The ICPS process:Typology of a novel

terminological system

Stefan SCHULZ IMBI, University Medical Center, Freiburg, Germany

Daniel KARLSSON Department of Medical Informatics, Linköping University, Sweden

Christel DANIEL INSERM, UMR_S 872, eq.20, Descartes University, Paris, France

Hans COOLS AGFA Healthcare, Gent, Belgium

Christian LOVIS Medical Informatics Service, University Hospitals of Geneva, Switzerland

Detecting and Eliminating Bacteria UsinG Information Technology 

Background

Background

• Patient safety: Increased attention and awareness on a global scale

• WHO is developing the International Classification for Patient Safety

(ICPS) together with the World Alliance for Patient Safety

• to represent patient safety workflows

• to facilitate international reporting and data exchange

• to facilitate international research collaboration

• Novel, ontology-based methodology

• Current state of ICPS:

– conceptual framework

– field testing, but not yet released

– available at http://www.who.int/patientsafety/taxonomy/en/

Structure of the Talk

• ICPS: How does it look like?

• ICPS: What it isn’t

• ICPS: What it is now

• ICPS: What it may be in the future

ICPS: Architecture

ICPS Architecture Critique Typology Outlook

Three components of ICPS

9. Hazard: a circumstance, agent or action with the potential to cause harm.

10. Circumstance: a situation or factor that may influence an event, agent or person(s).

11. Event: something that happens to or involves a patient.

12. Agent: a substance, object or system which acts to produce change.

13. Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum.

14. Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury.

15. Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient.

informsActionsT

akenT

o R

edu

ceR

isk

Contributing Factors/ Hazards

Incident

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcomes

Ameliorating Actions

ActionsT

akenT

o R

edu

ceR

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcomes

informs

informs

influences informs

informsActionsT

akenT

o R

edu

ceR

isk

Contributing Factors/ Hazards

Incident

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcomes

Ameliorating Actions

ActionsT

akenT

o R

edu

ceR

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcomes

informs

informs

influences informs

“Conceptual Framework”

“Key Concepts”

ICPS "taxonomy"

ICPS Architecture Critique Typology Outlook

Three components of ICPS

9. Hazard: a circumstance, agent or action with the potential to cause harm.

10. Circumstance: a situation or factor that may influence an event, agent or person(s).

11. Event: something that happens to or involves a patient.

12. Agent: a substance, object or system which acts to produce change.

13. Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum.

14. Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury.

15. Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient.

informsActionsT

akenT

o R

edu

ceR

isk

Contributing Factors/ Hazards

Incident

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcomes

Ameliorating Actions

ActionsT

akenT

o R

edu

ceR

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcomes

informs

informs

influences informs

informsActionsT

akenT

o R

edu

ceR

isk

Contributing Factors/ Hazards

Incident

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcomes

Ameliorating Actions

ActionsT

akenT

o R

edu

ceR

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcomes

informs

informs

influences informs

“Conceptual Framework”

“Key Concepts”

ICPS Architecture Critique Typology Outlook

ICPS "taxonomy"

ICPS Conceptual Framework

ICPS Major Class Subdivisions Example Leaf Concepts

Incident Type Medication/IV Fluids Problem: Wrong Drug Type of Harm: Pathophysiology: Diseases of the Nervous

System Patient Outcome Degree of harm: Severe Reason for encounter: Procedure Surgical Procedure Patient

Characteristics Demographics: Age Treatment status: Inpatient:

Immediate Post-OP or ICU/HDU Care

Discipline Involved: Intensive Care People Involved: Healthcare Professional:

Nurse Practitioner Incident Characteristics

Person Reporting: Healthcare Professional:

Doctor

Staff Factors: Performance Factors: Distraction/Inattention Contributing Factors / Hazards

Patient Factors: Communication Factors: With Whom:

With Staff

Directed to Patient: Patient Referred Mitigating Factors Directed to Staff: Relevant Persons Educated

Detection Healthcare Professional: Doctor Increase in Required Resource Allocation:

