1. For the IHTSDO Content Team and Project Groups
Concept Models for observables, investigations, and observation results
For the IHTSDO Content Team and Project Groups
Revision Date: Dec 26, 2014

2. clinical entity (definition):
Integrating / splitting “(finding)”, “(disorder)”, observables and observation results
We have adopted a formal meaning that covers most of the concepts in the current “(finding)” hierarchy :
Formal definition:
A phase of life of the subject during which he/she is the bearer of a clinical entity that is reportable in the context of health records
clinical entity (definition):
A subject-related body process, disposition, or (patho-) anatomical structure, which is reportable in the context of health records.

3. Integrating / splitting “(finding)”, “(disorder)”, observables and observation results
Some of the content of the current |Clinical finding| hierarchy does not fit the definition of “clinical phase”
information artifacts
observation results: the output of observation procedures
explicit context:
probability (suspected; likely; unlikely) or future (at risk, etc)
family history (someone other than the subject)
These meanings need to be separated out (moved, or else retired and re-created) into a different hierarchy (or hierarchies)

4. observation result
It is proposed that the results of observations should be placed under a top-level category that is distinct from |clinical finding|.
Proposed: new “information artifact” top level:
Information artifact
observation result
situation with explicit context

5. Integrating the models of |clinical finding| and |observation result|
Keep the current |Clinical finding| hierarchy.
Place |observation result| in its own hierarchy
Terms that record that something has been observed to be (or interpreted to be) increased, decreased, normal or abnormal are considered observation results
Remove “interprets” and “has interpretation” attributes from current |clinical finding| model

6. Observable, observation procedure, observation result
It is proposed that these all have closely-coordinated models
observation procedure
Uses most of the same attributes as observable, and adds method = evaluation action
observation result
Uses most of the same attributes as observable, and adds has value
Assumes that the meaning of “evaluation action” includes all types of observation procedures, including physical examination, imaging, etc.

7. Concept model attributes: OBSERVABLE ENTITY
Current
Proposed
(none)
property type
inheres in (location,ingredient)
towards
characterizes (agent, duration, output)
relative to (part of)
precondition
scale
units
technique
direct site
informer

8. observation procedure
observation result
observation procedure
output of
specified by
observes
observable entity
property or quality
An observable entity is specified by an observation procedure, which observes some property. [An observation procedure specifies an observable entity.]
An observation result is the output of an observation procedure, which observes some property
An observation procedure produces as output an observation result.
is about

9. observation procedure
observation result
observation procedure
output of
specified by
observes
observable entity
property or quality
An observable entity is specified by an observation procedure, which observes some property. [An observation procedure specifies an observable entity.]
An observation result is the output of an observation procedure, which observes some property
An observation procedure produces as output an observation result.
The “is about” relation (x is about z) can be inferred from:
the combination x specified-by y observes z
or the combination x output-of y observes z
is about

10. observation procedure
observation result
observation procedure
output of
specified by
observes
observable entity
property or quality
An observable entity is about some property.
An observation result is about some property.
Here the observation procedure is anonymous.
is about

11. observation procedure
observation result
observation procedure
output of
specified by
observes
observable entity
property or quality
An observable entity is specified by an observation procedure, which observes some property. [An observation procedure specifies an observable entity.]
An observation result is the output of an observation procedure, which observes some property
An observation procedure produces as output an observation result.
is about

12. observable model for qualities/properties [ infer the “observes” relation ]
observable entity
has value
<values>
specified by
observation procedure
scale
scale types
units
units
technique
techniques
direct site
material entities
informer
subjects
observes
is about
quality or property
property type
property types
inheres in
independent continuants
(inherent) location
material entities
(inherent) ingredient
substances
towards
independent continuants
relative to
substances
(rel-to) part of
independent continuants
precondition
precondition values
characterizes
processes
process agent
material entities
process duration
time frames
process output
substances

13. observable for qualities
observable entity
has value
<values>
property type
property types
inheres in
independent continuants
(inherent) location
material entities
is about
(inherent) ingredient
substances
quality
towards
independent continuants
relative to
substances
(rel-to) part of
independent continuants
precondition
precondition values
characterizes
processes
process agent
material entities
specified-by ○ observes ⊑ is-about
process duration
time frames
process output
substances
scale
scale types
specified by
units
units
observation procedure
technique
techniques
direct site
material entities
observes
informer
subjects

