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      <title-group>
        <article-title>WebProtege: Supporting the Creation of ICD-11</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <string-name>Sean M. Falconer</string-name>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Tania Tudorache</string-name>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Csongor Nyulas</string-name>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Natalya F. Noy</string-name>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Mark A. Musen</string-name>
          <email>museng@stanford.edu</email>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <aff id="aff0">
          <label>0</label>
          <institution>Stanford Center for Biomedical Informatics Research, Stanford University</institution>
          ,
          <country country="US">US</country>
        </aff>
      </contrib-group>
      <abstract>
        <p>WebProtege is a highly customizable Web interface for browsing and editing ontologies, which provides support for collaboration. We have created a customized version to support the World Health Organization with the collaborative development of the 11th revision of the International Classi cation of Diseases (ICD-11). Our demo will present this customized version and focus on how content creation and collaboration is being supported in WebProtege for the development of ICD-11.</p>
      </abstract>
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    <sec id="sec-1">
      <title>Introduction</title>
      <p>
        The International Classi cation of Diseases (ICD) is a public global standard
that organizes and classi es information about diseases and related health
problems [
        <xref ref-type="bibr" rid="ref4">4</xref>
        ]. Health o cials use ICD in all United Nations member countries to
compile basic health statistics, to monitor health-related spending, and to
inform policy makers. In the United States, use of the ICD is also a requirement
for all medical billing. ICD has therefore a major impact on many aspects of
health care all over the world.
      </p>
      <p>
        In 2007, the WHO initiated the 11th revision of ICD. Several ambitious goals
were set for this version (details in [
        <xref ref-type="bibr" rid="ref2">2</xref>
        ]). One such goal is to allow the ICD to
become a multi-purpose classi cation for a much larger number of usages.
Previous versions of ICD were strictly classi cation hierarchies used for statistical
purposes. To meet the new revision goals, ICD-11 will use OWL to create a
rich formal representation. Another key di erence between ICD-11 and
previous versions is that the development process of ICD-11 will use a Web-based
open process powered by collaboration and social features. That is, similar to
Wikipedia, the WHO hopes that a large number of medical experts will
contribute to the content of ICD-11.
      </p>
      <p>
        Our group has been working closely with the WHO to provide the technical
support for these ambitious goals. We have created a customized version of
WebProtege speci cally designed to support the ICD authoring process. In [
        <xref ref-type="bibr" rid="ref2">2</xref>
        ],
we discuss in detail the use of Semantic Web technologies for the revision of
ICD. Our demo will showcase features of the customized WebProtege such as
content creation and collaboration. For the remainder of this paper, we present
the architecture and highlight features of the user interface.
      </p>
      <p>Ontology Repository
SNOMED
Mappings</p>
      <p>ICD
ChAO
interacts with
imports</p>
      <p>IND</p>
      <p>Mappings
ICD Umbrella</p>
      <p>UMLS
Mappings</p>
      <p>ICD
ICD Content</p>
      <p>Model
Java /
RMI</p>
      <p>WebProtégé Server Side</p>
      <p>UI Configuration</p>
      <p>Services
Collaboration</p>
      <p>Services</p>
      <p>BioPortal
Services</p>
      <p>ICD</p>
      <p>Services</p>
      <p>Java / RMI
Collaboration Framework</p>
      <p>Notes Change</p>
      <p>API Tracking API
Workflow</p>
      <p>User
Management</p>
      <p>Ontology</p>
      <p>Access API</p>
      <p>Access Policies
WebProtégé
servlets</p>
      <p>BioPortal</p>
      <p>
        REST calls
2 WebProtege| Authoring Platform for ICD-11
WebProtege is a pluggable and extensible platform for authoring ontologies. The
tool was designed such that it could be customized for each project according
to its own requirements. This is particularly important for the ICD revision
project, as it is still in its infancy, many fundamental issues and requirements
are unde ned. Our tools need to be adaptable on the y when changes are made
to the content model, user-interface requirements, and work ow. In the following
sections, we brie y describe the architecture and highlight some of the features
of the user interface.
