1. Strategies for Referent Tracking in Electronic Health Records. Arguments to Werner Ceusters presentation Imia WG6 Workshop on Ontology and Biomedical Informatics Roma 29 April-2 May 2005 Is Ontology needed in Biomedical Informatics ? Jean marie Rodrigues rodrigues@univ-st-etienne.fr Dpt of public health and medical informatics, University of Saint Etienne USE, France

2. Tracking “Particular/Instance” a sufficient Ontology? 1 RTS IS NOT ADRESSING AN UNKNOWN ISSUE BY EHR EITHER EXISTING OR DEVELOPING (Cimino,HL7,Open EHR, CEN TC 251 et.) ex CEN Archetype 2 IT IS AN INTERESTING CONTRIBUTION TO SEMANTIC INTEROPERABILITY 3 IT IS NOT EASY TO IMPLEMENT FOR TOO MUCH BASED ON AN HOLISTIC MODEL :PUI/IUI Tracking “Particular/Instance” a sufficient Ontology? 1 RTS IS NOT ADRESSING AN UNKNOWN ISSUE BY EHR EITHER EXISTING OR DEVELOPING (Cimino,HL7,Open EHR, CEN TC 251 et.) ex CEN Archetype 2 IT IS AN INTERESTING CONTRIBUTION TO SEMANTIC INTEROPERABILITY 3 IT IS NOT EASY TO IMPLEMENT FOR TOO MUCH BASED ON AN HOLISTIC MODEL :PUI/IUI Dpt of public health and medical informatics, University of Saint Etienne USE, France

3. Tracking “Particular/Instance” a sufficient Ontology? 4 IT IS CONTRADICTORY WITH THE NECESSARY DISJUNCTION BETWEEN MODEL OF KNOWLEDGE (Ontology) and MODEL OF USE (clinical terminology:snomed ct) 5 IT ADRESSES INTERESTING SIDE POINTS -Definition of ontology in Biomedicine -Philosophical based oppositions.Particular/Universal.Assignment/Reservation 6 A VERY GOOD ANALYSIS OF NEEDS FOR SEMANTIC INTEROPERABILITY BETWEEN EHR BUT NOT THE MOST EFFICIENT (EVEN IF ELEGANT)WAY TO SOLVE THE PROBLEM IF USED ALONE Tracking “Particular/Instance” a sufficient Ontology? 4 IT IS CONTRADICTORY WITH THE NECESSARY DISJUNCTION BETWEEN MODEL OF KNOWLEDGE (Ontology) and MODEL OF USE (clinical terminology:snomed ct) 5 IT ADRESSES INTERESTING SIDE POINTS -Definition of ontology in Biomedicine -Philosophical based oppositions.Particular/Universal.Assignment/Reservation 6 A VERY GOOD ANALYSIS OF NEEDS FOR SEMANTIC INTEROPERABILITY BETWEEN EHR BUT NOT THE MOST EFFICIENT (EVEN IF ELEGANT)WAY TO SOLVE THE PROBLEM IF USED ALONE Dpt of public health and medical informatics, University of Saint Etienne USE, France

4. 1 IT IS NOT AN UNKNOWN ISSUE PARTICULAR INSTANCE IN CONCRETE REALITY (introduction and case study) Vs CONTEXT LONGITUDINAL EHR EXISTING TERMINOLOGY TOOLS RELATION INFORMATION MODEL TERMINOLOGY RELATION TERMINOLOGY ONTOLOGY 1 IT IS NOT AN UNKNOWN ISSUE PARTICULAR INSTANCE IN CONCRETE REALITY (introduction and case study) Vs CONTEXT LONGITUDINAL EHR EXISTING TERMINOLOGY TOOLS RELATION INFORMATION MODEL TERMINOLOGY RELATION TERMINOLOGY ONTOLOGY Dpt of public health and medical informatics, University of Saint Etienne USE, France

5. USE Department of public health and medical informatics - Electronic healthcare record prEN13606 Part 2 : Archetypes CEN prEN13606 Archetype : set of minimal terminology and context structure constraints to support the production of meaningful units of restricted knowledge(not only information but not full knowledge) to be interchanged without ambiguity No language priority: Person status Point of time Terminology /ontology used Type of event,ordered or fixed Observation,evaluation,instruction an archetype must be designed to constrain configurations of instances of a simple node/arc information model, that express for instance “microbiology test result” or a “physical examination”. It is the interface between the formalisms used for generic EHR classes representation(reference architecture,data types,format )and information on PARTICULAR/INSTANCE encapsulating context and terminologies based or not on ontology.