14. completely “flattened” model for ‘quality’ observables (deprecated)
entity
is about quality with property type
property types
is about quality that inheres in
independent continuants
is about quality with inherent location
material entities
is about quality with inherent ingredient
substances
is about quality that is towards
functions, substances
is about quality with precondition
body states (challenges, fasting)
The “flattened” attributes are not the same as other attributes with almost identical meanings, that would have similar ranges (value sets) but different domains.
An attribute that means “specified by procedure with scale” is not the same as an attribute that means “with scale”. The former defines an observable, the latter defines a procedure.
specified-by-procedure-with-scale
scale types
specified-by-procedure-with-units
units
specified-by-procedure-with-technique
techniques
specified-by-procedure-with-direct site
body structures, specimens
specified-by-procedure-with-informer
subjects

15. process observables observable entity has value <values>
property type
property types
inheres in
independent continuants
(inherent) location
material entities
is about
(inherent) ingredient
substances
property of process
towards
independent continuants
relative to
substances
(rel-to) part of
independent continuants
precondition
precondition values
characterizes
processes
process agent
material entities
process duration
time frames
process output
substances
scale
scale types
specified by
units
units
observation procedure
technique
techniques
direct site
material entities
observes
informer
subjects

16. Concept model attributes: CLINICAL FINDING
Current
Proposed
associated with
associated morphology
finding site
pathological process
occurrence
clinical course
episodicity
severity
has definitional manifestation
finding method
finding informer
associated with
associated morphology
site
pathological process
occurrence
clinical course
episodicity
severity

17. Clinical finding / disorder (current)
associated morphology
<morphologically abnormal structures> G
finding site
<anatomical or acquired body structures>
laterality
<sides>
associated with &/subs
<association values>
pathological process
<pathological processes>
has definitional manifestation
<findings>
occurrence
<periods of life>
severity
<severities>
clinical course
<courses>
episodicity
<episodicities>
interprets
<observables, evaluation procedures> G
has interpretation
<findings values>
finding method
<techniques>
finding informer
<performer of method; or subject of record>

18. Clinical finding / disorder -> finding includes (structure, process, disposition)
associated morphology
<morphologically abnormal structures>
includes condition
site
<anatomical or acquired body structures>
laterality
<sides>
associated with &/subs
<association values>
pathological process
<pathological processes>
has definitional manifestation
<findings>
occurrence
<periods of life>
severity
<severities>
clinical course
<courses>
The role group can be interepreted as “includes some condition and …”, meaning that the other attributes are attributes of the included condition.
Note: the papers of Schulz et al that refer to “situation” are using the word “situation” to refer to what is here called “clinical finding”.
episodicity
<episodicities>
interprets
<observables, evaluation procedures> G
has interpretation
<findings values>
finding method
<techniques>
finding informer
<performer of method; or subject of record>

19. Concept model attributes: CLINICAL FINDING (2)
Current
Proposed
finding informer
finding method
interprets
has interpretation
-> observation result

20. Concept model attributes: OBSERVATION RESULT
Current
Proposed
finding informer
finding method
interprets
has interpretation
informer
technique
observes
has value
units
scale

21. Concept model attributes: MEASUREMENT procedure
Current
Proposed – observation procedure
method = measurement action
property
has specimen
scale type
time aspect
measurement method
component
method = evaluation action
property type
direct site
scale
process duration
technique
towards + inheres in + precondition
units
informer

22. independent continuants quality or property (inherent) location
observation result
property type
property types
inheres in
independent continuants
quality or property
(inherent) location
material entities
(inherent) ingredient
substances
is about
characterizes
processes
process agent
material entities
process duration
time frames
observation result
process output
substances
towards
independent continuants
has value
relative to
substances
<values>
(rel-to) part of
independent continuants
output of
precondition
precondition values
observation procedure
scale
scale types
units
units
technique
techniques
observes
direct site
material entities
informer
subjects

23. observation result for a quality
property type
property types
inheres in
independent continuants
quality
(inherent) location
material entities
(inherent) ingredient
substances
is about
observation result
towards
independent continuants
has value
relative to
substances
<values>
(rel-to) part of
independent continuants
output of
precondition
precondition values
observation procedure
scale
scale types
units
units
technique
techniques
observes
direct site
material entities
informer
subjects

24. observation procedure performer of observation / subject
observation result for property of a process
property type
property types
property of process
is about
characterizes
processes
process agent
material entities
process duration
time frames
observation result
process output
substances
has value
<values>
output of
precondition
precondition values
observation procedure
scale
scale types
units
units
technique
techniques
observes
direct site
material entities
informer
performer of observation / subject

25. left knee jerk reflex 2+ out of 4+ (observation result)
property type
briskness of response
property of process
is about
characterizes
knee jerk reflex (process)
process agent
material entities
process duration
time frames
observation result
process output
substances
has value
++ out of ++++
output of
precondition
precondition values
observation procedure
scale
ordinal
units
units
technique
techniques
observes
direct site
left knee/patellar tendon
informer
performer of observation / subject

