ADVANCED TERMINOLOGY information system applications to support

SYSTEMS clinical decision-making and the evaluation

of processes and outcomes of care.
Secondary uses of the data for the purposes
such as clinical research, development of
OBJECTIVES:
practice-based nursing knowledge, and
1. Describe the need for advanced generation of healthcare policy are dependent
terminology systems. on the initial collection and representation of
2. Identify the components of advance the data.
terminology systems
THE VOCABULARY PROBLEM
3. Compare and contrast two approaches
for representing nursing concepts Reasons:
within an advanced terminology
system. The development of multiple specialized
terminologies has resulted in areas of
overlapping content, areas for which no
content exists, and large number of codes and
VOCABULARY PROBLEM terms
-the failure to achieve a single, integrated Existing terminologies are most often
terminology with broad coverage of the developed to provide sets of terms and
healthcare domain. definitions of concepts for human
interpretation, with computer interpretation
Evolving criteria for healthcare terminologies
as only a secondary goal
for implementation in computer-based
systems suggest that concept-oriented -this is true for nursing terminology that
approaches are needed to support the data nurses use in clinical care. Unfortunately,
needs of today’s complex, knowledge-driven knowledge that is eminently understandable
healthcare and health management to humans is often confusing, ambiguous, or
environment. opaque to computers, and, consequently,
current efforts have been resulted in
And it is a problem for people indexing
databases, such as the indexes for human- terminologies that are inadequate in meeting
the data needs of today’s healthcare systems.
computer interaction. The problem arises
because people use different words for the “terminology” is used to refer to the set of
same thing. terms representing a system of concepts.
problem generated by the use of natural
languages and caused by semantic mistakes
due to synonyms (different words for the CONCEPT ORIENTATION
same meaning) The health informatics literature provides an
evolving framework that enumerates the
criteria that render healthcare terminologies
BACKGROUND AND DEFINITION suitable for implementation in computer-
based systems. In particular, it is clear that
The primary motivation for standardized
terms in nursing is the need for valid, such terminologies must be concept-oriented
(with explicit semantics), rather than based
comparable data that can be used across
on surface linguistics. Several studies have perceivable or conceivable world (referent),
reported that existing nursing terminologies thoughts about the things in the world, and
do not meet the criteria related to concept the labels (symbols or terms) used to
orientation. represent thoughts about things in the world.
In order to appreciate the significance of this Object – anything perceivable or conceivable
approach, it is important to understand first
the definitions of and relationships among
things in the world (object), our thoughts COMPONENTS OF ADVANCED
about the things in the world (concepts), and TERMINOLOGY SYSTEMS
the labels we used to represent and
communicate our thoughts about things in the Terminology Model – concept-based
world (terms). representation of a collection of domain-
specific terms that is optimized for the
The International Standardization management of terminological definitions. It
Organization (ISO) provides the definitions encompasses both schemata and type
for the elements that correspond to each definitions.
vertex of the triangle.
• Schemata incorporate domain -
specific knowledge ab out the typical
constellations of entities, attributes,
SEMIOTIC TRIANGLE
and events in the real world and, as
such, reflect plausible combinations
of concepts.
• Type Definitions – obligatory
conditions that state only the essential
properties of a concept
Representation Language – terminology
models maybe formulated and elucidated in
an ontology language. In this way, ontology
languages are able to support, thru explicit
semantics, the formal definition of concepts
in terms of their relationships with the other
concepts.
Concept – unit of knowledge created by a
unique combination of characteristics Representation is the depiction of a thing,
(abstraction of a property of an object or of a person or idea in written, visual, performed or
set of objects) spoken language. In representing we make
choices from the language offered by these
Term – verbal designation of a general modes.
concept in a specific subject field—a general
concept corresponds to two or more objects Computer-based Tools – representation
which form a group by reason of common language may be implemented using
properties description logic within a software system or
by a suite of software tools. The functionality
The semiotic triangle depicts the of these tools varies but may include among
relationships among objects in the the other things, management and internal
organization of the model, and the reasoning The beta 2 version of the ICNP is an example
on the model, such as automatic classification of a second-generation system
of composed concepts based on their formal
definition.
ADVANTAGES OF ADVANCED
Molecular modeling software would be one
TERMINOLOGY SYSTEMS
example of a computer-based tool.
allow much greater granularity thru
controlled composition, while avoiding a
SUITABILITY FOR COMPUTER combinatorial explosion of precoordinated
PROCESSING as characterized in terms terms.
of “generation”:
facilitate 2 important facets of knowledge
First-generation Terminology Systems - representation for computer-based systems
consist of a list of enumerated terms, possibly that support clinical care:
arranged as a single hierarchy.
- serve as single purpose or a group of closely
a.) describing concepts
related purposes and allow minimal computer
processing advantages:
Second-generation Systems – include an -nonambiguous representation of concepts
abstract terminology model or terminology
model schema that describes the organization -facilitation of data abstraction or de-
of the main categories used in a particular abstraction without loss of original data
terminology or set of terminologies. -nonambiguous mapping among
- can be used for a range of purposes, but they terminologies
allow only limited computer processing, -date reuse in different contexts
automatic classification of composed concept
is not possible.
Third-generation Language System – b.) manipulating and reasoning about those
supports sufficient formalisms to enable concepts using computer- based tools.
computer- based processing, they include a -automated classification of new concepts
grammar that defines the rules of automated
generation and classification of new -ability to support multiple inheritance of
concepts. defining characteristics

