Is the “International Classification for Patient Safety” (ICPS) a Classification?

Is the “International Classification for Patient Safety” (ICPS) a Classification? Stefan SCHULZ IMBI, University Medical Center, Freiburg, Germany Daniel KARLSSON Department of Medical Informatics, Linköping University, Sweden Christel DANIEL INSERM, UMR_S 872, eq.20, Descartes University, Paris, France Hans COOLS AGFA Healthcare, Gent, Belgium Christian LOVIS Medical Informatics Service, University Hospitals of Geneva, Switzerland

Background • Patient safety (PS): Increased attention and awareness • Several PS-specific vocabularies have been developed • WHO is developing the International Classification for Patient Safety (ICPS) • to represent patient safety workflows • to facilitate international reporting and data exchange • to facilitate international research collaboration • Current state of ICPS: Field testing

Structure of the Talk • ICPS: Overview of architecture • ICPS: What it isn’t • ICPS: What it is now • ICPS: What it may be in the future

ICPS Architecture Critique Typology Outlook ICPS: Overview of architecture

ICPS Architecture Critique Typology Outlook Three components of ICPS ICPS tree “Conceptual Framework” • Hazard: a circumstance, agent or action with the potential to cause harm. • Circumstance: a situation or factor that may influence an event, agent or person(s). • Event: something that happens to or involves a patient. • Agent: a substance, object or system which acts to produce change. • Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum. • Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury. • Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient. “Key Concepts”

ICPS Architecture Critique Typology Outlook ICPS Conceptual Framework Contributing Factors / Hazards influences informs PatientCharacteristics IncidentCharacteristics IncidentType Actions Taken To Reduce Risk Actions Taken To Reduce Risk influences Detection informs informs influences Mitigating Factors informs Organi-zationalOutcome informs PatientOutcome influences informs Ameliorating Actions

ICPS Architecture Critique Typology Outlook

ICPS Architecture Critique Typology Outlook ICPS Components ICPS tree “Conceptual Framework” • Hazard: a circumstance, agent or action with the potential to cause harm. • Circumstance: a situation or factor that may influence an event, agent or person(s). • Event: something that happens to or involves a patient. • Agent: a substance, object or system which acts to produce change. • Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum. • Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury. • Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient. IncidentCharacteristics IncidentCharacteristics “Key Concepts”

ICPS Architecture Critique Typology Outlook ICPS “Taxonomy” IncidentCharacteristics

ICPS Architecture Critique Typology Outlook ICPS Conceptual Framework ICPS tree “Conceptual Framework” • Hazard: a circumstance, agent or action with the potential to cause harm. • Circumstance: a situation or factor that may influence an event, agent or person(s). • Event: something that happens to or involves a patient. • Agent: a substance, object or system which acts to produce change. • Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum. • Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury. • Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient. “Key Concepts”

ICPS Architecture Critique Typology Outlook ICPS Key Concepts • Classification: an arrangement of concepts into classes and their subdivisions, linked so as to express the semantic relationships between them. • Concept: a bearer or embodiment of meaning. • Class: a group or set of like things.Hazard: a circumstance, agent or action with the potential to cause harm. • Healthcare: services received by individuals or communities to promote, maintain, monitor or restore health. • Event: something that happens to or involves a patient. • Patient: a person who is a recipient of healthcare. • Agent: a substance, object or system which acts to produce change. • Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum. • Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury. • Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient.

ICPSArchitectureCritique Typology Outlook Structure of the Talk • ICPS: Overview of architecture • ICPS: What it isn’t • ICPS: What it is now • ICPS: What it may be in the future

ICPSArchitecture Critique Typology Outlook Analyzing ICPS • target of analysis: the ICPS tree… • graph structure: resemblance with WHO-FIC classifications(4 – 5 levels, single parents) • artifact meant to be used by medical coders • key concepts and conceptual framework: meta information from user’s point of view • Hazard: a circumstance, agent or action with the potential to cause harm. • Circumstance: a situation or factor that may influence an event, agent or person(s). • Event: something that happens to or involves a patient. • Agent: a substance, object or system which acts to produce change. • Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum. • Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury. • Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient.

ICPSArchitecture Critique Typology Outlook ICPS is not… … a taxonomy (ENV 12264:2005, Cornet 2006) • Semantic nature of hierarchic links are not specified • Subclass or is-a relation:a class B is a subclass of a class Aif and only if all members of B are also members of A(ENV 12264:2005, Horrocks 2003)

ICPSArchitecture Critique Typology Outlook ICPS is not… … a classification (ISO 17115:2007, Ingenerf MIM 1998, Madden [WHO-FIC] 2007) • Criterion of mutually disjoint,exhaustive classes not fulfilled • more than hundred ICPS concepts occur more than once in different hierarchies • Healthcare Professional occurs both as a child of People Involved and Person Reporting • Are they the same?

