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Resolving Semantic Heterogeneity in
Healthcare: An Ontology Matching Approach
Iroju O. Ganiyat, Soriyan, H. Abimbola and Gambo P. Ishaya

AbstractThe major goal of semantic interoperability in the healthcare domain is to ensure that healthcare systems exchange
information with a shared and unambiguous meaning. However, this objective is yet to be realized within the healthcare domain
due to the problem of semantic heterogeneity of information. However, diverse ontologies have been developed to resolve the
problem of semantic heterogeneity in the healthcare domain. Nevertheless, the use of these ontologies has proved abortive
towards the resolution of semantic heterogeneity. Consequently, semantic heterogeneity is a critical problem that is currently
being faced by healthcare organizations since it is often difficult for healthcare systems to interpret clinical terms appropriatel y
during communication process. This paper therefore outlines the causes and major challenges of semantic heterogeneity within
the healthcare domain and also proposes an ontology matching framework that intends to explicitly specify the semantics of
information in the healthcare domain in an unambiguous fashion.
Index Terms healthcare domain, ontology matching, semantic heterogeneity, semantic interoperability


ne of the major barriers to the delivery of effective
healthcare in the healthcare domain is the presence
of semantic heterogeneity amongst healthcare
systems. This is because the healthcare system is
characterized by heterogeneous terms which may refer to
the same concept (e.g. heart and cardiac, heart attack and
myocardial infarctions) [1]. This inherent polysemy of
healthcare concepts makes data interpretation amongst
communicating systems a formidable challenge because
of the inability of computers and other ICT related
facilities to capture the semantics of information [2].
Semantic heterogeneity in the context of
healthcare can therefore be considered as a phenomenon
which occurs whenever there is a discrepancy in the
meaning and the interpretation of the same or related
medical concepts. It is regarded as a major obstacle to the
seamless exchange of health-related information as well
as the correct interpretation of this information in an
unambiguous way. In essence, semantic heterogeneity is
the major hindrance to semantic interoperability in
In recent times, ontologies have been deployed
for resolving semantic heterogeneity by explicitly
specifying the semantics of terms in a well defined and
unambiguous manner [3], [4], and [5]. Unfortunately, the
healthcare domain is composed of diverse ontologies
with contradicting or overlapping parts [1]. Thus, the
heterogeneous nature of the healthcare ontologies also
introduces semantic heterogeneity to this domain [6].
Consequently, the healthcare domain is faced with major
challenges such as increasing costs, undesirable error
rates, dissatisfied patients and healthcare providers, as
well as gross medical errors [7]. However, to alleviate
this problem, the heterogeneous ontologies should be
matched by finding the correspondences between the
semantically related entities of the ontologies in order to
reduce heterogeneity between them [5]. This will ensure
that the knowledge and data in the matched ontologies
are semantically interoperable.
This paper therefore presents the concepts of
interoperability, semantic heterogeneity and its attendant
causes in healthcare. The paper also appraises the effects
of semantic heterogeneity in healthcare and presents a
proposed ontology matching framework for ameliorating
the problems of semantic heterogeneity in healthcare.
Interoperability, according to Trond and Jochen [8], is
the ability of Information and Communication
Technology (ICT) systems and of the business processes
they support to exchange data and share information and
knowledge. The Institute of Electrical and Electronics
Engineers standard computer dictionary [9], also viewed
interoperability as the ability of two or more systems or
components to exchange information and to understand
the meaning of the information that have been
exchanged. Semantic Health Report [6], however, viewed
interoperability in the context of the health system as the
ability of Information and Communication Technology
(ICT) applications and systems to exchange, understand
and act on patients and other health-related information
and knowledge, among linguistically and culturally
disparate health professionals, patients and other actors
and organizations within and across health system
jurisdictions in a collaborative manner.
There are different levels of interoperability [10].
These include:

2.1 Level 0 or No Interoperability
This is usually characterized by stand-alone systems
which have no interoperability.

2.2 Level 1 or Technical Interoperability
This level of interoperability involves the use of a
communication protocol for the exchange of data between
systems. Technical interoperability establishes
harmonization at the plug and play, signal and protocol

2.3 Level 2 or Syntactic interoperability
This is the ability of two or more systems to exchange
data and services using a common interoperability
protocol such as the High Level Architecture (HLA).

