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GALEN-IN-USE and The GALEN Organisation Progress in 1998

GALEN-IN-USE and The GALEN Organisation Progress in 1998. A.L. Rector, J. Rogers, The GALEN Organisation Limited www.cs.man.ac.uk/mig/galen www.galen-organisation.com galen@cs.man.ac.uk. GALEN-IN-USE Partners. University of Manchester, Reuters Health, UK University of Nijmegen, Holland

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GALEN-IN-USE and The GALEN Organisation Progress in 1998

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  1. GALEN-IN-USE and The GALEN OrganisationProgress in 1998 A.L. Rector, J. Rogers, The GALEN Organisation Limited www.cs.man.ac.uk/mig/galenwww.galen-organisation.comgalen@cs.man.ac.uk

  2. GALEN-IN-USE Partners University of Manchester, Reuters Health, UK University of Nijmegen, Holland EFCC and its affiliates: • WCC, CNR Rome, U St Etienne • IASIST, IDGmbH, CMITD, STAKE, U Louvain University Hospital of Geneva, LNAT, Switzerland L&C, RAMIT, Datasoft, Belgium GSF Medis, U Ulm, Germany CNR, Rome, Italy SPRI, U Linköping, Sweden VTT, Oulu Univ Hospital, Medici Data, Finland

  3. The GALEN Organisation Shareholder Companies • Kermanog BV, The Netherlands • L&C, Belgium • LNAT, Switzerland • Manchester Informatics Limited, UK • Semantic Technologies Limited, UK

  4. The Task for GALEN IN USEA Common Reference Model for Procedures • Make it easy to do • Make it easy to learn The Means • Dissections in ‘Intermediate Representation’ • Natural Language Generation

  5. MethodologyTools &Common ReferenceModel Classification Management:Structure of Project Developmental Phase4 ‘Participating Centres’ Validation Phase4 ‘Participating Centres’5 ‘Collaborating Centres’4 self-funding Centres

  6. Evolution of the MethodologyTechnology Transfer and Facilitation Classification Centre Effort Central Modelling Effort GIU Year 3 & Beyond GALEN GIU Years 1-2

  7. Clinical Terminology Data Entry Clinical Record Decision Support Data Entry Electronic Health Records Decision Support &Aggregated Data GALENClinicalTerminology HealthCard Mr Ivor Bigun Dun Roamin Anytown Any country 4431 3654 90273 The Vision Best Practice Best Practice

  8. Coding & Classification Decision support MeSH MEGA-TERM G A L E N UMLS Medical Records SNOMED Axes ICPC ACRNEMA READ OPCS Data entry ICD-9 ICD-10 GALEN: Bridging to Classifications Decision support Clinical Applications Medical Records ` Data entry

  9. Structured Data Entry File Edit Help More... Radius Tibia Fibula Wrist Ulna Femur Ankle Closed Right More... Shaft Neck Open Left More... Open Left Femur Fixation Humerus Reduction Fixation Gt Troch Neck Simplicity for End Users... FRACTURE SURGERY 2 steps to heaven...

  10. …in their own language “open fixation of fracture of collum of left femur” “open fractuurvan collum femur van linkerfemoraal van bot fixeren” “Áíïé÷ôüò ÓôåñÝùóç on Ðáèïëïãéêüò ÄïìÞ Óþìáôïò of Ïóôü of Êüëï of Áñéóôåñüò Ìçñéáßï Ïóôü caused by Êüôáãìá” “ fixation on patologisk struktur of ben of inre kroppsdeldel of lateral position femur caused by fraktur #surgicallyOpen (Adjective)# #leftSelection (Adjective)# #Collum (Noun)#”

  11. Simplicity for terminologists... "Open fixation of a fracture of the neck of the left femur" MAIN fixing ACTS_ON fracture HAS_LOCATION neck of long bone IS_PART_OF femur HAS_LATERALITY left HAS_APPROACH open