26. left knee jerk reflex 2+ out of 4+ (observation result)
property of process
property type
briskness of response
is about
characterizes
knee jerk reflex (process)
observation procedure
scale
ordinal
output of
direct site
left knee/patellar tendon
has value
++ out of ++++

27. Presence, absence of condition
Proper description logic representation of the presence or absence of a condition in a patient could be represented using the object property INCLUDES:
“life phase and INCLUDES some condition” and
“life phase and not INCLUDES some condition”
The OWL 2 EL profile does not provide negation.
‘Clinical finding which does not include condition’ concepts will have to be primitive in a module that is based on EL
or else these absence concepts will need to be separated into a module that is classified using a reasoner that can handle a profile that includes negation

28. observation result An information artifact Is-about some observable
Has-value some {value}

29. observation result model (1)
This model makes a distinction between the target of an observation – the thing the observation is about - such as an inherent quality or independent continuant that is being observed – and any aspects of the act of observation that defines the observation
Two parts of the observables model:
A) the quality/property part of the model: This models the thing being observed, which is the intended object of the observation
This part of the model deals with real entities that exist independent of being observed
B) the observation procedure part of the model: This models the defining characteristics of the observation act
This part of the model deals with the various characteristics that define the type of observation that is done, such as technique, units, time scale, etc. These characteristics may also help us infer how we know, and how accurately we know, that the object of observation has the characteristics that are observed. The defining characteristics of the observation act are ontological with respect to acts of observation. Some people have called these “epistemological” and declared them out of bounds for an ontology, but this is a misunderstanding of what observables are about. These features are only out of bounds for an ontology of the targets of observation, but not out of bounds for “observables” as intended to be covered with this proposed model.
Note: It is important to differentiate the object of an observation (the thing it “is about”) from the purpose of an observation. Some people interpret the word “object” to mean “objective”, meaning “purpose.” This is NOT what is meant by the object of the observation. This potential for confusion is a good reason to avoid proposing attribute names containing the word “object”.

30. observation result model (2)
uses a nested expression or pre-coordinated named dependent quality (or other type of entity) to represent what is being observed
Note: there is a difference between “what is being observed” and “what the thing observed is a quality of”
E.g. “color of skin”: What is being observed is color. The color happens to be a quality of skin, which might happen to have a particular location.
we assume only one set of observation characteristics per act of observation
If the results of an observation are multiple, then the model requires that there be multiple individual observations.
observation result is a replacement for the name “finding” for those entities (including things already represented in SNOMED CT that have the tag “finding”) that fit this model.

31. observation result model (3)
What does this model do to existing measurement procedure attributes?
Replaces HAS SPECIMEN with direct site
The direct site is the immediate direct locus of the observation action (as opposed to the exact locus of the quality that is intended to be measured or assessed) and is available to be used when the entity that is being directly observed is not at the same locus as the intended object of the observation. (The intended object of the observation is the entity in which the observed property inheres; or the independent continuant which is ideally intended to be observed).
Replaces measurement method with technique
Not all observations of interest are measurements, and “measurement method” is too close a name to “method” which takes values from the action hierarchy to define procedures in SNOMED CT.
There is a new techniques hierarchy from which the values will be drawn
Revises and changes the configuration of COMPONENT, PROPERTY, SYSTEM
COMPONENT and SYSTEM
Replaced by inheres in and towards. These are expected to achieve better reproducibility via clearer ontological definitions.
property type
Retains current properties and adds values related to PATO (ontology of qualities)
scale TYPE
Retains scale TYPE in the observation part of model, and adds units to coordinate with IFCC-IUPAC.
TIME ASPECT
Eliminates TIME ASPECT from quality type observations because they are necessarily present at a single point in time; adds process duration for processes
Moves to their own hierarchies, separate from observables:
functions
processes
activities
Allows functions, processes, activities also to be values of towards (in addition to substances, etc)
Does not allow observables to be values of inheres in or towards.
Direct object versus intended object:
Core temperature estimated from rectal temperature: If we measure rectal temperature as a surrogate for core body temperature, then the direct object is the rectum but the “core” of the body is the locus of the quality intended to be assessed. If the slightly lower temperature in the rectum is clinically meaningful in some context, it is possible to use a standard correction factor. (which has been estimated to be 0.04 degrees C). For most purposes, this is insignificant, so most people ignore the difference between rectal and core body temp, and use rectal temp measured without correction as the core body temp.
Plasma sodium concentration, measured in serum: If I measure sodium concentration in serum, the direct object is serum but the intended object is the intravascular blood plasma (there is no serum in the body – serum is plasma with the coagulation proteins removed, and only exists as an out-of-the-body preparation).