2.4 Level 3 or Semantic Interoperability
Semantic interoperability, according to the Institute of
Electrical and Electronics Engineers Standard Computer
Dictionary [6], refers to the ability of two or more systems
to automatically interpret the information exchanged
meaningfully and accurately in order to produce useful
results as defined by the end users of the systems.
Semantic interoperability is also used in a more general
sense to refer to the ability of two or more systems to
exchange information with an unambiguous and shared
meaning [11]. In other words, semantic interoperability
connotes that the precise meaning of the exchanged
information is understood by the communicating
systems. Hence, the systems are able to recognize and
process semantically equivalent information
homogeneously, even if their instances are
heterogeneously represented, that is, if they are
differently structured, and/or using different
terminology or different natural language [6]. Semantic
interoperability can thus be said to be distinct from the
other levels of interoperability because it ensures that the
receiving system understands the meaning of the
exchange information, even when the algorithms used by
the receiving system are unknown to the sending system.

2.5 Pragmatic Interoperability
This level of interoperability is achieved when the
interoperating systems are aware of the methods and
procedures that each other are employing [10]. In other
words, the use of the data or the context of its application
is understood by the participating systems.

2.6 Dynamic Interoperability
A system is said to have attained dynamic
Interoperability when they are able to comprehend the
state changes that occur in the assumptions and
constraints that each other is making over time, and are
able to take advantage of those changes.

2.7 Conceptual Interoperability
Conceptual interoperability is reached if the assumptions
and constraints of the meaningful abstraction of reality
are aligned.
The healthcare domain is a complex system that is made
up of diverse independent sub-systems such as
pharmacy, nursing, dentistry, medicine and radiology.
These systems are composed of different specialities,
physical locations and core principles [12]. The major goal
of these autonomous systems is to manage patient
information which is usually exchanged across these
various systems. This information may be presented in
diverse geographical locations and on diverse e-health
systems. These systems are typically standalone systems
developed by different people, with different methods
and tools and are typically incompatible with one
another. The heterogeneity of these systems represents a
major problem in transferring data among healthcare
systems. The heterogeneity in these systems can either be
syntactic, schematic, or semantic. Syntactic heterogeneity
is usually caused when different models or languages are
used to develop the systems. Schematic heterogeneity
typically occurs when different database structures are
used in the development of the system while semantic
heterogeneity is usually encountered whenever there is
an inconsistency or a discrepancy in the meaning and the
interpretation of the same or related medical concepts.
Basically, semantic heterogeneity generally occurs when
the same medical concept is represented using different
denotations, thus the concepts are interpreted differently
[13]. Semantic heterogeneity can occur as a result of the
differences in data-definition constructs, differences in
object representations, and system-level differences [14].
Thus, semantic heterogeneity is a complicated term for
the phenomenon of disagreement about the meaning or
interpretation of the same or related data.

3.1 Types of Semantic Heterogeneity
Goh, [15], identified three main types of semantic
heterogeneity. These include confounding conflicts,
scaling conflict and naming conflict. Confounding conflict
occurs when information items which seem to have the
same meaning differ in reality, owing to different
temporal contexts. Scaling conflict usually occurs when
different reference systems are used to measure a value.
Naming conflict occurs when the naming schemes of
information differ significantly. A frequent occurrence is
the presence of homonyms and synonyms. This
heterogeneity makes data interoperability a complex task.

There are various factors inhibiting the meaningful
exchange of healthcare information amongst healthcare
systems. These factors include:

4.1 Lack of a Unified Terminological Set in
The healthcare system lacks a unified terminology set.

Consequently, healthcare concepts are characterized by
different terminologies which consist of multiple
representations for the same clinical concept [16]. A
typical example of this is the use of synonymous terms
such as heart attack, MI, and myocardial infarction. These
terms mean the same to a cardiologist but they are
different to computers and other ICT related facilities.
This is because of their inability to capture the semantics
of information. This poses challenge to semantic
interoperability in the healthcare domain.