Increased Length of Stay Organizational Outcome

Legal Ramifications Patient Related: Compensation Ameliorating Actions Patient Related: Management of Disability Staff Factors: Staff Supervision/Assistance Actions Taken to

Reduce Risk Organizational Factors: Matching of Staff to Tasks/Skills

informs

Act

ions

Tak

en T

o R

educ

e R

isk

Contributing Factors / Hazards

IncidentType

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcome

Ameliorating Actions

Act

ions

Tak

en T

o R

educ

e R

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcome

informs

informs

influences informs

ICPS Architecture Critique Typology Outlook

ICPS Conceptual Framework

ICPS Major Class Subdivisions Example Leaf Concepts

Incident Type Medication/IV Fluids Problem: Wrong Drug Type of Harm: Pathophysiology: Diseases of the Nervous

System Patient Outcome Degree of harm: Severe Reason for encounter: Procedure Surgical Procedure Patient

Characteristics Demographics: Age Treatment status: Inpatient:

Immediate Post-OP or ICU/HDU Care

Discipline Involved: Intensive Care People Involved: Healthcare Professional:

Nurse Practitioner Incident Characteristics

Person Reporting: Healthcare Professional:

Doctor

Staff Factors: Performance Factors: Distraction/Inattention Contributing Factors / Hazards

Patient Factors: Communication Factors: With Whom:

With Staff

Directed to Patient: Patient Referred Mitigating Factors Directed to Staff: Relevant Persons Educated

Detection Healthcare Professional: Doctor Increase in Required Resource Allocation:

Increased Length of Stay Organizational Outcome

Legal Ramifications Patient Related: Compensation Ameliorating Actions Patient Related: Management of Disability Staff Factors: Staff Supervision/Assistance Actions Taken to

Reduce Risk Organizational Factors: Matching of Staff to Tasks/Skills

informs

Act

ions

Tak

en T

o R

educ

e R

isk

Contributing Factors / Hazards

IncidentType

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcome

Ameliorating Actions

Act

ions

Tak

en T

o R

educ

e R

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcome

informs

informs

influences informs

ICPS Architecture Critique Typology Outlook

ICPS Conceptual Framework

ICPS Major Class Subdivisions Example Leaf Concepts

Incident Type Medication/IV Fluids Problem: Wrong Drug Type of Harm: Pathophysiology: Diseases of the Nervous

System Patient Outcome Degree of harm: Severe Reason for encounter: Procedure Surgical Procedure Patient

Characteristics Demographics: Age Treatment status: Inpatient:

Immediate Post-OP or ICU/HDU Care

Discipline Involved: Intensive Care People Involved: Healthcare Professional:

Nurse Practitioner Incident Characteristics

Person Reporting: Healthcare Professional:

Doctor

Staff Factors: Performance Factors: Distraction/Inattention Contributing Factors / Hazards

Patient Factors: Communication Factors: With Whom:

With Staff

Directed to Patient: Patient Referred Mitigating Factors Directed to Staff: Relevant Persons Educated

Detection Healthcare Professional: Doctor Increase in Required Resource Allocation:

Increased Length of Stay Organizational Outcome

Legal Ramifications Patient Related: Compensation Ameliorating Actions Patient Related: Management of Disability Staff Factors: Staff Supervision/Assistance Actions Taken to

Reduce Risk Organizational Factors: Matching of Staff to Tasks/Skills

informs

Act

ions

Tak

en T

o R

educ

e R

isk

Contributing Factors / Hazards

IncidentType

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcome

Ameliorating Actions

Act

ions

Tak

en T

o R

educ

e R

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcome

informs

informs

influences informs

ICPS Architecture Critique Typology Outlook

ICPS Conceptual Framework

ICPS Major Class Subdivisions Example Leaf Concepts

Incident Type Medication/IV Fluids Problem: Wrong Drug Type of Harm: Pathophysiology: Diseases of the Nervous

System Patient Outcome Degree of harm: Severe Reason for encounter: Procedure Surgical Procedure Patient

Characteristics Demographics: Age Treatment status: Inpatient:

Immediate Post-OP or ICU/HDU Care

Discipline Involved: Intensive Care People Involved: Healthcare Professional:

Nurse Practitioner Incident Characteristics

Person Reporting: Healthcare Professional:

Doctor

Staff Factors: Performance Factors: Distraction/Inattention Contributing Factors / Hazards

Patient Factors: Communication Factors: With Whom:

With Staff

Directed to Patient: Patient Referred Mitigating Factors Directed to Staff: Relevant Persons Educated

Detection Healthcare Professional: Doctor Increase in Required Resource Allocation:

Increased Length of Stay Organizational Outcome

Legal Ramifications Patient Related: Compensation Ameliorating Actions Patient Related: Management of Disability Staff Factors: Staff Supervision/Assistance Actions Taken to

Reduce Risk Organizational Factors: Matching of Staff to Tasks/Skills

informs

Act

ions

Tak

en T

o R

educ

e R

isk

Contributing Factors / Hazards

IncidentType

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcome

Ameliorating Actions

Act

ions

Tak

en T

o R

educ

e R

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcome

informs

informs

influences informs

ICPS Architecture Critique Typology Outlook

ICPS Conceptual Framework

ICPS Major Class Subdivisions Example Leaf Concepts

Incident Type Medication/IV Fluids Problem: Wrong Drug Type of Harm: Pathophysiology: Diseases of the Nervous

System Patient Outcome Degree of harm: Severe Reason for encounter: Procedure Surgical Procedure Patient

Characteristics Demographics: Age Treatment status: Inpatient:

Immediate Post-OP or ICU/HDU Care

Discipline Involved: Intensive Care People Involved: Healthcare Professional:

Nurse Practitioner Incident Characteristics

Person Reporting: Healthcare Professional:

Doctor

Staff Factors: Performance Factors: Distraction/Inattention Contributing Factors / Hazards

Patient Factors: Communication Factors: With Whom:

With Staff

Directed to Patient: Patient Referred Mitigating Factors Directed to Staff: Relevant Persons Educated

Detection Healthcare Professional: Doctor Increase in Required Resource Allocation:

Increased Length of Stay Organizational Outcome

Legal Ramifications Patient Related: Compensation Ameliorating Actions Patient Related: Management of Disability Staff Factors: Staff Supervision/Assistance Actions Taken to

Reduce Risk Organizational Factors: Matching of Staff to Tasks/Skills

informs

Act

ions

Tak

en T

o R

educ

e R

isk

Contributing Factors / Hazards

IncidentType

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcome

Ameliorating Actions

Act

ions

Tak

en T

o R

educ

e R

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcome

informs

informs

influences informs

ICPS Architecture Critique Typology Outlook

ICPS Conceptual Framework

ICPS Major Class Subdivisions Example Leaf Concepts

Incident Type Medication/IV Fluids Problem: Wrong Drug Type of Harm: Pathophysiology: Diseases of the Nervous

System Patient Outcome Degree of harm: Severe Reason for encounter: Procedure Surgical Procedure Patient

Characteristics Demographics: Age Treatment status: Inpatient:

Immediate Post-OP or ICU/HDU Care

Discipline Involved: Intensive Care People Involved: Healthcare Professional:

Nurse Practitioner Incident Characteristics

Person Reporting: Healthcare Professional:

Doctor

Staff Factors: Performance Factors: Distraction/Inattention Contributing Factors / Hazards

Patient Factors: Communication Factors: With Whom:

With Staff

Directed to Patient: Patient Referred Mitigating Factors Directed to Staff: Relevant Persons Educated

Detection Healthcare Professional: Doctor Increase in Required Resource Allocation:

Increased Length of Stay Organizational Outcome

Legal Ramifications Patient Related: Compensation Ameliorating Actions Patient Related: Management of Disability Staff Factors: Staff Supervision/Assistance Actions Taken to