32. observation result model (4)
Differentiates between a dependent quality per se and a property type.
Concentration is a property type.
The concentration of sodium in serum is a dependent quality.
Renames PROPERTY to property type

33. observation result model (5)
Deprecates the use of “absence” as a property type
Asserting absence of findings/functions/abilities/etc. requires negation (using a modification of the situation model).
Observables would also not use “associated morphology”
But note: Conditions can be modeled using “associated morphology” with a value that implies physical absence of a structure that is normally present
E.g congenital atresia, traumatic acquired absence
Deprecates the use of “presence” as a property type.
Presence is necessarily implied by conditions modeled with associated-morphology, but presence is not a property type for observables
E.g supernumerary structure (morphologic abnormality) implies presence of an extra structure not normally present.

34. Model for observable entities
First attribute is:
is about (observation target)
Its domain includes observables, observation procedures, and observation results.
Its range includes:
dependent qualities of independent continuants
properties of processes (may be called “process profiles” in BFO2)
Range MAY include:
Dependent continuants (qualities, dispositions, roles)
Independent continuants – but interpretation rules are needed.
Occurrents, and in particular, situations

35. The observation part of the model
Main attributes are:
scale
units
technique
direct site

36. model for observables is about observable scale scale types units
Dep. Qualities/Dispositions,
Indep. continuants
is about
observable
scale
scale types
units
units
technique
techniques
direct site
body structures, specimens

37. independent continuants
model for dependent qualities
property type
property types
inheres in
independent continuants
quality
towards
functions, substances
precondition
body states
What about subject? Donor, mother, fetus etc who are not the subject of record -> Invokes context, and would be situation concepts.

38. model for ‘quality’ observables
property type
property types
inheres in
independent continuants
is about
quality
towards
functions, substances
precondition
body states (challenges, fasting etc.)
observable
scale
scale types
units
units
technique
techniques
direct site
body structures, specimens

39. model for ‘quality’ observables
LOINC elements
IFCC-IUPAC NPU elements
property type
property types
Kind-of-property
property
inheres in
independent continuants
System/specimen
system
is about
quality
towards
functions, substances
component
component
precondition
body states
component
observable
scale
scale types
scale
units
units
units
technique
techniques
method
method
direct site
body structures, specimens
System/specimen

40. Sodium:SCnc:PT:Ser/Plas:Qn
LOINC Example:
Sodium:SCnc:PT:Ser/Plas:Qn
Qualities are continuants
that exist in their entirety
at a single point in time
property type
Substance concentration
Kind-of-property
inheres in
plasma
is about
quality
towards
Sodium ion
component
precondition
body states
observable
scale
quantitative
scale
units
units
technique
techniques
direct site
Serum/plasma specimen
System/specimen

41. IFCC-IUPAC NPU Example: P—Sodium ion; subst.c. = ? mmol/l
property type
Substance concentration
property
inheres in
plasma
system
is about
quality
towards
Sodium ion
component
precondition
body states
observable
entity
scale
quantitative
units
mmol/l
units
technique
techniques
direct site
body structures, specimens

42. DRAFT model for observation results
qualities, dispositions, independent continuants
is about
observation result
scale
scale types
units
units
technique
techniques
direct site
body structures, specimens
has value
Numeric, ordinal, nominal

43. DRAFT model for results of observations of qualities
property type
property types
inheres in
independent continuants
is about
quality
towards
functions, substances
precondition
body states
observation result
scale
scale types
units
units
has value
Numeric, ordinal, nominal
technique
techniques
direct site
body structures, specimens

44. DRAFT model for procedures that observe qualities
property type
property types
inheres in
independent continuants
is about
quality
towards
functions, substances
precondition
body states
observation procedure
Note the removal of VALUE, relative to observation results, and the addition of method = observation action, relative to the observable.
scale
scale types
units
units
technique
techniques
direct site
body structures, specimens
method
observation action

45. Attributes that define the quality that the observation is intended to elucidate
Property type
Coordinated with BFO Qualities. Quality: a dependent continuant that is exhibited if it inheres in an entity or entities at all. (See BFO Manual, definition of “Quality”)
Inheres-in
Relationship between a quality (property) and the independent continuant on which it depends for its existence, in which it is manifest
Towards (meaning the object or target of the property)
Third element of a relational quality, (other than the quality, and the continuant in which it inheres) e.g. sodium, in the quality of concentration of sodium in serum
Precondition
States of the individual that contextualize the property (e.g. standing, fasting, post-challenge, etc)

