Development of an ontology to model medical errors, information needs, and the clinical communication space

Medical errors are common, costly and often preventable. Work in understanding the proximal causes of medical errors demonstrates that systems failures predispose to adverse clinical events. Most of these systems failures are due to lack of appropriate information at the appropriate time during the course of clinical care. Problems with clinical communication are common proximal causes of medical errors. We have begun a project designed to measure the impact of wireless computing on medical errors. We report here on our efforts to develop an ontology representing the intersection of medical errors, information needs and the communication space. We will use this ontology to support the collection, storage and interpretation of project data. The ontology's formal representation of the concepts in this novel domain will help guide the rational deployment of our informatics interventions. A real-life scenario is evaluated using the ontology in order to demonstrate its utility.

Barriers to the clinical implementation of compositionality

BACKGROUND

Compositional mechanisms for the entry of clinically relevant controlled vocabularies have been suggested as a possible solution to providing adequate descriptive precision while keeping term vocabulary redundancy under control. As of yet, there are no widely accepted term navigators that allow physicians to enter problem lists utilizing controlled vocabularies with compositionality.

METHODS

We report on the results of a usability trial of 5 physicians using our most recent attempt at developing the Mayo Problem List Manager. We tested the implementation of an automated term composition, and hierarchical term dissection.

RESULTS

Participants found acceptable terms 96% of the time and found automated term composition helpful in 85% of the case scenarios. There was significant confusion about the terminology used to describe compositional elements (kernel concepts, modifiers, and qualifiers) however participants used the functions appropriately. Speed of entry was universally stated as the limiting factor.

CONCLUSIONS

The variety of methods that our participants used to enter terms highlights the need for multiple ways to accomplish the task of data entry. Successful implementation of user directed compositionality could be accomplished with further improvement of the user interface and the underlying terminology.