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 none were freely sharable and contained 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 SNOMED-CT. Results:Our system consists of a polyhierarchical ontology containing 692 unique concepts, 2,118 synonyms, and 30,613 non-visible descriptions to correct misspellings and non-standard terminology. Our ontology successfully captured structured data for 95.9% of visits in our validation dataset. Discussion and Conclusion:We present the HierArchical Presenting Problem ontologY (HaPPy). This ontology was empirically derived 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.

Data Model Requirements for a Digital Cognitive Aid for Anesthesia to Support Intraoperative Crisis Management

“…Furthermore, a common structure across all emergencies within a digital CA will enhance its suitability in diverse anesthetic departments in Germany. Similar to Horng et al who developed an ontology to solve the problem of how to present the characteristic nature of an emergency department visit, 19 our study has attempted to characterize the structure of a CA for intraoperative emergencies. An ontology describes a set of domain concepts and their relations in a structured way and hence can contribute to improved domain understanding and also to promote the integration of medical knowledge into different applications.…”

Generating contextual embeddings for emergency department chief complaints

“…Recently, much important work has been done to create a standardized ontology, namely, the Hierarchical Presenting Problem Ontology (HaPPy), which increased the likelihood of label assignment from a free-text chief complaint from 26.2% to 97.2% in one study. 5 , 21 , 32 Using such an ontology for training and testing purposes may present an opportunity for gold standard labels to be used to derive contextual embeddings.…”

“… 4 Moreover, even when chief complaints are stored in a structured format, there exists no standard nomenclature or guidance on how they should be categorized. 5 , 6 As a consequence, administrators and researchers frequently find chief complaint data difficult to use for downstream tasks such as quality improvement initiatives and predictive analytics. 7 Thus, the secondary use of chief complaint data in daily operational decisions and research has been hampered by its form and representation.…”

“… 29 Lastly, contextual embeddings may be used to derive a standardized, data-driven ontology of ED chief complaints that could be shared among healthcare institutions and research entities to minimize the variability in how chief complaint labels are assigned from ED to ED, 7 , 30 , 31 as has been suggested by recent work on the Hierarchical Presenting Problem Ontology (HaPPy). 5 , 21 , 32 …”