46. Values for property type
Top levels of value hierarchy – determined by empirical
analysis of values in the observables hierarchy
Detail
Dimension
Feature
Fluid property
Force property
Location
Quantity
Ratio
Result
Stage
Temperature
Time
Velocity
Wave property

47. dimension [2] (possible: size)
observable entity property types
dimension [2] (possible: size)
area [20]
distance (synonym: linear dimension)
breadth [20]
circumference [27]
depth [7]
diameter [31]
height [29]
length [42]
width [11]

48. Approach to properties
Influenced by OBO
Quality ontology

49. precondition
body states that define the context in which the property is defined. For example, “standing blood pressure” is defined in the context of the body state “standing position”. Various challenge tests would be defined in terms of body states specifying the challenge that occurred, e.g. “2 hour post-prandial glucose” would have body state = “2 hours after meal”.

50. Attributes that define the characteristics of the observation
scale type
Same as LOINC scale type and current measurement procedure attribute
units
Same as IFCC-IUPAC NPU units
direct site
the direct object of the observation action; the site or specimen where the observation takes place. May be different from the value of inheres in, since the property being observed may be inferred from a specimen or from a remote site.
Examples: rectum as the site of temperature measurement, where the property being observed is the core body temperature (rectal temperature being a surrogate); or serum specimen being used to determine body plasma sodium concentration. The concentration inheres in the plasma, but is being measured in a serum specimen.
Needs to be modeled only when this site is different from the value of inheres in
technique
Any specialization of “observation” that tells us how we did the observing; for example, “enzyme-linked immunosorbent assay” or “immunofluorescence”.

51. Revision of “site” object property
A possible attribute hierarchy could be:
site
inheres in
direct site
indirect site
inheres in can be a sub-role of site. This works for observation findings and observation procedures, and direct site would be used in addition where necessary
The attribute procedure site direct, in the current procedure model, is the same meaning as direct site in the observable model.

52. Replace measurement method with more general technique
observables model revision:
For observation and evaluation procedures, the method (with values from the action hierarchy) represents the goal or objective of what is done: evaluation, testing, imaging, measurement, examination
observation techniques define the observable, via technique (with values from a value set that includes lab techniques and other specific measurement and evaluation actions, such as inspection, palpation, percussion, auscultation)
Techniques are the means by which the action is carried out, not the intended outcome.
Techniques include specific measurement techniques such as Enzyme-linked immunosorbent assay (ELISA).
Need to examine whether this works for procedures other than evaluations, i.e. can we make the distinction between method (means) and technique for all procedures

53. Auditory threshold at 3kHz, in dB
property type
Threshold
inheres in
Auditory system
is about
quality
towards
Hearing (function)
precondition
body states
observable
entity
Need to define what relational properties are, and how to recognize them.
Concentration is a relational property. IS threshold also?
scale
quantitative
units dB
technique
3 kHz audiometry
direct site
ear

54. Blood hemoglobin concentration (quality)
property type
Mass concentration
inheres in
Intravascular blood
quality
towards
hemoglobin
precondition
body states

55. body structures, specimens
Blood hemoglobin concentration,
quantitative (observable)
property type
Mass concentration
inheres in
Intravascular blood
is about
quality
towards
hemoglobin
precondition
body states
observable
entity
scale
quantitative
units
units
technique
techniques
direct site
body structures, specimens

56. body structures, specimens
Blood hemoglobin 14 gm/dL (observation result)
property type
Mass concentration
inheres in
Intravascular blood
is about
quality
towards
hemoglobin
precondition
body states
observation result
scale
quantitative
units
gm/dL
has value 14
technique
techniques
direct site
body structures, specimens

57. Head circumference (quality)
property type
circumference
inheres in
Head (necessarily also: surface along fronto-parietal coronal plane of head)
quality
towards
hemoglobin
precondition
body states

58. body structures, specimens
Head circumference in cm (observable)
property type
circumference
inheres in
head
is about
quality
towards
hemoglobin
precondition
body states
observation result
scale
quantitative
units cm
technique
techniques
direct site
body structures, specimens

59. body structures, specimens
Head circumference 42 cm (observation result)
property type
circumference
inheres in
head
is about
quality
towards
hemoglobin
precondition
body states
observation result
scale
quantitative
units cm
has value 42
technique
techniques
direct site
body structures, specimens

60. Serum concentration of Borrelia antibody
property type
concentration
inheres in
plasma
is about
quality
towards
Borrelia antibody
precondition
body states
observable
entity
scale
quantitative
units
units
technique
techniques
direct site
Serum specimen

