uses of informatics to solve real world problems in veterinary medicine
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Uses of Informatics to Solve Real World Problemsin Veterinary Medicine
Suzanne L. Santamaria n Kurt L. Zimmerman
ABSTRACTVeterinary informatics is the science of structuring, analyzing, and leveraging information in an effort to advance animalhealth, disease surveillance, research, education, and business practices. Reference and terminology standards arecore components of the informatics infrastructure. This paper focuses on three current activities that use referencestandards in veterinary informatics: (1) the construction of a messaging standard in a national animal health laboratorynetwork, (2) the creation of breed and species terminology lists for livestock disease surveillance, and (3) the develop-ment of a standardized diagnoses list for small animal practices. These and other endeavors will benefit from researchconducted to identify innovative and superior tools, methods, and techniques. The authors believe there are manyareas requiring study and special focus in order to advance veterinary informatics, and this paper highlights some ofthe needs and challenges surrounding these areas.
Key words: veterinary informatics, reference standards, terminology standards
INFORMATICS IS THE SCIENCE OF INFORMATIONInformatics, by strict definition, is the study of the scienceof information. Medical informatics is the science ofstructuring and analyzing information and data to im-prove problem solving and decision making in healthcare.1 Informatics provides the basis by which mean-ingful advancements toward evidence-based veterinarymedicine can be made, and standardized references andterminology are core components of the informatics in-frastructure,2 as demonstrated by their use in electronicmedical records for patient diagnosis and procedures.This helps with the management of patient informa-tion and enables clinicians to aggregate such informationfor epidemiological surveillance, to perform retrospectivestudies, and to drive evidence-based medical decisionmaking. For example, suppose a state health monitoringagency needs to monitor the number of cases of lowerrespiratory disease seen in the past 10 days. Viral orbacterial pneumonia, decreased respiratory function, andbronchioloalveolar adenocarcinoma, among others, areall classified as types of lower respiratory disorders inthe standardized terminology hierarchy. However, stand-ardized terminology could provide the means by whichto gather more specific types of lower respiratory dis-orders. Medical informatics encompasses a wide varietyof topics beyond terminology standards; however, itis too broad of a discipline to fully discuss these otheraspects of medical informatics in a single article. Thegoal of this paper is therefore to highlight the use ofstandardized medical terminology3 in veterinary medi-cine by examining how use of these standards haveaddressed three different problems: (1) the constructionof a messaging standard in a national animal health labo-ratory network, (2) the creation of breed and speciesterminology lists for livestock disease surveillance, and(3) the development of a standardized diagnoses list forsmall animal practice. Finally, this paper will also discuss
some of the challenges and necessary research within thearea of veterinary medical informatics terminology.
REFERENCE STANDARDS IN INFORMATICSReference standards are an integral part of informaticsas they enable unambiguous communication betweendisparate users and systems in order to ensure that twousers derive the same meaning from the same bit ofinformation. The need for reference standards is evidentin all areas of medicine such as in meta-analyzing pub-lished biomedical results, relating phenotypical findingsto clinical microscopic and molecular data, naming thedisorders, and even in describing the patients in terms ofbreeds, reproductive status, and so forth.411 Using refer-ence standards allows for the compilation and compari-son of large amounts of data from multiple sources. Forexample, a common terminology language is used totransmit and store diagnoses from eight veterinary teach-ing hospitals to a large data repository at Veterinary Medi-cal Databases (VMDB).12 This data repository can then besearched as a whole and compared to other data sets.13Typically, reference standards either provide the message/report (laboratory report) or the terminology to fit inthe message/report (test performed). A description of onemessage standard and two terminology standards usedin medical informatics follows.
