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The high functional demands for a terminology system for primary care

The high functional demands for a terminology system for primary care in a trilingual country and in a globalising world Robert Vander Stichele , MD, PhD Heymans Institute of Pharmacology , Ghent University

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The high functional demands for a terminology system for primary care

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  1. The high functionaldemandsfor a terminology system forprimary care in a trilingual country and in a globalisingworld Robert Vander Stichele, MD, PhD Heymans Institute of Pharmacology , GhentUniversity Conference Terminologie.be, BelgianMedicalInformatics Association Tuesday June 4, 2013, 19.00 – 20.30h FederalDepartment of Public Health, Brussels, Room 0D10-0D11

  2. Conflict of intereststatement The author - is a generalpractitioner and a clinicalpharmacologistatGhentUniversity - was a member of the BelgianWorking Group on Terminology SEMINOP (2010 – 2011) - is a member of the research consortium MERITERM (UGENT, CETIC, FBK), keeper of intellectualpropertyrights on terminology, under Common Creative Licence Withspecialthanks to Meritermmembers : Joseph Roumier, Elena Cardillo, Marc Jamoulle

  3. OVERVIEW Whatis a terminology system ? What are the functionaldemands for an interface terminology ? How far are we and are we on the right track ? How are wegoing to test this ? Perspective of PrimaryHealth Care Professionals

  4. Whatis a terminology system ?

  5. Terminology system • Terminologicalresources • With a structure • With a content • Withfunctionalities • Terminological applications • To produce the resources • To maintain the resources • To use be able to use the resources in practical programs • Terminology server • To provideaccess to resources and applications for practical programs • Terminology Center • To keepresources, applications, and server up-to-date and operational • To follow up on governance instructions

  6. Public health GOVERNANCE e-Health Terminology Center Academic expertise Server Business users End-users

  7. What are the functionaldemands for an interface terminologie ?

  8. Demands for terminologyresources • in Primary Care • Geared to 3 basic functionalities • High qualitymedical registration of daily practice activities • Intermittent summaries in a SUMEHR • Permanent Episode-oriënted registration • Multidisciplinairy registration of care targets • Retrieval of bibliographic or EBM information and decision Support • ContinuousQuality Assurance and epidemiologicalresearch • => imperative use of GP classifications (ICP and ICD) • Suitable for communication withotherhealth care providers • In primary care • In secundary and tertiary care (30 specialist disciplines) • Suitable for communication with patients • Suitable for semanticinteroperability (language, info systems)

  9. Definition of SemanticInteroperability is the ability to automatically interpret the information exchanged meaningfully and accurately in order to produce useful results as defined by the end users of both systems.

  10. Semantische interoperabiliteit Is a questto bridge between the wealthandversatility of human language, on the one hand, and the rigidityandprecision of registrationandclassification systems, on the other hand In diferrentlanguages, in different contexts GP in Primary Care / Health Care / Patient– Physician Communication

  11. Language Machine language Word Concept Sense 1 Preferredterm Synonym Sense 2 Synonym Synonym

  12. Language Machine language Word String Match Concept Sense 1 Preferredterm Synonym Sense 2 Synonym Synonym

  13. Language Machine language Word Semantic Match Concept Sense 1 Preferredterm Synonym Sense 2 Synonym Synonym

  14. Recommendation 1 of the SEMINOP Report Our terminologicalresourceswithin an interface terminologyshould respect the specific international standards for languageresources and for machine languageresources. For language : The ISO-standard LMF (Lexical Markup Framework) For machine language: The ISO-standard TMF (TerminologicalMarkup Framework)

  15. Recommendation 2 of the SEMINOP Report Buildpragmatichybridterminologicalresources Interface terminology Nomen-clatures Core Set of 15.000 concepts Natural Language Processing resources End-user Terminology ISO-LMF Unilingual Reference Terminology ISO- TMF Multilingual Classifications Thesauri