Reduce Risk Organizational Factors: Matching of Staff to Tasks/Skills

informs

Act

ions

Tak

en T

o R

educ

e R

isk

Contributing Factors / Hazards

IncidentType

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcome

Ameliorating Actions

Act

ions

Tak

en T

o R

educ

e R

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcome

informs

informs

influences informs

ICPS Architecture Critique Typology Outlook

ICPS Conceptual Framework

ICPS Major Class Subdivisions Example Leaf Concepts

Incident Type Medication/IV Fluids Problem: Wrong Drug Type of Harm: Pathophysiology: Diseases of the Nervous

System Patient Outcome Degree of harm: Severe Reason for encounter: Procedure Surgical Procedure Patient

Characteristics Demographics: Age Treatment status: Inpatient:

Immediate Post-OP or ICU/HDU Care

Discipline Involved: Intensive Care People Involved: Healthcare Professional:

Nurse Practitioner Incident Characteristics

Person Reporting: Healthcare Professional:

Doctor

Staff Factors: Performance Factors: Distraction/Inattention Contributing Factors / Hazards

Patient Factors: Communication Factors: With Whom:

With Staff

Directed to Patient: Patient Referred Mitigating Factors Directed to Staff: Relevant Persons Educated

Detection Healthcare Professional: Doctor Increase in Required Resource Allocation:

Increased Length of Stay Organizational Outcome

Legal Ramifications Patient Related: Compensation Ameliorating Actions Patient Related: Management of Disability Staff Factors: Staff Supervision/Assistance Actions Taken to

Reduce Risk Organizational Factors: Matching of Staff to Tasks/Skills

informs

Act

ions

Tak

en T

o R

educ

e R

isk

Contributing Factors / Hazards

IncidentType

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcome

Ameliorating Actions

Act

ions

Tak

en T

o R

educ

e R

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcome

informs

informs

influences informs

ICPS Architecture Critique Typology Outlook

ICPS Conceptual Framework

ICPS Major Class Subdivisions Example Leaf Concepts

Incident Type Medication/IV Fluids Problem: Wrong Drug Type of Harm: Pathophysiology: Diseases of the Nervous

System Patient Outcome Degree of harm: Severe Reason for encounter: Procedure Surgical Procedure Patient

Characteristics Demographics: Age Treatment status: Inpatient:

Immediate Post-OP or ICU/HDU Care

Discipline Involved: Intensive Care People Involved: Healthcare Professional:

Nurse Practitioner Incident Characteristics

Person Reporting: Healthcare Professional:

Doctor

Staff Factors: Performance Factors: Distraction/Inattention Contributing Factors / Hazards

Patient Factors: Communication Factors: With Whom:

With Staff

Directed to Patient: Patient Referred Mitigating Factors Directed to Staff: Relevant Persons Educated

Detection Healthcare Professional: Doctor Increase in Required Resource Allocation:

Increased Length of Stay Organizational Outcome

Legal Ramifications Patient Related: Compensation Ameliorating Actions Patient Related: Management of Disability Staff Factors: Staff Supervision/Assistance Actions Taken to

Reduce Risk Organizational Factors: Matching of Staff to Tasks/Skills

informs

Act

ions

Tak

en T

o R

educ

e R

isk

Contributing Factors / Hazards

IncidentType

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcome

Ameliorating Actions

Act

ions

Tak

en T

o R

educ

e R

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcome

informs

informs

influences informs

ICPS Architecture Critique Typology Outlook

ICPS Conceptual Framework

ICPS Major Class Subdivisions Example Leaf Concepts

Incident Type Medication/IV Fluids Problem: Wrong Drug Type of Harm: Pathophysiology: Diseases of the Nervous

System Patient Outcome Degree of harm: Severe Reason for encounter: Procedure Surgical Procedure Patient

Characteristics Demographics: Age Treatment status: Inpatient:

Immediate Post-OP or ICU/HDU Care

Discipline Involved: Intensive Care People Involved: Healthcare Professional:

Nurse Practitioner Incident Characteristics

Person Reporting: Healthcare Professional:

Doctor

Staff Factors: Performance Factors: Distraction/Inattention Contributing Factors / Hazards

Patient Factors: Communication Factors: With Whom:

With Staff

Directed to Patient: Patient Referred Mitigating Factors Directed to Staff: Relevant Persons Educated

Detection Healthcare Professional: Doctor Increase in Required Resource Allocation:

Increased Length of Stay Organizational Outcome

Legal Ramifications Patient Related: Compensation Ameliorating Actions Patient Related: Management of Disability Staff Factors: Staff Supervision/Assistance Actions Taken to

Reduce Risk Organizational Factors: Matching of Staff to Tasks/Skills

informs

Act

ions

Tak

en T

o R

educ

e R

isk

Contributing Factors / Hazards

IncidentType

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcome

Ameliorating Actions

Act

ions

Tak

en T

o R

educ

e R

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcome

informs

informs

influences informs

ICPS Architecture Critique Typology Outlook

ICPS Conceptual Framework

ICPS Major Class Subdivisions Example Leaf Concepts

Incident Type Medication/IV Fluids Problem: Wrong Drug Type of Harm: Pathophysiology: Diseases of the Nervous

System Patient Outcome Degree of harm: Severe Reason for encounter: Procedure Surgical Procedure Patient

Characteristics Demographics: Age Treatment status: Inpatient:

Immediate Post-OP or ICU/HDU Care

Discipline Involved: Intensive Care People Involved: Healthcare Professional:

Nurse Practitioner Incident Characteristics

Person Reporting: Healthcare Professional:

Doctor

Staff Factors: Performance Factors: Distraction/Inattention Contributing Factors / Hazards

Patient Factors: Communication Factors: With Whom:

With Staff

Directed to Patient: Patient Referred Mitigating Factors Directed to Staff: Relevant Persons Educated

Detection Healthcare Professional: Doctor Increase in Required Resource Allocation:

Increased Length of Stay Organizational Outcome

Legal Ramifications Patient Related: Compensation Ameliorating Actions Patient Related: Management of Disability Staff Factors: Staff Supervision/Assistance Actions Taken to

Reduce Risk Organizational Factors: Matching of Staff to Tasks/Skills

informs

Act

ions

Tak

en T

o R

educ

e R

isk

Contributing Factors / Hazards

IncidentType

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcome

Ameliorating Actions

Act

ions

Tak

en T

o R

educ

e R

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcome

informs

informs

influences informs

ICPS Architecture Critique Typology Outlook

ICPS Conceptual Framework

ICPS Major Class Subdivisions Example Leaf Concepts

Incident Type Medication/IV Fluids Problem: Wrong Drug Type of Harm: Pathophysiology: Diseases of the Nervous

System Patient Outcome Degree of harm: Severe Reason for encounter: Procedure Surgical Procedure Patient

Characteristics Demographics: Age Treatment status: Inpatient:

Immediate Post-OP or ICU/HDU Care

Discipline Involved: Intensive Care People Involved: Healthcare Professional:

Nurse Practitioner Incident Characteristics

Person Reporting: Healthcare Professional:

Doctor

Staff Factors: Performance Factors: Distraction/Inattention Contributing Factors / Hazards

Patient Factors: Communication Factors: With Whom:

With Staff

Directed to Patient: Patient Referred Mitigating Factors Directed to Staff: Relevant Persons Educated

Detection Healthcare Professional: Doctor Increase in Required Resource Allocation:

Increased Length of Stay Organizational Outcome

Legal Ramifications Patient Related: Compensation Ameliorating Actions Patient Related: Management of Disability Staff Factors: Staff Supervision/Assistance Actions Taken to

Reduce Risk Organizational Factors: Matching of Staff to Tasks/Skills

informs

Act

ions

Tak

en T

o R

educ

e R

isk

Contributing Factors / Hazards

IncidentType

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcome

Ameliorating Actions

Act

ions

Tak

en T

o R

educ

e R

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcome

informs

informs

influences informs

ICPS Architecture Critique Typology Outlook

ICPS Conceptual Framework

ICPS Major Class Subdivisions Example Leaf Concepts

Incident Type Medication/IV Fluids Problem: Wrong Drug Type of Harm: Pathophysiology: Diseases of the Nervous