6. 2 IT IS AN INTERESTING CONTRIBUTION TO SEMANTIC INTEROPERABILITY Starting from clear “philosophical” assumptions 1 Particular versus Universal 2 Assignment versus reservation The use of PUI/IUI in EHR statements is presented with “logical” ELEGANCE: - Text-based EHR systems - Formally structured statements (ontology) - Concept based systems (Snomed) 2 IT IS AN INTERESTING CONTRIBUTION TO SEMANTIC INTEROPERABILITY Starting from clear “philosophical” assumptions 1 Particular versus Universal 2 Assignment versus reservation The use of PUI/IUI in EHR statements is presented with “logical” ELEGANCE: - Text-based EHR systems - Formally structured statements (ontology) - Concept based systems (Snomed) Dpt of public health and medical informatics, University of Saint Etienne USE, France

7. 3 IT IS NOT EASY TO IMPLEMENT Questions are listed 1 Distinction assignment reservation “can be problematic” 2 The existential uniqueness of the PUI/IUI “existence has already been determined” 3 Previous assignment ? 4 Relevance to assign different across EHRs 5 Management of PUI/IUI generator,PUI/IUI repository, RTSDB data bases To what extent this ideal solution can be operationalized and at what cost to be practically implemented to be useful ? 3 IT IS NOT EASY TO IMPLEMENT Questions are listed 1 Distinction assignment reservation “can be problematic” 2 The existential uniqueness of the PUI/IUI “existence has already been determined” 3 Previous assignment ? 4 Relevance to assign different across EHRs 5 Management of PUI/IUI generator,PUI/IUI repository, RTSDB data bases To what extent this ideal solution can be operationalized and at what cost to be practically implemented to be useful ? Dpt of public health and medical informatics, University of Saint Etienne USE, France

8. 4 IT IS CONTRADICTORY WITH THE NECESSARY DISJUNCTION BETWEEN MODEL OF KNOWLEDGE (Ontology) AND MODEL OF USE (Clinical terminology :snomed ct) “although none of these architecture take particulars into account …the modifications to be made are minor” Text based EHR Concept Systems Formally structured statements(ontology) Some curious equivalence as ONTOLOGY/CONCEPT SYSTEMS To what extent existing applications and tools can be improved and at what cost to come useful ? 4 IT IS CONTRADICTORY WITH THE NECESSARY DISJUNCTION BETWEEN MODEL OF KNOWLEDGE (Ontology) AND MODEL OF USE (Clinical terminology :snomed ct) “although none of these architecture take particulars into account …the modifications to be made are minor” Text based EHR Concept Systems Formally structured statements(ontology) Some curious equivalence as ONTOLOGY/CONCEPT SYSTEMS To what extent existing applications and tools can be improved and at what cost to come useful ? Dpt of public health and medical informatics, University of Saint Etienne USE, France

9. 4 IT IS CONTRADICTORY WITH THE NECESSARY DISJUNCTION BETWEEN MODEL OF KNOWLEDGE (Ontology) AND MODEL OF USE (Clinical terminology :snomed ct) BUT IF THIS IS TRUE Some curious equivalence as ONTOLOGY/CONCEPT SYSTEMS Is Ontology needed in Biomedical Informatics? Tracking “Particular/Instance” a sufficient Ontology? 4 IT IS CONTRADICTORY WITH THE NECESSARY DISJUNCTION BETWEEN MODEL OF KNOWLEDGE (Ontology) AND MODEL OF USE (Clinical terminology :snomed ct) BUT IF THIS IS TRUE Some curious equivalence as ONTOLOGY/CONCEPT SYSTEMS Is Ontology needed in Biomedical Informatics? Tracking “Particular/Instance” a sufficient Ontology? Dpt of public health and medical informatics, University of Saint Etienne USE, France

10. 5 IT ADRESSES INTERESTING SIDE POINTS -Definition of ontology in Biomedicine -Philosophical based oppositions.Particular/Universal.Assignment/Reservation 5 IT ADRESSES INTERESTING SIDE POINTS -Definition of ontology in Biomedicine -Philosophical based oppositions.Particular/Universal.Assignment/Reservation Dpt of public health and medical informatics, University of Saint Etienne USE, France

11. 6 A VERY GOOD ANALYSIS OF NEEDS FOR SEMANTIC INTEROPERABILITY BETWEEN EHRs BUT NOT THE MOST EFFICIENT (EVEN IF ELEGANT)WAY TO SOLVE THE PROBLEM IF USED ALONE Dpt of public health and medical informatics, University of Saint Etienne USE, France

12. USE Department of public health and medical informatics END