Clinical LOINC Meeting	    LOINC Tutorial	                                Documents	           Daniel J. Vreeman, PT, DPT,...
Overview	      1.  Origins of a Document Ontology	      2.  HL7/LOINC Model	      3.  Evaluation and Ongoing          Deve...
Origins of a DocumentOntology
Local systems have idiosyncratic names…	 Outpatient Pain   Dr. Smith’s Tues     Chronic Pain     Note	        Pain Clinic ...
06/2000	•  Document Ontology   Task Force	                           09/2003	                           •  First Axis Valu...
Document Type Codes	Provide consistent semantics for names ofdocuments exchanged b/w systems		                            ...
What is a Document?	a collection of information	                                photo via striatic
Sections	                                     Sentences	                                     Sentences	                   ...
Clinical Notes	Clinical Note   	    	    A clinical document, produced by clinicians    spontaneously or in response to a ...
Approach	Empiric analysis of >2000document names	  Mayo, 3M/Intermountain, VA in SLC, VA  in Nashville		Find the level of ...
Ultra-specific local names	•  Dr. Evil’s Friday Afternoon Pain   Clinic Note	        Commonly        understood elements	  ...
Local Codes and Names	Still probably needed	Can send both in HL7	Mapping to a standard enables:	 Interoperability	 Aggrega...
Document Ontology Model	Multi-axial / Poly-hierarchical
Names are based onexpected information      contentNOT document format	                 photo via karen horton
Names Based on Content	Same LOINC code for…		     …if information content is the same
Not Part of the Name	Author	Location of service	Date of service	Status (e.g. signed, unsigned)	Security/privacy flags (e.g....
Assume that these otherimportant attributes wouldbe sent in different fields ofthe message
Model of Document Names	Subject Matter Domain	 •  e.g. Cardiology, Pediatric Cardiology, Physical Therapy	Role	 •  Author ...
Rules forConstructing Names	                 photo via Robert S Donovan
1. Enumerated List	Document names are constructed fromenumerated lists of values for each axis.
2. Document + One Other	Document name needs specification of a Kindof Document value and at least one of theother four axe...
3. Combinations	Combinations from within an axis are allowedwhere they make sense (SMD, Service).	 Assessment + Plan
Example LOINC Names	Component	                       Prop	 Time	 System	         Scale	 Method	Group counseling note	     ...
Hierarchy	Made a 1st pass Component hierarchy	  –  Based on Type of Service Axis	  –  Ignored Kind of Document	Multi-axial...
Hierarchy in RELMA
Evolution,Evaluation	We’re not done yet
Evolution	Ongoing evaluation and evolution	Exceptional contributions from ColumbiaUniversity and the VA			 Expanded origin...
Iterative EvaluationCase Study	NYPH-CUMC
Case Study	             SMD	 Role	 Setting	 Type Service	 Kind of Doc	 Overall	 Distinct 	Original	   26.7%	 99.9%	   99.9...
Nursing	           SMD	 Role	 Setting	 Type Service	 Kind of Doc	 Overall	 Distinct 	SMD ++	   74%	   100%	   100%	     10...
Case Study	German University Hospital
German University Hospital	                  Used LOINC v2.24 (original DocOnt terms)	86 Document Types (1.2 mil documents...
German University Hospital	  LOINC codes that existed fordocuments in their set (by volume)
Ongoing Development
A Work-in-Progress		LOINC User’s Guide is definitivesource for current policy			Collaboration/discussion	  Clinical LOINC M...
The Future	Great Scott!
Future Directions	More v1 and v2 axis value harmonization	Axis definitions	Extension to other Kind of Documents	Empiric ana...
photo via milos milosevic
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2011 08 15 - Clinical LOINC Tutorial - Documents

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2011 08 15 - Clinical LOINC Tutorial - Documents