System Patient Outcome Degree of harm: Severe Reason for encounter: Procedure Surgical Procedure Patient

Characteristics Demographics: Age Treatment status: Inpatient:

Immediate Post-OP or ICU/HDU Care

Discipline Involved: Intensive Care People Involved: Healthcare Professional:

Nurse Practitioner Incident Characteristics

Person Reporting: Healthcare Professional:

Doctor

Staff Factors: Performance Factors: Distraction/Inattention Contributing Factors / Hazards

Patient Factors: Communication Factors: With Whom:

With Staff

Directed to Patient: Patient Referred Mitigating Factors Directed to Staff: Relevant Persons Educated

Detection Healthcare Professional: Doctor Increase in Required Resource Allocation:

Increased Length of Stay Organizational Outcome

Legal Ramifications Patient Related: Compensation Ameliorating Actions Patient Related: Management of Disability Staff Factors: Staff Supervision/Assistance Actions Taken to

Reduce Risk Organizational Factors: Matching of Staff to Tasks/Skills

ICPS Architecture Critique Typology Outlook

ICPS Components

9. Hazard: a circumstance, agent or action with the potential to cause harm.

10. Circumstance: a situation or factor that may influence an event, agent or person(s).

11. Event: something that happens to or involves a patient.

12. Agent: a substance, object or system which acts to produce change.

13. Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum.

14. Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury.

15. Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient.

informsActionsT

akenT

o R

edu

ceR

isk

Contributing Factors/ Hazards

Incident

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcomes

Ameliorating Actions

ActionsT

akenT

o R

edu

ceR

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcomes

informs

informs

influences informs

informsActionsT

akenT

o R

edu

ceR

isk

Contributing Factors/ Hazards

Incident

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcomes

Ameliorating Actions

ActionsT

akenT

o R

edu

ceR

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcomes

informs

informs

influences informs

“Conceptual Framework”

“Key Concepts”

IncidentCharacteristics

IncidentCharacteristics

ICPS Architecture Critique Typology Outlook

ICPS "taxonomy"

ICPS Architecture Critique Typology Outlook

informsActionsT

akenT

o R

educeR

isk

Contributing Factors/ Hazards

Incident

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcomes

Ameliorating Actions

ActionsT

akenT

o R

educeR

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcomes

informs

informs

influences informs

informsActionsT

akenT

o R

educeR

isk

Contributing Factors/ Hazards

Incident

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcomes

Ameliorating Actions

ActionsT

akenT

o R

educeR

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcomes

informs

informs

influences informs

IncidentCharacteristics

ICPS “Taxonomy”

ICPS Conceptual Framework

9. Hazard: a circumstance, agent or action with the potential to cause harm.

10. Circumstance: a situation or factor that may influence an event, agent or person(s).

11. Event: something that happens to or involves a patient.

12. Agent: a substance, object or system which acts to produce change.

13. Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum.

14. Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury.

15. Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient.

informsActionsT

akenT

o R

edu

ceR

isk

Contributing Factors/ Hazards

Incident

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcomes

Ameliorating Actions

ActionsT

akenT

o R

edu

ceR

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcomes

informs

informs

influences informs

informsActionsT

akenT

o R

edu

ceR

isk

Contributing Factors/ Hazards

Incident

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcomes

Ameliorating Actions

ActionsT

akenT

o R

edu

ceR

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcomes

informs

informs

influences informs

“Conceptual Framework”

“Key Concepts”

ICPS Architecture Critique Typology Outlook

ICPS "taxonomy"

ICPS Key Concepts

• Classification: an arrangement of concepts into classes and their subdivisions, linked so as to express the semantic relationships between them.

• Concept: a bearer or embodiment of meaning.

• Class: a group or set of like things.Hazard: a circumstance, agent or action with the potential to cause harm.

• Healthcare: services received by individuals or communities to promote, maintain, monitor or restore health.

• Event: something that happens to or involves a patient.

• Patient: a person who is a recipient of healthcare.

• Agent: a substance, object or system which acts to produce change.

• Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum.

• Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury.

• Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient.