- also referred to as formal concept ADVANCE TERMINOLOGICAL

representation systems or reference APPROACHES IN NURSING
technology
Majority of existing nursing terminologies ISO 18104:2003
can be characterized as first-generation
systems because they were designed An International Standard (ISO 18104:2003)
primarily for direct manual use in the process covering reference terminology models for
of care. E.g., NANDA nursing diagnoses and nursing actions was
approved in The development of ISO
18104:2003 was motivated in part by a desire is to facilitate the systematic evaluation and
to harmonize the plethora of nursing refinement of existing terminologies—
terminologies in use around the world. It’s discovering anomalies within nursing
development was intended to “be consistent terminologies through noncompliant
with the goals and objectives of other specific decompositions.
health terminology models in order to
provide a more unified reference health
model.” GALEN PROGRAM
A concept-oriented approach has been
developed within the GALEN Program.
-Used in supporting clinical applications
-Support the authoring, maintenance, and
quality assurance of other kinds of
terminologies
POTENTIAL USES: GRAIL – ontology language for representing
concepts and their interrelationships
1. Facilitate the representation of nsg.
diagnosis and nsg. action concepts and their 2 Integrated Sets of Tools Used in GRAIL:
relationships
Computer-based modeling environment –
2. Provide a framework for the generation of facilitates the collaborative formulation of
compositional expressions from anatomic models. It allows authoring of clinical
concepts within a reference terminology knowledge at different levels of abstraction.
3. Facilitate the mapping among nsg. Terminology server – a software system that
diagnosis and nsg. action concepts from implements GRAIL. It is also used to deliver
various terminologies the model for use by clinical applications and
other kinds of authoring environments
4. Enable the systematic evaluation of
terminlologies and associated terminology
models for purposes of harmonization
5. Provide a language to describe the
structure of nsg. diagnosis and nsg. action.

ISO 18104:2003 is intended to be of use to

those that develop coding systems,
terminologies, terminology models for other
domains, health information models,
information systems, software for natural Performs the ff functions:
language processing, and markup standards
for representation of healthcare documents. 1. internally managing and representing the
Thus, it is not intended to be of direct benefit model
to practicing nurses. one of the main purposes
2. testing the validity of combinations of OWL Standard Ontology Language
concepts
- intended for use where applications, rather
3. constructing valid composed concepts than humans, are to process information.
4. transforming composed concept into
canonical form
5. automatically classifying composed
concepts into the hierarchy

SNOMED RT (Reference Technology)

Is a reference terminology optimized for
clinical data retrieval and analysis. Concepts
and relationships in SNOMED RT are
represented using modified KRSS rather than
GRAIL.
More recently, along with the U.K. Clinical
Terms, SNOMED RT has been used as a
foundation for a new terminology system,
SNOMED CT (Clinical Terms), which has
been developed collaboratively by the
College of American Pathologists and the
U.K. National Health Service.

SNOMED CT possesses both reference

terminology properties and user interface
terms.