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Appl Clin Inform 2019; 10(03): 409-420
DOI: 10.1055/s-0039-1691842
Research Article
Georg Thieme Verlag KG Stuttgart · New York

Consensus Development of a Modern Ontology of Emergency Department Presenting Problems—The Hierarchical Presenting Problem Ontology (HaPPy)

Steven Horng
1   Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
2   Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
,
Nathaniel R. Greenbaum
1   Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
2   Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
,
Larry A. Nathanson
1   Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
2   Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
,
James C. McClay
3   Department of Emergency Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States
,
Foster R. Goss
4   Department of Emergency Medicine, University of Colorado Hospital, University of Colorado School of Medicine, Aurora, Colorado, United States
,
Jeffrey A. Nielson
5   Northeastern Ohio Medical University, University Hospitals Samaritan Medical Center, Ashland, Ohio, United States
› Author Affiliations Funding Administrative support was partially funded by an American College of Emergency Physicians Section Grant.
Further Information

Publication History

27 February 2019

24 April 2019

Publication Date:
12 June 2019 (online)

Also available at
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Abstract

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.

Keywords

chief complaint - presenting problem - emergency department - emergency medicine - ontology

Data Availability

As a derivative work of SNOMED CT, the HierArchical Presenting Problem ontologY (HaPPy) is released freely to anyone with a valid SNOMED CT license. The ontology as well as analysis toolkit can be downloaded via our Web site http://bit.ly/2KVZJPp.


Protection of Human and Animal Subjects

This project was reviewed by the Committee on Clinical Investigations at Beth Israel Deaconess Medical Center and a determination (#2019D000313) was made that this activity did not constitute Human Subjects Research and no further review was required.


 

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