  12. …but with a solid, formal foundation. (‘SurgicalProcess’ which isMainlyCharacterisedBy (performance which isEnactmentOf (‘SurgicalFixing’ which hasSpecificSubprocess (‘SurgicalAccessing’ hasSurgicalOpenClosedness (SurgicalOpenClosedness which hasAbsoluteState surgicallyOpen)) actsSpecificallyOn (PathologicalBodyStructure which < involves Bone hasUniqueAssociatedProcess FracturingProcess hasSpecificLocation (Collumwhich isSpecificSolidDivisionOf (Femurwhich hasLeftRightSelector leftSelection))>))))

  13. Value Added • Automatic classification • When do two expressions mean the same thing? • Automatic cross-mapping/integration • Multilingual natural language generation • Smooth extension and maintenance • Local autonomy and ‘loose coupling’ • Efficient indexing

  14. Classification ManagementThree country specific examples: The Dutch Centre NHS/CCC French CCAM

  15. UK: NHSCCC Cross-validation • 2500 ‘atomisations’ imported from NHS CCC • 25% of surgical procedure chapter • Endocrine, cardiovascular, gynaecology, ear, male urology, lymphatic surgery • Derived classification compared with manual classification • Substantial agreement despite independent working • Differences detect errors and omissions on both sides • Corrections in latest READ release attributed to this work

  16. Further UK efforts • PRODIGY - Terminology for Decision Support • Ongoing • UK National Drug Dictionary • Discussions in progress

  17. France: CCAM Goal - to harmonize 2 different systems: CDAM for DRG in hospitals NGAP for billing the fees of physicians

  18. CCAM (Classification Commune des Actes Médicaux) 1) a flat list of labels 2) validate lists for clinical completeness 3) a pilot lists in use The problem: jargon labels 4) to insure the compliance to CEN / ENV 1828 5) to control the semantic representation (Galen modeling) 6) Natural language generation for QA Final Product

  19. CCAM (Classification Commune des Actes Médicaux) 11 chapters prepared so far within national project 3 chapters completed within GIU 8 chapters within a contract with the ministry 4 additional chapters planned for future

  20. Consensus Method 6 full day meetings, 10 specialists Ad hoc, scattered update > 5 manmonth effort 5 Rubrics need revision Turnaround 8 months Invisible costs Constant high cost of maintenance GALEN Method 2 half day meetings, 5 specialists One time dissection, 1720 Rubrics = 2.5 manmonth effort 20% Rubrics need revision Turnaround 2 months Clear defined cost Decreasing cost of maintenane Initial cost much lower than expected The Dutch Centre: EconomicsUpdate of ICPM-DE version 2.420 new rubrics in Musculo-Skeletal Surgery

  21. Further efforts with Dutch Centres • Royal Dutch College of Physicians • Discussions started • Netherlands Paramedic Institute • Continued co-operation scheduled for 1999 • ‘Pain’ Classification • Clinergy-like PDMS foreseen for 2001 • Work on ICPC-2 started • Continue on ICIDH-2

  22. Can it integrate Classifications?

  23. International: Discussions with WHO • Meeting 23 June Geneva • Pilot on ICIDH-2 started in 31 July 1998 • Strong interest for test in ICD 10 • Renewed interest in Procedures

  24. Other standards • CEN, ISO, CORBAMed, G7, … • Definition of CorbaLex Standard

  25. Summary/Questions It is now working Who will hold the Dissections and Intermediate Representation?

  26. GALEN More Information GALEN CD ROM(available here) www.galen-organisation.com galen@cs.man.ac.uk Tel +44-161-275-6239FAX +44-161-275-6204

  27. GALEN • GALEN Combines: • Formal logical representation and ontology • User oriented Intermediate representation • Naturallanguage presentation • Mapping to existing coding systems • Indexing of other information • GALEN supports loosely coupled development • User oriented Classification Workbench (ClaW) • Comprehensive tools for central services (TIGGER/KNOME)