ICPSArchitecture Critique Typology Outlook ICPS is not… … a terminology according toCimino 1998: (Desiderata for controlled medical vocabularies in the twenty-first century, MIM 1998) • its representational units have no unique identifiers • e.g., eight different categories identified by the string “Problem” • it has no definitions: • only frequent words are defined (“key concepts”),but not the nodes in the hierarchy

ICPSArchitectureCritique Typology Outlook Structure of the Talk • ICPS: Overview of architecture • ICPS: What it isn’t • ICPS: What it is now • ICPS: What it may be in the future

ICPSArchitectureCritique Typology Outlook ICPS: What it is now ICPS tree “Conceptual Framework” • Hazard: a circumstance, agent or action with the potential to cause harm. • Circumstance: a situation or factor that may influence an event, agent or person(s). • Event: something that happens to or involves a patient. • Agent: a substance, object or system which acts to produce change. • Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum. • Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury. • Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient. “Key Concepts”

ICPSArchitectureCritique Typology Outlook ICPS: What it is now • This is a rudimentary, informal ontology • describes terms by their generic properties • close to upper-level ontologies (e.g. BioTop): “state”, “substance”, “event”, “agent”, “object”, “action”, “quality”. “Concepts by Class” “Conceptual Framework” • Hazard: a circumstance, agent or action with the potential to cause harm. • Circumstance: a situation or factor that may influence an event, agent or person(s). • Event: something that happens to or involves a patient. • Agent: a substance, object or system which acts to produce change. • Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum. • Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury. • Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient. “Key Concepts”

ICPSArchitectureCritique Typology Outlook ICPS: What it is now ICPS tree “Conceptual Framework” • Hazard: a circumstance, agent or action with the potential to cause harm. • Circumstance: a situation or factor that may influence an event, agent or person(s). • Event: something that happens to or involves a patient. • Agent: a substance, object or system which acts to produce change. • Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum. • Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury. • Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient. • This is a complex patient safety model • Similarity with • - workflows • business models • Ontologically: • complex event type “Key Concepts”

ICPSArchitectureCritique Typology Outlook ICPS: What it is now This is a structured data acquisition template consisting of (mostly) binary fields Can be described as information modelHierarchical parents provide context information for fields(but are not superclasses) ICPS tree “Conceptual Framework” • Hazard: a circumstance, agent or action with the potential to cause harm. • Circumstance: a situation or factor that may influence an event, agent or person(s). • Event: something that happens to or involves a patient. • Agent: a substance, object or system which acts to produce change. • Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum. • Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury. • Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient. “Key Concepts”

Structure of the Talk • ICPS: Overview of architecture • ICPS: What it isn’t • ICPS: What it is now • ICPS: What it may be in the future

ICPSArchitectureCritique Typology Outlook What ICPS may be in the future • ICPS deserves to be universally accepted as a reporting standard, but it should no longer be misleadingly named “classification” or “taxonomy” • The ICPS “key concepts” may become a fully-fledged formal ontology rooted in existing upper-level ontologies and using Semantic Web standards, e.g. OWL • The ICPS “conceptual framework” can be ontologized in the same line • The ICPS tree may be fully described in terms of ICPS’s ontological core

ICPSArchitectureCritique Typology Outlook What the authors may contribute • With in the EU IP “DebugIT”, patient safety ontology under construction (DCO = DebugIT Core Ontology) • using OWL-DL and Protégé • Aligned with BioTop domain upper ontology • A formally and ontologically sound ICPS can be redesigned as a by-product of DCO • Interesting use case for a new generation of multi-component terminological systems

ICPSArchitectureCritique Typology Outlook Conclusion • The needs for semantically interoperable patient-safety relevant event reporting is essentially different from the reporting of diseases • For the latter, the format of a statistical classification is adequate (ICD-10) • For the former, the format of a reporting template is adequate • Desideratum: both kinds of artifacts should • be based on ontological principles • separate models of meaning (ontology) from model of use (information model) • ICPS is a good step into this direction but there are still challenges to overcome • Rename ICPS: the name “classification” evokes false associations

Acknowledgements Is the “International Classification for Patient Safety” (ICPS) a Classification? Stefan SCHULZ, Daniel KARLSSON, Christel DANIEL, Hans COOLS, Christian LOVIS Thanks: Pierre Lewalle and the ICPS team

Annex

There is some a similarity between ICPS and the HL7 Individual Case Safety Report (ICSR) standard and the Public Health Reporting Domain Information Model. Both are restricted to the reporting aspect, whereas the scope of ICPS seems to be much broader, covering information related to workflow activities related to patient safety. This may justify describing the ICPS hierarchical tree as a complex information model. However, ICPS leaves many questions unanswered, e.g., how to deal with overlapping categories such as incident types, or which items are optional etc. It is in from an information model perspective that ICPS has been implemented at the University Hospitals of Geneva in the context of the incident reporting system. The experience has shown that the information model can mostly be used by professionals in charge of managing incidents, while the report forms for users are implemented using free text.

icps project • - classification of events • need for a classification • interrelated classifications • philipp cimiano • stefan grimm • contracted jean marie • oscar corcho: • analytical work - • ontology • galen dissection approach • australia have a classification • consolidation between different countries • inherited some notions blurred • reporting system • ... live with it it... • classification across countries.... • same flavor: ICD • theseus: • icps:

Is the “International Classification for Patient Safety” (ICPS) a Classification?