HL7 Standard for MessagesHealth Level Seven (HL7)14 is an international standardthat promotes and enables interoperability in health careby providing a mechanism for electronic informationtransfer within and among clinics. It provides a structureand rules for when a message is instigated (patientadmitted to a hospital), the actual message composition(patients name), and how the message is encoded (thefirst and last name are separated by a certain symbol in
doi:10.3138/jvme.38.2.103JVME 38(2) 6 2011 AAVMC 103
the message).15 In some parts of the message, a form ofstandardized terminology may provide the value (patientdiagnosis is recorded using medical terminology). HL7is fee-based and members vote on changes. It is widelyused in human health care. The American VeterinaryMedical Association (AVMA) endorsed HL7 as an officialinformatics standard for veterinary medicine.1624
LOINC Terminology for Laboratory TestsLogical Observations Identifiers Names and Codes(LOINC),25 a medical terminology managed by the non-profit Regenstrief Institute at Indiana University,26 con-tains over 30,000 terms and numeric codes for laboratorytests and clinical documents (e.g., Over The Counteranimal drug label). Each LOINC term is divided intofive or six parts, including the component or analytetested, its property, timing aspect, the body systemtested, and the scale and method used. For example, theLOINC term for a heartworm serum antigen test (its longname is Dirofilaria immitis Ag [Presence] in Serum and itscode is 318014) contains the following parts: componentof Dirofilaria immitis with the subcomponent Antigen,property of Arbitrary Concentration, time of Point in time,Serum system, and Ordinal scale. The terminology can besearched and downloaded online without charge. LOINCis endorsed for use by numerous federal agencies and theAVMA.24,2729
SNOMEDCT Terminology for MedicineThe Systematized Nomenclature of MedicineClinicalTerms (SNOMEDCT)30 is a large, international standar-dized medical terminology managed by the non-profitInternational Health Terminology Standards DevelopmentOrganization of Copenhagen, Denmark.31,32 SNOMEDCT attempts to describe the whole discipline of medicinethrough its 19 interrelated hierarchies of concepts: clini-cal finding, procedure, observable entity, body structure,organism, substance, pharmaceutical/biologic product,specimen, special concept, linkage concept, physical force,event, environment or geographic location, social context,situation with explicit context, staging and scales, physicalobject, qualifier value, and record artifact.33 SNOMEDCTconcepts have numeric identifiers and computable defini-tions created through the use of attribute-value triplesand inheritance from parental concepts.31,32,34-40 For ex-ample, the computable definition of the concept viralkeratitis includes a causative agent of virus, pathologicalprocess of infectious process, morphology of inflammation,and a finding site of the cornea. Figure 1 provides a
graphical representation of this concept. SNOMEDCTcontains over 300,000 medical concepts and 900,000 syn-onyms or alternate descriptions. SNOMEDCT has beenadopted by numerous federal agencies, the AVMA, andother veterinary organizations.24,41 It is free to usersin the United States and available for download, butit requires users to consent to a licensure agreement.41SNOMEDCT has an extension mechanism31 wherebyorganizations can create concepts and descriptions fortheir specific needs which still fit into the SNOMED frame-work. The Veterinary Terminology Services Laboratoryat Virginia Tech maintains an extension of SNOMEDCT to house additional veterinary content.42
TERMINOLOGIES IN ACTIONDescriptions of three examples of cases where standardswere used to overcome a challenge in veterinary medi-cine follow. Information on the stakeholders, their needs,and the solution are discussed.
Common Structure for Individual LaboratoriesReporting to the National Veterinary Laboratory
The ChallengeThe National Veterinary Services Laboratory (NVSL), adivision of the US Department of Agriculture, Animaland Plant Health Inspection ServicesVeterinary Services(USDA, APHISVS), is a national, regional, and interna-tional veterinary diagnostic reference laboratory.43 TheNVSL protects US animal health, public health, and inter-national trade through disease surveillance and emer-gency response. State veterinary diagnostic laboratoriessubmit laboratory test results to the NVSL, which thencompiles the reports to detect and analyze emerginganimal-health events. Efficient categorization and analysisof the laboratory reports have proven difficult for multiplereasons. One problem has been that different structures,different terms, and paper submissions provided inade-quate turn-around time during emergencies. Other chal-lenges included the lack of a reliable Internet connectionand insufficiently configured computers at some labo-ratories. Also, many laboratory personnel do not haveknowledge or experience in informatics.
The SolutionThe National Animal Health Laboratory Network(NAHLN)44 was created to coordinate the NVSL withinthe existing infrastructure of state and university labora-
Figure 1: Concept map of a SNOMED-CT concept. Viral keratitis and its associated defining relationships areshown. Each concept has a numeric