  28. But “It doesn’t make the coffee” • GALEN is not • A complete decision support system • A complete medical record system • A complete mediation system • A complete knowledege management system • GALEN is • A key enabling technology

  29. GALEN does add value • Automatic Classification / normalisation • Automatic cross-mapping / integration • Multilingual systems • Smooth extension and maintenance • Empowering users • Efficient indexing

  30. The GALEN Intermediate Representation Categorial Structure of Procedures Links and Constraints

  31. The GALEN Intermediate Representation • A Realisation of CEN ENV 1828 • Easy to learn and use • Well supported by tools • An common language for describing procedures • Independent of any specific underlying representation • Convertable to GRAIL • And probably most other formal representations

  32. Simplicity for terminologists... "Open fixation of a fracture of the neck of the left femur" MAIN fixing ACTS_ON fracture HAS_LOCATION neck of long bone IS_PART_OF femur HAS_LATERALITY left HAS_APPROACH open

  33. Links & Descriptors MAIN fixing ACTS_ON fracture HAS_LOCATION neck of long bone IS_PART_OF femur HAS_LATERALITY left HAS_APPROACH open LINKS

  34. Links & Descriptors MAIN fixing ACTS_ON fracture HAS_LOCATION neck of long bone IS_PART_OF femur HAS_LATERALITY left HAS_APPROACH open descriptors

  35. VUM03 • Categorial Structure and definitions of descriptors • List of links • Templates for use • Guidelines for normalisation

  36. Descriptors: Categorial Structure Anatomy AnatomicalPart Graft SensorySystemAnatomy NervousSystemAnatomy Nerve MusculoSkeletalSystemAnatomy Bone Joint GenitoUrinarySystemAnatomy EndocrineSystemAnatomy Gland CardiovascularSystemAnatomy BloodVessel PartOfHeart RespiratorySystemAnatomy DigestiveSystemAnatomy LymphNode BodySpace (Things).. Substance BodySubstance Chemical Characteristic Sex Age Laterality Position Occupation Feature Extent Method TemporalMarker Quantity Range Number OrdinalPosition Banned Things Untyped Pathology Lesion Approach Structure AbstractStructure Organism Person Device Prosthesis Material Process BodyProcess Deed HealthCareAct Anatomy….

  37. Links ACTS_ON HAS_LOCATION BY_MEANS_OF BY_TECHNIQUE HAS_APPROACH CAUSES CAUSED_BY CONNECTS FOLLOWS FOLLOWED_BY HAS_EXTENT HAS_FUNCTION HAS_LATERALITY HAS_NUMBER HAS_PART IS_PART_OF HAS_PATIENT HAS_TEMPORAL_MARKER IS_BRANCH_OF IS_MADE_OF IS_FEATURE_OF HAS_FEATURE SERVES IS_SERVED_BY CONTAINS IS_CONTAINED_IN MOTIVATED_BY TO_ACHIEVE OCCURS_DURING REPLACES MAIN OR_MAIN WITH OR_WITH WITHOUT*

  38. Constraints e.g. Deed BY_APPROACH_TECHNIQUE Deed Deed BY_MEANS_OF BodySubstance Deed BY_MEANS_OF Material Deed BY_MEANS_OF Prosthesis Deed BY_MEANS_OF Structure Deed CAUSES Deed Deed CAUSES Structure Deed FOLLOWED_BY Deed Deed FOLLOWS Process Deed HAS_APPROACH Approach Deed HAS_APPROACH Device Deed HAS_APPROACH Anatomy Deed CAUSED_BY Deed Deed CAUSED_BY Structure Deed HAS_EXTENT Characteristic Deed HAS_EXTENT Extent Deed HAS_LATERALITY Laterality Deed HAS_NUMBER Number Deed HAS_QUANTITY Range Deed HAS_ROUTE Approach Deed HAS_ROUTE Lesion Deed HAS_ROUTE Structure Deed HAS_TEMPORAL_MARKER TemporalMarker Deed method Device Deed method Method Deed method Characteristic Deed MOTIVATED_BY Deed Deed MOTIVATED_BY HealthCareAct Deed OCCURS_DURING BodyProcess Deed OCCURS_DURING Deed Deed OCCURS_DURING TemporalMarker Deed TO_ACHIEVE Process Deed TO_ACHIEVE Feature Deed WITH_GUIDANCE_BY Device

