Consensus Development of a Modern Ontology of Emergency Department Presenting Problems-The Hierarchical Presenting Problem Ontology (HaPPy)
care; chief complaint; coded chief complaints; electronic medical-record; emergency; emergency department; Medical Informatics; medicine; ontology; presenting problem; rods; systems; terminologies
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.
Horng S; Greenbaum N R; Nathanson L A; McClay J C; Goss F R; Nielson J A
Applied Clinical Informatics
2019
2019-05
<a href="https://www.biorxiv.org/content/10.1101/126870v2" target="_blank" rel="noreferrer noopener">10.1055/s-0039-1691842</a>
Health Information Exchange in Emergency Medicine
clinical information; cost; department care; Emergency Medicine; impact; network; new-york-city; physicians; public-health; reuse; usage
Emergency physicians often must make critical, time-sensitive decisions with a paucity of information with the realization that additional unavailable health information may exist. Health information exchange enables clinician access to patient health information from multiple sources across the spectrum of care. This can provide a more complete longitudinal record, which more accurately reflects the way most patients obtain care: across multiple providers and provider organizations. This information article explores various aspects of health information exchange that are relevant to emergency medicine and offers guidance to emergency physicians and to organized medicine for the use and promotion of this, emerging technology. This article makes 5-primary emergency medicine-focused recommendations, as well as 7 additional secondary generalized recommendations, to health information exchanges, policymakers, and professional groups, which are crafted to facilitate health information exchange's purpose and demonstrate its value.
Shapiro J S; Crowley D; Hoxhaj S; Langabeer J; Panik B; Taylor T B; Weltge A; Nielson J A
Annals of Emergency Medicine
2016
2016-02
Journal Article
<a href="http://doi.org/10.1016/j.annemergmed.2015.06.018" target="_blank" rel="noreferrer noopener">10.1016/j.annemergmed.2015.06.018</a>