IHTSDO Observable and Investigation Model Project Update 2012-10-27

Observables... project Started ca. 2008 Lab test in 2009 Still on-going Planned new lab test 2012

Laboratory test 2012 Larger set of test cases Quality criteria specified Completeness, Understandability, Reproducibility Qualitative aspects in addition to metrics

Example: Core body temperature observable entity = what is intended to be observed + how that is observed

Example: Core body temperature observable entity = what is intended to be observed + how that is observed

Observables model Quality, which is the object of observation Observation procedure, how the quality is observed

Observables model PROPERTY TYPE INHERES IN INHERENT LOCATION INHERENT INGREDIENT CHARACTERIZES PROCESS AGENT PROCESS DURATION PROCESS OUTPUT TOWARDS RELATIVE TO REL-TO PART-OF PRECONDITION Observable = SCALE UNITS TECHNIQUE DIRECT SITE

Observables model WARNING! For educational purpose. Not 100 % true to the model.

Clinically intended target of observation Challenge Body state Environment

PROPERTY TYPE INHERES IN (QUALITY OF) INHERENT LOCATION INHERENT INGREDIENT (INHERENT) OUTPUT OF PROCESS PROCESS AGENT PROCESS DURATION TOWARDS RELATIVE TO RELATIVE TO PART OF Clinically intended target of observation Challenge PRECONDITION Body state Environment

Example: Core body temperature Observation device Observation proxy location Observation technique

Example: Core body temperature Observation device USING DEVICE Observation proxy location DIRECT SITE Observation technique TECHNIQUE

Example: Core body temperature SCALE UNIT

Example |Observable entity|: |Property type| = |Temperature|, |Inheres in| = |Body internal region|, |Using device|=|Tympanic thermometer|, |Units| = |degrees C|, |Direct site| = |Tympanic membrane structure|

Example |Observable entity|: |Property type| = |Temperature|, |Inheres in| = |Body internal region|, |Using device|=|Oral thermometer|, |Units| = |degrees C|, |Direct site| = |Mouth|

Example: Serum sodium concentration relational quality Clinically intended target of observation |PROPERTY TYPE|=|Mass conc.|, |QUALITY OF|=|Plasma|, |TOWARDS|=|Sodium electrolyte| Observation proxy location |DIRECT SITE|=|Serum sample|

|PROPERTY TYPE|=|Mass concentration|, |QUALITY OF|=|Plasma|, Example: Serum sodium concentration |Observable entity|: |PROPERTY TYPE|=|Mass concentration|, |QUALITY OF|=|Plasma|, |TOWARDS|=|Sodium electrolyte|, |DIRECT SITE|=|Serum sample|

TOWARDS QUALITY OF RELATIVE TO RELATIVE TO PART OF Ig G Csf LOINC code 42207-1 Component IgG.CSF Quotients IgG.CSF/IgG.serum Divisors IgG.serum Property RelMCnc System Ser+CSF Time aspect Pt Scale Qn QUALITY OF TOWARDS RELATIVE TO RELATIVE TO PART OF Csf Ig G Plasma NPU19660 Csf— Immunoglobulin G; rel.mass c.(Csf/P) = ? × 10-3

Example |Observable entity|: |Property type| = |Substance concentration|, |Inheres in| = |Plasma|, |Towards| = |Sodium electrolyte|, |Unit| = |mmol/L|, |Direct site| = |Serum sample|

Observables in SNOMED CT Approx. 7 000 Observable entities Approx. 17 000 Observation procedures (Laboratory, Evaluation)

Kinds of observable Body substance/structure observables: lab Physiological observables (e.g. vital signs) Function/Process Scores and indexes Procedure observables: device settings, targets (?) ”non-body” observables Information entity observables: identification code, interpretation Temporal observable Social/personal observable

Non-laboratory use of the model Domains suggested Vital signs – physiology Scores, indexes, assessments Function and activity (ICF related)

Physiological observables Vital signs Previous examples NIBP, Cardiac Output, … Aggregation (min, max, average, …) Reference to process stages/events

Function/Process Functions or processes or ? Are functions needed? E.g. biological transport, body growth, QRS interval, Are functions needed? Processes, ability to realize function, and realization of functions sufficient? Possibly upcoming WHO collaboration on ICF

Scores and indexes Score = a specific SCALE? E.g. VAS pain, where VAS is a specialization of Ordinal Scale Relation to Staging and Scales? Index = a specific TECHNIQUE involving calculation/aggregation of two or more distinct observables? E.g. Glasgow Coma Scale, Disease Activity Score

ICF-related work Aim: to represent the ICF model inside the Observables model What to represent/map? The observable? The finding/observation result? Significant overlap between conditions and observation results ICF classification principles vs. subsumption hierarchy

ICF-related results, so far ICF observables are on a more aggregated level than typical lab observables Not specifically a problem ICF qualifiers correspond to/represent property types (kinds of quality), e.g. Extent of impairment Performance Capacity ICF components are defining characteristics of the qualities

ICF-related results, so far ICF represent values/result on specific ordinal scales

ICF example (b144.x) obs:observable and ((obs:IS_ABOUT some (obs:quality and (obs:INHERES_IN some (organism and (BEARER_OF some memoryFunction))) and (obs:PROPERTY_TYPE some extentOfImpairment))) and (obs:SCALE some obs:ordinal))

ICF example (s750.x_) obs:observable and ((obs:IS_ABOUT some (obs:quality and (obs:INHERES_IN some lowerExtremity) and (obs:PROPERTY_TYPE some extentOfImpairment))) and (obs:SCALE some obs:ordinal))

ICF example (s750.x_) obs:observable and ((obs:IS_ABOUT some (obs:quality and (obs:INHERES_IN some lowerExtremity) and (obs:PROPERTY_TYPE some extentOfImpairment))) and (obs:SCALE some obs:ordinal))

ICF example (d540.x_) obs:observable and ((obs:IS_ABOUT some (obs:quality and (obs:INHERES_IN some (obs:organism and (BEARER_OF some dressingOrUndressingFunction))) * and (obs:PRECONDITION some withoutAssistance) and (obs:PROPERTY_TYPE some capacity))) and (obs:SCALE some obs:ordinal)) * or (AGENT_IN some dressingOrUnderssingProcess)

ICF example (d540._x) obs:observable and ((obs:IS_ABOUT some (obs:quality and (obs:INHERES_IN some (obs:organism and (BEARER_OF some dressingOrUndressingFunction))) and (obs:PRECONDITION some withoutAssistance) and (obs:PROPERTY_TYPE some performance))) and (obs:SCALE some obs:ordinal))