Speech acts and medical records: The ontological nexus

Despite the recent advances in information and communication technology that have increased our ability to store and circulate information, the task of ensuring that the right sorts of information gets to the right sorts of people remains. We argue that the many efforts underway to develop efficient means for sharing information across healthcare systems and organizations would benefit from a careful analysis of human action in healthcare organizations. This in turn requires that the management of information and knowledge within healthcare organizations be combined with models of resources and processes of patient care that are based on a general ontology of social interaction. The Health Level 7 (HL7) is one of several ANSI-accredited Standards Developing Organizations operating in the healthcare arena. HL7 has advanced a widely used messaging standard that enables healthcare applications to exchange clinical and administrative data in digital form. HL7 focuses on the interface requirements of the entire healthcare system and not exclusively on the requirements of one area of healthcare such as pharmacy, medical devices, imaging or insurance transactions. This has inspired the development of a powerful abstract model of patient care called the Reference Information Model (RIM). The present paper begins with an overview of the core classes of the HL7 (Version 3) RIM and a brief discussion of its “actcentered” view of healthcare. Central to this account is what is called the life cycle of events. A clinical action may progress from defined, through planned and ordered, to executed. These modalities of an action are represented as the mood of the act. We then outline the basis of an ontology of organizations, starting from the theory of speech Acts, and apply this ontology to the HL7 RIM. Special attention is given to the sorts of preconditions that must be satisfied for the successful performance of a speech act and to the sorts of entities to which speech acts give rise (e.g. obligations, claims, commitments, etc.). Finally we draw conclusions for the efficient communication and management of medical information and knowledge within and between healthcare organizations, paying special attention to the role that medical documents play in such organizations

Foundation for the Electronic Health Record: An ontological analysis of the HL7 Reference Information Model

Despite the recent advances in information and communication technology that have increased our ability to store and circulate information, the task remains of ensuring that the right sorts of information reach the right sorts of people. In what follows we defend the thesis that efforts to develop efficient means for sharing information across healthcare systems and organizations would benefit from a careful analysis of human action in healthcare organizations, and that the communication of healthcare information and knowledge needs to rest on a sound ontology of social interaction. We illustrate this thesis in relation to the HL7 RIM, which is one centrally important tool for communication in the healthcare domain

Human Action in the Healthcare Domain: A Critical Analysis of HL7’s Reference Information Model

If we are to develop efficient, reliable and secure means for sharing information across healthcare systems and organizations, then a careful analysis of human actions will be needed. To address this need, the HL7 organization has proposed its Reference Information Model (RIM), which is designed to provide a comprehensive representation of the entire domain of healthcare centered around the phenomenon of human action. Taking the Basic Formal Ontology as our starting point, we examine the RIM from an ontological point of view, describing how it fails to provide a representation of the healthcare domain which would enjoy the sort of clarity, coherence, rigor and completeness that is claimed on its behalf

Using Dependence Relations in MeSH as a Framework for the Analysis of Disease Information in Medline

Motivation: Many terminologies such as MeSH have a hierarchical structure, but no trans-ontological relations. Such relations, however, are useful for characterizing the relations identified in data sets. Methods: We identified trans-ontological relations in MeSH (between diseases and other categories) based on formal ontological principles and compared them to co-occurrence data in MEDLINE. Results: Dependence relations identified between a disease and other categories generally correspond to the highest proportion of relations between this disease and any other category under investigation. The other relations observed between this disease and other categories correspond mostly to contingent relations.

Enhancing biomedical ontologies through alignment of semantic relationships: Exploratory approaches

Objective: This paper investigates several methods for aligning Metathesaurus relationships with their counterparts in the UMLS Semantic Network. Unlike the categorization link defined between Metathesaurus concepts and Semantic Network types, no such correspondence exists between the relationships at these two levels of the UMLS. Methods: The first approach attempts to elicit the semantics of Metathesaurus relationships through an examination of their relata at different levels: concept, high-level ancestors and semantic types. The second approach examines the frequency of association between a given Semantic Network relationship and the actual relationships observed in the Metathesaurus between the concepts categorized by these semantic types. Results: A total of 139 relationships are present in the Metathesaurus. Using the methods described in this paper, 80 (58%) could be aligned with Semantic Network relationships. The remaining relationships are vocabulary internal, used, for example, for vocabulary management or to indicate strictly lexical relationships. The work reported here is a first step in the attempt to build a more comprehensive ontology of biomedical relationships