1. G A L E N Slide No.: 1 G A L E N Where we started Building Classifications with GALEN A look into the future…? Key Questions

2. G A L E N Slide No.: 2 GALEN-IN-USE Partners University of Manchester, VAMP Health, UK University of Nijmegen, Holland EFCC and its affiliates: WCC, NOMESCO, CNR Rome, U St Etienne WCC, NOMESCO, CNR Rome, U St Etienne IASIST, IDGmbH, CMITD, STAKE, U Louvain IASIST, IDGmbH, CMITD, STAKE, U Louvain University Hospital of Geneva, LNAT, Switzerland OLE, RAMIT, Datasoft, Belgium GSF Medis, U Hildesheim, Germany CNR, Rome, Italy SPRI, U Linköping, Sweden VTT, Oulu Univ Hospital, Medici Data, Finland

3. G A L E N Slide No.: 3 G A L E N Where we started

4. G A L E N Slide No.: 4 Best Practice Clinical Terminology Data Entry Clinical Record Decision Support Best Practice GALEN Clinical Terminology Data Entry Clinical Record Decision Support

5. G A L E N Slide No.: 5 enter search: Choose terms from a coding scheme cystitis Acute cystitis Subacute cystitis, NOS Follicular cystitis Cystitis, NOS Idiopathic cystitis Chemical cystitis Postoperative cystitis Drug induced cystitis Iatrogenic cystitis Radiation cystitis Chronic cholecystitis Acute cholecystitis Bacterial Cholecystitis Cholecystitis, NOS Bacterial cystitis next page etc...picking lists too long Too Big Too Small...not enough clinical detail

6. G A L E N Slide No.: 6 cystitis chronic severity severe onset chronicity mild A new clinician-friendly option: structured data entry gradual sub-acute Assemble a phrase... …from a set of useful pieces... …displayed on the screen. “moderately severe, acute cystitis of sudden onset” acute sudden moderate

7. G A L E N Slide No.: 7 Only one problem: How can the computer know in advance what are the sensible pieces to display? Traditional coding schemes do not have the information required ICD Read OPCS SNOMED ? cystitis

8. G A L E N Slide No.: 8 What is cystitis combined with ‘acute and mild? how would you like the answer ? A new resource... a resource that can cope with arbitrarily complex clinical concepts...

9. G A L E N Slide No.: 9 as an English phrase and as an ICD Code <“mild, acute cystitis”, D595.0 >... and cope with different natural languages and coding schemes. A new resource

10. G A L E N Slide No.: 10 Computer knows ‘rules’ for: how do you classify things? Fractures of femur, and of femoral neck Fractures of femur, and of femoral neck when are two things the same ? ‘Inflammation of Liver’ vs ‘Hepatitis’ ‘Inflammation of Liver’ vs ‘Hepatitis’ are there any illegal combinations? ‘fractured eyebrow causing donkey’ ‘fractured eyebrow causing donkey’ are any combinations redundant? ‘finger which is part of hand’ ‘finger which is part of hand’

11. G A L E N Slide No.: 11 G A L E N Building Classifications with GALEN

12. G A L E N Slide No.: 12 Manual Classifications Most medical ‘classifications’ are really ‘thesauri’ Thesauri have mixed hierarchies Thesauri have mixed hierarchies –kind, part, cause, modified,... heart heart valve aortic valve cusp of aortic valve For interpretation by people Only people can reorganise (and that isn’t easy or quick) Only people can reorganise (and that isn’t easy or quick) Must read rubrics Must read rubrics Model of use implicit and fixed Model of use implicit and fixed

13. G A L E N Slide No.: 13 ‘Computed’ Classifications Strict hierarchies using ‘kind of’ ‘Disorder of heart’ ‘Disorder of valve in heart’ ‘Disorder of valve in left ventricle in heart’ ‘Disorder of cusp in valve in left ventricle in heart’ Computable People can understand (but don’t have to) People can understand (but don’t have to) Computers can reorganise Computers can reorganise –because all meaning is explicit in formal expression

14. G A L E N Bridges from patient data to classifications Coding & Classification ICD-9 ICD-10 MeSH ACRNEMA ICPC SNOMED Axes UMLS Clinical Applications Medical Records Data entry Decision support READOPCS MEGA- TERM G A L E N

15. Slide No.: 15 Added value of Computed Classifications Hide the complexity Let the computer do the work Let the computer do the work Small on the outside, huge on the inside Small on the outside, huge on the inside Reorganise classifications when needed More complete, consistent and automatic indexing Automatic cross mapping/merging Quicker to update - worry about what, not where ‘Coherence without Uniformity’

16. G A L E N Issues to consider Can not prove result is complete or correct (but can’t do that with manual result either) Initially expensive to build

17. G A L E N Slide No.: 17 G A L E N A look into the future…?

18. G A L E N Slide No.: 18 What will the classifications of today look like in the future? They won’t exist Each will be replaced by several different views on something else, each serving individually the specific (conflicting) functions which were formerly tortured out of the one classification NOT a book NOT a picking list

19. G A L E N Slide No.: 19 What will these ‘views’ be like ? Each view is like a classification, but... Multiaxial (very) One, single clear purpose Humans say what terms are included and what they mean Computers decide how to arrange them Not fixed in stone - malleable, customisable, localisable - but always coherent

20. G A L E N Slide No.: 20 ‘Views’ of what ? ‘Clinical Terminology’ Something clinicians use to record information about real, individual patients Somebody else’s problem..as long as the bridge to classification views exists

21. G A L E N Slide No.: 21 G A L E N Key Questions

22. G A L E N Slide No.: 22 Key Questions (for users of terminology systems) What do you want it to do? Clinical systems are the end Clinical systems are the end terminology the means terminology the means –Don’t get the cart before the horse Can it do it? Can anything do it? Can anything do it? A universal coding scheme for everything is implausible A universal coding scheme for everything is implausible Coherence without Uniformity Coherence without Uniformity

23. G A L E N Slide No.: 23 Key Questions (for builders of terminology systems) Can it be built? implemented? maintained? Quickly enough? Quickly enough? Are there short-term milestones and a migration pathway? Are there short-term milestones and a migration pathway? Will it scale? Organisationally? Technically? Organisationally? Technically? Can applications use it? Can we maintain them? Can vendors sell them Can we maintain them? Can vendors sell them

24. G A L E N Slide No.: 24 Warnings Be cautious of hype It’s not as easy as it looks It’s not as easy as it looks Beware scaling Beware scaling It’s not how big it is that counts - it’s what you can do with it It’s not how big it is that counts - it’s what you can do with it Don’t reinvent the wheel Simple to understand doesn’t mean simple to use Coding systems are now software

25. G A L E N Slide No.: 25 GALEN-IN-USE Advanced terminological services to support integrated clinical information systems galen@cs.man.ac.uk http://www.cs.man.ac.uk/mig/galen/