4.2 Heterogeneous Structures
There is no standardized structure for medical reports
and clinical terminology [16]. For instance, the titles and
codes of case notes, diseases, drugs, diagnostic tests, and
examination differ in different healthcare organizations.
The code for a particular disease in a clinical terminology
or case note could refer to another disease in another
terminology or case note. However, the basic
precondition for the exchange of information in the
healthcare domain requires that both the sender and
receiver of the data use the same healthcare information
standard [17].

4.3 Abbreviated Medical/Clinical Terms in Clinical
Clinical texts are generally characterized by numerous
abbreviations which are highly ambiguous. For example,
pe, may represent physical examination, pleural
effusion, or pulmonary embolism [18]. This phenomenon
presents a high degree of semantic heterogeneity to the
healthcare domain. Consequently, this leads to gross and
intolerable medical errors.

4.4 Exponential Increase in the Number of
Incompatible Terminology Systems
The exchange of patient records and other health related
data as well as their meaningful analysis across diverse
electronic health systems requires that the
communicating systems have an understanding of the
concepts stored in terminology systems such as
nomenclatures, vocabularies, thesauri, or ontologies. The
notion behind this theory is that, computer systems will
comprehend one another perfectly if they deploy the
same terminology or mutually compatible ones.
However, the number of terminological systems with
mutually incompatible definition is growing
exponentially day by day [19].

4.5 Standardization Problems
Most healthcare systems are proprietary and served a
specific department within a healthcare institute at a time.
This however makes it difficult to easily share
information across diverse systems. However, there are
several standards (such as Health Level 7 standards,
Open EHR) that are aimed at providing standard
interfaces to healthcare systems. These standards are
usually established by consensus and approved by a
recognized body to provide rules, guidelines or
characteristics foe activities [20]. One of the major goals of
these standards is to improve patients care by resolving
heterogeneity among disparate healthcare systems.
However, healthcare institutes do not conform to a single
standard. Hence, the seamless exchange of information
within the healthcare domain remains a difficulty.
Some of the major challenges of semantic heterogeneity in
the healthcare domain are highlighted as follows:

5.1 Clinical Misinterpretation
Medical information might be expressed in a way that is
suitable for physicians but not necessarily for
computation or even implementers of information
systems [7]. Hence, the use of diverse terms for the same
concept introduces semantic heterogeneity to the
implementers thereby facilitating the misinterpretation of
these terms.

5.2 High Rate of Error
The delivery of safe and effective healthcare is a
challenge, particularly as the degree of medical errors is
becoming evident. The United States Institute of Medicine
reported that 100,000 US citizens die each year through
medical errors [21]. This is because the healthcare domain
lacks a unified terminology as well as a unified ontology,
which leads to semantic heterogeneity and hence the
problem of semantic interoperability. Consequently, the
healthcare system is characterized by high error rate.

5.3 Increased Cost of Healthcare
One of the major challenges that the healthcare industry
is facing is increasing costs. For instance, the costs of
healthcare in the United States alone was about 14.9 % of
the Gross Domestic Product specifically $1.6 trillion in
2002 [23], 1.9 trillion in 2005 [24] and projected to rise to
3.6 trillion by 2014 [23]. Increased cost of healthcare is
usually due to the ineffective sharing and communication
of data, information, and knowledge among various
stakeholders in the healthcare network which is usually
due to semantic heterogeneity.

5.4 Difficulty in Data Integration
Patients records are usually stored on diverse hospital
information systems with heterogeneous databases which
usually require integration for effective and meaningful
exchange of health related information. The integration of
patients records, however, usually poses a problem
within the healthcare domain. For instance, integrating
patients records from two different databases with
different formats might result in semantic heterogeneity.
For example, one database schema might store the patient
hospital number in a field named Hospital Number, but
in another database schema, a field containing the same

data could be called Patient _Number. Hence, the
integration of these data in these databases might results
in data corruption.

