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Advanced Terminology Systems

Yu, Merrill Van C.

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Background and Definitions

The primary motivation for standardized terms in nursing is the need for valid, comparable data that can be used across information system applications to support clinical decision-making and the evaluation of processes and outcomes of care. 
                
The Vocabulary Problem
  • The failure to achieve a single, integrated terminology with broad coverage of the healthcare domain
  • Reasons for the vocabulary problem in health and nursing informatics:
  1. The development of multiple specialized terminologies has resulted in areas of overlapping content, areas for which no content exists, and large numbers of codes and terms
  2. Existing terminologies are most often developed to provide sets of terms and definitions of concepts for human interpretation, which computer interpretation as only a secondary goal

Concept Orientation

The Semiotic Triangle
  • Concept (i.e., thought or reference) – unit of knowledge created by a unique combination of characteristics – a characteristic is an abstraction of a property of an object or of a set of objects
  • Object (i.e., referent) – anything perceivable or conceivable
  • Term (i.e., symbol) – verbal designation of a general concept in a specific subject field – a general concept corresponds to two or more objects which form a group by reason of common properties        

Evaluation Criteria Related to Concept-Oriented Approaches
  • Atomic-based – concepts must be separable into constituent components
  • Compositionality – ability to combine simple concepts into composed concepts
  • Concept permanence – once a concept is defined it should not be deleted from a terminology
  • Language independence – support for multiple linguistic expressions
  • Multiple hierarchy – accessibility of concepts through all reasonable hierarchical paths with consistency of views
  • Nonambuiguity – explicit definition for each term
  • Nonredundancy – one preferred way of representing a concept or idea
  • Synonymy – support for synonyms and consistent mapping of synonyms within and among terminologies
             * A single concept may be associated with multiple terms (synonymy); however, a term should represent only one concept.

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Components of Advanced Terminology Systems

Terminology Model
  • A terminology model is a concept-based representation of a collection of domain-specific terms that is optimized for the management of terminological definitions. It encompasses both schemata and type definitions
  • Schemata incorporate domain-specific knowledge about the typical constellations of entities, attributes, and events in the real world and, as such, reflect plausible combinations of concepts
  • Type definitions are obligatory conditions that state only the essential properties of a concept

Representation Language
  • Terminology models may be formulated and elucidated in an ontology language
  • Ontology languages represent classes (also referred to as concepts, categories, or types) and their properties (also referred to as relations, slots, roles, or attributes)
  • Ontology languages are able to support, through explicit semantics, the formal definition of concepts in terms of their relationships with other concepts
  • They also facilitate reasoning about those concepts

Computer-Based Tools
  • A representation language may be implemented using description logic within a software system or by a suite of software tools.
  • Includes:
  1. Management and internal organization of the model
  2. Reasoning on the model (e.g. automatic classification of composed concepts based on their formal definition
  3. Facilitate transformation of concept representations into canonical form or support a set of sanctions that test whether a proposed composed concept is sensible
  • Generations:
  1. First-generation – consist of a list of enumerated terms, possibly arranged as a single hierarchy; serve a single purpose or a group of closely related purposes and allow minimal computer processing
  2. Second-generation – include an abstract terminology model or terminology model schema that describes the organization of the main categories used in a particular terminology or set of terminologies
  3. Third-generation – support sufficient formalisms to enable computer-based processing; also referred to as formal concept representation systems

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Advantages of Advanced Terminology Systems

  • Allow much greater granularity through controlled composition while avoiding a combinatorial explosion of precoordinated terms
  • Facilitate two important facets of knowledge representation for computer-based systems that support clinical care: (a) describing concepts, and (b) manipulating and reasoning about those concepts using computer-based tools


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Advanced Terminological Approaches to Nursing
               
ISO 18104:2003
  • Motivated in part by a desire to harmonize the plethora of nursing terminologies around the world and to integrate with other evolving terminology and information and model standards
  •  Potential uses include to:
  1. Facilitate the representation of nursing diagnosis and nursing action concepts and their relationships in a manner suitable for computer processing
  2. Provide a framework for the generation of compositional expressions from atomic concepts within a reference terminology
  3. Facilitate the mapping among nursing diagnosis and nursing action concepts from various terminologies
  4.  Enable the systematic evaluation of terminologies and associated terminology models for purposes of harmonization
  5. Provide a language to describe the structure of nursing diagnosis and nursing action concepts in order to enable appropriate integration with information models

GALEN Program

  • Can be used in a range of ways, from directly supporting clinical applications to supporting the authoring, maintenance and quality assurance of other kinds of terminologies
  • GRAIL (GALEN Representation and Integration Language) – an ontology language for representing concepts and their interrelationships – the source material for the construction of terminology models
  • Two integrated sets of tools are used in the development of a GRAIL model:
  1. A computer-based modeling environment – facilitates the collaborative formulation of models; it allows authoring of clinical knowledge at different levels of abstraction
  2. A terminology server – a software system that implements GRAIL; performs a range of functions:
             - Internally managing and representing the model
             - Testing the validity of combination of concepts
             - Constructing valid composed concepts
             - Transforming composed concepts into canonical form
             - Automatically classifying composed concepts into the hierarchy
             - Also used to deliver the model for use by clinical applications and other kinds of authoring environments
  • Motivation for applying GALEN to nursing
  1. The desire to meet the requirements of users of clinical applications
  2. The need to provide a reusable and extensible model of nursing terminology
  • GALEN does not seek to replace existing nursing terminologies; rather, it seeks to contribute to the development of those terminologies, to supplement them, to allow comparison among them, and to make them available for describing day-to-day nursing care.

SNOMED RT
  • SNOMED Reference Terminology (TR) is a reference terminology optimized for clinical data retrieval and analysis
  1. Concepts and relationships in SNOMED are represented using modified KRSS (Knowledge Representation Specification Syntax) rather than GRAIL
  2. Concept definition and manipulation are supported through a set of tools with functionality such as Acronym resolution, word completion, term completion, spelling correction, display of the authoritative form of the term entered by the user, and decomposition of unrecognized input
           - Acronym resolution, word completion, term completion, spelling correction, display of the authoritative form of the term entered by the user, and decomposition of unrecognized input
           - Automated classification
           - Conflict management, detection, and resolution
  3. SNOMED RT has been used as a foundation for a new terminology system SNOMED Clinical Terms (CT) – possess both reference terminology properties and user interface terms

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