61. observation procedure
Measurement of serum concentration of
Borrelia antibody by ELISA technique (procedure)
property type
concentration
inheres in
plasma
is about
quality
towards
Borrelia antibody
precondition
body states
observation procedure
There could be an attempt to specify a difference between observation action and measurement action:
Some draft definitions:
observation is the determination of the type of a dependent quality, or the presence or identity of an independent continuant.
observation can involve the determination of a nominal quality (one that has no magnitude).
measurement is the determination of the magnitude of a quality (one that has a magnitude).
Nominal, ordinal, differential, and rational:
nominal: no magnitude
ordinal: magnitude ordered, but not on a scale that can be subtracted
differential: magnitude that can be subtracted, but not divided
rational: magnitude that can be divided
scale
quantitative
units
units
technique
ELISA
direct site
Serum specimen
method
Measurement action

62. Cultured E.coli serotype is O157
The information model is used to link this result to the
Culture and specimen that came from the patient.
Cultured E.coli serotype is O157
property type
serogroup
inheres in
E. Coli (organism)
is about
quality
towards
hemoglobin
precondition
body states
observation result
“E. Coli serotype” is a nominal quality ( one without magnitude ).
scale
scales
units
units
has value
O157
technique
Bacterial serotyping
direct site
Microbial culture

63. What about abilities?
Able with respect to normal functioning and activities
Ontologically these are “realizables”.
Two types:
Sure-fire (“dispositions”): if you have the ability to feel pain, then when a painful stimulus is applied, you feel it (assuming you are conscious – and actually even if you are unconscious – with some exceptions based on threshold of intensity)
Those abilities that depend on the bearer’s decision (ability to walk, talk, throw a ball, eat an apple, etc)

64. Disposition type
Possible replacement for “property type” where the value of “is about” is neither a quality nor a process, but instead is a disposition or function
* could consider expanding the domain/range for property type instead

65. ability to hear (meaning the “sure-fire” disposition for a hearing process to be instantiated on exposure to sound)
disposition type
ability
inheres in
auditory system
disposition
towards
hearing (process)
precondition
body states
Note: a disposition is defined as something that necessarily occurs given a certain condition; it is not the same as tendency, which is defined as something that is likely to occur but in different circumstances it may or may not occur.
The relationship between force applied and the shattering of a pane of glass is a disposition.
A pane of glass has a disposition to shatter when exposed to enough force; it will always shatter once the force reaches the threshold required.
The relationship between smoking and lung cancer is a tendency.
People who smoke have a tendency to develop lung cancer, but regardless of the amount they smoke, some people don’t develop lung cancer.

66. body structures, specimens
Able to hear (as an observation result)
(there exists some observation result which has a target
of some disposition which is ability to hear)
disposition type
ability
inheres in
auditory system
is about
disposition
towards
hearing (process)
precondition
body states
observation result
Maybe ability should be regarded as a quality.
“whether is able” is rendered unnecessary.
Consider “ablity to do x = able, unable, does, does not, assisted, etc.” ??
There should be a difference between volitional skill-based abilities and functional/dispositional abilities.
For example, “ability to feel pain” (functional / dispositional) is not the same type of thing as “ability to sign name” (volitional / skill-based)
scale
scale types
units
units
has value
able
technique
techniques
direct site
body structures, specimens

67. Able to hear (clinical phase)
Interpreted as disposition present in life of patient,
or “ability to hear = present”
(the clinical phase includes the existence of some disposition
which is ability to hear)
disposition type
ability
inheres in
auditory system
includes
disposition
towards
hearing (process)
precondition
body states
clinical phase

68. body structures, specimens
Able to hear (observation result)
Interpreted as an observation result, using the VALUE attribute
disposition type
ability
inheres in
auditory system
is about
disposition
towards
hearing (process)
precondition
body states
observation result
There exists some observation result, in which the target of the observation is some disposition, and which has value = able.
scale
scale types
units
units
has value
able
technique
techniques
direct site
body structures, specimens

69. Impaired ability to hear (as a disposition)
disposition type
Impaired ability
inheres in
auditory system
disposition
towards
hearing (process)
precondition
body states
Ontologically, the impairment of ability to hear exists independently of being observed.

70. body structures, specimens
Impaired ability to hear (as an observation result)
disposition type
ability
inheres in
auditory system
is about
disposition
towards
hearing (process)
precondition
body states
observation result
Now what about “hearing not impaired” ? How do we determine that “hearing not impaired” implies “able to hear”?
One option:
“not impaired” is a value subtype of “able”
AND do not use the negation for this model.
There are some things that we should regard as “positives” even though expressed in the negative.
Hearing NOT impaired is one of those, IF we model “able to hear” as a positive.
OTHERWISE, we could turn it around and model the deficits as the positives. This might be more consistent with “NORMAL” as the absence of abnormality.
This would mean that “ability = able” would be disallowed, and we would have the double negative of “ability = unable” with situation NOT includes “ability = unable”.
That seems awkward.
scale
scale types
units
units
has value
impaired
technique
techniques
direct site
body structures, specimens

71. Impaired ability to hear (as disposition included in situation,
or “impaired hearing = present”)
disposition type
Impaired ability
inheres in
auditory system
includes
disposition
towards
hearing (process)
precondition
body states
clinical phase
In this model, impaired ability is a disposition, and “whether is able” is not necessary.
what do we do with “ablity to do x = able, unable, does, does not, assisted, etc.” ??
There should be a difference between volitional actions and functional properties.
For example, “ability to feel pain” is not the same as “ability to sign name”.

