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Concept Model forobservables, investigations, and
observation results
For the IHTSDO Observables Project Groupand LOINC Coordination ProjectRevision Date: March 14, 2014
Part-2
observation result model (5)– Continue from Part-1 slide deck
– Deprecates the use of “absence” as a property type – Asserting absence of findings/functions/abilities/etc. requires
negation (using a modification of the situation model).– Observables would also not use “associated morphology”
• But note: Conditions can be modeled using “associated morphology” with a value that implies physical absence of a structure that is normally present
• E.g. 56457002 congenital atresia, 55425006 traumatic acquired absence
– Deprecates the use of “presence” as a property type. – Presence is necessarily implied by conditions modeled with
associated-morphology, but presence is not a property type for observables
• E.g. 91431006 supernumerary structure (morphologic abnormality) implies presence of an extra structure not normally present.
observablescale scale types
model for observables
units units
technique techniques
direct site body structures, specimens
is about Dep. Qualities/Dispositions, Indep. continuants
quality
property type property types
model for dependent qualities
independent continuantsinheres in
towards functions, substances
precondition body states
observable
property type property types
scale scale types
model for ‘quality’ observables
independent continuantsinheres in
towards functions, substances
units units
technique techniques
is about
precondition body states (challenges, fasting etc.)
direct site body structures, specimens
quality
observable
property type property types
scale scale types
model for ‘quality’ observables
independent continuantsinheres in
towards functions, substances
units unitstechnique techniques
is about
precondition body states
direct site body structures, specimens
IFCC-IUPAC NPU elementsLOINC elements
Kind-of-property property
System/specimen system
component component
scale
units
method method
System/specimen
component
quality
observable
property type Substance concentration
scale quantitative
LOINC Example:Sodium:SCnc:PT:Ser/Plas:Qn
plasmainheres in
towards Sodium ion
units unitstechnique techniques
is about
precondition body states
direct site Serum/plasma specimen
quality
Kind-of-property
component
scale
System/specimen
Qualities are continuantsthat exist in their entiretyat a single point in time
observableentity
property type Substance concentration
scale quantitative
IFCC-IUPAC NPU Example:P—Sodium ion; subst.c. = ? mmol/l
plasmainheres in
towards Sodium ion
units mmol/l
technique techniques
is about
precondition body states
direct site body structures, specimens
quality
property
system
component
units
observation result
scale scale types
DRAFT model for observation results
units units
technique techniques
direct site body structures, specimens
is about qualities, dispositions, independent continuants
has value Numeric, ordinal, nominal
observation result
property type property types
scale scale types
DRAFT model for results of observations of qualities
independent continuantsinheres in
towards functions, substances
units units
technique techniques
is about
precondition body states
direct site body structures, specimens
quality
has value Numeric, ordinal, nominal
observation procedure
property type property types
scale scale types
DRAFT model for procedures that observe qualities
independent continuantsinheres in
towards functions, substances
units units
technique techniques
is about
precondition body states
direct site body structures, specimens
quality
method observation action
• Attributes that define the quality that the observation is intended to elucidate– Property type
• Coordinated with BFO Qualities. Quality: a dependent continuant that is exhibited if it inheres in an entity or entities at all. (See BFO Manual, definition of “Quality”)
– Inheres-in• Relationship between a quality (property) and the independent continuant on
which it depends for its existence, in which it is manifest
– Towards (meaning the object or target of the property)• Third element of a relational quality, (other than the quality, and the continuant in
which it inheres) e.g. sodium, in the quality of concentration of sodium in serum
– Precondition• States of the individual that contextualize the property (e.g. standing, fasting, post-
challenge, etc)
Values for property type
• Detail• Dimension• Feature• Fluid property• Force property• Location• Quantity
• Ratio• Result• Stage• Temperature• Time• Velocity• Wave property
Top levels of value hierarchy – determined by empiricalanalysis of values in the observables hierarchy
• observable entity property types– dimension [2] (possible: size)
• area [20]
• distance (synonym: linear dimension)– breadth [20]– circumference [27]– depth [7]– diameter [31]– height [29]– length [42]– width [11]
precondition
– body states that define the context in which the property is defined. For example, “standing blood pressure” is defined in the context of the body state “standing position”. Various challenge tests would be defined in terms of body states specifying the challenge that occurred, e.g. “2 hour post-prandial glucose” would have body state = “2 hours after meal”.
