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 FP7 EU-ADR project - MIE 2009 - Sarajevo
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 . FP7 EU-ADR project - MIE 2009 - Sarajevo
Basic Characteristics • FP7 - Grant Agreement no. 215847 • Start date: 1-Feb-2008 • Duration: 42 months • 15 beneficiaries from 8 countries. 3 Subcontractors • Budget (total costs): 5.880.600 € • Funding: 4.500.000 € FP7 EU-ADR project - MIE 2009 - Sarajevo
Basic Characteristics • Medical records • Not spontaneous reporting systems • More than 30 million European citizens • 8 heterogeneous databases FP7 EU-ADR project - MIE 2009 - Sarajevo
heterogeneous databases • 4 terminologies : • Free text in 2 languages : – ICD9-CM – Italian – Dutch – ICD10 – READ CODES – ICPC2 • Impossibility to create only one same query for all the databases • Need of a common semantic basis FP7 EU-ADR project - MIE 2009 - Sarajevo
FP7 EU-ADR project - MIE 2009 - Sarajevo
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 • Vascular Hypotension • Riduzione della pressione • val in bloeddruk • Hypotension, Vascular arteriosa • hypotensie • Lowered blood pressure • Pressione arteriosa • bloeddrukval arterieel • Fall in blood pressure diminuita • bloeddruk verlaagd • Blood pressure drop arterial • Pressione arteriosa bassa • arteriale bloeddruk verlaagd • Blood pressure decreased Unique Concept: Hypotension FP7 EU-ADR project - MIE 2009 - Sarajevo
Resource: the UMLS • Unified Medical Language System • Metathesaurus – include 148 source vocabularies – ~ 1,8 million concepts (cluster of synonyms) UMLS version : 2008AB FP7 EU-ADR project - MIE 2009 - Sarajevo
Method for the terminology mapping 3. Search 1. Event 2. Event for UMLS Description Form concepts (EDF) FP7 EU-ADR project - MIE 2009 - Sarajevo
Method for the terminology mapping 4. First Draft of Terminology mapping 3. Search for UMLS C0041909 Upper gastrointestinal hemorrhage concepts RCD X30Be Upper gastrointest haemorrhage ENG RCD X30Be Upper gastrointestinal haemorrhage ENG RCD X30Be Upper GI - gastrointestinal haemorrhage ENG RCD X30Be Upper GI-gastrointes haemorrh ENG C0018926 Hematemesis ICD10 K92.0 Haematemesis ENG ICD9CM 578.0 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 5. Discussion on RCD J680. Vomiting blood ENG Forum and C0239293 Esophageal bleeding Conference calls for ICD9CM 530.82 Esophageal hemorrhage E N G ICPC2ICD10DUT MTHU011694 bloeding; oesofagus D U T harmonization ICPC2ICD10DUT MTHU054119 oesofagus; bloeding D U T issues R C D J10y0 Haemorrhage of oesophag u s E N G R C D J10y0 Oesophageal haemorrhage E N G R C D Xa7T U Oesophageal bleeding E N G […] FP7 EU-ADR project - MIE 2009 - Sarajevo
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 • FP7 EU-ADR project - MIE 2009 - Sarajevo
Example 2: Choc Anaphylactique EDF FP7 EU-ADR project - MIE 2009 - Sarajevo
Example 2: Choc Anaphylactique Missing ICD9CM mapping manual FP7 EU-ADR project - MIE 2009 - Sarajevo
Discussion • Consensus founded • Heterogeneous databases • Different rules in coding • Different granularity • Primary or secondary diagnosis • Biology results FP7 EU-ADR project - MIE 2009 - Sarajevo
Conclusion • A projection of UMLS concepts in the terminologies • A shared semantic basis for the creation of queries • External semantic interoperability FP7 EU-ADR project - MIE 2009 - Sarajevo
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 FP7 EU-ADR project - MIE 2009 - Sarajevo
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