72. Other dispositions
Antimicrobial sensitivity

73. Antimicrobial susceptibility test (procedure)
disposition type
Resistance/sensitivity
inheres in
Microbial isolate
is about
disposition
towards
Antimicrobial
precondition
body states
observation procedure
TIME ASPECT
Time aspects
scale
scale types
units
units
technique
techniques
direct site
body structures, specimens
method
observation action

74. Process observables/observations
characterizes
process duration
other process attributes

75. Left knee deep tendon reflex – briskness (observable)
property type
Briskness of response
property of process
inheres in
Neuromuscular structures of the left knee deep tendon reflex
is about
characterizes
Deep tendon reflex (process)
precondition
body states
observable
entity
scale
scale types
units
units
technique
techniques
direct site
body structures, specimens

76. Left knee jerk reflex 2+ (observation result)
property type
Briskness of response
property of process
inheres in
Neuromuscular structures of the left knee deep tendon reflex
is about
characterizes
Deep tendon reflex (process)
precondition
body states
observation result
scale
scale types
units
units
has value
2+ out of 4+
technique
techniques
direct site
body structures, specimens

77. Other question/answer pairs as quality / quality region pairs

78. Histologic type (of lesion)
property type
Histologic type
inheres in
lesion
quality
towards
functions, substances
precondition
body states

79. (located-in would be a relational spatial quality)
Tumor site
(located-in would be a relational spatial quality)
property type
Located in
inheres in
tumor
quality
towards
functions, substances
precondition
body states

81. Dealing with “presence”
Disallow “presence” and “absence” as a value of property type
But allow “detected”, “present”, “absent” as an observation result, if the value of “is about” is a situation, or independent continuant (not a dependent continuant). and possibly also a process with process properties.

82. observation result observation result has value <values>
property type
property types
inheres in
independent continuants
(inherent) location
material entities
is about
(inherent) ingredient
substances
quality or property
towards
independent continuants
relative to
substances
(rel-to) part of
independent continuants
precondition
precondition values
characterizes
processes
process agent
material entities
process duration
time frames
process output
substances
scale
scale types
output of
units
units
observation procedure
technique
techniques
direct site
material entities
observes
informer
subjects

83. independent continuant observation procedure
Observation result for presence / absence
observation result
is about
output of
observes
independent continuant
observation procedure
has location
<location>
has value
scale
scale types
units
units
technique
techniques
present/absent
direct site
material entities
informer
subjects

84. Methicillin-resistant staphylococcus aureus
(MRSA) present in abdominal wound,
swab specimen, by PCR rapid detection method
observation result
is about
output of
observes
MRSA
observation procedure
has location
abdominal wound
has value
scale
qualitative
units
units
technique
PCR rapid detection method
detected
direct site
abdominal wound swab (specimen)
informer
subjects

85. is about MRSA (organism) observation result has value detected
Methicillin-resistant staphylococcus aureus
(MRSA) present
This is a “close to user” form. It is a sufficient definition,
supplemented with a second sufficient definition that says:
observation_result and
(output-of = (observation_procedure and observes = MRSA)) and
(has_value = detected)
is about
MRSA (organism)
observation result
has value
detected

86. Mycoplasma pneumoniae
Mycoplasma pneumoniae detected
is about
Mycoplasma pneumoniae
observation result
scale
qualitative
units
units
has value
detected
technique
techniques
direct site
specimens

87. PCR rapid detection method
Methicillin-resistant staphylococcus aureus
(MRSA) in abdominal wound,
swab specimen, by PCR rapid detection method
(observable)
is about
MRSA (organism)
has location
Abd. wound
observable
entity
scale
qualitative
units
units
technique
PCR rapid detection method
direct site
Wound swab (specimen)

88. MRSA (methicillin resistant staph aureus)
POC (point-of-care) test (procedure)
is about
MRSA (organism)
observationprocedure
scale
scale types
units
units
has value
Numeric, ordinal, nominal
technique
MRSA POC detection technique
direct site
specimen
method
observation action

