RE: Minutes of last week's (Dec 2) HL7 ITS RDF Subgroup / W3C HCLS COI call -- Review of FHIR ontology approaches (cont.)

I can think of two reasons why (except maybe in an academic paper or PHD 
thesis) we would not put SNOMED and the information model in one RDF/OWL 
Ontology.

One is the idea of keeping the information model, specifically FIHR, very 
small. The goal is to keep it under 200 resources, closer to 100 even 
better.
SNOMED has over half a million classes.  I have argued with others who 
want to put it all in one Ontology that you are adding an ocean to a 
puddle. You don't need or want all those millions of extra triples riding 
around in your FHIR.

The other idea has to do with the way people think.  Less than one person 
in 2000 who does clinical models thinks "open world" and OWL.  Domains and 
Ranges would be thought of as constraints. Differently named resources 
would be assumed to be different. There would be many unpredictable 
modeling and logic errors if people who clearly think in "closed world" 
database and UML were to start mixing OWL DL logic in the same model. 
Since the whole mixed ontology would be OWL and not UML or FHIR, there 
would be many false and unintended problems. 

I believe we should not add the "open world" OWL / SNOMED models into the 
closed world UML, DB, FHIR models for these two different reasons.  OK to 
put FHIR into RDF or even OWL (after you do all the extra work of making 
all the disjoint assertions) but keep the connection with the vocabulary 
the way it is now, via bindings to coded concepts.

Thanks






NOTICE TO RECIPIENT:  If you are not the intended recipient of this 
e-mail, you are prohibited from sharing, copying, or otherwise using or 
disclosing its contents.  If you have received this e-mail in error, 
please notify the sender immediately by reply e-mail and permanently 
delete this e-mail and any attachments without reading, forwarding or 
saving them.  Thank you.






From:   "Vipul Kashyap" <kashyap.vipul@gmail.com>
To:     Peter Hendler/CA/KAIPERM@KAIPERM
Cc:     <david@dbooth.org>, <grahame@healthintersections.com.au>, 
<its@lists.hl7.org>, <lloyd@lmckenzie.com>, 
<public-semweb-lifesci@w3.org>, "'Vipul Kashyap'" 
<kashyap.vipul@gmail.com>
Date:   12/20/2014 02:06 PM
Subject:        RE: Minutes of last week's (Dec 2) HL7 ITS RDF Subgroup / 
W3C HCLS COI call -- Review of FHIR ontology approaches (cont.)



Hi Peter,
 
Thanks for your email below – If I may summarize:
 
Clinical Models capture the “who, when, where, why”
Snomed/Medical Terminogies – capture the “what”
 
Agree with your suggestion that Snomed should not be used for the former – 

The underlying motivation for my suggestion – as has been suggested by 
other medical informatics researchers is to 
“combine” both information models and terminologies is a common 
“model/ontology” and leverage the semantic expressiveness of OWL
for the purpose.
 
I think that primary reason divergence appears to be whether Snomed is 
viewed as a set of codes which can be used as “tags” or “values”
or Snomed is a full fledged ontology with classes, properties, 
relationships and instances of those classes. Based on the perspective 
taken,
Of course there are pros and cons of these approaches and can lead us to 
different choices of how we model clinical information and knowledge.
 
---Vipul
 
 
 
From: Peter.Hendler@kp.org [mailto:Peter.Hendler@kp.org] 
Sent: Saturday, December 13, 2014 5:31 PM
To: kashyap.vipul@gmail.com
Cc: david@dbooth.org; grahame@healthintersections.com.au; 
its@lists.hl7.org; lloyd@lmckenzie.com; public-semweb-lifesci@w3.org
Subject: RE: Minutes of last week's (Dec 2) HL7 ITS RDF Subgroup / W3C 
HCLS COI call -- Review of FHIR ontology approaches (cont.)
 
SNOMED can not and should not map to FHIR resources.  This is the 
difference between clinical models that capture who, when where and why 
with the medical terminologies like SNOMED that are only the what. 
In HL7 V3, the information model has the entities in roles that 
participate in acts.  That is perfectly what should be in a clinical 
model. Then the "what" part of the clinical model may go only as far as 
say it is an "observation". 
SNOMED does not, and should not ever deal with who when where or why.  It 
only deals with what. 

The medical terminology such as SNOMED supplies the "value" of the 
Observation.  Which might be "diabetes". 

There is no one to one between a FHIR observation and a SNOMED concept. 
They don't overlap. The FHIR, just like the HL7 V3 tells you who when 
where why but the what stops at "observation". The medical terminology 
which is linked to that observation resource then can be SNOMED diabetes. 
You would not make a FHIR resource for Diabetes. You use the FHIR 
observation and then code it with a SNOMED value. 

The FHIR Observation does not get subclassed to Diabetes.  It is only ever 
Observaiton.  The specific "value" of the Observation is the medical 
terminology part supplied for example by SNOMED. 

So I would never see it being appropriate to create any SNOMED terms to 
represent FHIR resources. 

Thanks 







NOTICE TO RECIPIENT:  If you are not the intended recipient of this 
e-mail, you are prohibited from sharing, copying, or otherwise using or 
disclosing its contents.  If you have received this e-mail in error, 
please notify the sender immediately by reply e-mail and permanently 
delete this e-mail and any attachments without reading, forwarding or 
saving them.  Thank you.






From:        "Vipul Kashyap" <kashyap.vipul@gmail.com> 
To:        "'Grahame Grieve'" <grahame@healthintersections.com.au>, 
"'Lloyd McKenzie'" <lloyd@lmckenzie.com> 
Cc:        "'David Booth'" <david@dbooth.org>, "'w3c semweb HCLS'" <
public-semweb-lifesci@w3.org>, "'HL7 ITS'" <its@lists.hl7.org> 
Date:        12/13/2014 10:41 AM 
Subject:        RE: Minutes of last week's (Dec 2) HL7 ITS RDF Subgroup / 
W3C HCLS COI call -- Review of FHIR ontology approaches (cont.) 




 
If every FHIR element was mapped to a snomed term, then you could 
represent that in RDF no problems. 
  
VK> Would propose that FHIR could be the hub – and we could leverage 
RDF/OWL constructs to map FHIR elements to Snomed, MedDRA, ICD11, RxNorm, 
etc.? 
 
However the problem with this is that we already have a slot for mapping 
an element to it's snomed code, but there are hardly any snomed codes that 
are appropriate. 
  
VK> Not sure if I understand this – If no Snomed codes are appropriate for 
a particular FHIR element – then we can request the IHTSDO folks to create 
a new one, no? 
        Also, if the RDF/OWL metamodel gives us the language to express 
more general relationships – we may not want to use a specific slot for a 
Snomed code? Or we can perhaps 
       Create an axiom linking the values of the snomed code based on the 
sameAs/subClassOf relationship for a particular terminology, e.g., Snomed? 

  
Thanks, 
  
---Vipul