  39. Constraints e.g. Anatomy CAUSES Process Anatomy CAUSES Structure Anatomy CAUSES Substance Anatomy CONNECTS Anatomy Anatomy CONNECTS Lesion Anatomy CONNECTS Structure Anatomy CONNECTS_1 Anatomy Anatomy CONNECTS_1 Lesion Anatomy CONNECTS_1 Structure Anatomy CONNECTS_2 Anatomy Anatomy CONNECTS_2 Lesion Anatomy CONNECTS_2 Structure Anatomy CONNECTS_3 Anatomy Anatomy CONNECTS_3 Lesion Anatomy CONNECTS_3 Structure Anatomy CONTAINS Structure Anatomy CAUSED_BY Process Anatomy CAUSED_BY Structure Anatomy CAUSED_BY Substance Anatomy HAS_FUNCTION Process Anatomy HAS_LATERALITY Laterality Anatomy HAS_NUMBER Number Anatomy HAS_ORDINAL_POSITION OrdinalPosition Anatomy HAS_POSITION Position Anatomy HAS_QUANTITY Range Anatomy HAS_SOURCE Structure Anatomy IS_CONTAINED_IN Structure Anatomy IS_MADE_OF Substance Anatomy HAS_PART Substance Anatomy IS_PART_OF Structure Anatomy IS_SERVED_BY BloodVessel Anatomy or Structure

  40. Examples-1 RUBRIC "Bilateral adrenalektomi" PARAPHRASE "Removal of both of the adrenal glands" ENGLISH_RUBRIC "Bilateral adrenalectomy" SOURCE "NCSP" CODE "BCA40" MAIN removing HAS_LATERALITY bilateral ACTS_ON adrenal gland

  41. Examples-2 RUBRIC "Reperméation [recanalisation] d'une thrombose d'une artère de jambe, avec pose d'endoprothèse, par voie percutanée" CODE "V372" MAIN unblocking ACTS_ON artery IS_PART_OF leg HAS_APPROACH percutaneous route BY_TECHNIQUE removing ACTS_ON thrombus HAS_LOCATION artery IS_PART _OF leg WITH installing ACTS_ON endovascular implant HAS_DESTINATION artery IS_PART_OF leg TO_ACHIEVE_OVERALL revascularising ACTS_ON artery IS_PART_OF leg

  42. Examples-2: Normalisation RUBRIC "Reperméation [recanalisation] d'une thrombose d'une artère de jambe, avec pose d'endoprothèse, par voie percutanée" CODE "V372" MAIN unblocking ACTS_ON artery IS_PART_OF leg HAS_APPROACH percutaneous route BY_TECHNIQUE removing ACTS_ON thrombus HAS_LOCATION artery IS_PART _OF leg WITH installing ACTS_ON endovascular implant HAS_DESTINATION artery IS_PART_OF leg TO_ACHIEVE_OVERALL revascularising ACTS_ON artery IS_PART_OF leg Purpose separate from DeedsL1-L4, Angelo RossiMori

  43. Descriptors Analysis of 9905 manually authored dissections 320 Deeds (excising, amputating, biopsy) 1035 Anatomy (leg, arm, stomach) 295 Pathology (ulcer, infection, tumour) 111 Approach (percutaneous, transthoracic) 145 Feature (partial, major, permanent, rigid) 201 Device (endoscope, ultrasound machine) 253 Other 2460 TOTAL

  44. GALEN More Information GALEN CD ROM(available here) www.galen-organisation.com galen@cs.man.ac.uk Tel +44-161-275-6239FAX +44-161-275-6204

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