Chapter:18
ADVANCED TERMINOLOGY
SYSTEMS
OBJECTIVES:
Describe
the need for advanced terminology
system.
Identify the components of advanced
terminology systems.
Compare and contrast two approaches for
representing nursing concept within an
advanced terminology system.
Primary motivation:
the
need for valid, comparable data
that can be used across information
system application to support
clinical decision-making and the
evaluation of process and outcomes
of care.
Secondary
uses of data for purposes
such as clinical research,
development of practiced-based
nursing knowledge, and generation
of healthcare policy are dependent
on the initial collection and
representation of the data.
Vocabulary problem
 Failure
to achieve a single,
integrated terminology with broad
coverage of the healthcare
domain.
Reasons for Vocabulary problem:
 Multiple
specialized terminologies has resulted to
overlapping content areas of which no content exists
and large numbers of codes and terms
 Existing terminologies are primarily intended for
human interpretation with computer interpretation
as only a secondary goal
Concept Orientation
In
order to appreciate the significance
of concept-oriented approaches, it is
important to first understand the
definitions of and relationships among
objects ,concepts and the terms we
use.
Semiotic Triangle
The
semiotic triangle depicts the
relationships among objects in the
perceivable and conceivable world
(referent),thoughts about things in the
world, and the labels (symbols of
terms)used to represent thoughts about
things in the world
ISO 1087-1:2000

Concept-unit of knowledge created by a unique
combination of characteristics.
o
Characteristics-is an abstraction of a property of an
object of a set of objects.

Object-anything perceivable or conceivable

Term-verbal designation of a general concept in a
specific subject field.
o
General concept corresponds to two or more objects
which form a group by reason of common properties.
Evaluation Criteria r/t Concept-oriented
Approaches
Atomic-based- concepts must be separable into constituent
components.
 Compositionality- ability to combine simple
concepts into composed concepts
 Concept permanence- once a concept is defined it should not
be deleted from a terminology.
 Language independence- support for multiple linguistic
expressions.
 Multiple hierarchy- accessibility of concepts through all
reasonable hierarchal paths with consistency of views.

Evaluation Criteria related to
Concept-oriented Approaches
 Nonambiguity-
explicit definition for each
term.
 Nonredundancy- one preffered way of
representing a concept or idea.
 Synonym support for synonyms and consistent
mapping of synonyms within and among
terminologies.
A
single concept may be
associated with multiple
terms , but a term should
represent only one concept.
Components of Advanced
Terminology System
Terminology Model
 Representation Language
 Computer-Based Tools

Terminology Model
A concept-based representation of a collection
of domain-specific terms that is optimized for
the management of terminological definitions.
 It encompasses both schemata and type
definition
 Incorporate domain-specific knowledge about
the typical constellations of entities, attributes,
and events in the real world and as such reflect
plausible combinations of concepts.

Ex:”dyspnea”+”severe dyspnea”
Type of Definitions

Obligatory conditions that state only the
essential properties of a concept.
Ex. A nursing activity must have a recipient ,an
action, and a target.
Representation Language
 GALEN
Representation and Integration
Language (GRAIL)
 Knowledge Representation
Specification Syntax (KRSS)
 Web Ontology language(OWL)
Ontology Language


Represents classes and their properties
Able to support the formal definition of
concepts in terms of their relationships
with other concepts, and facilitate
reasoning about those concepts
Computer-Based Tools
A
representation language may be
implemented using description
logic within a software system or
by a suite of software tools.
Classification of Terminology System
First-generation
terminology systems
Second-generation terminology
system
Third-generation system
First-generation terminology systems
 Consists
of a list of enumerated terms,possibly
arranged as a single hierarchy.
 It serve as a single purpose or a group of closely
related purpose and allow minimal computer
processing
 NANDA,Nsg.Interventions Classification (NIC)
NIC
A
comprehensive,standardized system to
classify treatments performed by nurses
Second-generation terminology systems
Include an abstract terminology model
Can be used for a range of purposes
Beta 2 version of the International
Classification for Nsg. Practice(ICNP)
Third-generation systems
 Support
sufficient formalisms to enable
computer based processing
 They include a grammar that defines the
rules for automated generation and
classification of new concepts.
Advantages of advanced Terminology
System

Allow much greater granularity through controlled
composition,while avoiding combinatorial explosion of
precoordinated terms

Facilitate two important facets of knowledge representation
2 important facets:

Describing concepts

Manipulating and reasoning about those concepts using
computer-based tools
Advantages resulting from first
facet:
1.Nonambiguous
representation of concepts
2.Facilitation of data abstraction or deabstraction without loss of original data
3.Nonambiguous mapping among
terminologies
4.Data reuse in different contexts
 These
advantages are particularly important
for clinical uses of the terminology.
 Advantages gained from the second facet
include:
 Automated classification of new concept
 Ability to support multiple inheritance of
defining characteristics
Advanced terminological
approaches in Nursing
ISO 18104:2003
 GALEN
 SNOMED RT

ISO 18104:2003
 Developed by ISO Technical Committee 215(health
informatics)working Group 3 (health concept
representation)under the collaborative leadership of the
international Medical Informatics Association-Nursing
Special Interest Group (IMIA-NI)and the

International Council of Nurses

Approved in 2003

Covers reference terminology model for nursing diagnosis
and nursing actions
 The
model built on work origination within the
European Committee for standardization
 Development was partly motivated by a desire
to harmonize the plethora of nursing
terminologies in use around the world
 Intended to be" consistent with the goals and
objectives of other specific health
terminology model I order to provide a more
unified reference health model|”
Potential Uses:





Facilitate nsg.representation of nsg.dx.and nsg.action concept
and their relationships in a manner suitable for computing
processing
Provide a framework for the generation of compositional
expressions from atomic concepts within a reference
terminology
Facilitate he mapping among nsg.dx. and nsg.action concepts
from various action
Enable he systematic evolution of terminologies and associated
terminology models for the purpose of harmonization
Provide language to describe the structure of nursing diagnosis
and nursing action concepts to enable appropriate integration
with information models
GALEN
A
concept-oriented approach developed
within the GALEN PROGRAM
 Used in a range of ways from directly
supporting clinical applications t supporting
the authoring, maintenance and quality
assurance of other kinds of terminologies
 GRAIL is an anthology language for
representing concepts and their
interrelationships-the source material for
construction of terminology models
TWO SETS OF TOOLS USED IN DEVELOPMENT OF GRAIL
MODEL:

Computer-based modeling

Terminology server
COMPUTER-BASED MODELING
-Facilitates
the collaborative formulation of models
-Allows authoring of clinical knowledge at different levels of abstraction
TERMINOLOGY SERVER
-A
software systems that implements GRAIL
-A major motivation for applying GALEN to nursing was the desire to meet
the requirements of users of clinical application and the need to provide
a reusable and extensible model of nursing terminology
Function of GALEN

Internally managing and representing the mode

Testing the validity of combinations of concepts

Constructing valid composed concepts

Transforming composed concepts into canonical
form

Automatically classifying composed concepts into
the hierarchy

Deliver the model for the used by clinical
applications and other kinds of authoring
environments
SNOMED Reference Technology
( SNOMED RT)

An alternative concept-oriented approach; develop
through the collaboration between the College of
American Pathologist and Kaiser Permanent based on
SNOMED International.

Is a reference terminology optimized for clinical data
retrieval and analysis

Concepts and relationships and represented using
modified KRSS rather than GRAIL
Functions of SNOMED RT:
Acronym resolution ,word completion, term completion,
spelling, correction, display of the authoritative form of the
term entered by the user, and decomposition of unrecognized
input
 Automated classification
 Conflict mngt., detection,and resolution

SNOMED CLINICAL TERMS:
Developed by College of American Pathologists and UK National
Health Service
 Possess both reference terminology properties and user
interface terms

EMERGING APPROACHES
Web Ontology Language (OWL)

Intended for use where applications ,not humans, are to
process information
OWL builds on existing recommendations such as:

External Markup language(XML)-surface syntax for structures
documents

Resource Description Framework(RFD)-a data model for
resources

RDF Schema-a vocabulary for describing the properties and
classes of resources
IMPLICATION FOR NURSING
Provide for nonambiguous concept
definitions
 Facilitate composition of complex
concepts from more primitive concepts
 Support mapping among terminologies

BENEFITS OF CLINICAL APPROACH
 Facilitation
 Of
evidence-based practice
 Matching of potential research subjects to research
protocols for which they are potentially eligible
 Detection of and prevention of potential adverse drug
effects
 Linking online information resources
 Increased reliability and validity of data for quality
evaluation
 Data mining for purpose such as clinical research ,health
services ,research or knowledge discovery
Thank You for
listening…
Reported by: Ms. Ermac , Ma. Concepcion H.
BSN-II-Jade
Throw back…… 