2.1 Architecture
Figure 1 shows a high level architecture diagram and the interaction of the
software components for the customized version of WebProtege. The core
functionality of the application is supported by the Protege server, which provides
access to the ontology content, such as retrieving and changing classes,
properties and individuals in the ontology. The ontologies that the server accesses
are stored in a database on the server side. The Collaboration Framework [
        <xref ref-type="bibr" rid="ref3">3</xref>
        ]
provides the collaboration and ontology access services: Ontology Access API,
Notes and Discussions API, and Change Tracking API.
      </p>
      <p>
        Both WebProtege and the \traditional" Protege desktop client can connect
through the Collaboration Framework to interact with the ontology. Support
for importing terms from existing terminologies was one of the requirements
for the ICD-11 revision. In order to search external biomedical terminologies
and to import terms from these terminologies, WebProtege accesses BioPortal,
a repository of about 200 biomedical ontologies and terminologies [
        <xref ref-type="bibr" rid="ref1">1</xref>
        ]. BioPortal
provides REST service access that enables search across di erent ontologies and
access to information about speci c terms.
WebProtege is a web portal, inspired by other portals, such as myYahoo or
iGoogle. Our vision is to enable users to build a custom user interface by
combining existing components in a form that is appropriate for their project. The
user interface is composed of tabs, either prede ned ones or user-de ned. A new
tab is an empty container in which users can add and arrange by drag-n-dropping
portlets. A portlet is a user interface component that provides some
functionality. For example, the Class tree portlet displays the class hierarchy in an ontology
and has support for class level operations (create and delete class, move class in
hierarchy, etc.). WebProtege is extensible and has a plugin infrastructure.
      </p>
      <p>For the ICD-11 revision project, we had to take into consideration that most
of the ICD editors are domain experts, mainly medical doctors, who do not have
backgrounds in ontology engineering. We con gured the customized version of
WebProtege to use simple Web-based entry forms with elds that correspond to
the attributes of the ICD content model. We have tried to ensure that the user
interface does not look like an ontology editing environment, but is a customized
experience for the domain experts.</p>
      <p>The customized WebProtege user interface is shown in Figure 2. The user
interface is organized in a series of tabs: MyICD, ICD Content, Category Notes
and Discussion, Reviews, Change History and Manage Hierarchy tab. Each tab
presents a certain piece of functionality to the user.</p>
      <p>The main functionality of WebProtege is the support for browsing and editing
ontologies on the Web. Editing support is available in the ICD Content tab.
Medical experts from all over the world are using the system to edit ICD-11
simultaneously. Each change by an editor is immediately committed and visible
to other editors of ICD-11.</p>
      <p>Another key piece of functionality is collaborative support. This is critical
in such a large distributed project. Editors can use WebProtege to add notes to
classes, properties, and individuals in the ontology. This allows authors to raise
questions and discuss di erent issues that arise during editing. The WHO plans
to use a peer review process to ensure quality of the ICD content model. In
the current version, WebProtege supports a prototypical implementation of this
feature. A user with appropriate permissions can request the review of a disease
description.</p>
      <p>WebProtege uses a declarative user interface where the user interface
components and layout is speci ed in an XML con guration le. The con guration
can be changed on the y, allowing the interface to be updated without
recompiling or re-deploying the application. This feature provides great exibility
for customizing WebProtege.
3</p>
    </sec>
    <sec id="sec-2">
      <title>Summary</title>
      <p>We have brie y presented a customization of WebProtege, a web-based tool for
distributed collaborative development of ontologies. The WHO is using WebProtege
as the primary development environment for ICD-11. Developers of other
terminologies within the WHO Family of International Classi cations (WHO-FIC)
are beginning to use WebProtege as well. In the demo session, we will
demonstrate the main features and bene ts of WebProtege, speci cally how to create
and edit the ICD content model, how to create notes and discussion threads,
and import terms from Bioportal.</p>
    </sec>
  </body>
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