project Group and LOINC Coordination Project Revision Date: March 14, 2014

2. precondition observation result property type serogroup scale scales Cultured E.coli serotype is O157 E. Coli (organism) inheres in towards hemoglobin units technique Bacterial serotyping is about body states direct site Microbial culture quality has value O157 The information model is used to link this result to the Culture and specimen that came from the patient. Continue from Part-2 slide deck

3. What about abilities? Able with respect to normal functioning and activities – Ontologically these are “realizables”. – Two types: Sure-fire (“dispositions”): if you have the ability to feel pain, then when a painful stimulus is applied, you feel it (assuming you are conscious – and actually even if you are unconscious – with some exceptions based on threshold of intensity) Those abilities that depend on the bearer’s decision (ability to walk, talk, throw a ball, eat an apple, etc)

4. Disposition type Possible replacement for “property type” where the value of “is about” is neither a quality nor a process, but instead is a disposition or function – * could consider expanding the domain/range for property type instead

5. disposition disposition type ability ability to hear (meaning the “sure-fire” disposition for a hearing process to be instantiated on exposure to sound) auditory system inheres in towards hearing (process) precondition body states

6. precondition body states observation result disposition type ability scale scale types Able to hear (as an observation result) (there exists some observation result which has a target of some disposition which is ability to hear) auditory system inheres in towards hearing (process) units technique techniques is about direct site body structures, specimens disposition has value able

7. precondition body states situation disposition type ability Able to hear (situation) Interpreted as disposition present in situation, or “ability to hear = present” (the situation includes the existence of some disposition which is ability to hear) auditory system inheres in towards hearing (process) includes disposition

8. precondition body states observation result disposition type ability scale scale types Able to hear (observation result) Interpreted as an observation result, using the VALUE attribute auditory system inheres in towards hearing (process) units technique techniques is about direct site body structures, specimens disposition has value able

9. disposition disposition type Impaired ability Impaired ability to hear (as a disposition) auditory system inheres in towards hearing (process) precondition body states

10. precondition body states observation result disposition type ability scale scale types Impaired ability to hear (as an observation result) auditory system inheres in towards hearing (process) units technique techniques is about direct site body structures, specimens disposition has value impaired

11. precondition body states situation disposition type Impaired ability Impaired ability to hear (as disposition included in situation, or “impaired hearing = present”) auditory system inheres in towards hearing (process) includes disposition

12. Other dispositions Antimicrobial sensitivity

13. observation procedure disposition type Resistance/sensitivity TIME ASPECT scale Time aspects scale types Antimicrobial susceptibility test (procedure) Microbial isolate inheres in towards Antimicrobial units technique techniques is about precondition body states direct site body structures, specimens disposition method observation action

14. Process observables/observations characterizes process duration other process attributes

15. observable entity property type Briskness of response scale scale types Left knee deep tendon reflex – briskness (observable) inheres in characterizes Deep tendon reflex (process) units technique techniques is about precondition body states direct site body structures, specimens property of process Neuromuscular structures of the left knee deep tendon reflex

16. observation result property type Briskness of response scale scale types Left knee jerk reflex 2+ (observation result) inheres in characterizes Deep tendon reflex (process) units technique techniques is about precondition body states direct site body structures, specimens property of process Neuromuscular structures of the left knee deep tendon reflex has value 2+ out of 4+

17. Other question/answer pairs as quality / quality region pairs

18. quality property type Histologic type Histologic type (of lesion) lesion inheres in towards functions, substances precondition body states

19. quality property type Located in Tumor site (located-in would be a relational spatial quality) tumor inheres in towards functions, substances precondition body states

21. Dealing with “presence” Disallow “presence” and “absence” as a value of property type But allow “detected”, “present”, “absent” as an observation result, if the “is about” is an independent continuant (not a dependent continuant).

