Consensus Development of a Modern Ontology of Emergency Department Presenting Problems--The Hierarchical Presenting Problem Ontology (HaPPy)

Steven Horng, Nathaniel R. Greenbaum, Larry A. Nathanson, James C McClay, Foster R. Goss, Jeffrey A. Nielson

Research output: Contribution to journalArticle

Abstract

Objective Numerous attempts have been made to create a standardized presenting problem or chief complaint list to characterize the nature of an emergency department visit. Previous attempts have failed to gain widespread adoption as they were not freely shareable or did not contain the right level of specificity, structure, and clinical relevance to gain acceptance by the larger emergency medicine community. Using real-world data, we constructed a presenting problem list that addresses these challenges. Materials and Methods We prospectively captured the presenting problems for 180,424 consecutive emergency department patient visits at an urban, academic, Level I trauma center in the Boston metro area. No patients were excluded. We used a consensus process to iteratively derive our system using real-world data. We used the first 70% of consecutive visits to derive our ontology, followed by a 6-month washout period, and the remaining 30% for validation. All concepts were mapped to Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT). Results Our system consists of a polyhierarchical ontology containing 692 unique concepts, 2,118 synonyms, and 30,613 nonvisible descriptions to correct misspellings and nonstandard terminology. Our ontology successfully captured structured data for 95.9% of visits in our validation data set. Discussion and Conclusion We present the HierArchical Presenting Problem ontologY (HaPPy). This ontology was empirically derived and then iteratively validated by an expert consensus panel. HaPPy contains 692 presenting problem concepts, each concept being mapped to SNOMED CT. This freely sharable ontology can help to facilitate presenting problem-based quality metrics, research, and patient care.

Original languageEnglish (US)
Pages (from-to)409-420
Number of pages12
JournalApplied Clinical Informatics
Volume10
Issue number3
DOIs
StatePublished - Jan 1 2019

Fingerprint

Systematized Nomenclature of Medicine
Ontology
Hospital Emergency Service
Consensus
Emergency Medicine
Trauma Centers
Terminology
Patient Care
Medicine
Research

Keywords

  • chief complaint
  • emergency department
  • emergency medicine
  • ontology
  • presenting problem

ASJC Scopus subject areas

  • Health Informatics
  • Computer Science Applications
  • Health Information Management

Cite this

Consensus Development of a Modern Ontology of Emergency Department Presenting Problems--The Hierarchical Presenting Problem Ontology (HaPPy). / Horng, Steven; Greenbaum, Nathaniel R.; Nathanson, Larry A.; McClay, James C; Goss, Foster R.; Nielson, Jeffrey A.

In: Applied Clinical Informatics, Vol. 10, No. 3, 01.01.2019, p. 409-420.

Research output: Contribution to journalArticle

Horng, Steven ; Greenbaum, Nathaniel R. ; Nathanson, Larry A. ; McClay, James C ; Goss, Foster R. ; Nielson, Jeffrey A. / Consensus Development of a Modern Ontology of Emergency Department Presenting Problems--The Hierarchical Presenting Problem Ontology (HaPPy). In: Applied Clinical Informatics. 2019 ; Vol. 10, No. 3. pp. 409-420.
@article{d5fca7ea3aa84da8a3ab36196dfaf297,
title = "Consensus Development of a Modern Ontology of Emergency Department Presenting Problems--The Hierarchical Presenting Problem Ontology (HaPPy)",
abstract = "Objective Numerous attempts have been made to create a standardized presenting problem or chief complaint list to characterize the nature of an emergency department visit. Previous attempts have failed to gain widespread adoption as they were not freely shareable or did not contain the right level of specificity, structure, and clinical relevance to gain acceptance by the larger emergency medicine community. Using real-world data, we constructed a presenting problem list that addresses these challenges. Materials and Methods We prospectively captured the presenting problems for 180,424 consecutive emergency department patient visits at an urban, academic, Level I trauma center in the Boston metro area. No patients were excluded. We used a consensus process to iteratively derive our system using real-world data. We used the first 70{\%} of consecutive visits to derive our ontology, followed by a 6-month washout period, and the remaining 30{\%} for validation. All concepts were mapped to Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT). Results Our system consists of a polyhierarchical ontology containing 692 unique concepts, 2,118 synonyms, and 30,613 nonvisible descriptions to correct misspellings and nonstandard terminology. Our ontology successfully captured structured data for 95.9{\%} of visits in our validation data set. Discussion and Conclusion We present the HierArchical Presenting Problem ontologY (HaPPy). This ontology was empirically derived and then iteratively validated by an expert consensus panel. HaPPy contains 692 presenting problem concepts, each concept being mapped to SNOMED CT. This freely sharable ontology can help to facilitate presenting problem-based quality metrics, research, and patient care.",
keywords = "chief complaint, emergency department, emergency medicine, ontology, presenting problem",
author = "Steven Horng and Greenbaum, {Nathaniel R.} and Nathanson, {Larry A.} and McClay, {James C} and Goss, {Foster R.} and Nielson, {Jeffrey A.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1055/s-0039-1691842",
language = "English (US)",
volume = "10",
pages = "409--420",
journal = "Applied Clinical Informatics",
issn = "1869-0327",
publisher = "Schattauer GmbH",
number = "3",

