=Paper=
{{Paper
|id=Vol-1747/IP27_ICBO2016
|storemode=property
|title=Dealing with Elements of Medical Encounters: an Approach Based on the Ontological Realism
|pdfUrl=https://ceur-ws.org/Vol-1747/IP27_ICBO2016.pdf
|volume=Vol-1747
|authors=Fernanda Farinelli,Mauricio Almeida,Peter Elkin,Barry Smith
|dblpUrl=https://dblp.org/rec/conf/icbo/FarinelliAES16a
}}
==Dealing with Elements of Medical Encounters: an Approach Based on the Ontological Realism ==
https://ceur-ws.org/Vol-1747/IP27_ICBO2016.pdf
Dealing with elements of medical encounters: an
approach based on ontological realism
Fernanda Farinellia, b, c, 1, Mauricio Barcellos Almeida a,d , Peter Elkinb,d and Barry Smithc,d
a
School of Information Science, Federal University at Minas Gerais, Belo Horizonte, MG, Brazil
b
Department of Biomedical Informatics and c Department of Philosophy, University at Buffalo, Buffalo NY, USA
d
National Center for Ontological Research, University at Buffalo, Buffalo NY, USA
1
Corresponding Author: fernanda.farinelli@gmail.com
Abstract — Electronic health records (EHRs) serve as medical practice. In the future, we will conduct interviews also
repositories of documented data collected in a health care with pediatricians to identify their needs.
encounter. An EHR records information about who receives, who
provides the health care and about the place where the encounter The course of pregnancy, childbirth and child development
happens. We also observe additional elements relating to social involves a series of stages referred to as the prenatal, intrapartum
relations in which the healthcare consumer is involved. To provide and postnatal periods of care [2; 7]. Clinical care in each of these
a consensus representation of common data and to enhance stages calls upon different medical specialties. Information
interoperability between different EHR repositories we have pertaining to all stages of care is recorded in specific EHRs
created a solution grounded in formal ontology. Here, we present according to their specialty of origin.
how an ontology for the obstetric and neonatal domain deals with
these general elements documented in health care encounters. Our EHRs across different medical specialties need information
goal is to promote the interoperability of information among about elements observed in medical encounters. Each such
EHRs created in different specialties. To develop our ontology, we encounter necessarily involves three elements: first, the location
used two main approaches: one based on ontological realism, the where clinical activity is performed, named health care facility;
other based on the principles of the OBO Foundry, including reuse second, who performs or serves as the provider of health care,
of reference ontologies. named the human health care provider; and third, who
participates in an event as recipient of health care (consumers),
Keywords — Biomedical Ontology, Obstetric and Neonatal named the human health care consumer.
Ontology, electronic health records, BFO, OBO Foundry, social
entities. In addition, during the health care encounter a provider
collects demographic data from a consumer. The demographic
data section of an EHR is more than just data to allow the
I. INTRODUCTION identification and categorization of the consumer [4]. It includes
The motivation here grows out of the workings of the Stork also information needed to locate the consumer and data about
Network Program, a Brazilian Healthcare Program that aims to people related to the consumer: the consumer’s emergency
provide comprehensive care of both woman and child during the contact, information about the spouse or partner of the
course of pregnancy and in the postpartum stage. The consumer, and finally, if the consumer is a minor, information
organization of healthcare in Brazil involves health facilities at about the legally responsible person. All of these persons are
different government levels each of which has certain autonomy. elements that are documented in medical encounters and
These government levels are even free to adopt their own included in a corresponding demographic sub-section of the
electronic health record (EHR) information systems, which EHR. They are connected to a consumer by social relations, as
creates challenges to data interoperability. To address some of a marital status defined by Ontology of Medically Related
these challenges we are developing the Obstetric and Neonatal Social Entities (OMRSE) [4].
Ontology (OntONeo) [3], which aims to represent the diversity
of data registered in EHRs involved in pregnancy care. Our representation of the demographic data section of the
OntONeo is an initiative to overcome failures of semantic EHR and the elements of the medical encounter are quite
interoperability among EHR information systems that were built generic. We follow the practice of the Ontology for General
using different standards and terminologies. Medical Science (OGMS) which deal with general terms of
medicine used across medical disciplines [5]. Thus they will
The scope of OntONeo was defined from a set of Brazilian meet not only the needs of interoperability of the Stork Network
and international EHR standards, for instance: the Woman’s Program, but also corresponding needs of EHRs pertaining to
Health Record and Antepartum Record and Postpartum Form any medical specialty.
provided by the American College of Obstetricians and
Gynecologists (ACOG); the Children’s Electronic Health This paper describes the OntONeo approach to deal with the
Record Format provided by the Agency for Healthcare Research elements present in medical appointments: the consumer and the
and Quality (AHRQ). We also conducted interviews with provider in a medical encounter, the place of the health care
Brazilian and American obstetricians to identify the workflow facility, and the social relations of the consumer that are
of the women's health clinic and the information needs of this
important to document. We are extending OGMS and OMRSE (OGMS) and Ontology of Medically Related Social Entities
to the specific case of pregnancy. (OMRSE).