• Attributes that define the characteristics of the observation– scale type
• Same as LOINC scale type and current measurement procedure attribute
– units• Same as IFCC-IUPAC NPU units
– direct site• the direct object of the observation action; the site or specimen where
the observation takes place. May be different from the value of inheres in, since the property being observed may be inferred from a specimen or from a remote site.
– Examples: rectum as the site of temperature measurement, where the property being observed is the core body temperature (rectal temperature being a surrogate); or serum specimen being used to determine body plasma sodium concentration. The concentration inheres in the plasma, but is being measured in a serum specimen.
• Needs to be modeled only when this site is different from the value of inheres in
– technique• Any specialization of “observation” that tells us how we did the observing; for
example, “enzyme-linked immunosorbent assay” or “immunofluorescence”.
*Draft* suggestion for general site object property
• A possible attribute hierarchy could be:site
inheres indirect site (used for procedures, observation results, and
observables)indirect site (still used only for procedures)
• inheres in can be a sub-role of site. This works for observation findings and observation procedures, and direct site would be used in addition where necessary
• The attribute procedure site direct, in the current procedure model, is the same meaning as direct site in the observable model.
Replace measurement method with more general technique
• Proposal:– For observation and evaluation procedures, the method (with values
from the action hierarchy) represents the goal or objective of what is done: evaluation, testing, imaging, measurement, examination
– observation techniques define the observable, via technique (with values from a value set that includes lab techniques and other specific measurement and evaluation actions, such as inspection, palpation, percussion, auscultation)
• Techniques are the means by which the action is carried out, not the intended outcome.
• Techniques include specific measurement techniques such as Enzyme-linked immunosorbent assay (ELISA).
– Need to examine whether this works for procedures other than evaluations, i.e. can we make the distinction between method (means) and technique for all procedures
observableentity
property type Threshold
scale quantitative
Auditory threshold at 3kHz, in dB
Auditory systeminheres in
towards Hearing (function)
units dB
technique 3 kHz audiometry
is about
precondition body states
direct site ear
quality
precondition body states
quality
property type Mass concentration
Blood hemoglobin concentration (quality)
Intravascular bloodinheres in
towards hemoglobin
precondition
observableentity
property type Mass concentration
scale quantitative
Blood hemoglobin concentration,quantitative (observable)
Intravascular bloodinheres in
towards hemoglobin
units unitstechnique techniques
is about
body states
direct site body structures, specimens
quality
precondition
observation result
property type Mass concentration
scale quantitative
Blood hemoglobin 14 gm/dL (observation result)
Intravascular bloodinheres in
towards hemoglobin
units gm/dL
technique techniques
is about
body states
direct site body structures, specimens
quality
has value 14
precondition body states
quality
property type circumference
Head circumference (quality)
Head (necessarily also: surface along fronto-parietal coronal
plane of head)
inheres in
towards hemoglobin
precondition
observation result
property type circumference
scale quantitative
Head circumference in cm (observable)
headinheres in
towards hemoglobin
units cm
technique techniques
is about
body states
direct site body structures, specimens
quality
precondition
observation result
property type circumference
scale quantitative
Head circumference 42 cm (observation result)
headinheres in
towards hemoglobin
units cm
technique techniques
is about
body states
direct site body structures, specimens
quality
has value 42
precondition
observableentity
property type concentration
scale quantitative
Serum concentration of Borrelia antibody
plasmainheres in
towards Borrelia antibody
units unitstechnique techniques
is about
body states
direct site Serum specimen
quality
precondition
observation procedure
property type concentration
scale quantitative
Measurement of serum concentration of Borrelia antibody by ELISA technique (procedure)
plasmainheres in
towards Borrelia antibody
units unitstechnique ELISA
is about
body states
direct site Serum specimen
quality
method Measurement action
precondition
observation result
property type serogroup
scale scales
Cultured E.coli serotype is O157
E. Coli (organism)inheres in
towards hemoglobin
units units
technique Bacterial serotyping
is about
body states
direct site Microbial culture
quality
has value O157
The information model is used to link this result to the Culture and specimen that came from the patient.
What about abilities?
• Continued in Part-3 slide deck
• Able with respect to normal functioning and activities– Ontologically these are “realizables”.– Two types:
• Sure-fire (“dispositions”): if you have the ability to feel pain, then when a painful stimulus is applied, you feel it (assuming you are conscious – and actually even if you are unconscious – with some exceptions based on threshold of intensity)
• Those abilities that depend on the bearer’s decision (ability to walk, talk, throw a ball, eat an apple, etc)