=Paper=
{{Paper
|id=None
|storemode=property
|title=iCAT: A Collaborative Authoring Tool for ICD-11
|pdfUrl=https://ceur-ws.org/Vol-809/paper-09.pdf
|volume=Vol-809
}}
==iCAT: A Collaborative Authoring Tool for ICD-11==
https://ceur-ws.org/Vol-809/paper-09.pdf
iCAT: A Collaborative Authoring Tool for ICD-11
Tania Tudorache, Csongor Nyulas, Natalya F. Noy,
Timothy Redmond, Mark A. Musen
Stanford Center for Biomedical Informatics Research, Stanford University, US
{tudorache, nyulas, noy, tredmond, musen}@stanford.edu
Abstract. We present iCAT—the Collaborative Authoring Tool for the 11th re-
vision of the International Classification of Diseases (ICD-11). ICD is a funda-
mental health-care resource developed by the World Health Organization (WHO)
and applied in all United Nations countries for a variety of uses. A landmark
change in this ICD-11 revision compared to previous ones is the use of OWL as
a representation language and of Semantic Web technologies for the collabora-
tive authoring of the ICD content. A community of international medical experts
develops ICD-11 in a collaborative setting using the Web-based iCAT platform.
Besides its extensive collaboration support, iCAT also fosters the interconnected-
ness of ICD-11 with other biomedical ontologies and terminologies by providing
interlinking and reusing capabilities as a fundamental feature of the tool, while
also storing the provenance metadata. The generic and extensible infrastructure
as well as its declarative user interface allowed us to easily deploy iCAT in a
production setting for the development of ICD-11 and two other WHO classifica-
tions. The declarative user interface allowed us to custom tailor the platform for
domain experts use. iCAT is in production use since October 2009; it was used to
author over 105,000 changes in the ICD-11 ontology, to create more than 40,000
cross-links to other biomedical ontologies, and to produce over 19,000 notes and
discussions. The software is open source and a demo version of the platform is
available at http://icatdemo.stanford.edu.1
1 ICD-11 – Using Semantic Web Technologies
The International Classification of Diseases (ICD) is the standard diagnostic classifica-
tion developed by the World Health Organization (WHO) to encode information rele-
vant for epidemiology, health management, and clinical use. Over the years, ICD has
become an essential resource in all United Nations countries, who are applying ICD
for a variety of uses, ranging from compiling basic health statistics, to billing, and to
informing policy making.
To keep up to date with the scientific progress, WHO publishes new revisions of ICD
every decade. ICD-10 is the latest revision that is currently in use. Our group has been
collaborating with WHO since 2007 to support the development of ICD-11.2 A large
community of medical experts around the world are involved in the authoring of ICD-
11 in a collaborative Web-based platform, called iCAT [2]. The most important change
1
For the OCAS challenge we created a user account: ocas and password: ocas.
2
http://www.who.int/classifications/icd/revision/en/index.html
in ICD-11 compared to previous revisions is the decision of WHO to adopt a solid
formalization of ICD-11 and to use Semantic Web technologies for its development.
As a result, the underlying formalization of ICD-11 is OWL, and the platform used for
the collaborative authoring of ICD-11, iCAT, a customization of a generic Web-based
ontology editor, WebProtégé.3
2 The ICD-11 Semantic Web Platform—iCAT
With the radical change in the ICD-11 revision with respect to the underlying repre-
sentation, we needed to develop tools and methods that, on the one hand, are suited for
domain experts and on the other hand support the much richer Semantic Web content of
ICD-11. Some of the main requirements for the platform are: a) support the Web-based
collaboration of experts all around the world, b) provide features to inter-connect and
inter-link ICD-11 with other biomedical ontologies and terminologies, and c) provide
a user interface tailored to the needs of the domain experts that would hide or sugar-
coat complex OWL formalization details.
As an overall strategy, we decided to implement generic features that can be used
for the development of other Semantic Web applications in the more generic WebProtégé
platform, and have only a very small number of plugins that are specific for ICD in iCAT
(which is a customization of WebProtégé).
