Evaluation of an integrated system for classification, assessment and comparison of services for long-term care in Europe: the eDESDE-LTC study

The harmonization of European health systems brings with it a need for tools to allow the standardized collection of information about medical care. A common coding system and standards for the description of services are needed to allow local data to be incorporated into evidence-informed policy, and to permit equity and mobility to be assessed. The aim of this project has been to design such a classification and a related tool for the coding of services for Long Term Care (DESDE-LTC), based on the European Service Mapping Schedule (ESMS). Methods. The development of DESDE-LTC followed an iterative process using nominal groups in 6 European countries. 54 researchers and stakeholders in health and social services contributed to this process. In order to classify services, we use the minimal organization unit or "Basic Stable Input of Care" (BSIC), coded by its principal function or "Main Type of Care" (MTC). The evaluation of the tool included an analysis of feasibility, consistency, ontology, inter-rater reliability, Boolean Factor Analysis, and a preliminary impact analysis (screening, scoping and appraisal). Results: DESDE-LTC includes an alpha-numerical coding system, a glossary and an assessment instrument for mapping and counting LTC. It shows high feasibility, consistency, inter-rater reliability and face, content and construct validity. DESDE-LTC is ontologically consistent. It is regarded by experts as useful and relevant for evidence-informed decision making. Conclusion: DESDE-LTC contributes to establishing a common terminology, taxonomy and coding of LTC services in a European context, and a standard procedure for data collection and international comparison

Análisis de terminologías de salud para su utilización como ontologías computacionales en los sistemas de información clínicos Analysis of health terminologies for use as ontologies in healthcare information systems

Objetivos: Las ontologías son un recurso que permite trabajar informáticamente con la conceptualización del significado y evitar la limitación impuesta por los términos normalizados. El objetivo de este estudio es establecer el grado de usabilidad de las terminologías para el diseño de ontologías, que contribuyan a resolver los problemas de interoperabilidad semántica, y de reutilización de conocimiento en los sistemas de información clínicos. Métodos: Se han analizado 6 de las terminologías más relevantes para el ámbito clínico, epidemiológico, documental y administrativo-económico. Se valoraron las siguientes cualidades: cobertura conceptual, estructura jerárquica, granularidad conceptual, relaciones conceptuales y grado de formalismo utilizado en la representación conceptual, para establecer el grado de usabilidad. Resultados: Se consideran como ontologías ligeras los MeSH, los DeCS y el UMLS, aunque con diferencias entre ellas, al explicitar los conceptos, el tipo de relación y las restricciones entre los conceptos asociados. SNOMED y GALEN, con su formalismo declarativo basado en descripciones lógicas, incluyen la explicitación de las cualidades, una mayor restricción para relacionar conceptos y las reglas de combinación entre ellos, por lo que se consideran como ontologías pesadas. Conclusiones: El análisis de la representación declarada de las terminologías muestra las posibilidades de su reutilización como ontologías. Su grado de usabilidad dependerá de si se pretende que los sistemas de información clínicos resuelvan los problemas de interoperabilidad semántica (ontologías ligeras) o además reutilizar su conocimiento para sistemas de ayuda a la toma de decisiones (ontologías pesadas) y para tareas de recuperación, extracción y clasificación de información no estructurada.Objectives: Ontologies are a resource that allow the concept of meaning to be represented informatically, thus avoiding the limitations imposed by standardized terms. The objective of this study was to establish the extent to which terminologies could be used for the design of ontologies, which could be serve as an aid to resolve problems such as semantic interoperability and knowledge reusability in healthcare information systems. Methods: To determine the extent to which terminologies could be used as ontologies, six of the most important terminologies in clinical, epidemiologic, documentation and administrative-economic contexts were analyzed. The following characteristics were verified: conceptual coverage, hierarchical structure, conceptual granularity of the categories, conceptual relations, and the language used for conceptual representation. Results: MeSH, DeCS and UMLS ontologies were considered lightweight. The main differences among these ontologies concern conceptual specification, the types of relation and the restrictions among the associated concepts. SNOMED and GALEN ontologies have declaratory formalism, based on logical descriptions. These ontologies include explicit qualities and show greater restrictions among associated concepts and rule combinations and were consequently considered as heavyweight. Conclusions: Analysis of the declared representation of the terminologies shows the extent to which they could be reused as ontologies. Their degree of usability depends on whether the aim is for healthcare information systems to solve problems of semantic interoperability (lightweight ontologies) or to reuse the systems' knowledge as an aid to decision making (heavyweight ontologies) and for non-structured information retrieval, extraction, and classification

Evaluation of an integrated system for classification, assessment and comparison of services for long-term care in Europe: the eDESDE-LTC study

Background: The harmonization of European health systems brings with it a need for tools to allow the standardized collection of information about medical care. A common coding system and standards for the description of services are needed to allow local data to be incorporated into evidence-informed policy, and to permit equity and mobility to be assessed. The aim of this project has been to design such a classification and a related tool for the coding of services for Long Term Care (DESDE-LTC), based on the European Service Mapping Schedule (ESMS). Methods: The development of DESDE-LTC followed an iterative process using nominal groups in 6 European countries. 54 researchers and stakeholders in health and social services contributed to this process. In order to classify services, we use the minimal organization unit or “Basic Stable Input of Care” (BSIC), coded by its principal function or “Main Type of Care” (MTC). The evaluation of the tool included an analysis of feasibility, consistency, ontology, inter-rater reliability, Boolean Factor Analysis, and a preliminary impact analysis (screening, scoping and appraisal). Results: DESDE-LTC includes an alpha-numerical coding system, a glossary and an assessment instrument for mapping and counting LTC. It shows high feasibility, consistency, inter-rater reliability and face, content and construct validity. DESDE-LTC is ontologically consistent. It is regarded by experts as useful and relevant for evidence-informed decision making. Conclusion: DESDE-LTC contributes to establishing a common terminology, taxonomy and coding of LTC services in a European context, and a standard procedure for data collection and international comparison