  16. Furtherrecommendations in the SEMINOP Report • Limit in a pragmaticway the number of concepts (to approx; 15.000) and invest in postcoordination • Do not limityourself to SNOMED alone, but alsolink to other relevant international classifications • Assure continuitywithpast registration by maintaining the existingterminology for primary care (3BT), withlegacy conversion • Make sure thatyour information format in the terminologicalresourcesallows applications for semantic web (RDF) • Use the linguistic expertise present in academicdepartments for translation technology, computer linguistics and medicalinformatics. • Pay attention to the language of the patiënt (laylanguage)

  17. How far are we and are we on the right track ?

  18. Governancebeslissingen • No plenum meetings of SEMINOP since 2 years • Round Table ICT in Health : Working group Terminology • Ambiguousoutcomes (3 contradictorytexts) • No sign of startinga supervisingworking group • Builiding of a terminologicalresource (in excel) according to an explicit methodology, withtermsfromdifferentBelgian sources (VUB, 2BT, RIZIV nomenclagure, ICD translations) around diagnoses and procedures, withlinking to SNOMED (already running up to 30.000 terms for diagnoses). • A national licence for snomedwassubscriberd (a politicaldecisionbetweenregional / federalgovernment / Public Health / RIZIV) • No public tender for a Terminology Center or Terminology Server

  19. Follow up on SEMINOP Recommendations • No use of terminological ISO-standards • No use of semantic web technology • No contacts withacademiccenterswithlinguisticexpertice • No budget for maintenance of 3BT • No budget for attendance of international meetings of primary care classification committees • No budget for legacy conversion of registrations in 3BT / ICD • No budget for experimentswith alternative approach • Uncontrolledgrowth of the number of terms (words) to bemanaged • Only attention to SNOMED • Hospitalo-centristicapproach, little attention to classifications in primary care • No projects to handlelaylanguage and communicataionwith patients

  20. How are wegoing to test this ?

  21. Use cases • How does the generalpractitionerevaluates the value of the automaticallyexported SUMERH from the EMD of a specific patient ? If the qualityis not good, isitbecause registration activitywas not good, or is the underlyingterminology system to blame ? • (see the littleencouragingresults of the REGM-I project) • How user-friendly and accurateis the terminological support evaluated by the generalpractitioner, whenhe/shemanually corrects the automatacallyexported SUMERH to a document thathe/sheisready to sign and put on the eHealthplatform ? • How easyisit to update the SUMERH to new eventsregistered in the journal notes or comingfrom a dischargeletter of a recent hospitalisation ? • Does the patient understand the SUMEHR or itslqylqnguqge version ? • Does a French speakingphysicianfrom Brussels or Walloniaunderstands the SUMEHR ? Does an American physicianworkingwithopenEHR en HL7 understand the SUMEHR ?

  22. Methods for testing Processevaluation How much time wasneeded ? How much effort wasneeded ? Wherediditwentwrong ? Outcomeevaluatie How muchmisundertanding ? How muchpainfull and dangereousmisunderstanding ? Satisfaction of the sender of the reciever

  23. Whichmethodologicalapproach in testingwillsave us fromthisresults ? The new cloths of the emperor Hans Christian Andersen, 1837. The emperoriswearingcloths, made by clevertailors, whosaythat only intelligent people are able to seethem.

  24. Conclusion

  25. Conclusion Everybodyagreesthatitis urgent thatsomethinghappens. If a sense of urgencybrings us to choose one and only solution, thenwe have a problem : « If youonly have a hammer, everything looks like a nail » There willbe a reallybigproblem if aftersome time the chosen solution turns out to be not as adequate as thought. The ROADMAP for ICT – eHEALTH in Belgium tells us whatshouldbeready in 2014 and in 2015. But are the conditions for successpresent and do wegivesufficient attention to alternative, more long-termapproaches.

  26. Epilogue

  27. EPILOGUE SAMOURAI RULE 176

  28. EPILOGUE SAMOURAI RULE 176 • Matters of greatimportance must be taken lightly

  29. EPILOGUE SAMOURAI RULE 176 • Matters of greatimportance must be taken lightly SAMOURAI RULE 177

  30. EPILOGUE SAMOURAI RULE 176 • Matters of greatimportance must be taken lightly SAMOURAI RULE 177 • Matters of smallimportance must be taken seriously

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