Health IT Ontologies of the Future

Traditionally listed as a part of the major branch of philosophy known as metaphysics, ontology deals with questions concerning what entities exist or can be said to exist, and how such entities can be grouped, related within a hierarchy, and subdivided according to similarities and differences.(http://en.wikipedia.org/wiki/Ontology)
One of the foundational elements of interoperability in health IT is the development of standards. Standards are usually developed around specific use cases. Standards are developed by Standards Development Organizations (SDOs). Isolated, single standards are not very useful in real life. However, when several standards are assembled in a system to work together then a lot can be accomplished. The work of organizing collections of standards that work together is done by standards harmonizing organizations. Often, they work from goals or use cases that define a business purpose. Some of the better-known examples of organizations that harmonize standards in the health care field are HITSP (no longer active) and Integrating the Healthcare Enterprise (IHE.) If you review the work products of SDOs and harmonization organizations, two things become apparent: 1) The products of their efforts become increasingly complex and, 2) many existing standards or components are repurposed/reused for new tasks. This causes problems for intended users.


The standards harmonization publications usually just reference the original standards. This is done for two primary reasons. First, many standards are proprietary and therefore are often not available unless license fees are paid by the users. Next, the publications would become unmanageably large if each of the separate standards documents was included. Implementers have a valid claim that they have to search in many different places to find all the documentation. Even then, necessary information might not be available publicly.


A number of approaches have been recommended to solve the problems. First, it is essential that open health care standards be adopted and be made available to developers and implementers. The challenge is to settle on a business model that solves the financial issues related to intellectual property. Ultimately, users will have to pay, either directly or indirectly. I think the Federal government will become more involved in the near future. The second issue is the real focus of this blog. Current documentation methods, such as documents, spread sheets, tables, and even more complicated programs do a poor job of graphically portraying the complex relationships involved in harmonized standards. It is hard to navigate the layers and drill down to the fine details when that is needed. This became clear to me during the final six months of HITSP activity while I listened in on teleconference sessions of the workgroup dealing with the standards harmonization framework. Few have utilized programs such as Protégé that were specifically designed to manage ontologies. Ontologies, like neural networks, do not lend themselves well to representation on a flat sheet of paper. I am going to go out on a limb and predict a revolution in graphical knowledge representations, transitioning from 2-D to 3-D in the next few years. We have already seen the leap to 3-D in movie making, computer gaming, and television set design. I do not think that it will be much of a stretch for developers to produce new software that will allow graphic representation of complexes of standards with imbedded knowledge content that can be selected and viewed. Just as an example, imagine how much easier it would be to view the route maps of the large airlines in 3-D rather than the confusing flat maps that we find in the back of airline magazines now. We should have tools to manipulate the views, change our point of view, find information about the terminals at either end of a route, and review the types of aircraft used for particular routes along with the schedule and gate information. Hopefully this analogy provides an idea of what I envision. I think the development of 3-D software to represent ontologies of standards, their relationships, and associated knowledge content and the availability of open standards will make the work of implementers much easier in the future.