Challenges in Connecting Clinicians to Semantic Web

Q. Scott, A. Pecucci, T. Mitchell, C. Ordonez, M. Cardwell, F. Naeymi-Rad

Introduction
Intelligent Medical Objects, Inc. (IMO) provides physicians with interface terminologies for use within EHR systems. Over 300,000 users of IMO users now leverage an IMO-hosted web portal to search +260,000 terms and access such content. Interface Terminologies are controlled vocabularies, which comply to applicable standards while providing for the capture and storage of language preferences of the end-user. Should we aim to connect researchers to all entities involved in healthcare information exchange (e.g. clinicians, patients, administrators, payers etc.), it is imperative that both such terminological functions are present and appropriately implemented. Interface terminologies are one necessary condition for a well-functioning Semantic Web. Reasonably, we assert that a world connected by the Semantic Web is an ideal we should achieve despite certain challenges that inhibit its adoption. We assessed the feasibility of connecting clinicians to the Semantic Web via promotion and education on a local level. We interviewed 30 clinics in rural Champaign County, home to the University of Illinois. We found 90% of physician practices shared similar difficulties pertaining to interoperability and health information exchange. Between clinics, we found a lack of coordination in documentation and terminology protocols for medical records. Nearly 80% of practices use paper medical records and a paper list of clinical terms & codes. Approximately 10% of clinics employed a customized EMRS which captured free text entries. Both methods inhibit standardization of data which cannot be readily exchanged between parties without modification. We conclude that the process of informing clinicians about the Semantic Web via promotion and education will be necessary in establishing local professional networks to foment larger networks in the goal of improving the healthcare system. We hope to use the Semantic Web to create a higher level of communication between clinical teams within each community as well as academic centers without exposing any PHI (Patient Health Information0.

How the Semantic Web can form a Clear Picture of Disease for Clinicians
We display these results to illustrate applications of future analysis. With increased portal usage in the United States, this data could indicate instances of new diseases or outbreaks at the point of diagnosis. The interesting thing to note is that this chart (left) represents the top 25 clinical concepts by selection from the IMO Problem IT portal. In total, these represent 20% of all selections out of a total of 4.7 million. Hypertension being the #1 searched term, is broken down into the different ways in which it is searched by frequency (below).

Evidence of learned search behavior

IMOs Problem(IT) content includes 260,000+ terms. As such, it is important during initial implementation to train physicians to search specifically, with clinical intent in mind. One way that we accomplish this is to recommend searching by stems or word fragments. For instance, to retrieve the diagnosis diabetes mellitus with renal manifestations, we recommend entering a search-string like:

diab mel ren man

Searching in this manner is in opposition to asking for all diabetic diagnoses or typing the entire diagnosis description. This method of searching also helps counteract the pain points of physicians related to more time searching for codes and issues with finding the appropriate diagnosis term. Physicians are then mapped immediately to the term they know and then to the ICD-9-CM, ICD-10-CM and SNOMED-CT codes that they need much faster. Overall, The data demonstrates that there is a slight, negative correlation between the time using IMO Problem IT and the TTS (or time to selection), meaning that as users become more experienced, they learn how to search the portal more efficiently for diagnoses that they ultimately select.

Search-term trends
Time Used Vs. Mean TTS

Future indications and directions

Portal growth trends
Over the last year, searches against IMOs Problem(IT) content have grown by more than 180%. In fact, searches per month in the last six months have increased from 6 to 10 million searches per month. Increased awareness to the emergence of new diseases, Increased sensitivity to regional and seasonal patterns, Greater ability to connect providers based upon patient population commonalities.

Developing a Semantic Web Community

Methodology for Connecting Clinicians to IMO

We conducted market research in the Champaign-Urbana vicinity, which is a growing rural area and has a population of about 122,000. We discovered over 60 facilities deemed health clinics; however, that number was reduced to about 30 clinics based on the criteria that these clinics must address medical coding. We interviewed 30 medical clinics (n=30) ranging from single physician practices, to general hospitals. These clinics were surveyed via phone interview, to identify their specialty, number of providers, size, organizational hierarchy, medical record system, and knowledge of IMO. Following the phone interviews, we traveled to each clinic to conduct an in-person interview for follow-up. The interview script was used as a criteria for gauging the pain points clinicians had with medical documentation and exchanging health information between parties (e.g. clinics, payers). Upon assessing the nee ds of each clinic, we informed them about IMO solutions and how IMO is attempting to connect all clinics to the semantic web. We offered an IMO-hosted web portal for use in complimenting their medical information documentation, and exchange, and ultimately, connecting them to the semantic web. Presently, we are continuing our efforts to reach out to additional clinics, connect previously interviewed clinics, and collect data from current users of the IMO web portal.
RESEARCH POSTER PRESENTATION DESIGN 2011

In a separate specific case study we inquired as to how many clinics in the Urbana-Champaign area are using any EHR/EMR system. This information provided us with the knowledge of whether or not each clinic in question had ever been exposed to IMO or a terminology search tool that was similar to that of IMO. Our main mission was to educate and make aware every clinic in the UIUC area the benefits and possible connection opportunities among doctors themselves. A sample of this analysis is presented below.

2010

Recording Systems in the UIUC Area

2012

A future consequence of the analysis of search requests will be the development of a semantic web community, linking medical professionals based upon common search habits. Using links between IMOs core terminologies to over 1000 specialties and sub-specialties, search habits can indicate a physicians patient population without exposure of personal health information. In so doing, physicians can be dynamically linked to foment greater collaboration between providers in the same specialty or sub-specialty.

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