Collaborative Semantic Annotation Tooling (CoAT) to Improve Efficiency and Plug-and-Play Semantic Interoperability in the Secondary Use of Medical Data: Concept, Implementation, and First Cross-Institutional Experiences

Featured Application Within the context of the Medical Informatics Initiative (MII) funded by the Federal Ministry of Research and Education (BMBF), German academic medicine constructs a nationally harmonized, joint infrastructure enabling secondary use of patient data from heterogeneous clinical IT sources. The semantic annotation of such data is a prerequisite for cross-site usage. The approach and software described in and published jointly with this manuscript may not only facilitate a more efficient semantic annotation process but also promote fully interoperable semantic representations by catalyzing convergent user decisions in the presence of non-uniqueness of annotation choices. Abstract The cross-institutional secondary use of medical data benefits from structured semantic annotation, which ideally enables the matching and merging of semantically related data items from different sources and sites. While numerous medical terminologies and ontologies, as well as some tooling, exist to support such annotation, cross-institutional data usage based on independently annotated datasets is challenging for multiple reasons: the annotation process is resource intensive and requires a combination of medical and technical expertise since it often requires judgment calls to resolve ambiguities resulting from the non-uniqueness of potential mappings to various levels of ontological hierarchies and relational and representational systems. The divergent resolution of such ambiguities can inhibit joint cross-institutional data usage based on semantic annotation since data items with related content from different sites will not be identifiable based on their respective annotations if different choices were made without further steps such as ontological inference, which is still an active area of research. We hypothesize that a collaborative approach to the semantic annotation of medical data can contribute to more resource-efficient and high-quality annotation by utilizing prior annotational choices of others to inform the annotation process, thus both speeding up the annotation itself and fostering a consensus approach to resolving annotational ambiguities by enabling annotators to discover and follow pre-existing annotational choices. Therefore, we performed a requirements analysis for such a collaborative approach, defined an annotation workflow based on the requirement analysis results, and implemented this workflow in a prototypical Collaborative Annotation Tool (CoAT). We then evaluated its usability and present first inter-institutional experiences with this novel approach to promote practically relevant interoperability driven by use of standardized ontologies. In both single-site usability evaluation and the first inter-institutional application, the CoAT showed potential to improve both annotation efficiency and quality by seamlessly integrating collaboratively generated annotation information into the annotation workflow, warranting further development and evaluation of the proposed innovative approach.