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This article is published online with Open Access by IOS Press and distributed under the terms
A Pilot Ontology for Healthcare Quality Indicators
Pam Whitea and Abdul Roudsarib
a
School of Informatics, City University London, United Kingdom
b
Department of Health Information Science, University of Victoria, British Columbia, Canada
Abstract
Computerisation of quality indicators for the English National
Health Service currently relies primarily on queries and
clinical coding, with little use of ontologies. We created a
searchable ontology for a diverse set of healthcare quality
indicators. We investigated attributes and relationships in a
set of 222 quality indicators, categorised by clinical pathway,
inclusion and exclusion criteria and US Institute of Medicine
purpose. Our pilot ontology could reduce duplication of effort
in healthcare quality monitoring.
Keywords:
Ontologies; Quality Indicators, Healthcare
Introduction
Quality indicators are useful tools for monitoring healthcare
outcomes. When quality indicators are issued by more than
one governing body, they may overlap in content. Ontologies
can facilitate automated quality monitoring by categorising
and establishing relationships between concepts. In England’s
National Health Service (NHS), quality indicators are
frequently measured electronically by using separate queries
and data extraction for each quality indicator. An ontology for
quality indicators issued from different sources can reduce
effort needed to find data for quality indicators by linking
common criteria in the indicators.
Method
We developed a pilot ontology that specifies inclusion and
exclusion criteria, along with relationships between quality
indicators. We categorised a large set of quality indicators [1]
by clinical pathway, dimension, and US Institute of Medicine
[2] purpose. The Clinical Pathway and Dimension categories
were based on a 2008 strategic report for the NHS [3]. We
used Statement and Definition metadata from the NHS [4] to
specify layers of inclusion and exclusion criteria, creating
chunks of indicator components. We then identified broader,
narrower, and same level relationships between components of
different indicators. We explain further detail about
conceptualisation of the ontology in a separate article [5].
Results
Classes and Subclasses
Figure 1 shows the main classes and one of their subclasses.
Figure 1. Examples of Classes and Subclasses
MEDINFO 2015: eHealth-enabled Health
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of the Creative Commons Attribution Non-Commercial License.
doi:10.3233/978-1-61499-564-7-1110
Properties
39 properties were assigned to the classes and/or subclasses.
The Indicators class has 29 properties, with a maximum depth
of seven layers of Inclusion/Exclusion Criteria (an exmaple of
properties, due to different characteristics and names of the
criteria).
Discussion
Our ontology was intended to make components of the
indicators searchable, with a potential to reduce duplication of
effort in finding data for common components of quality
indicators from different sources. A use case example would
be a clinical auditor seeking blood pressure measurement
records within the past 9 months, for patients with
hypertension. The auditor could search the ontology, using the
keyword ‘hypertension’ to find related indicators. For
example, they would find an indicator requesting records of
lifestyle advice given to patients with hypertension. They
would only need to search for records of patients with
hypertension once to compile data for different indicators.
Conclusion
Our ontology offers the ability to search components of
quality indicators from different sources, with a view to
reducing duplication of effort in gathering data for indicators
with common criteria. Although the ontology is useful in its
present form, it would benefit from revision to improve its
structure and to reduce the number of properties.
References
[1] NHS Information Centre. Indicators for quality
improvement: Full indicator list. 2009. Available from:
https://mqi.ic.nhs.uk/IndicatorsList.aspx. [Accessed 4 July
2012]
[2] Field M and Lohr K (Eds). Guidelines for clinical practice:
from development to use. Institute of Medicine,
Washington, D.C. National Academy Press. 1992.
[3] Darzi A. High quality care for all. NHS next stage review:
Final report. London. Department of Health. 2008.
[4] NHS Information Centre Indicators for Quality
Improvement. 2009. Available from:
https://mqi.ic.nhs.uk/Default.aspx [Accessed 22 December
2014].
[5] White P and Roudsari A. Conceptual Analysis of a Diverse
Set of Healthcare Quality Indicators. Stud Health Technol
Inform 2015: 208:347-51.
Address for correspondence
Pam White, pamela.white.1@city.ac.uk