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

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

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

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

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

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

8. 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

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

10. Clinically intended target of observation
Challenge
Body state
Environment

11. 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

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

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

14. Example: Core body temperature
SCALE
UNIT

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

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

17. 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|

18. |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|

19. TOWARDS QUALITY OF RELATIVE TO RELATIVE TO PART OF Ig G Csf
LOINC code
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
NPU Csf—
Immunoglobulin G;
rel.mass c.(Csf/P) = ? × 10-3

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

21. Observables in SNOMED CT
Approx Observable entities
Approx Observation procedures (Laboratory, Evaluation)

22. 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

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

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

25. 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

26. 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

27. 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

28. 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

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

30. 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))

31. 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))

32. 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))

33. 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)

34. 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))