According to Shvaiko (2006) and Enuoyibofarhe et
al., [5], [24], an ontology provides a vocabulary that
describes a domain of interest and a specification of the
meaning of terms used in the vocabulary. They are
generally used to provide a uniform conceptualization of
terms [25]. An ontology according to Zaib [26] is a 5 tuple:

> =< D R I A C O , , , , (1)
such that:
} .......... .......... ,......... {
1 k
c c C = (2)
is the set of concepts.
)} ( .... .......... ),........ ( {
1 k
c A c A A= (3)
} ...... .......... ,......... { ) (
1 1 in i
a a c A = (4)
being a set of attributes assigned to a concept c
} ....., .......... ,......... {
1 m
r r R = (5)
o e c c r
being the set of relations; a relation
connects two concepts with each other, denotes the
natural alphabet in which the name/type of the relation is
} .......... .......... ,......... {
1 k
I I I = (6)
} ......., .......... ,......... {
1 o n
i i I = (7)
being a set of instances assigned to a concept c
, and D is
a set of description logic sentences.
In the context of healthcare, ontologies are developed to
facilitate the reuse and exchange of medical data [27].
Examples of ontologies in healthcare include disease
ontology, the Systemized Nomenclature of Medical-
Clinical Terms (SNOMED-CT), Unified Medical
Language System (UMLS) and OpenGALEN. The basic
advantage of using ontologies in the healthcare system is
the ability to resolve semantic heterogeneity. Thus,
medical ontologies are developed to enable the reuse and
sharing of health related data and to resolve semantic
heterogeneity that are present within the data. In spite of
the advantages of ontology in the healthcare domain, the
use of diverse ontologies introduces heterogeneity
problems to this domain [6].

6.1 A Brief Description of Ontology Matching
According to Interop [28], ontology matching can be
viewed as the process of setting up conjunction between
heterogeneous ontologies without changing the original
ontology, so that both sides can obtain a common
understanding of the same object.
Formally, the ontology matching process
according to Zaib [26] is defined as:
) , ( ) , ( :
2 1
c c P O Match (8)
P c
O c
t c c sim > ) , (
2 1
where O and P are the ontologies,c
and c
are the
concepts or entities of the ontologies, sim is the similarity
function between the two entities and t is the similarity
threshold. Ontology matching, according to Euzenat and
Shvaiko [29], can be represented as a function which
matches two input ontologies O and O by using a
previous alignment A, a set of parameters and several
other resources such as a knowledge or domain specific
thesauri. This process generates an alignment A which
represents the correspondences between the two input
ontologies is produced.
) , , , ' , ( R P A O O f A= (11)
The result of the ontology matching process is called an
alignment. An alignment is defined as a set of
correspondences which represent relations between
different entities. A correspondence, c, according to
Shvaiko, [5], is a 5-tuple:
> =< n r e e id c , , ' , , (12)
Where id is a unique identifier of the correspondence, e is
an entity of ontology O, e is an entity of O, r denotes an
alignment relation such as equivalence (=), more general,
overlapping and disjointness between the two entities
and n gives a confidence value such as a similarity value.
The ontology matching process is classified into
three stages namely pre-matching stage, matching stage
and post-matching stage [32]. The pre-matching stage
involves feature engineering which involves the
transformation of two ontologies into a common format
suitable for similarity computation. Syntactic
normalization is also involved in the feature engineering
task. This involves the application of natural language
processing techniques such as tokenization,
lemmatization and elimination to the ontologies to be
matched. Another task in the pre-matching stage is the
determination of the next search step. This involves
finding a matching candidate in the ontologies to be
matched. The most common approach is to compare all
entities of the first ontology with all entities of the second

ontology. After the completion of the pre-matching stage,
is the matching stage where the actual similarity
computation is carried out to determine the similarity
values between matching candidates. The post-matching
stage requires the aggregation of different similarity
values into a single value for one candidate pair. The final
task of the post-matching stage is the interpretation of the
similarity value in order to derive the best matching
pair(s) among concepts in the first ontology and a set of
concepts in the second ontology. These five tasks of
ontology matching iterate until no new similarities are

