Slide No.: 1 G A L E N

G A L E NG A L E NWhere we started

Building Classifications with GALEN

A look into the future…?

Key Questions

Slide No.: 2 G A L E N

GALEN-IN-USE PartnersGALEN-IN-USE Partners

University of Manchester, VAMP Health, UK

University of Nijmegen, Holland

EFCC and its affiliates: WCC, NOMESCO, CNR Rome, U St EtienneWCC, NOMESCO, CNR Rome, U St Etienne IASIST, IDGmbH, CMITD, STAKE, U LouvainIASIST, IDGmbH, CMITD, STAKE, U Louvain

University Hospital of Geneva, LNAT, Switzerland

OLE, RAMIT, Datasoft, Belgium

GSF Medis, U Hildesheim, Germany

CNR, Rome, Italy

SPRI, U Linköping, Sweden

VTT, Oulu Univ Hospital, Medici Data, Finland

Slide No.: 3 G A L E N

G A L E NG A L E NWhere we started

Slide No.: 4 G A L E N

Best Practice

Clinical Terminology

Data Entry

Clinical Record

Decision Support

Best Practice

GALEN Clinical

Terminology

Data Entry

Clinical Record

Decision Support

Slide No.: 5 G A L E N

enter search:

Choose terms from a coding Choose terms from a coding schemescheme

cystitis

Acute cystitis

Subacute cystitis, NOS

Follicular cystitis

Cystitis, NOS

Idiopathic cystitis

Chemical cystitis

Postoperative cystitis

Drug induced cystitis

Iatrogenic cystitis

Radiation cystitis

Chronic cholecystitis

Acute cholecystitis

Bacterial Cholecystitis

Cholecystitis, NOS

Bacterial cystitis

next pageetc

...picking liststoo long

Too Big

Too Small...not enoughclinical detail

Slide No.: 6 G A L E N

cystitis

chronic

severitysevere

onset

chronicity

mild

A new clinician-friendly option: A new clinician-friendly option: structured data entrystructured data entry

gradual

sub-acute

Assemble a phrase...

…from a set of useful pieces...

…displayed on the screen.

“moderately severe, acute cystitis of sudden onset”

acute

sudden

moderate

Slide No.: 7 G A L E N

Only one problem:Only one problem:

How can the computer know in advance what are the sensible pieces to display?

Traditional coding schemes do not have the information required

ICDRea

d

OPCSSNOMED

?cystitis

Slide No.: 8 G A L E N

What is cystitis combined with ‘acute and mild?

how would you likethe answer ?

A new resourceA new resource

... a resource that can cope with arbitrarily complex clinical concepts ...

Slide No.: 9 G A L E N

as an English phrase and as an ICD Code

<“mild, acute cystitis”, D595.0 >

... and cope with different natural languages and coding schemes.

A new resourceA new resource

Slide No.: 10 G A L E N

Computer knows ‘rules’ for:Computer knows ‘rules’ for:

how do you classify things? Fractures of femur, and of femoral neckFractures of femur, and of femoral neck

when are two things the same ? ‘‘Inflammation of Liver’ vs ‘Hepatitis’Inflammation of Liver’ vs ‘Hepatitis’

are there any illegal combinations? ‘‘fractured eyebrow causing donkey’fractured eyebrow causing donkey’

are any combinations redundant? ‘‘finger which is part of hand’finger which is part of hand’

Slide No.: 11 G A L E N

G A L E NG A L E NBuilding Classifications with GALEN

Slide No.: 12 G A L E N

Manual ClassificationsManual Classifications

Most medical ‘classifications’ are really ‘thesauri’ Thesauri have mixed hierarchiesThesauri have mixed hierarchies

– kind, part, cause, modified,...kind, part, cause, modified,...

heartheart

heart valveheart valveaortic valveaortic valve

cusp of aortic valvecusp of aortic valve

For interpretation by people OnlyOnly people can reorganise (and that isn’t easy or quick) people can reorganise (and that isn’t easy or quick)