OntONeo is divided into modules designed to meet specific
II. METHODOLOGY needs. In this work, we present the part of the OntONeo-Social
To build OntONeo we adopt the principals of ontological that covers the domain of social entities involved in obstetric and
realism to foster semantic coherence, both for humans and neonatal care, such as family relations and demographic
computers [3]. On the view of ontological realism a useful information.
domain ontology should be built not to represent existing data
or models of a domain, but rather to represent the relevant III. ELEMENTS OF A MEDICAL APPOINTMENT
established science. The set of principles established to foster
achievement of this goal are summarized in [1; 8]. Fig. 1 and 2 show a sketch of the elements documented in a
health care encounter. Terms in black represent entities reused
The top-level ontology used as starting point for OntONeo from BFO, terms in gray are taken over from other ontologies;
is the Basic Formal Ontology 2.0 [1]. To maximize the and terms in white are new entities of OntONeo. The term health
interoperability among biomedical ontologies, and following the care encounter is defined by OGMS ontology as a process in
OBO Foundry principles [6], we reuse previous ontologies which at least one human being participates. Then we have in
developed as: Ontology of Document Acts (d-acts), Phenotype OMRSE ontology the term Homo sapiens that was reused from
Ontology (PATO), and Ontology for Biomedical Investigations NCBI organismal.
(OBI), in addition to Ontology for General Medical Science
Fig. 1 : Basic elements in a healthcare encounter (By authors)
Fig. 2: Complimentary elements in a healthcare encounter (By authors)
IV. CONCLUSION AND REMARKS REFERENCES
[1] R. Arp, B. Smith, and A.D. Spear, Building ontologies with basic formal
This paper described how OntONeo deals with the elements ontology, Mit Press, 2015.
involved in a health care encounter. These elements defined by [2] C.R.B. Beckmann, F.W. Ling, W.N.P. Herbert, D.W. Laube, and R.P.
OntONeo has the potential to contribute to interoperability of Smith, Obstetrics and Gynecology, Lippincott Williams & Wilkins, 2014.
information among EHR from different specialties. In addition, [3] F. Farinelli, M.B. Almeida, P. Elkin, and B. Smith, OntONeo: The
these definitions facilitate the understanding of how such Obstetric and Neonatal Ontology, in: 7th International Conference on
Biological Ontology (ICBO 2016), Oregon State University, Corvallis, OR,
information can be organized in EHRs for purposes of USA, 2016.
healthcare. [4] W.R. Hogan, S. Garimalla, and S.A. Tariq, Representing the Reality
Underlying Demographic Data, in: 2nd International Conference on Biological
OntONeo is an on-going project in the early stages of Ontology (ICBO 2011), CEUR Workshop Proceedings, Buffalo, NY, USA,
development, and the current version is available on the web at 2011, pp. 147-152.
http://ontoneo.wordpress.com. Its worth to mention that this [5] R.H. Scheuermann, W. Ceusters, and B. Smith, Toward an ontological
work is justified above all by the lack of formal representations treatment of disease and diagnosis, Proceedings of the 2009 AMIA summit on
in the obstetric and neonatal domains. translational bioinformatics 2009 (2009), 116-120.
[6] B. Smith et al., The OBO Foundry: coordinated evolution of ontologies to
support biomedical data integration, Nature Biotechnology 25 (2007), 1251-
ACKNOWLEDGMENT 1255.
[7] B. Smith and B. Brogaard, Sixteen days, The Journal of Medicine and
We thank CAPES and CNPq for financial support to the Philosophy 28 (2003), 45-78.
primary author. This work is also supported in part by the NIH [8] B. Smith and W. Ceusters, Ontological realism: A methodology for
NCATS under CTSA award Number UL1TR001412. coordinated evolution of scientific ontologies, Applied ontology 5 (2010), 139-
188.