29

Combining Ontologies and Cognitive

Engineering to Innovate Electronic Health
Records
Eric Little, Ph.D
Chief Knowledge Engineer
Computer Task Group (CTG), Buffalo, NY

Abstract
Several challenges exist for implementing electronic health records (EHRs). Tantamount
to these challenges are issues surrounding the most effective ways to model medical
information and subsequently deliver that information to necessary stakeholders.
Therefore, it is important to design and implement EHR systems that are robust in terms
of their content and intuitive in terms of their use value. Ontologies can provide robust
and intuitive EHR capabilities, since ontological approaches more closely mirror the
ordinary ways in which people interact (and problem solve) with the world. In a like
manner, cognitive systems engineering – particularly the area of cognitive work analysis
(CWA) – offers empirically-based methodologies for better understanding the ways in
which people interact with data. By combining ontologies and CWA methodologies in
healthcare settings, it is possible to build systems that both model information in correct
ways and present it to those that need to utilize it in their day-to-day work environments.

Keywords: ontology, cognitive engineering, electronic health records, knowledge

management, semantics, life sciences.

1. INTRODUCTION
Ontologies are being applied to ever expanding areas of investigation to provide improved capabilities
for knowledge management, data modeling, data querying, relationship discovery/definition, and rule
manipulation [1-7]. Electronic health records (EHRs) are a growing technology, which are becoming
more prevalent throughout healthcare systems, but where challenges exist in terms of their
implementation and use [8-10]. The purpose of this paper is to provide an argument for how ontologies,
combined with certain practices from cognitive systems engineering, can be utilized , in tandem, to
provide for better structured, and easier to use, EHRs. Ontologies can be utilized to enhance EHRs in
knowledge management applications by providing: better realist models of reality, explicitly defined
semantics, more flexibility in the system’s design/use, and improved capabilities for merging
heterogeneous data sources, ultimately resulting in improved knowledge sharing, retrieval and
collaboration across medical areas [11-13]. Likewise, cognitive systems engineering practices,
particularly those in the area of work domain analysis (WDA) can be utilized to empirically study the
tasks and work environment of medical professionals and utilize that information to better design EHRs
from the standpoint of system functionality, visualization and ease of use. In this sense, ontologies
coupled with WDA can serve to augment heritage medical record systems, databases, and the like,
providing an improved overarching structure which can allow better manipulation of medical
information for a variety of user communities [14].
This approach understands ontologies as providing a metaphysical structure in the form of an
overarching upper ontology that sits above numerous domain-level sub-ontologies, providing a unified
classification system and semantic framework for all entities, attributes, processes and relations of
interest [15-17]. Transactional data specific to a given enterprise remains housed within heritage data
systems and is ingested by the ontology as needed, thereby becoming transformed into instances within
the domain represented by the ontology. This allows for improved reasoning capabilities across various
sorts of heterogeneous data, since numerous perspectives can be captured from subject matter experts
(SMEs) within the enterprise and added to the ontology over time. Subsequently, through the utilization
of WDA (and its capabilities to model tasks, user needs and the like) SME knowledge can be more
effectively utilized without the need for retooling the heritage systems themselves.

Volume 2 · Number 1 · 2010

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Eric Little 37

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