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RE: Multi-layered Knowledge Representations for Healthcare (was RE: An argument for bridging information models and ontologies at the syntactic level)

From: Elkin, Peter L., M.D. <Elkin.Peter@mayo.edu>
Date: Tue, 22 Apr 2008 15:07:17 -0500
Message-Id: <88F6E375D7433549A2F8DB3FFA6267EE10E3CE@msgebe26.mfad.mfroot.org>
To: "Kashyap, Vipul" <VKASHYAP1@PARTNERS.ORG>, <dan.russler@oracle.com>
Cc: "Samson Tu" <swt@stanford.edu>, <public-semweb-lifesci@w3.org>, <public-hcls-coi@w3.org>
Dear Vipul and Dan,
In order to not confuse the Ontology classification with First Order /
Second Order / Higher Order logics, we use Level 1 Ontologies to be
domain independent (EAV just being a representational mechanism for a
logical system), level 2 Ontologies are domain dependent (e.g. CDA), and
level three contain defined instances as well as class based
definitions.  We have been able to make these distinctions work across
multiple projects.  If there is a level zero I would suggest that
Metaphysics or perhaps value systems might be something that I have not
seen well represented by the upper level Ontologies with which I am
I believe we need a final single formal representational schema where
constructions defined across Information Models and Terminological
Models can be validated.  This interlingua should be defined from
transforms from all other valid logical languages and should empower all
those SMEs familiar with any valid logical system to work as they are
comfortable.  In the end, that work product must be validated through
the common interlingua to ensure that meaning is preserved and therefore
we are not creating unrecognized ambiguity.
With warm personal regards,
Peter L. Elkin, MD, FACP, FACMI
Professor of Medicine
Mayo Clinic College of Medicine
Baldwin 4B
Mayo Clinic
(507) 284-1551
fax:  (507) 284-5370


From: Kashyap, Vipul [mailto:VKASHYAP1@PARTNERS.ORG] 
Sent: Tuesday, April 22, 2008 2:48 PM
To: dan.russler@oracle.com
Cc: Samson Tu; public-semweb-lifesci@w3.org; public-hcls-coi@w3.org;
Elkin, Peter L., M.D.
Subject: Multi-layered Knowledge Representations for Healthcare (was RE:
An argument for bridging information models and ontologies at the
syntactic level)

Dan and Peter,
Based on conversations on this topic, there appears to be consensus of
the need for multi-layered knowledge representation schemes
for heatlhcare.  Will be great if we could brainstorm and come to some
sort of consensus on these "layers". Would like to propose a
strawman as enumerated below.
Layer 0 = Entity - Attribute - Value or RDF triple based
Layer 1 = MetaClasses, e.g., Observation as in HL7/RIM
Layer 2 = Classes in a Patient Model, Document Models, etc, e.g., the
class of HbA1c results for a class of Patients.
Layer 3 = Data that are instances of Classes, e.g., a particular HbA1c
result for a patient John...
As per your e-mail, you seem to be suggesting that there is something in
between Layer 1 and Layer 2. However, please note that Layer 2 consists
of classes of assertions in the patient record and not instances.
More reespnses are embedded in the e-mail below.
<dan> With apologies to Peter in case I misrepresented your SOA
presentation...Last week, Peter Elkin of Mayo Clinic delivered a
presentation where he called the HL7 RIM a "first order ontology"
because of the abstraction level of the RIM. He called the models
derived from the RIM, e.g. analytic models, patient care document models
like CDA, etc, "second order ontology" because they add a layer of
concreteness to the abstractions of the RIM, i.e. an object with
classCode of observation and moodCode of order becomes an "observation
order object" with neither a classCode nor a moodCode. 
[VK] Are there mathematical ways of describing these "derivations" for
e.g., by using operations such as instantiations and
Also, in the above, it's not clear what the semantics of an "observation
order" object is?
For e.g., observations and orders are semantically distinct concepts, so
in some sense an observation order class is likely to be unsatisfiable?
The semantics of "moodCode" is not clear in Knowledge Representation
terms. For instance, do various mood codes partition the instances of a
into subclasses that are possbily mutually disjoint?
 Finally, the coding systems themselves support the concreteness of a
"third order ontology." For example, the SNOMED concept becomes an
object itself without a code attribute, moodCode attribute, or classCode
attribute, e.g. a WBC order. />
[VK] One way of looking at a Snomed code is that it defines a class
(e.g., blood pressure) of all the instances of blood pressure readings
which would imply that it belongs to Layer 2 as defined above? 

			<dan> see above for the "first order to third
order model." Your metaclass looks like Peter's "first order ontology."
However, your "instances" get introduced too early...your "instances"
point to actual medical record assertions, and Peter's model suggests
that there is more "in between." In Peter's model, the actual medical
record assertion would be an instance of his "third order ontology." />
			[VK] Agree. As per the layering introduced
above,  Layer 2 would correspond to classes of assetions and Layer 3
would correspond to actual instances or assertions.
			 <dan> I completely agree that the HL7 RIM is
one level more "concrete" than the earlier EAV models. The EAV model
represents the ultimate in abstraction, similar to RDF triples. Perhaps
Peter would be more correct to say that EAV is a "first order ontology"
and that the HL7 RIM is a "second order ontology." />
			[VK]  Agree: As per layering introduced abiove,
The EAV/RDF triples layer could be layer 0, and the HL7/RIM layer could
be layer 1

			Look forward to further brainstorming and
feedback on this.

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Received on Wednesday, 23 April 2008 01:36:19 UTC

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