Institute of Medical Informatics, Statistics and Documentation, Medical University of Graz, Austria.
Department of Medical Informatics, Amsterdam Public Health Research Institute, The Netherlands.
Int J Med Inform. 2019 Mar;123:37-48. doi: 10.1016/j.ijmedinf.2018.12.011. Epub 2018 Dec 31.
Semantic interoperability of eHealth services within and across countries has been the main topic in several research projects. It is a key consideration for the European Commission to overcome the complexity of making different health information systems work together. This paper describes a study within the EU-funded project ASSESS CT, which focuses on assessing the potential of SNOMED CT as core reference terminology for semantic interoperability at European level.
This paper presents a quantitative analysis of the results obtained in ASSESS CT to determine the fitness of SNOMED CT for semantic interoperability.
The quantitative analysis consists of concept coverage, term coverage and inter-annotator agreement analysis of the annotation experiments related to six European languages (English, Swedish, French, Dutch, German and Finnish) and three scenarios: (i) ADOPT, where only SNOMED CT was used by the annotators; (ii) ALTERNATIVE, where a fixed set of terminologies from UMLS, excluding SNOMED CT, was used; and (iii) ABSTAIN, where any terminologies available in the current national infrastructure of the annotators' country were used. For each language and each scenario, we configured the different terminology settings of the annotation experiments.
There was a positive correlation between the number of concepts in each terminology setting and their concept and term coverage values. Inter-annotator agreement is low, irrespective of the terminology setting.
No significant differences were found between the analyses for the three scenarios, but availability of SNOMED CT for the assessed language is associated with increased concept coverage. Terminology setting size and concept and term coverage correlate positively up to a limit where more concepts do not significantly impact the coverage values. The results did not confirm the hypothesis of an inverse correlation between concept coverage and IAA due to a lower amount of choices available. The overall low IAA results pose a challenge for interoperability and indicate the need for further research to assess whether consistent terminology implementation is possible across Europe, e.g., improving term coverage by adding localized versions of the selected terminologies, analysing causes of low inter-annotator agreement, and improving tooling and guidance for annotators. The much lower term coverage for the Swedish version of SNOMED CT compared to English together with the similarly high concept coverage obtained with English and Swedish SNOMED CT reflects its relevance as a hub to connect user interface terminologies and serving a variety of user needs.
电子健康服务在国家内部和国家之间的语义互操作性一直是多个研究项目的主要议题。克服不同健康信息系统协同工作的复杂性是欧盟委员会的关键考虑因素。本文描述了欧盟资助的 ASSESS CT 项目中的一项研究，该研究侧重于评估 SNOMED CT 作为欧洲层面语义互操作性核心参考术语的潜力。
本文对 ASSESS CT 中获得的结果进行定量分析，以确定 SNOMED CT 用于语义互操作性的适用性。
定量分析包括与六种欧洲语言（英语、瑞典语、法语、荷兰语、德语和芬兰语）相关的注释实验的概念覆盖、术语覆盖和注释者间一致性分析，以及三种情况：（i）ADOPT，注释者仅使用 SNOMED CT；（ii）ALTERNATIVE，注释者使用 UMLS 中除 SNOMED CT 以外的固定术语集；（iii）ABSTAIN，注释者使用本国当前国家基础设施中可用的任何术语。对于每种语言和每种情况，我们都为注释实验配置了不同的术语设置。
每个术语设置中的概念数量与其概念和术语覆盖值之间存在正相关关系。注释者间一致性无论术语设置如何都很低。
三种情况下的分析结果没有显著差异，但评估语言中 SNOMED CT 的可用性与概念覆盖的增加相关。术语设置大小和概念及术语覆盖呈正相关，直到更多的概念不会显著影响覆盖值。由于可用的选择较少，结果并未证实概念覆盖与 IAA 之间存在负相关的假设。整体较低的 IAA 结果对互操作性提出了挑战，并表明需要进一步研究，以评估在整个欧洲是否有可能实现一致的术语实施，例如，通过添加所选术语的本地化版本来提高术语覆盖，分析注释者间一致性低的原因，并改进注释者的工具和指南。与英语相比，瑞典语版本的 SNOMED CT 的术语覆盖率低得多，而英语和瑞典语 SNOMED CT 的概念覆盖率却相似，这反映了它作为连接用户界面术语的枢纽并满足各种用户需求的重要性。
