Addendum to Informatics for Health 2017: Advancing both science and practice

This article presents presentation and poster abstracts that were mistakenly omitted from the original publication

Introducing realist ontology for the representation of adverse events

The goal of the REMINE project is to build a high performance prediction, detection and monitoring platform for managing Risks against Patient Safety (RAPS). Part of the work involves developing in ontology enabling computer-assisted RAPS decision support on the basis of the disease history of a patient as documented in a hospital information system. A requirement of the ontology is to contain a representation for what is commonly referred to by the term 'adverse event', one challenge being that distinct authoritative sources define this term in different and context-dependent ways. The presence of some common ground in all definitions is, however, obvious. Using the analytical principles underlying Basic Formal Ontology and Referent Tracking, both developed in the tradition of philosophical realism, we propose a formal representation of this common ground which combines a reference ontology consisting exclusively of representations of universals and an application ontology which consists representations of defined classes. We argue that what in most cases is referred to by means of the term 'adverse event' - when used generically - is a defined class rather than a universal. In favour of the conception of adverse events as forming a defined class are the arguments that (1) there is no definition for 'adverse event' that carves out a collection of particulars which constitutes the extension of a universal, and (2) the majority of definitions require adverse events to be (variably) the result of some observation, assessment or (absence of) expectation, thereby giving these entities a nominal or epistemological flavour

Concept-Based Retrieval from Critical Incident Reports

Background: Critical incident reporting systems (CIRS) are used as a means to collect anonymously entered information of incidents that occurred for example in a hospital. Analyzing this information helps to identify among others problems in the workflow, in the infrastructure or in processes. Objectives: The entire potential of these sources of experiential knowledge remains often unconsidered since retrieval of relevant reports and their analysis is difficult and time-consuming, and the reporting systems often do not provide support for these tasks. The objective of this work is to develop a method for retrieving reports from the CIRS related to a specific user query. Methods: atural language processing (NLP) and information retrieval (IR) methods are exploited for realizing the retrieval. We compare standard retrieval methods that rely upon frequency of words with an approach that includes a semantic mapping of natural language to concepts of a medical ontology. Results: By an evaluation, we demonstrate the feasibility of semantic document enrichment to improve recall in incident reporting retrieval. It is shown that a combination of standard keyword-based retrieval with semantic search results in highly satisfactory recall values. Conclusion: In future work, the evaluation should be repeated on a larger data set and real-time user evaluation need to be performed to assess user satisfactory with the system and results. Keywords. Information Retrieval, Data Mining, Natural Language Processing, Critical Incidents Reporting

Understanding Patient Safety Reports via Multi-label Text Classification and Semantic Representation

Medical errors are the results of problems in health care delivery. One of the key steps to eliminate errors and improve patient safety is through patient safety event reporting. A patient safety report may record a number of critical factors that are involved in the health care when incidents, near misses, and unsafe conditions occur. Therefore, clinicians and risk management can generate actionable knowledge by harnessing useful information from reports. To date, efforts have been made to establish a nationwide reporting and error analysis mechanism. The increasing volume of reports has been driving improvement in quantity measures of patient safety. For example, statistical distributions of errors across types of error and health care settings have been well documented. Nevertheless, a shift to quality measure is highly demanded. In a health care system, errors are likely to occur if one or more components (e.g., procedures, equipment, etc.) that are intrinsically associated go wrong. However, our understanding of what and how these components are connected is limited for at least two reasons. Firstly, the patient safety reports present difficulties in aggregate analysis since they are large in volume and complicated in semantic representation. Secondly, an efficient and clinically valuable mechanism to identify and categorize these components is absent. I strive to make my contribution by investigating the multi-labeled nature of patient safety reports. To facilitate clinical implementation, I propose that machine learning and semantic information of reports, e.g., semantic similarity between terms, can be used to jointly perform automated multi-label classification. My work is divided into three specific aims. In the first aim, I developed a patient safety ontology to enhance semantic representation of patient safety reports. The ontology supports a number of applications including automated text classification. In the second aim, I evaluated multilabel text classification algorithms on patient safety reports. The results demonstrated a list of productive algorithms with balanced predictive power and efficiency. In the third aim, to improve the performance of text classification, I developed a framework for incorporating semantic similarity and kernel-based multi-label text classification. Semantic similarity values produced by different semantic representation models are evaluated in the classification tasks. Both ontology-based and distributional semantic similarity exerted positive influence on classification performance but the latter one shown significant efficiency in terms of the measure of semantic similarity. Our work provides insights into the nature of patient safety reports, that is a report can be labeled by multiple components (e.g., different procedures, settings, error types, and contributing factors) it contains. Multi-labeled reports hold promise to disclose system vulnerabilities since they provide the insight of the intrinsically correlated components of health care systems. I demonstrated the effectiveness and efficiency of the use of automated multi-label text classification embedded with semantic similarity information on patient safety reports. The proposed solution holds potential to incorporate with existing reporting systems, significantly reducing the workload of aggregate report analysis

Paying for Language Services in Medicare: Preliminary Options and Recommendations

Discusses how the federal government could design payment systems for language services in Medicare, and offers preliminary recommendations for implementing such programs