Pediatric Informatics: Computer Applications in Child Health (Health ...

33 The Case for a Pediatric Terminology 433
33.4.1 Creation of a Pediatric Clinical Corpus
One approach that has been undertaken is the development of a pediatric corpus
of clinical information (including text data) at the Cincinnati Children’s Hospital
Medical Center, including nurses and surgical notes, discharge summaries, information
about symptoms, procedures, findings, and therapeutic response, genetic
specimen and other data 22 for use in experiments with natural language processing
tools and lexical/semantic tagging.
33.4.2 Workflow-Based Templates
Another approach to creating terminologies is to define a clinical workflow (such as
a well-child visit) in terms of the data that are collected, recorded, and processed in
performing the task. Representations of these data needs (descriptions of developmental
stages and delays, nutrition, immunizations) are then matched to a candidate
terminology (such as those in the CHI, discussed previously) proposed for use in
the workflow. Evaluation of coverage and level of detail can help identify gaps
within the candidate terminology in meeting the terminology needs of the clinical
workflow.
The requirements of this approach are: (a) a robust terminology that is matched
to the domain (such as pediatric ambulatory care); and (b) cooperation between a
dedicated and representative group of clinicians (who define the data needs of the
specific workflow) and informaticians (who are versed in the nuances of clinical
work and terminology development). Barriers to this approach include engaging
the needed expertise and its labor-intensiveness. In addition, while the structure of
a terminology such as SNOMED CT may allow for the development of extensions
to fill gaps in that the basic terminology does not cover, such extensions must be
formally submitted for incorporation.
This approach has been studied for use in medical evaluations 23,24 and has been
explored but not formally investigated for pediatric work.
33.4.3 Content Analysis of Reports
A third approach has been used to develop taxonomies for use in patient safety
event reporting in general pediatrics 25 and neonatology. 26 In these cases, text reports
on reported patient safety events were collected either by voluntary submission
to an online database or through direct interviews with clinicians. Textual data is
reviewed and classified using a constant comparative analysis method 27 in conjunction
with a conceptual model of errors to develop hierarchical taxonomies of error
types. Strengths of such taxonomies include structure that is both descriptive and