  1. 1. Clinical LOINC Meeting LOINC Tutorial Documents Daniel J. Vreeman, PT, DPT, MSc Assistant Research Professor, Indiana University School of Medicine Research Scientist, Regenstrief Institute, Inc 08.15.2011 dvreeman@regenstrief.org © 2011
  2. 2. Overview 1.  Origins of a Document Ontology 2.  HL7/LOINC Model 3.  Evaluation and Ongoing Development 4.  Future Directions photo via Vernio77
  3. 3. Origins of a DocumentOntology
  4. 4. Local systems have idiosyncratic names… Outpatient Pain Dr. Smith’s Tues Chronic Pain Note Pain Clinic Note Clinic …need a common, controlled vocabulary
  5. 5. 06/2000 •  Document Ontology Task Force 09/2003 •  First Axis Values and LOINC06/2005 Codes •  Expanded SMD Domain 10/2007 •  Revised Axis Value Approval Ongoing •  Harmonization Efforts •  New Content Creation
  6. 6. Document Type Codes Provide consistent semantics for names ofdocuments exchanged b/w systems Preparation of Display Templates Organization Retrieval Frazier P, Rossi-Mori A, Dolin RH, Alschuler L, Huff SM. The creation of an ontology of clinical document names. Stud Health Technol Inform. 2001;84(Pt 1):94-8.
  7. 7. What is a Document? a collection of information photo via striatic
  8. 8. Sections Sentences Sentences Other content an information collection Different than a panel enumerated, discrete elements photo via karen horton
  9. 9. Clinical Notes Clinical Note A clinical document, produced by clinicians spontaneously or in response to a request for consultation. Clinical Report A clinical document, produced in response to an order for a procedure. Formal Document Ontology model and rulesapply to clinical notes, but not (yet) to reports.
  10. 10. Approach Empiric analysis of >2000document names Mayo, 3M/Intermountain, VA in SLC, VA in Nashville Find the level of granularity thatbest meets exchange use case Photo via Jeffrey Beall
  11. 11. Ultra-specific local names •  Dr. Evil’s Friday Afternoon Pain Clinic Note Commonly understood elements •  Outpatient Pain Clinic Note
  12. 12. Local Codes and Names Still probably needed Can send both in HL7 Mapping to a standard enables: Interoperability Aggregation
  13. 13. Document Ontology Model Multi-axial / Poly-hierarchical
  14. 14. Names are based onexpected information contentNOT document format photo via karen horton
  15. 15. Names Based on Content Same LOINC code for… …if information content is the same
  16. 16. Not Part of the Name Author Location of service Date of service Status (e.g. signed, unsigned) Security/privacy flags (e.g. protected) Updates or amendments to a document
  17. 17. Assume that these otherimportant attributes wouldbe sent in different fields ofthe message
  18. 18. Model of Document Names Subject Matter Domain •  e.g. Cardiology, Pediatric Cardiology, Physical Therapy Role •  Author training/professional classification (not @ subspecialty) •  e.g. Physician, Nursing, Case Manager, Therapist, Patient Setting •  Modest extension of CMS’s definition (not equivalent to location) •  E.g. Hospital, Outpatient, Emergency Department Type of Service •  Service or activity provided to patient •  Eg. Consultation, History and Physical, Discharge Summary Kind of Document •  General structure of the document •  E.g. Note, Letter, Consent
  19. 19. Rules forConstructing Names photo via Robert S Donovan
  20. 20. 1. Enumerated List Document names are constructed fromenumerated lists of values for each axis.
  21. 21. 2. Document + One Other Document name needs specification of a Kindof Document value and at least one of theother four axes. Component •  <Type of Service> <Kind of Document> Property •  Find Time •  Pt System •  <Setting> Scale •  Doc Method •  <SMD>.<Role>
  22. 22. 3. Combinations Combinations from within an axis are allowedwhere they make sense (SMD, Service). Assessment + Plan
  23. 23. Example LOINC Names Component Prop Time System Scale Method Group counseling note Find Pt Hospital Doc {Provider} Evaluation and management note Find Pt Outpatient Doc {Provider} Evaluation and management note Find Pt {Setting} Doc {Provider} History and physical note Find Pt {Setting} Doc {Provider} Initial evaluation note Find Pt {Setting} Doc Physician {curly braces} notation: send that content as aseparate item in the message (field or segment).
  24. 24. Hierarchy Made a 1st pass Component hierarchy –  Based on Type of Service Axis –  Ignored Kind of Document Multi-axial hierarchy is auto-generated –  Available as a separate download Custom hierarchies (e.g. context-specific) ones are easily imagined
  25. 25. Hierarchy in RELMA
  26. 26. Evolution,Evaluation We’re not done yet
  27. 27. Evolution Ongoing evaluation and evolution Exceptional contributions from ColumbiaUniversity and the VA Expanded original SMD values with ABMS specialty names and iterative discussion More ontology additions from submissions
  28. 28. Iterative EvaluationCase Study NYPH-CUMC
  29. 29. Case Study SMD Role Setting Type Service Kind of Doc Overall Distinct Original 26.7% 99.9% 99.9% 43.5% 100% 23.4% 7.9% CDO (n=894) Expanded 98.6% 100% 100% 99.9% 99.9% 98.5% 39.1% CDO (n=935) 1.  Expanded CDO is better 2.  Many local documents map to 1 LOINC 3.  Inter-rater reliability was good Hyun S, Shapiro JS, Melton G, Schlegel C, Stetson PD, Johnson SB, Bakken S. Iterative evaluation of the Health Level 7--Logical Observation Identifiers Names and Codes Clinical Document Ontology for representing clinical document names: a case report. J Am Med Inform Assoc. 2009 May-Jun;16(3):395-9.
  30. 30. Nursing SMD Role Setting Type Service Kind of Doc Overall Distinct SMD ++ 74% 100% 100% 100% 100% 74.5% 33% CDO (n=94) Hyun S, Shapiro JS, Melton G, Schlegel C, Stetson PD, Johnson SB, Bakken S. Iterativeevaluation of the Health Level 7--Logical Observation Identifiers Names and CodesClinical Document Ontology for representing clinical document names: a case report. J AmMed Inform Assoc. 2009 May-Jun;16(3):395-9. In a separate analysis… Section headings from nursingdocuments that could be mappedto existing LOINCs Hyun S, Bakken S. Toward the creation of an ontology for nursing document sections:mapping section names to the LOINC semantic model. AMIA Annu Symp Proc. 2006:364-8.
  31. 31. Case Study German University Hospital
  32. 32. German University Hospital Used LOINC v2.24 (original DocOnt terms) 86 Document Types (1.2 mil documents) 12% Mapped to LOINC 44% Not specific enough mapping 44% No LOINC match Dugas M, Thun S, Frankewitsch T, Heitmann KU. LOINC codes for hospital informationsystems documents: a case study. J Am Med Inform Assoc. 2009 May-Jun;16(3):400-3.
  33. 33. German University Hospital LOINC codes that existed fordocuments in their set (by volume)
  34. 34. Ongoing Development
  35. 35. A Work-in-Progress LOINC User’s Guide is definitivesource for current policy Collaboration/discussion Clinical LOINC Meetings HL7 SDTC Online
  36. 36. The Future Great Scott!
  37. 37. Future Directions More v1 and v2 axis value harmonization Axis definitions Extension to other Kind of Documents Empiric analysis of document contents
  38. 38. photo via milos milosevic

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