}

TY - JOUR

T1 - Consensus Development of a Modern Ontology of Emergency Department Presenting Problems--The Hierarchical Presenting Problem Ontology (HaPPy)

AU - Horng, Steven

AU - Greenbaum, Nathaniel R.

AU - Nathanson, Larry A.

AU - McClay, James C

AU - Goss, Foster R.

AU - Nielson, Jeffrey A.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective Numerous attempts have been made to create a standardized presenting problem or chief complaint list to characterize the nature of an emergency department visit. Previous attempts have failed to gain widespread adoption as they were not freely shareable or did not contain the right level of specificity, structure, and clinical relevance to gain acceptance by the larger emergency medicine community. Using real-world data, we constructed a presenting problem list that addresses these challenges. Materials and Methods We prospectively captured the presenting problems for 180,424 consecutive emergency department patient visits at an urban, academic, Level I trauma center in the Boston metro area. No patients were excluded. We used a consensus process to iteratively derive our system using real-world data. We used the first 70% of consecutive visits to derive our ontology, followed by a 6-month washout period, and the remaining 30% for validation. All concepts were mapped to Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT). Results Our system consists of a polyhierarchical ontology containing 692 unique concepts, 2,118 synonyms, and 30,613 nonvisible descriptions to correct misspellings and nonstandard terminology. Our ontology successfully captured structured data for 95.9% of visits in our validation data set. Discussion and Conclusion We present the HierArchical Presenting Problem ontologY (HaPPy). This ontology was empirically derived and then iteratively validated by an expert consensus panel. HaPPy contains 692 presenting problem concepts, each concept being mapped to SNOMED CT. This freely sharable ontology can help to facilitate presenting problem-based quality metrics, research, and patient care.

AB - Objective Numerous attempts have been made to create a standardized presenting problem or chief complaint list to characterize the nature of an emergency department visit. Previous attempts have failed to gain widespread adoption as they were not freely shareable or did not contain the right level of specificity, structure, and clinical relevance to gain acceptance by the larger emergency medicine community. Using real-world data, we constructed a presenting problem list that addresses these challenges. Materials and Methods We prospectively captured the presenting problems for 180,424 consecutive emergency department patient visits at an urban, academic, Level I trauma center in the Boston metro area. No patients were excluded. We used a consensus process to iteratively derive our system using real-world data. We used the first 70% of consecutive visits to derive our ontology, followed by a 6-month washout period, and the remaining 30% for validation. All concepts were mapped to Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT). Results Our system consists of a polyhierarchical ontology containing 692 unique concepts, 2,118 synonyms, and 30,613 nonvisible descriptions to correct misspellings and nonstandard terminology. Our ontology successfully captured structured data for 95.9% of visits in our validation data set. Discussion and Conclusion We present the HierArchical Presenting Problem ontologY (HaPPy). This ontology was empirically derived and then iteratively validated by an expert consensus panel. HaPPy contains 692 presenting problem concepts, each concept being mapped to SNOMED CT. This freely sharable ontology can help to facilitate presenting problem-based quality metrics, research, and patient care.

KW - chief complaint

KW - emergency department

KW - emergency medicine

KW - ontology

KW - presenting problem

UR - http://www.scopus.com/inward/record.url?scp=85067463175&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85067463175&partnerID=8YFLogxK

U2 - 10.1055/s-0039-1691842

DO - 10.1055/s-0039-1691842

M3 - Article

VL - 10

SP - 409

EP - 420

JO - Applied Clinical Informatics

JF - Applied Clinical Informatics

SN - 1869-0327

IS - 3

ER -