89. Radial pulse palpability
is about
arterial pulsation
has location
radial artery at the wrist
observable
entity
scale
scale types
units
units
technique
palpation
direct site
Ventral aspect of wrist over radial artery

90. radial pulse present by palpation
is about
arterial pulsation
has location
radial artery at the wrist
observation result
scale
scale types
units
units
has value
present
technique
palpation
direct site
ventral aspect of wrist over radial artery

91. abdominal wall stoma present (observation result)
is about
stoma
has location
Abdominal wall
observation result
scale
scale types
units
units
has value
present
technique
techniques
direct site
place

92. colostomy present (observation result)
is about
colostomy
has location
Abdominal wall
observation result
scale
scale types
units
units
has value
present
technique
techniques
direct site
place

93. adenocarcinoma of the colon present (observation result)
is about
adenocarcinoma
has location
colon
observation result
Probably we don’t need this meaning because one can’t directly observe that there is an adenocarcinoma present.
But – “malignant tumor present” is something that can be directly a result of observation based on the characteristics observed (and can be mistaken, etc).
scale
scale types
units
units
has value
present
technique
techniques
direct site
place

94. associated morphology
adenocarcinoma of the colon (disorder)
disorder
includes
associated morphology
adenocarcinoma
site
colon
adenocarcinoma lesion observed in colon (observation result)
adenocarcinoma of the colon present (finding) - deprecated FSN
observation result
is about
A disorder and an observation result are not the same thing. Disorders are interpreted as phases of a subject’s life during which they are the bearer of the condition.
adenocarcinoma
has location
colon
has value
present

95. Determining “contents”
observations that seek to answer:
What things are present as physical parts of a specimen (such as a fluid) or structure?
What things are present and contained within a structure (but not part of it)?

96. body structures, specimens
Contents of urine by light microscopy (observable)
Assumes “having physical part” is a valid relation between discrete solid entities in a fluid and the fluid substance.
property type
Having physical part
inheres in
urine
is about
quality
towards
functions, substances
precondition
body states
observable
scale
scale types
units
units
technique
Light microscopy
direct site
body structures, specimens

97. observationprocedure
Determining contents of urine by light microscopy
on urine sample (procedure)
Synonym: microscopic urinalysis
property type
Having physical part
inheres in
urine
is about
quality
towards
functions, substances
precondition
body states
observationprocedure
scale
scale types
units
units
technique
Light microscopy
direct site
Urine sample
method
observation action

98. Urine microscopy: hyaline casts present
property type
Having physical part
inheres in
urine
is about
quality
towards
Hyaline casts
precondition
body states
observation result
scale
scale types
units
units
has value
Observed
technique
Light microscopy
direct site
Urine specimen

99. What about counts?
Count >=1 seems to mean the same as “retinal hemorrhage present”
But does it?
There is a difference between
an observation result in which a count was made, and
a phase of a subject’s life during which the countable entity was present (or not present)
And this difference matters because
counts can be incorrect
a count of zero can be made when the situation is that there is a hemorrhage present
and a count of 1 can be mistakenly made when the situation is that there is no hemorrhage
and we may need to be able to record and do quality assurance based on the difference between the count and the actual situation

100. body structures, specimens
4 retinal hemorrhages present (observation result)
property type
entitic number
inheres in
retina
is about
quality
towards
hemorrhages
precondition
body states
observation result
The property type is entitic number if the result means “4 hemorrhages in a single entire retina”.
The property type is count of entities, if the result means “4 hemorrhages were counted altogether, regardless of how many retinas or what proportions of the retinas were examined”.
scale
quantitative
units
units
has value 4
technique
techniques
direct site
body structures, specimens

101. body structures, specimens
retinal hemorrhage count >= 1 (observation result)
property type
entitic number
inheres in
retina
is about
quality
towards
hemorrhage
precondition
body states
observation result
scale
quantitative
units
units
has value
>= 1
technique
techniques
direct site
body structures, specimens

102. observation procedure
retinal hemorrhage present (observation result)
observation result
has value
detected
is about
hemorrhage
has location
retina
scale
qualitative
output of
units
units
observation procedure
technique
techniques
direct site
material entities
observes
informer
subjects

103. associated morphology
Retinal hemorrhage present (clinical phase)
clinical phase
includes
associated morphology
hemorrhage
site
retina
These probably should be regarded as having the same meaning.
How can we correlate this with the observation that count >= 1 ?

105. Which models are preferred and why?
Several different options have been presented
Criteria for choosing among options:
1) semantic consistency
2) simplicity
3) interoperability
4) reproducibility of modeling individual concepts
5) lower degree of disruption of existing implementations and content
6) lower comparative cost of the change
7) computability