The proposed ontology matching framework for
resolving semantic heterogeneity in the healthcare
domain is depicted in Fig. 1. The goal of this framework
is to match medical terms/concepts extracted from
heterogeneous medical ontologies such as SNOMED-CT
and disease ontology. These terms are disambiguated by
looking up the Unified Medical Language System which
is a form of medical ontology for the meaning of the
concepts.The concepts are then matched in a pair-wise
manner. This is achieved by querying the Unified Medical
Language System (UMLS) for the meaning of the terms
and their set of synonyms. This is done based on the
assumption that two terms are similar if they have at least
one common word in their sets of synonyms [30]. If there
is a common word in the set of synsets, it indicates that
the two terms are semantically similar. The semantic
similarity of the concepts is computed with the use of the
Wu and Palmers algorithm and Jiang Coranth semantic
similarity measures. The Wu and Palmer algorithm
determines how semantically similar two word senses are
in the UMLS, based on the depth of the two senses in the
resource and their lower common subsumer.

Fig. 1: Proposed Ontology Matching Framework

In addition, the Jiang Conrath semantic similarity
measure measures the semantic similarity of the two
terms by using the difference in the information content
of the two concepts to indicate their similarity [31]. This
measure returns a score denoting how similar two word
senses are, based on the information content of the lowest
common subsumer in the UMLS and that of the input
synsets. These semantic similarity measures result in a
semantic similarity matrix between the concepts
compared. Afterwards, the results of the semantic
similarity measures are aggregated using the ordered
weighted average of the two semantic similarity measures
as depicted in equation 6.3.

i i
i jc wup agg
we sim we sim sim sim
. ) , ( (13)
Where we
is the weight assigned to the similarity values
. The aggregated values are pruned as values that are
below the threshold of 0.6 are eliminated. If the ratio is
exactly 1.0, it indicates that the terms are equivalent. As a
rule of thumb, if the ratio is over 0.6, it means the terms
are close matches. Consequently, terms that are within
this range can be said to be semantically equivalent.
The proposed ontology matching framework is
aimed at solving semantic heterogeneity in healthcare by
determining concepts that are characterized by similar
terminologies. This will help in reducing medical
diagnostic errors.

8.0 Conclusion
The use of ontologies within the healthcare domain is the
primary means of resolving semantic heterogeneity.
However, the diversity of ontologies used within this
domain raises semantic heterogeneity to a higher level.
However, a successful ontology matching between two
systems reconciles the semantic heterogeneity between

them. This paper therefore appraised semantic
heterogeneity, its causes within the healthcare domain
and also the challenges of semantic heterogeneity within
the healthcare domain. The paper also examines the
concepts of ontology and ontology matching, and also
presents an ontology matching framework for resolving
semantic heterogeneity in healthcare.


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Iroju O. Ganiyat has a B.Sc. in Computer Technology at Babcock
University, Nigeria. She also has M.Sc and PhD in Computer
Science at Obafemi Awolowo University, Nigeria. She is a lecturer at
the Department of Computer Science, Adeyemi College of
Education, Ondo, Nigeria. Her research interest is on interoperability
and ontology matching.

Soriyan H. Abimbola is an Associate Prof of Computer Science at
the Obafemi Awolowo University Ile-Ife, Nigeria. Her research
interest is in Information Systems, Health Informatics, and Software

Gambo P. Ishaya is a lecturer of Computer Science at the Obafemi
Awolowo University Ile-Ife, Nigeria. He is pursuing a PhD degree in
Computer Science. He has got a good number of publications in
reputable journals and learned conferences. His research interest is
in Information systems design and methodology, software
engineering with emphasis on Software Architecture and software
quality issues.