Must read rubricsMust read rubrics Model of use implicit and fixedModel of use implicit and fixed

Slide No.: 13 G A L E N

‘‘Computed’ ClassificationsComputed’ Classifications

Strict hierarchies using ‘kind of’‘‘Disorder of heart’Disorder of heart’

‘‘Disorder of valve in heart’Disorder of valve in heart’‘‘Disorder of valve in left ventricle in heart’Disorder of valve in left ventricle in heart’

‘‘Disorder of cusp in valve in left ventricle in heart’Disorder of cusp in valve in left ventricle in heart’

Computable People can understand (but don’t have to)People can understand (but don’t have to) Computers can reorganiseComputers can reorganise

– because all meaning is explicit in formal expressionbecause all meaning is explicit in formal expression

G A L E N

Bridges from patient data to Bridges from patient data to classificationsclassifications

Coding &Classification

ICD-9 ICD-10

MeSH

ACRNEMA

ICPC

SNOMED Axes

UMLS

Clinical Applications

Medical Records

Data entry

Decision support

READ

OPCS

MEGA-TERM

G A L E N

Slide No.: 15 G A L E N

Added value of Computed Added value of Computed ClassificationsClassifications

Hide the complexity Let the computer do the workLet the computer do the work Small on the outside, huge on the insideSmall on the outside, huge on the inside

Reorganise classifications when needed

More complete, consistent and automatic indexing

Automatic cross mapping/merging

Quicker to update - worry about what, not where

‘Coherence without Uniformity’

G A L E N

Issues to considerIssues to consider

Can not prove result is complete or correct(but can’t do that with manual result either)

Initially expensive to build

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G A L E NG A L E N

A look into the future…?

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What will the classifications of What will the classifications of today look like in the future?today look like in the future?

They won’t exist

Each will be replaced by several different views on something else, each serving individually

the specific (conflicting) functions which were formerly tortured out of the one

classification

NOT a book

NOT a picking list

Slide No.: 19 G A L E N

What will these ‘views’ be What will these ‘views’ be like ?like ?

Each view is like a classification, but...

Multiaxial (very)

One, single clear purpose

Humans say what terms are included and what they mean

Computers decide how to arrange them

Not fixed in stone - malleable, customisable, localisable - but always coherent

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‘‘Views’ of what ?Views’ of what ?

‘Clinical Terminology’

Something clinicians use to record information about real, individual patients

Somebody else’s problem

..as long as the bridge to classification views exists

Slide No.: 21 G A L E N

G A L E NG A L E NKey Questions

Slide No.: 22 G A L E N

Key Questions Key Questions (for users of terminology systems)(for users of terminology systems) What do you want it to do?

Clinical systems are the endClinical systems are the end terminology the meansterminology the means

– Don’t get the cart before the horseDon’t get the cart before the horse

Can it do it? Can anything do it?Can anything do it? A universal coding scheme for everything is implausibleA universal coding scheme for everything is implausible Coherence without UniformityCoherence without Uniformity

Slide No.: 23 G A L E N

Key QuestionsKey Questions(for builders of terminology (for builders of terminology

systems)systems) Can it be built? implemented? maintained?

Quickly enough?Quickly enough? Are there short-term milestones and a migration pathway?Are there short-term milestones and a migration pathway?

Will it scale? Organisationally? Technically?Organisationally? Technically?

Can applications use it? Can we maintain them? Can vendors sell themCan we maintain them? Can vendors sell them

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WarningsWarnings

Be cautious of hype It’s not as easy as it looksIt’s not as easy as it looks Beware scalingBeware scaling It’s not how big it is that counts - it’s what you can do with itIt’s not how big it is that counts - it’s what you can do with it

Don’t reinvent the wheel

Simple to understand doesn’t mean simple to use

Coding systems are now software

Slide No.: 25 G A L E N

GALEN-IN-USEGALEN-IN-USEAdvanced terminological services to support

integrated clinical information systems

galen@cs.man.ac.ukhttp://www.cs.man.ac.uk/mig/galen/