1. TOWARD A TAXONOMY OF ACUTE PAIN CONDITIONS: LUMPING VS. SPLITTING AND OTHER GENERAL CONSIDERATIONS Patrick Tighe MD MS | Assistant Professor, Depts. Of Anesthesiology & Orthopedic Surgery Affiliate Asst. Professor, Information Sciences & Operations Management

2. Disclosures I have no financial conflicts of interest to report Research supported by NIH/NIGMS: K23 GM102697 R01 GM114290 Most importantly: Support from family, mentors, collaborators, and colleagues!

3. Overview The Need for Ontologies Schema Architectures Potential Applications to ACTTION Dimensions

4. The Need for Ontologies Why We Need Great Ontologies Now, More Than Ever

5. What is a Vocabulary? List of terms without context Blue, pizza, bubbles, beach, red, hamburger

6. What is a Taxonomy? Organizational listing of items in ‘tree’ form Kingdom -> Phylum -> Class -> Order -> Family -> Genus -> Species

7. What is a Taxonomy? Parent Child

8. What is an Ontology? Method for organizing multifaceted, complex relationships “…formal naming and definition of the types, properties, and interrelationships of the entities that really or fundamentally exist for a particular domain of discourse.”entities that really or fundamentally exist for a particular domain of discourse Wikipedia: https://en.wikipedia.org/wiki/Ontology_(information_science)

9. What is an Ontology? Blood Pressure Site Time Value Medication Activity systolic diastolic mean Method A-line NIPB Femoral Aortic Arm Heart Rate

10. Why Are They Now So Important? Electronic Medical Records “What Does That Value Mean?” Variables defined by Variables

11. Schema Architectures Designing a Translational Bridge to Clinical Application

12. Why Explore UML & Schema? Define Acute Pain Ontology (APO) Disseminate APO Operationalize APO TodayTomorrowForever? DiscussionPublication Electronic Medical Record Systems

13. What Are the Components of an Ontology? ComponentDescription of ComponentExample ClassesCategory, type, setVital Sign ObjectsInstance; individual observationBlood Pressure AttributesKind of object Femoral, A-line, Systolic, value (in mmHg) MethodsThings we can do to/with objectsDecrease RelationshipsLinkage between objects Blood Pressure is a Vital Sign; has a Site; interacts with Heart Rate

14. Notation for Schema: Classes Vehicle Abstract Class Vehicle: Car Vehicle: Bike classname: objectname

15. Notation for Schema: UML Class Attributes Methods

16. Notation for Schema: Classes & Objects ObjectClass

17. Notation for Schema: Attributes Class Attributes Methods Intrinsic: physically imbued into object Extrinsic: depends on external relationships Attributes can be Classes unto themselves!

18. Notation for Schema: Relationships What was your trip like? Vehicle Hotel People Food Association Parking

19. Notation for Schema: Inheritance Vehicle Inheritance: Car “is a” vehicle Inheritance: Bike “is a” vehicle Children, or Subclasses Parent, or Superclass More General More Specific

20. When to introduce new classes? Vehicle Planes: Many New Attributes…. Perhaps new superclass?

21. Classes to Subclasses: 1 and 12 Parent Child Too Few Subclasses Child > 12 Parent Too Many Subclasses

22. Patterns of Multiple Inheritance 2 Superclasses: inherits attributes from BOTH Parent (Red Wine) Parent (Red Wine) Parent (Dessert Wine) Parent (Dessert Wine) Port wine

23. New Class or New Attribute? “If the concepts with different attribute values become restrictions for different attributes in other classes, then we should create a new class for the distinction. Otherwise, we represent the distinction as an attribute.” Natalya F. Noy and Deborah L. McGuinness (with slight modifications for terminology)

24. New Class or New Attribute? “If a distinction is important in the domain and we think of the objects with different values for the distinction as different kinds of objects, then we should create a new class for the distinction.” Natalya F. Noy and Deborah L. McGuinness

25. Top-Down versus Bottom-Up Approaches Top-Down: Start with general concepts (classes) and work ”down” to objects, attributes, and methods Bottom-Up: Start with attributes and methods describing most specific objects, and then build “up” to classes

26. Purpose Why are we doing this?

27. Independently Decompose Each Characteristic ClassesObjectsAttributesMethods AcutePostoperativeLocationDiagnostic Test ChronicAmputationTimeTreatment CentralEtiology TraumaticRadiation CancerQuality

28. Making an Ontology: The 5-Step Program 1. Determine the domain and scope2. List important ‘terms’ for consideration3. Define classes & hierarchy of objects4. Define attributes of classes5. Create instances (objects)

29. Application to ACTTION Dimensional Structure A Blueprint for Systematic EMR Deployment of the Acute Pain Ontology

30. The Dimensions Dimension 1: Core diagnostic criteria Dimension 2: Common features Dimension 3: Common medical comorbidities Dimension 4: Neurobiological, psychosocial, and functional consequences Dimension 5: Putative neurobiological and psychosocial mechanisms, risk factors, and protective factors

31. The Dimensions Diagnostic Criteria Common Features Comorbidities NBPSF ConsequencesMechanisms/Factors Attributes

32. Superclasses and Classes Diagnostic Criteria Common Features Comorbidities NBPSF ConsequencesMechanisms/Factors Attributes Classes Acute Chronic Subclass 1

33. Things We Do with Pain Diagnostic Criteria Common Features Comorbidities NBPSF ConsequencesMechanisms/Factors Attributes Methods Classes Acute Chronic Subclass 1 Imaging PROMIS Pharmacologic Tx Physical Therapy QST Surgery

34. Classes Unto Themselves? Diagnostic Criteria Common Features Comorbidities NBPSF ConsequencesMechanisms/Factors Attributes Methods Classes Acute Chronic Subclass 1 Imaging PROMIS Pharmacologic Tx Physical Therapy QST Surgery Attributes & Methods May Need Further Ontologic Organization as Classes

35. Specific Instances (Objects) of Acute Pain? Diagnostic Criteria Common Features Comorbidities NBPSF ConsequencesMechanisms/Factors Attributes Methods Objects Classes Acute Chronic Subclass 1 Imaging PROMIS Pharmacologic Tx Physical Therapy QST Surgery Postoperative Orofacial Visceral Trauma/Burn Cancer MSK Neuropathic

36. Where Are We? 1. Determine the domain and scope2. List important ‘terms’ for consideration3. Define classes & hierarchy of objects4. Define attributes of classes5. Create instances (objects)

37. Where Are We? Diagnostic Criteria Common Features Comorbidities NBPSF ConsequencesMechanisms/Factors Attributes Methods Objects Classes Acute Chronic Subclass 1 Imaging PROMIS Pharmacologic Tx Physical Therapy QST Surgery Postoperative Orofacial Visceral Trauma/Burn Cancer MSK Neuropathic

38. Classes in the Acute Pain Ontology Superclass Subclass Attributes (Dimensions) Methods

39. Organizing Class/Sublclass Relationships

40. Specifying Acute Pain Ontology Objects Superclass Class Objects

41. Attributes & Methods can be Classes Objects Methods as Classes

42. Ontologies are Relationships Non-Linear Relationships

43. Summary The Need for Ontologies Schema Architectures Potential Applications to ACTTION Dimensions

44. Thank you! Patrick Tighe MD MS ptighe@anest.ufl.edu @ptighe ptighe@anest.ufl.edu