22. has value detected Methicillin-resistant staphylococcus aureus (MRSA) present in abdominal wound, swab specimen, by PCR rapid detection method (A) observation result scale qualitative units technique PCR rapid detection method direct site abdominal wound swab (specimen) MRSA (organism) is about has location abd. wound

23. has value detected Mycoplasma pneumoniae detected observation result scale qualitative units technique techniques direct site specimens Mycoplasma pneumoniae is about

24. observation result scale qualitative Methicillin-resistant staphylococcus aureus (MRSA) present in abdominal wound, swab specimen, by PCR rapid detection method units technique PCR rapid detection method direct site Wound swab (specimen) MRSA (organism) is about has location Abd. wound has value present only/some

25. observable entity scale qualitative Methicillin-resistant staphylococcus aureus (MRSA) in abdominal wound, swab specimen, by PCR rapid detection method (observable) units technique PCR rapid detection method direct site Wound swab (specimen) MRSA (organism) is about has location Abd. wound only

26. observation procedure is about MRSA (organism) scale scale types has value Numeric, ordinal, nominal MRSA (methicillin resistant staph aureus) POC (point-of-care) test (procedure) units technique MRSA POC detection technique direct site specimen method observation action

27. observable entity scale scale types units technique palpation direct site Ventral aspect of wrist over radial artery Radial pulse palpability arterial pulsation is about has location radial artery at the wrist

28. observation result scale scale types has value present units technique palpation direct site ventral aspect of wrist over radial artery radial pulse present by palpation arterial pulsation is about has location radial artery at the wrist

29. observation result scale scale types has value present units technique techniques direct site place abdominal wall stoma present (observation result) stoma is about has location Abdominal wall

30. observation result scale scale types has value present units technique techniques direct site place colostomy present (observation result) colostomy is about has location Abdominal wall

31. observation result scale scale types has value present units technique techniques direct site place adenocarcinoma of the colon present (observation result) adenocarcinoma is about has location colon

32. adenocarcinoma of the colon present (situation) adenocarcinoma of the colon (disorder) adenocarcinoma site colon situation includes associated morphology

33. Determining “contents” observations that seek to answer: – What things are present as physical parts of a specimen (such as a fluid) or structure? – What things are present and contained within a structure (but not part of it)?

34. observable property type Having physical part scale scale types Contents of urine by light microscopy (observable) urine inheres in towards functions, substances units technique Light microscopy precondition body states direct site body structures, specimens Assumes “having physical part” is a valid relation between discrete solid entities in a fluid and the fluid substance. is about quality

35. observation procedure property type Having physical part scale scale types Determining contents of urine by light microscopy on urine sample (procedure) Synonym: microscopic urinalysis urine inheres in towards functions, substances units technique Light microscopy precondition body states direct site Urine sample method observation action is about quality

36. property type Having physical part scale scale types has value Observed Urine microscopy: hyaline casts present urine inheres in towards Hyaline casts units technique Light microscopy precondition body states direct site Urine specimen observation result is about quality

37. What about counts? Count >=1 seems to mean the same as “retinal hemorrhage present” But does it? – There is a difference between an observation result in which a count was made, and a phase of a subject’s life during which the countable entity was present (or not present) – And this difference matters because counts can be incorrect a count of zero can be made when the situation is that there is a hemorrhage present and a count of 1 can be mistakenly made when the situation is that there is no hemorrhage and we may need to be able to record and do quality assurance based on the difference between the count and the actual situation

38. property type entitic number scale quantitative has value 4 4 retinal hemorrhages present (observation result) retina inheres in towards hemorrhages units technique techniques precondition body states direct site body structures, specimens observation result is about quality

39. observation result property type entitic number scale quantitative has value >= 1 retinal hemorrhage present (observation result) retina inheres in towards hemorrhage units technique techniques precondition body states direct site body structures, specimens is about quality

40. Retinal hemorrhage present (situation) Retinal hemorrhage (finding) hemorrhage site retina situation includes associated morphology

42. Which models are preferred and why? Several different options have been presented Criteria for choosing among options: – 1) semantic consistency – 2) simplicity – 3) interoperability – 4) reproducibility of modeling individual concepts – 5) lower degree of disruption of existing implementations and content – 6) lower comparative cost of the change – 7) computability