ADVANCED

TERMINOLOGY SYSTEMS
Prepared by: Abigail P. Basco
PRIMARY MOTIVATION:
The need for valid, comparable
data that can be used across
information system applications to
support clinical decision-making
and the evaluation of processes
and outcomes of care.
VOCABULARY PROBLEM
• failure to achieve a single,
integrated terminology with broad
coverage of the healthcare domain

REASONS FOR VOCABULARY

PROBLEM:
1. Multiple specialized terminologies has resulted
to overlapping content, areas of which no
content exists, and large numbers of codes and
terms.
2. Existing terminologies are
primarily intended for human
interpretation, with computer
interpretation as only a
secondary role.
CONCEPT ORIENTATION
• In order to appreciate the
significance of concept-
oriented approaches, it is
important to first understand the
definitions of and relationships
among objects, concepts and
the terms we use.
SEMIOTIC TRIANGLE

THOUGHT or Reference

symbol Referent
Stands for
ISO 1087-1:2000
• CONCEPT- unit of knowledge created by a
unique combination of characteristics.
*characteristic is an abstraction of
a property of an object of an set of objects.
• OBJECT- anything perceivable or
conceivable.
• TERM- verbal designation of a general
concept in a specific subject field.
*general concept corresponds to
two or more objects which form a group by
reason of common properties.
EVALUATION CRITERIA RELATED TO
CONCEPT-ORIENTED APPROACHES
• Atomic-based- concept must be separable into constituent
• Compositionality- ability to combine simple concepts into
composed concepts
• Concept permanence- once a concept is defined it should not
be deleted from s terminology.
• Language independence- support for multiple linguistic
expressions.
• Multiple hierarchy- accessibility of concepts through all
reasonable hierarchal paths with consistency of views.
• Nonambiguity- explicit definition for each term.
• Nonredundancy- one preferred way of representing a concept or
idea
• Synonymy- support for synonyms and consistent mapping of
synonyms within and among terminologies
A single concept may be associated with multiple terms, but a term
should represent only one concept.
COMPONENTS OF ADVANCED
TERMINOLOGY SYSTEMS
• Terminology Model
• Representation Language
• Computer-Based Tools
 TERMINOLOGY MODEL
• a concept-based representation of a collection of domain-
specific terms that is optimized for the management of
terminological definitions.
• It encompasses both schemata and type definitions.
Schemata
• -incorporate domain-specific knowledge about the typical
constellations of entities, attributes, and events in the real world
and, as such, reflect plausible combinations of concepts.
• Ex.”dyspnea” + “severe” = severe dyspnea
TYPE DEFINITIONS
• obligatory conditions that state only the essential properties of
a concept.
• Ex. A nursing activity must have a recipient, an action, and a
REPRESENTATION
LANGUAGE
• GALEN Representation and Integration
Language (GRAIL)
• Knowledge Representation Specification
Syntax (KRSS)
• Web Ontology Language (OWL)
ONTOLOGY LANGUAGE
• Represents classes and their properties
• Able to support the formal definition
of concepts in terms of their
relationships with other concepts, and
facilitate reasoning about those
concepts
COMPUTER-BASED TOOLS
• A representation language my be
implemented using description logic
within a software system or by a suite of
software tools.
CLASSIFICATION OF
TERMINOLOGY SYSTEMS
• First-generation terminology
systems
• Second-generation
terminology
• Third-generation systems
FIRST-GENERATION TERMINOLOGY SYSTEMS
• Consists of a list of enumerated terms, possibly arranged as
a single hierarchy.
• Severe a single purpose or a group of closely related
purposes and allow minimal computer processing
• NANDA, Nursing Interventions Classification (NIC)
Nursing Interventions Classification (NIC)
-a comprehensive, standardized system to classify
treatments performed by nurses.
North American Nursing Diagnosis Association (NANDA)
-professional organization of nurses standardized nursing
terminology that develops, researches, disseminates and
refines the nomenclature, criteria, and taxonomy of nursing
diagnoses.
SECOND-GENERATION TERMINOLOGY
SYSTEMS
• Include an abstract terminology model or terminology model
schema that describes the organization of the main
categories used in a particular terminology or set of
terminologies.
• Can be used for a range of purposes, but they allow only
limited computer processing: automatic classification of
composed concepts is not possible
• Beta 2 version of the International Classification for Nursing
Practice (ICPN)

ABSTRACT TERMINOLOGY MODEL

• Complemented by a thesaurus of elementary descriptors (terms) and
templates or rules (grammar)
THIRD-GENERATION
SYSTEMS
• Support sufficient formalisms to
enable computer-based processing
• Include grammar that defines the
rules for automated generation and
classification of new concepts.
ADVANTAGES OF ADVANCED
TERMINOLOGY SYSTEMS
• Allow much greater granularity through
controlled composition, while avoiding
a combinatorial explosion of
precoordinated terms.
• Facilitate two important facets of
knowledge representation for
computer-based systems that support
clinical care
TWO IMPORTANT FACETS:
• Describing concepts
• Manipulating and
reasoning about those
concepts using computer-
based tools
DESCRIBING CONCEPTS
• Nonambiguous representation of concepts.
• Facilitation of data abstraction or de-abstraction
without loss of original data.

