Recently, Theresa Regli announced in a CMS Watch about predictions for 2009 that taxonomy is dead, and that metadata was the future. The argument for death sentence is that taxonomies are viewed as too authoritarian, that it might be possible to auto-generate topics and concepts through computer processes and finally, that the work of taxonomists is to police vocabulary, and not to invite a multiple views of information. So let’s examine this assumption. So let’s confront a challenging information problem like health care insurance information systems.
To begin, let’s take a look at some of the heavily-used consumer websites for health care information such as Medicare website (www.medicare.gov) and the widely-touted Massachusetts Health Care Program. In each system, take the challenge what you can find out about benefits for specific conditions like type of cancer, asthma or allergies. Try to figure out what coverage is for routine office visits.
What you will notice is that both Medicare and the Massachusetts State public-facing information sources are hard to search.
Buried in Medicare under “Search Tools – Find Out What Medicare Covers“ and under “Find Out What Medicare Covers” is a picklist of about 150 alphabetically-arranged terms. A picklist is not a taxonomy. Let’s see what the picklist offers:
- · Multiple terms for Wheelchairs and Powered Operated Vehicles (POVS) and Motorized Wheelchairs, which are POVs. There are also multiple synonymous terms for Office Visit
- · No overarching concept for “Equipment.
- One term for all Surgical Services, but no specificity of terms by Surgical Specialty. That might lead to an assumption that all surgical services are covered.
- Important concepts are missing. There is no entry for “Asthma” or “Psoriasis” or “Dermatology or many other common complaints or hundreds of procedures.
- Multiple terms for Lab tests and Diagnostic Procedures with no overarching category and none of these terms are linked to standard medical coding systems.
- Over time, it’s difficult to scroll through hundreds of unorganized terms
- Picklists are not compatible with web accessibility needs, particularly important for the audience of health care (or any) website.
One of the problems is that taxonomists have NOT been involved in solving these serious information problems. What would a taxonomist do? Taxonomists help design other ways that users, such as consumers, patients, caretakers, advocates, doctors, insurance companies, and policy analysts look for information. They group terms in meaningful categories based on proven methodologies that are used to analyze predictable categories of knowledge. Taxonomists perform gap analysis to identify missing concepts. Some taxonomists work with auto-classification and ontological tools to develop rules and semantic models.
Wouldn’t it be useful to have a health care information system that look at care based on a various levels of modeling such as ”point of need” such as Routine Care, Non-Routine Care, Emergency Care, Rehabiliation and Restorative Care, Chronic Care (including preexisting conditions), and Life-Threatening and Palliative Care. At the lower, concrete levels, this taxonomy would connect to the detailed services, which could then be connected to cost control data.
Look at www.cancer.gov, while not providing health care insurance benefits, at least promotes finding information by type of cancer. http://www.Cancer.gov has a taxonomy that is faceted in that it is organized by types of cancer. Here is a good example of taxonomy at work and an example of what taxonomy can do to help make these interfaces simpler and more friendly to its audience.
I am a fan of faceted taxonomies, but now I am of the belief that simply categorizing a term to a canonical form might be sufficient, because it captures the context of the term in one moment in time. But as many as 80% categories of knowledge are predictable based on our shared knowledge and can be suggested as part of the web interface design process. But taxonomies also need to friendly to user terminology. Who cares if an office visit to the doctor is called “Wellness Visit” “Routine Visit” or “A day at the beach” as long as the terms link back to the same basic concept.
Is taxonomy dead. Old style authoritarian taxonomies are gone, but taxonomies as capturing models of how we think are very much alive and very necessary to improve public access to important information. Words matter. Long live taxonomy!
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