2011 01 27 - clinical loinc tutorial - documents
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TRANSCRIPT
Daniel J. Vreeman, PT, DPT, MSc Assistant Research Professor, Regenstrief Institute, Inc.
Associate Director of Terminology Services, Indiana University School of Medicine
Clinical LOINC Meeting | 01/27/2011 Copyright © 2011
Documents
Overview Origins of a Document Ontology HL7/LOINC Model
Evaluation and Ongoing Development Future Directions
Origins of a Document Ontology
Introduction
Local systems have idiosyncratic names…
…need a common, controlled vocabulary
Outpatient Pain Note
Dr. Smith’s Tues Pain Clinic Note
Chronic Pain Clinic
06/2000 • Document Ontology
Task Force
09/2003 • First Axis Values and LOINC
Codes 06/2005 • Expanded SMD Domain
10/2007 • Revised Axis
Value Approval
Ongoing • Harmonization Efforts • New Content Creation
Document Type Codes Provide consistent semantics for names of documents exchanged b/w systems
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.
Retrieval
Organization
Display Preparation of Templates
What is a Document? a collection of information
an information collection
Sections Sentences Sentences
Other content
Different than a panel Enumerated, discrete elements
Clinical Notes
Formal Document Ontology model and rules apply to clinical notes, but not (yet) to reports.
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.
Approach
Empiric analysis of >2000 document names – Mayo, 3M/Intermountain, VA in SLC, VA
in Nashville
Find the level of granularity that best meets exchange use case
Ultra-specific local names • Dr. Evil’s Friday Afternoon Pain
Clinic Note
Commonly understood elements • Outpatient Pain Clinic
Note
Local Codes and Names
Still probably needed
Can send both in HL7 Mapping to a standard enables: – Interoperability
– Aggregation
Document Ontology Model Multi-axial / Poly-hierarchical
Names are based on
expected information content
NOT document format
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. protected) Updates or amendments to a document
Assume that these other important attributes would be sent in different fields of the message
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. Inpatient 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
Rules for Constructing Names
1. Enumerated List Document names are constructed from enumerated lists of values for each axis.
2. Document + One Other Document name needs specification of a Kind of Document value and at least one of the other four axes.
• <Type of Service>.<Kind of Document> Component
• Find Property
• Pt Time
• <Setting> System
• Doc Scale
• <SMD>.<Role> Method
3. Combinations Combinations from within an axis are allowed where they make sense (SMD, Service).
Assessment Plan
Example LOINC Names Component Prop Time System Scale Method
Group counseling note Find Pt Inpa4ent Hospital Doc {Provider}
Evalua4on and management note Find Pt Outpa4ent Doc {Provider}
Evalua4on and management note Find Pt {Se>ng} Doc {Provider}
History and physical note Find Pt {Se>ng} Doc {Provider}
Ini4al evalua4on note Find Pt {Se>ng} Doc Physician
{curly braces} notation: send that content as a separate item in the message (field or segment).
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
Hierarchy in RELMA
Evolution, Evaluation We’re not done yet
Evolution Ongoing evaluation and evolution Exceptional contributions from Columbia University and the VA
Expanded original SMD values with ABMS specialty names and iterative discussion
Iterative Evaluation Case Study NYPH-CUMC
Case Study
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.
SMD Role Setting Type Service Kind of Doc Overall Distinct Original CDO
26.7% 99.9% 99.9% 43.5% 100% 23.4% (n=894)
7.9%
Expanded CDO
98.6% 100% 100% 99.9% 99.9% 98.5% (n=935)
39.1%
1. Expanded CDO is better 2. Many local documents map to 1 LOINC 3. Inter-rater reliability was good
Nursing
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.
SMD Role Setting Type Service Kind of Doc Overall Distinct SMD ++ CDO
74% 100% 100% 100% 100% 74.5% (n=94)
33%
In a separate analysis…
Section headings from nursing documents that could be mapped to 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.
Case Study German University Hospital
German University Hospital
86 Document Types (1.2 mil documents)
44%
44%
12% Mapped to LOINC
Not specific enough mapping
No LOINC match
Dugas M, Thun S, Frankewitsch T, Heitmann KU. LOINC codes for hospital information systems documents: a case study. J Am Med Inform Assoc. 2009 May-Jun;16(3):400-3.
Used LOINC v2.24 (original DocOnt terms)
German University Hospital
LOINC codes that existed for documents in their set (by volume)
Ongoing Development
A Work-in-Progress LOINC User’s Guide is definitive source for current policy
Collaboration/discussion – Clinical LOINC Meetings – HL7 SDTC – Online
Future Directions
Future Directions More v1 and v2 axis value harmonization Axis definitions Extension to other Kind of Documents Empiric analysis of document contents