MANIPULATING AND REASONING ABOUT THOSE

CONCEPTS USING COMPUTER-BASED TOOLS
• Automated classification of new concepts
• Ability to support multiple inheritance of defining
characteristics
ADVANCED TERMINOLOGICAL
APPROACHES IN NURSING
• ISO 18104:2003
• GALEN
• SNOMED RT
ISO I18104:2003
• Developed by ISO Technical
Committee 215 (Health Informatics)
Working Group 3(Health Concept
Representation) under the
collaborative leadership of the
International Medical Informatics
Association- Nursing Special Interest
Group (IMIA-NI) and the
International Council of Nurses
• Approved in 2003
• Covers reference terminology
models for nursing diagnoses
and nursing actions
• The model built on work
origination within the European
Committee for Standardization
• Development was partly motivated
by a desire to harmonize the
plethora of nursing terminologies in
use around the world
• Intended to be “consistent with the
goals and objectives of other
specific health terminology models
in order to provide a more unified
reference health model”
POTENTIAL USES:
• Facilitate the representation of
nursing diagnosis and nursing action
concepts and their relationships in a
manner suitable for computer
processing
• Provide a framework for the
generation of compositional
expressions from atomic concepts
within a reference terminology
• Facilitate the mapping among nursing
diagnosis and nursing action concepts from
various terminologies
• Enable the systematic evaluation of
terminologies and associated terminology
models for purpose of harmonization
• Provide a language to describe the
structure of nursing diagnosis and nursing
action concepts to enable appropriate
integration with information models
GALEN
• A concept-oriented approach
developed within the GALEN Program
• Used in a range of ways, from directly
supporting clinical applications to
supporting the authoring, maintenance,
and quality assurance of other kinds of
terminologies
• GRAIL is an ontology language for
representing concepts and their
interrelationships – the source material
for construction of terminology models
TWO SETS OF TOOLS USED
IN DEVELOPMENT OF GRAIL
MODEL:
• Computer-based modeling
environment
• Terminology server
COMPUTER-BASED
MODELING ENVIRONMENT
• Facilitates the collaborative
formulation of models
• Allows authoring of clinical
knowledge at different levels
of abstraction
TERMINOLOGY SERVER
• A software system that implements
GRAIL
• A major motivation for applying
GALEN to nursing was the desire to
meet the requirements of users of
clinical applications, and the need
to provide a reusable and
extensible model of nursing
terminology
GALEN advocates five
fundamental paradigm shifts:

• User interface
• Structure
• Establishing standards
• Presentation
• Delivery
In the user interface
• To shift from selecting codes to describing conditions
• Allow a central concepts to be described through
simple forms.

In the structure
• to shift from enumerated codes to composite
descriptions
• Terminologies are internally analogously to a
dictionary and a grammar
• Traditional coding systems are more like a phrase
book; each sentence must be listed separately.
In establishing standards
• To shift from a standard coding system to a
standard reference model

GALEN Common Reference

Model
• Provides a common means of representing
coding and classification systems so that they
can be interrelated –a common dictionary
and grammar.
In delivery
• To shift from static coding systems as data to
dynamic terminology services as software.
• GALEN originated the idea of a terminology
server and is participating actively in the
CorbaMed effort at standardizing the software
interface.
In presentation
• To shift from translation of monolingual
terminologies to multilingual terminologies.
 FUNCTIONS OF GALEN:
• Internally managing and representing the mode
• Testing the validity of combinations of concepts
• Constructing valid composed concepts
• Transforming composed concepts into canonical
form
• Automatically classifying composed concepts
into the hierarchy
• Deliver the model for use by clinical applications
and other kinds of authoring environments
SNOMED Reference
Technology (SNOMED RT)
• An alternative concept-oriented approach;
developed through the collaboration
between the College of American
Pathologists and Kaiser Permanente, based
on SNOMED International.
• Is a reference terminology optimized for
clinical data retrieval and analysis
• Concepts and relationships are represents
using modified KRSS rather than GRAIL
FUNCTIONS OF SNOMED RT:
• Acronym resolution, word completion,
term completion, spelling correction,
display of the authoritative form of the
term entered by the user, and
decomposition of unrecognized input
• Automated classification
• Conflict management, detection, and
resolution
SNOMED CLINICAL TERMS
(SNOMED CT)
• Developed by College of
American Pathologists and UK
National Health Service
• Possesses both reference
terminology properties and user
interface terms.
EMERGING APPROACHES
Web Ontology Language ( OWL)
• Intended for use where applications, not humans, are to
process information.

OWL builds on existing recommendations such as:

• eXtensible Markup Language (XML)- surface syntax for
structured documents
• Resource Description Framework (RDF)- a data model for
resources
• RDF Schema -a vocabulary for describing the properties and
classes of resources
IMPLICATIONS FOR NURSING
• Provide for nonambiguous concept
definitions
• Facilitate composition of complex
concepts from more primitive
concepts
• Support mapping among
terminologies.
BENEFITS OF CLINICAL
APPROACH:
• Facilitation of evidence-based
practice
• Matching of potential research
subjects to research protocols for
which they are potentially eligible.
• Detection of and prevention of
potential adverse drug effects
• Linking online information
resources
• Increased reliability and validity
of data for quality evaluation
• Data mining for purposes such
as clinical research, health
services research, or
knowledge discovery.
• THANK YOU
FOR LISTENING!