Experience with an Ontology of Pediatric Electrolyte Disorders
                              in a developing country
           Vorapong Chaichanamongkol, B.Sc., M.D., Wanwipa Titthasiri, M.Sc., Ed.D.
       Department of Information Technology, Rangsit University, Bangkok, Thailand
                           Email:vorapongch@yahoo.com
Motivation                                                      prototype of the Pediatric Electrolyte Disorder Ontol-
There are few pediatric nephrologists in Thailand and           ogy. There is a reliable ADSL network in the capital
physicians in rural Thailand have limited access to             Bangkok. Protégé and Swoop installed on a web
up-to-date biomedical information such, as biomedi-             server are used to publish and share the ontology. The
cal journals. Moreover, biomedical information is               same applications are also installed on client com-
often compiled in developed countries and may not               puters and can be used both online and offline.
appropriate for use in developing countries. For ex-
ample, the guidelines established by the World Health           Usability study
Organization (WHO) for the treatment of acute diar-             In order to evaluate the ontology, questionnaires were
rhea in children are not always applicable in the case          sent to the 25 end users, i.e., general pediatricians and
of rotavirus gastroenteritis, because the concentration         family physicians in rural areas. 24 responses were
of sodium in oral saline solutions is too high for in-          received and analyzed. Most physicians involved with
fants. In this context, we believe ontologies can play          the study were young (age 30-40).
an important role in patient management. Semantic               The Jambalaya plug-in in Protégé was found to pro-
Web ontologies foster sharing and reuse of knowl-               vide good visualization support, displaying 2D inter-
edge and facilitate collaboration between pediatri-             active representations of the domain of the electrolyte
cians and consultant pediatric nephrologists. Such              disorders. Some pediatricians liked Swoop publish-
ontologies can be part of the telemedicine arsenal and          ing, because it is easy to understand, especially in
help physicians in rural areas of Thailand to better            Text mode.
manage difficult cases. In this paper, we report our            Speed was sometimes an issue in those areas with a
experience in developing and using an ontology of               large number of ADSL users. Even lower connec-
pediatric electrolyte disorders.                                tivity was available in rural areas. In some cases, the
                                                                ontology had to be sent by email in several pieces.
Developing and publishing the ontology                          However, once downloaded, the OWL ontology can
In the knowledge elicitation phase, we used concept             be exploited offline, using Swoop or Protégé.
maps to formalize the knowledge of a small group of
eleven experts. Knowledge was contributed by pedi-              Conclusions
atric nephrologists, pediatricians, general practitio-          The development of our ontology of pediatric electro-
ners, as well as extracted from clinical practice guide-        lyte disorders took more than one year. It was moti-
lines, text books and the medical pediatric literature.         vated by the need for providing up-to-date therapeutic
Some 500 concepts were identified in the domain of              to general practitioners in this specialized domain,
pediatric electrolyte disorders.                                and to tailor this information to the particular patient
These concepts were then organized into an ontology             population. Preliminary results show that the ontol-
and related to other concepts. Textual definitions              ogy has helped physicians better manage pediatric
were created. For example, the concept severe hypo-             patients, especially in the rural areas of Thailand.
natremia is defined as “Sodium concentration is                 Despite limited connectivity in some areas and lim-
below 125 mEq/l” and is a subclass of the concept               ited performance of computer systems, the experience
disease. In addition to subclass relations, we use the          was globally successful, in both creating the ontology
relationship “look for” between diseases and symp-              from expert knowledge and making it available to
toms. Another example is the concept Urine Sodium               physicians in rural areas. Ontologies such as the one
concentration, subclass of Urine test, and for which            we created for pediatric electrolyte disorders will play
an important property is “more than or less than 20             an increasing role in telemedicine.
mEq/l”. The Web Ontology Language OWL-DL was                    In future work, we plan to build a larger Semantic
selected for representing the ontology. In this phase,          Web Ontology for Pediatric Nephrology. Rule lan-
we used Protégé-OWL (http://protege.stanford.edu/,              guages such as SWRL – the Semantic Web Rule
Stanford University and University of Manchester)               Language – may be used in addition to OWL in order
and     SWOOP        (http://www.mindswap.org/2004/-            to represent clinical guidelines.
SWOOP/, University of Maryland) for building a



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