A semantic approach for the homogeneous identification of events in eight patient databases: a contribution to the European EU-ADR project
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1 A semantic approach for the homogeneous identification of events in eight patient databases: a contribution to the European EU-ADR project Paul Avillach, Fleur Mougin, Michel Joubert, Frantz Thiessard, Antoine Pariente, Jean-Charles Dufour, Gianluca Trifirò, Giovanni Polimeni, Maria Antonietta Catania, Carlo Giaquinto, Giampiero Mazzaglia, Gianluca Baio, Ron Herings, Rosa Gini, Julia Hippisley-Cox, Mariam Molokhia, Lars Pedersen, Annie Fourrier-Réglat, Miriam Sturkenboom, Marius Fieschi
2 Objective The overall objective of the Alert project is the design, development and validation of a computerized system that exploits data from electronic healthcare records and biomedical databases for the early detection of adverse drug reactions.
3 Basic Characteristics FP7 - Grant Agreement no Start date: 1-Feb-2008 Duration: 42 months 15 beneficiaries from 8 countries. 3 Subcontractors Budget (total costs): Funding:
4 Basic Characteristics Medical records Not spontaneous reporting systems More than 30 million European citizens 8 heterogeneous databases
5 heterogeneous databases 4 terminologies : ICD9-CM ICD10 READ CODES ICPC2 Free text in 2 languages : Italian Dutch Impossibility to create only one same query for all the databases Need of a common semantic basis
6
7 Example 458 (ICD9) Hypotension I95.9 (ICD10) Hypotensie, niet gespecificeerd I95.9 (ICD10) Hypotension, unspecified K29022 (ICPC) low blood pressure G87z. (RCD) Hypotension NOS XM02U (RCD) Low blood pressure Riduzione della pressione arteriosa Pressione arteriosa diminuita Pressione arteriosa bassa Vascular Hypotension Hypotension, Vascular Lowered blood pressure Fall in blood pressure Blood pressure drop arterial Blood pressure decreased val in bloeddruk hypotensie bloeddrukval arterieel bloeddruk verlaagd arteriale bloeddruk verlaagd Unique Concept: Hypotension
8 Resource: the UMLS Unified Medical Language System Metathesaurus include 148 source vocabularies ~ 1,8 million concepts (cluster of synonyms) UMLS version : 2008AB
9 Method for the terminology mapping 1. Event 2. Event Description Form (EDF) 3. Search for UMLS concepts
10 Method for the terminology mapping 3. Search for UMLS concepts 4. First Draft of Terminology mapping C Upper gastrointestinal hemorrhage RCD X30Be Upper gastrointest haemorrhage ENG RCD X30Be Upper gastrointestinal haemorrhage ENG 5. Discussion on Forum and Conference calls for harmonization issues RCD X30Be Upper GI - gastrointestinal haemorrhage ENG RCD X30Be Upper GI-gastrointes haemorrh ENG C Hematemesis ICD10 K92.0 Haematemesis ENG ICD9CM Hematemesis ENG ICPC D14 Hematemesis/vomiting blood ENG ICPC2P D14001 vomiting out blood ENG ICPC2P D14001 Vomiting;blood ENG ICPC2P D14003 Haematemesis ENG ICPC2P D14003 Hematemesis ENG ICPCDUT D14 Haematemesis/bloed braken DUT ICPCITA D14 Ematemesi/vomito sanguinolento ITA RCD J680. Haematemesis ENG RCD J680. Vomiting blood ENG C Esophageal bleeding ICD9CM Esophageal hemorrhage ENG ICPC2ICD10DUT MTHU bloeding; oesofagus DUT ICPC2ICD10DUT MTHU oesofagus; bloeding DUT RCD J10y0 Haemorrhage of oesophagus ENG RCD J10y0 Oesophageal haemorrhage ENG RCD Xa7TU Oesophageal bleeding ENG [ ]
11 Results UGIB : 21 Concepts Upper gastrointestinal hemorrhage Gastrointestinal Hemorrhage Hematemesis Melena Esophageal bleeding Acute {gastric duodenal peptic} ulcer with hemorrhage (and/or) perforation Acute gastrojejunal ulcer with haemorrhage, without mention of obstruction Acute gastrojejunal ulcer with hemorrhage and perforation Acute gastrojejunal ulcer with hemorrhage Atrophic gastritis, with haemorrhage Other specified gastritis, with hemorrhage, Unspecified gastritis and gastroduodenitis, with hemorrhage Acute gastric mucosal erosion
12 Example 2: Choc Anaphylactique EDF
13 Example 2: Choc Anaphylactique Missing ICD9CM mapping manual
14 Discussion Consensus founded Heterogeneous databases Different rules in coding Different granularity Primary or secondary diagnosis Biology results
15 Conclusion A projection of UMLS concepts in the terminologies A shared semantic basis for the creation of queries External semantic interoperability
16 Consortium Members Participating institutions: Aarhus University Hospital, Århus Sygehus, Denmark Agenzia regionale di Sanità, Italy AstraZeneca AB, Sweden Erasmus University Medical Center, Netherlands Fundació IMIM, Spain Health Search - Italian College of General Practitioners, Italy Imperial College London, UK IRCCS Centro Neurolesi Bonino-Pulejo, Italy London School of Hygiene & Tropical Medicine, UK PHARMO Coöperation UA, Netherlands Pedianet - Societa Servizi Telematici SRL, Italy Tel-Aviv University, Israel Università di Milano-Bicocca, Italy Université Victor-Segalen Bordeaux II, France University of Aveiro IEETA, Portugal University of Nottingham, UK University of Santiago de Compostela, Spain University Pompeu Fabra, Spain
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