The development of the ICD-11 core ontology and of the Web platform took place
in parallel, with the former informing the latter. A WHO assigned committee of ontol-
ogy experts developed the core ontology in OWL. We defined forms and templates
based on this core ontology that domain experts use to enter the actual ICD-11 con-
tent in iCAT. During the last 4 years, the core ontology has evolved significantly, and
we had to make sure that our tools were adaptable enough to support seamlessly such
frequent changes. Our solution was to implement a declarative user interface4 as a
generic feature in WebProtégé, and iCAT became mainly a specific UI configuration
of WebProtégé. This feature allowed us to re-configure iCAT on-the-fly while the Web
application is running, and also to define user-specific views of the ICD ontology.
Collaboration support: One of the main features of iCAT is its extensive sup-
port for collaboration in the development of Semantic Web content, including change
tracking, contextualized threaded discussions, watches and notifications, an extensible
access policy mechanism, and generation of statistics of the ontology-development pro-
cess5 [2]. We reused the functionalities of Collaborative Protégé [3], which are them-
selves implemented using Semantic Web technologies.
Ontology interconnectedness and reuse support: ICD-11, as many other on-
tologies, reuses terms from external ontologies and terminologies. We implemented
a generic plugin for WebProtégé that enables simple import of terms from external on-
tologies stored in the BioPortal6 ontology repository [1]. This plugin allows users to
search for terms in BioPortal ontologies, to browse their details, and then to import
them into the ontology with a single click. All these operations are supported through
3
http://protegewiki.stanford.edu/wiki/WebProtege
4
http://protegewiki.stanford.edu/wiki/WebProtegeLayoutConfig
5
http://protegewiki.stanford.edu/wiki/ChangeAnalysisTab
6
http://bioportal.bioontology.org
REST calls to BioPortal. Several properties in ICD-11 have values coming from ex-
ternal ontologies, such as body part, morphology, or genomic linkages. Based on the
property range definitions in the ICD ontology, we configured the fields in the UI for
these properties to search specific ontologies, or their subsets, in BioPortal. Some of the
external ontologies and terminologies we have linked to ICD-11 include SNOMED-CT,
The Gene Ontology (GO), the Online Mendelian Inheritance in Men (OMIM), the Inter-
national Classification of Functioning, Disability and Health (ICF) and the International
Classification of External Causes of Injuries (ICECI). During the last year, users have
created more than 40,000 links between ICD-11 and terms from external biomedical
ontologies. More than 14,000 of these links are for body part associated to a disease
and take values from the SNOMED CT Anatomy branch. Another use case for inter-
linking ICD-11 with its previous revision, ICD-10 (also stored in BioPortal) is to keep
track of the ICD-10 to ICD-11 mappings that are essential for transitioning existing
medical software to the new ICD-11 coding system.
Infrastructure reuse: We implemented WebProtégé as a pluggable and extensible
architecture that can be customized to the needs of a particular project. As a proof, iCAT
is one particular customization of WebProtégé. We reused this generic infrastructure to
deploy similar platforms to support the production development of two other WHO
classifications: the International Classification of Traditional Medicine (ICTM) 7 and
the International Classification of Patient Safety (ICPS). 8 These two platforms required
only a new user interface configuration file and no code changes. Other customizations
of WebProtégé are available on the WebProtégé demo server.9
3 Conclusions
We presented iCAT, a customization of the WebProtégé platform for the development
of ICD-11. We discussed the advantages of using Semantic Web technologies for ICD-
11 elsewhere [2]. iCAT has been in production use since 2009 and other customization
of WebProtégé for real-world Semantic Web applications are available. All software is
open source, pluggable, reusable and under active development.
Acknowledgments
We thank our WHO collaborators for developing the project requirements and for the fruitful col-
laboration. The work presented in this paper is supported by the NIGMS Grant 1R01GM086587.
References
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Proceedings, volume 2010, page 552. American Medical Informatics Association, 2010.
2. T. Tudorache, S. Falconer, C. Nyulas, N. Noy, and M. Musen. Will Semantic Web Technolo-
gies Work for the Development of ICD-11? In The 9th Intl. Semantic Web Conference (ISWC
2010), pages 257–272. Springer, 2010.
3. T. Tudorache, N. F. Noy, and M. A. Musen. Supporting Collaborative Ontology Develop-
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Germany, 2008.
7
http://icatdemo.stanford.edu/ictm/
8
http://icat-ps.stanford.edu
9
http://webprotege.stanford.edu