ICPS Architecture Critique Typology Outlook

Structure of the Talk

• ICPS: How does it look like?

• ICPS: What it isn’t

• ICPS: What it is now

• ICPS: What it may be in the future

ICPS Architecture Critique Typology Outlook

ICPS is not yet…

ICPS Architecture Critique Typology Outlook

Analyzing ICPS

ICPS Architecture Critique Typology Outlook

• target of analysis: the ICPS tree…

– graph structure: resemblance with WHO-FIC classifications(4 – 5 levels, single parents)

– artifact meant to be used by medical coders

• key concepts winscp.exeand conceptual framework: meta information from user’s point of view

9. Hazard: a circumstance, agent or action with the potential to cause harm.

10. Circumstance: a situation or factor that may influence an event, agent or person(s).

11. Event: something that happens to or involves a patient.

12. Agent: a substance, object or system which acts to produce change.

13. Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum.

14. Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury.

15. Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient.

informsActionsTakenT

o R

educeR

isk

Contributing Factors/ Hazards

Incident

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcomes

Ameliorating Actions

ActionsTakenT

o R

educeR

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcomes

informs

informs

influences informs

informsActionsTakenT

o R

educeR

isk

Contributing Factors/ Hazards

Incident

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcomes

Ameliorating Actions

ActionsTakenT

o R

educeR

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcomes

informs

informs

influences informs

ICPS is not…

… a taxonomy (ENV 12264:2005, Cornet 2006)

• Semantic nature of hierarchic

links are not specified

• Subclass or is-a relation:

a class B is a subclass

of a class A

if and only if

all members of B are

also members of A

(ENV 12264:2005, Horrocks 2003)

ICPS Architecture Critique Typology Outlook

ICPS is not yet…

… a classification (ISO 17115:2007, Ingenerf MIM 1998, Madden [WHO-FIC] 2007)

• Criterion of mutually disjoint,

exhaustive classes not fulfilled

• more than hundred

ICPS concepts occur

more than once in different

hierarchies

– Healthcare Professional occurs both as

a child of People Involved and Person

Reporting

ICPS Architecture Critique Typology Outlook

Structure of the Talk

• ICPS: How does it look like?

• ICPS: What it isn’t

• ICPS: What it is now

• ICPS: What it may be in the future

ICPS Architecture Critique Typology Outlook

ICPS: What it is now

9. Hazard: a circumstance, agent or action with the potential to cause harm.

10. Circumstance: a situation or factor that may influence an event, agent or person(s).

11. Event: something that happens to or involves a patient.

12. Agent: a substance, object or system which acts to produce change.

13. Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum.

14. Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury.

15. Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient.

informsActionsT

akenT

o R

edu

ceR

isk

Contributing Factors/ Hazards

Incident

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcomes

Ameliorating Actions

ActionsT

akenT

o R

edu

ceR

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcomes

informs

informs

influences informs

informsActionsT

akenT

o R

edu

ceR

isk

Contributing Factors/ Hazards

Incident

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcomes

Ameliorating Actions

ActionsT

akenT

o R

edu

ceR

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcomes

informs

informs

influences informs

“Conceptual Framework”

“Key Concepts”

ICPS Architecture Critique Typology Outlook

ICPS "taxonomy"

ICPS: What it is now

9. Hazard: a circumstance, agent or action with the potential to cause harm.

10. Circumstance: a situation or factor that may influence an event, agent or person(s).

11. Event: something that happens to or involves a patient.

12. Agent: a substance, object or system which acts to produce change.

13. Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum.

14. Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury.

15. Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient.

informsActionsT

akenT

o R

edu

ceR

isk

Contributing Factors/ Hazards

Incident

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcomes

Ameliorating Actions

ActionsT

akenT

o R

edu

ceR

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcomes

informs

informs

influences informs

informsActionsT

akenT

o R

edu

ceR

isk

Contributing Factors/ Hazards

Incident

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcomes

Ameliorating Actions

ActionsT

akenT

o R

edu

ceR

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcomes

informs

informs

influences informs

“Concepts by Class” “Conceptual Framework”

“Key Concepts”

This is a rudimentary, informal ontology• describes terms by their generic properties• close to upper-level ontologies (e.g.

