Addiction-Related Vocabulary Proposal

[kevinawilson]

I would like to propose the addition of vocabulary related to addiction and the treatment of addiction. The accompanying diagram shows the proposed additions in red along with their relations to existing vocabulary in the core and the health-lifesci extension.

AddictionTreatmentCenter

The first class to be added is AddictionTreatmentCenter, which is a subclass of MedicalOrganization and MedicalBusiness. It is at the same level as other MedicalOrganization subtypes such as Physician, MedicalClinic, and Hospital. The properties are:

• onsiteDetox, which takes a Boolean value. This indicates whether the center has its own detox facilities on site or makes use of those at another entity such as a hospital.
• typesOfPrograms, which takes a Text value. Standard values would include inpatient, outpatient, and residential. I suggest Text as a type instead of enumerations for flexibility.
• availableService, which takes a MedicalTherapy as its type. This property is currently used on Hospital, MedicalClinic, and Physician. It may make sense to make availableService a property of the parent class MedicalBusiness because it is used on so many of the subtypes. On the other hand, makesOffer is already a property that AddictionTreatmentCenter would inherit. The Offer could indicate the service that is available, so availableService may not be necessary.

AddictionDisorder

The second proposed class is AddictionDisorder, which is a subclass of MedicalCondition. AddictionDisorder could be used as a value for healthCondition on the Patient class. The term AddictionDisorder corresponds to the language of DSM-V, and covers both substance and behavioral/process addictions. The properties are:

• addictedTo, which would take a Drug or Text as its type. This indicates the drug(s) or process(es) to which the patient is addicted and would be parallel to the language “drug of choice” that is used in addiction treatment.
• addictionType, which would take Text as its type. This would be used to indicate whether an addiction was a substance addiction or a behavioral addiction (e.g., sex, gambling, eating disorders).

MedicalSpecialty Enumerations

I also propose two enumerations be added to MedicalSpecialty. These are AddictionMedicine and AddictionPsychiatry, which are the two specialties recognized by the American Board of Medical Specialties. This has been discussed in issue #1334, and Leeza Rodriguez suggested using these two enumerations. AddictionTreatmentCenter would use these enumerations for the property medicalSpecialty it inherits from MedicalOrganization. This would allow them to indicate whether they provided medical or psychological treatment for addiction (or both).

Issues of Accreditation

Leeza also raised valid concerns about addiction treatment centers marketing themselves without having any parent boards that regulated them (akin to problems in the past with pain management providers). I considered proposing a property of accreditedBy for AddictionTreatmentCenter to allow organizations to list credentials. CARF International and The Joint Commission are the two main accrediting bodies for addiction treatment. MedicalEntity has a property of recognizingAuthority that is described as “the organization that officially recognizes this entity as part of its endorsed system of medicine.” I’m not sure whether this would correspond to an accrediting agency and therefore could be used as a property on AddictionTreatmentCenter or whether accreditedBy would be a better property. Either way, I would propose that it take MedicalOrganization as its type.

Coding

I have written the RDFa definitions for the proposed items, along with JSON-LD and RDFa markup examples. Unfortunately, I am having trouble getting the schema.org app to work (see issue #1384), so I am currently unable to put these up for comment. I will make these available as soon as I can.

[LeezaRodriguez]

hi Kevin--wow, this is a well thought out proposal. I haven't digested everything, but thank you for taking my Accreditation comments into consideration. I believe that identifying recognizingAuthority and accreditedBy is a critical step in helping the search engines and the consumer figure out which centers are the legitimate and well credentialed organizations and physicians.

With Accreditation, just for clarity, I believe are dealing with two variations of Accreditation:

1. Organization accreditation ( AAAASF , The Joint Commission)
   This is similar to the type of accreditation that out patient surgery centers and hospitals attain. It is granted to the organization.

2. MedicalSpecialty certification ( the Medical Board that has oversight of Board Certification of a Physician person). Board Certification is granted to the Physician person.

Allow me to rant about #2....
This is a particular hot button for me because the provenance of MedicalSpecialty is with the Physician, the person, and not the organization. But the Physician-person is currently non existent in the schema.org hierarchy. Physician is currently an organization, and NOT a person. @twamarc is aware and he proposed some solutions in this thread here: #492 (comment)
Recap of concerns:

MedicalSpecialty originates with the Physician person(s) in the organization.
If the Physician-person leaves with no replacement, the organization MedicalSpecialty is lost. It is the Physician, the person, who gets Board Certification in a particular MedicalSpecialty. Each MedicalSpecialty has a MedicalBoard who issues the Board Certification to the Physician person. Furthermore, each MedicalBoard has an oversight board. In your example, the individual physicians have Board Certification with either AddictionMedicine (issued by American Board of Preventive Medicine) or AddictionPsychiatry (issued by American Board of Psychiatry and Neurology) . The trainings are different pathways with different focus and each one of these Boards are regulated by the American Board of Medical Specialties (ABMS). Approximately 80% of US physicians are under this system in the USA. @twamarc had stated that ~a similar type structure applies to the EU.

Ontology alignment concerns
Physician was asserted as a person in Freebase, and it is a person in Wikidata. Physician only exists as an organization in schema.org. We need to make a data type for Physician, the person, and disambiguate it between the person and the organization. If not, this is going to be a hot mess when Insurance and Clinical Trial vocabulary are introduced. With Insurance, the Physician person and Physician organization are two different entities with different NPI numbers. In Clinical Trials, the PI (primary investigator) of any trial is a Physician person, NOT a Physician organization.

Apologies for the tangential rant.

Nevertheless, I support adding the two ABMS MedicalSpecialty enumerations of AddictionMedicine and AddictionPsychiatry. As I understand it, the next iteration would overhaul the list of enumerations. Here is my working spreadsheet to help address this.
https://docs.google.com/spreadsheets/d/1y7KIP0icoqowZ1uX4H33rVJKfj5WAjIeqkEpnuN6A9U/edit#gid=0

Thanks for taking the time to think all of this through. It's so important that we get this right so that the future AI engines will be able to deliver answers that can disambiguate the well credentialed providers from the posers.

[kevinawilson]

I have the testing app up and running on the Google App Engine for people to review. The link to the main entry is at [http://health-lifesci.3-2.sdo-addiction.sdo-addiction.appspot.com/AddictionTreatmentCenter]. The only change from the proposal above is the accreditedBy property that has been added pursuant to @LeezaRodriguez's comment.

The portal to the app is at [http://sdo-addiction-dot-sdo-addiction.appspot.com], but this is resulting in an https error when you try to go into the health-sci extension. For some reason, adding 3-2 to the URL makes it work. I'm also not sure why the AddictionTreatmentCenter page is giving the same example twice. It is only in the file once.

I look forward to input/feedback.

[github-actions]

This issue is being tagged as Stale due to inactivity.