BioTop): “state”, “substance”, “event”,

“agent”, “object”, “action”, “quality”.

ICPS Architecture Critique Typology Outlook

ICPS: What it is now

9. Hazard: a circumstance, agent or action with the potential to cause harm.

10. Circumstance: a situation or factor that may influence an event, agent or person(s).

11. Event: something that happens to or involves a patient.

12. Agent: a substance, object or system which acts to produce change.

13. Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum.

14. Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury.

15. Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient.

informsActionsT

akenT

o R

edu

ceR

isk

Contributing Factors/ Hazards

Incident

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcomes

Ameliorating Actions

ActionsT

akenT

o R

edu

ceR

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcomes

informs

informs

influences informs

informsActionsT

akenT

o R

edu

ceR

isk

Contributing Factors/ Hazards

Incident

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcomes

Ameliorating Actions

ActionsT

akenT

o R

edu

ceR

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcomes

informs

informs

influences informs

“Conceptual Framework”

“Key Concepts”

ICPS Architecture Critique Typology Outlook

ICPS "taxonomy"

This is a complex patient

safety model• Similarity with

- workflows- business models

- Ontologically:- complex event type

ICPS: What it is now

9. Hazard: a circumstance, agent or action with the potential to cause harm.

10. Circumstance: a situation or factor that may influence an event, agent or person(s).

11. Event: something that happens to or involves a patient.

12. Agent: a substance, object or system which acts to produce change.

13. Patient Safety: the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum.

14. Healthcare-associated harm: harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury.

15. Patient safety incident: an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient.

informsActionsT

akenT

o R

edu

ceR

isk

Contributing Factors/ Hazards

Incident

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcomes

Ameliorating Actions

ActionsT

akenT

o R

edu

ceR

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcomes

informs

informs

influences informs

informsActionsT

akenT

o R

edu

ceR

isk

Contributing Factors/ Hazards

Incident

IncidentCharacteristics

PatientCharacteristics

Detection

Mitigating Factors

PatientOutcomes

Ameliorating Actions

ActionsT

akenT

o R

edu

ceR

isk

influences

influences

informsinfluences

informsOrgani-zational

Outcomes

informs

informs

influences informs

“Conceptual Framework”

“Key Concepts”

This is a structured data

acquisition template

consisting of (mostly) binary

fields

Can be described as

information model

Hierarchical parents provide

context information for fields

(but are not superclasses)

ICPS Architecture Critique Typology Outlook

ICPS "taxonomy"

Structure of the Talk

• ICPS: How does it look like?

• ICPS: What it isn’t

• ICPS: What it is now

• ICPS: What it may be in the future

What ICPS may be in the future

• After finishing, ICPS has the potential to be universally

accepted as a reporting standard

• The ICPS “key concepts” may become a fully-fledged formal

ontology rooted in existing upper-level ontologies and using

Semantic Web standards, e.g. OWL

• The ICPS “conceptual framework” can be ontologized in the

same line

• The ICPS reporting template ("taxonomy") may be fully

described in terms of ICPS’s ontological core

• but…

ICPS Architecture Critique Typology Outlook

Open issues

• The needs for semantically interoperable

patient-safety relevant event reporting is

essentially different from the reporting of

diseases

• For the latter, the format of a statistical

classification is adequate (ICD-10)

• Is the format of a reporting template adequate

for the purpose ICPS is devised for?

• Is it necessary to transform the ICPS tree into a

real taxonomy or classification structure?

• Terms like “taxonomy”, “classification” should

be used thoughtfully

ICPS Architecture Critique Typology Outlook

Acknowledgements

Is the “International Classification for Patient Safety” (ICPS) a Classification?

Stefan SCHULZ, Daniel KARLSSON, Christel DANIEL, Hans COOLS, Christian LOVIS

Thanks for discussions: Pierre Lewalle (WHO)Jean-Marie RodriguesCédric Bousquet

(Université de St.Etienne)