1 aug 2008 © 2002-2008 health level seven ®, inc. all rights reserved. hl7 and health level seven...

11Aug 2008

© 2002-2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off

January 2009

Clinician Orientation

HL7 Clinical Interoperability Council (CIC)

22Aug 2008


Introductions

• Tell us a bit about yourself Your name and organization Why you are here today/this week What you hope to gain from today’s session


3333Aug 2008Aug 2008

Welcome!

44Aug 2008


Objectives for Today

• Convey mission and purpose of the HL7 Clinical Interoperability Council (CIC)

• Discuss how standards can support the clinical community

• Discuss how CIC conducts work• Describe what standards look like• Understand how to get involved• Understand general information about HL7

and how workgroup meetings function


5555Aug 2008Aug 2008

Introduction to HL7

Crystal Kallem

66Aug 2008


Health Level Seven, Inc. (HL7)

• An international standards development organization (SDO) established more than 20 years ago

• Creates standards for the exchange, management and integration of electronic healthcare information

• Develops specifications that enable disparate healthcare applications to exchange key sets of clinical and administrative data

77Aug 2008


HL7 Vision/Mission

VisionTo create the best and most widely used standards in healthcare.

MissionHL7 provides standards for interoperability that improve care delivery, optimize workflow, reduce ambiguity and enhance knowledge transfer among all of our stakeholders, including healthcare providers, government agencies, the vendor community, fellow SDOs and patients. In all of our processes we exhibit timeliness, scientific rigor and technical expertise without compromising transparency, accountability, practicality, or our willingness to put the needs of our stakeholders first.

88Aug 2008


Why Standards?

• Standards enable interoperability of healthcare information

• Three aspects of interoperability Technical: Moving data from system A to system B Semantic: Ensuring that system A and system B

understand the data in the same way Process: Enabling business processes at

organizations housing system A and system B to work together

99Aug 2008


HL7 Workgroups

• Multiple workgroups function within HL7 today addressing various aspects of standards development

• The Clinical Interoperability Council (CIC) is an official workgroup of HL7

1010Aug 2008


HL7 Workgroup Meetings

• HL7 face-to-face workgroup meetings occur in January, May and September each year

• Workgroup meetings offer A chance to meet face-to-face to work on standards

and conduct administrative work An opportunity to exchange knowledge and ideas

that lead to advancement in healthcare information technology utilization


11111111Aug 2008Aug 2008

Introduction to the Clinical Interoperability Council (CIC)

Crystal Kallem

1212Aug 2008


A Bit of History

• Early standards addressed what was needed as part of hospital information systems and departmental system

• Most current standards are transparent to the clinical community

• The needs for standards change as we progress with information technology

• The future must be different

1313Aug 2008

© 2002-2008 Health Level Seven ®, Inc. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off 13

The Problem

Data Collected or Generated During

Patient Care

Data Used

1414Aug 2008


Uses of Data Have Significant Overlap

ReimbursementManagementResearch

Quality M

easurement

& Patient Safety P

opul

atio

n H

ealth

Rep

ortin

g

Clinical Data

1515Aug 2008


Goal: Exchange and Use of Data

Patient

Clinician

Healthcare Data Systems

• Patient care• Quality Improvement• Research• Reimbursement• Post Marketing Safety• Decision Support• Administration & Mgt.• Population Health Reporting

• …

Data Uses

Single Source Multiple Uses

1616Aug 2008


Funding &Development

Partners

ResearchSurveillance

Patient CareRegulatory

Data Element: chest x-ray result

1717Aug 2008



Partners




= = = =

Data Mapping

1818Aug 2008



Partners




Global Data Standards:An agreed upon set of common data elements, how they are defined, and how they “look” electronically

1919Aug 2008


Where are the Gaps?

• No clinical content standards• Siloed approaches for:

Terminology Guidelines Performance measures EHR development & implementation Research …

• Clinician involvement

2020Aug 2008


History of the CIC

• Initiated by HL7 in May 2006• Initial focus: Survey the landscape of

clinically oriented standards efforts Many presentations providing a wealth of

information, all available on the CIC web page

• CIC objectives are now a strategic priority for HL7

2121Aug 2008


CIC Mission

This Council provides the standards development framework, organizational processes and forums to collaborate with the clinical community to define content, flow and other domain requirements necessary to the development of robust health data standards. The Council will provide mechanism for clinical domains to develop common approaches to standards-related activities and form consensus on issues of interest among multiple groups. This Council will be unique to Health Level Seven in that the focus is on the clinical content, not the technology of the standards.

2222Aug 2008


CIC Mission

This Council provides the standards development framework, organizational processes and forums to collaborate with the clinical community to define content, flow and other domain requirements necessary to the development of robust health data standards. The Council will provide mechanism for clinical domains to develop common approaches to standards-related activities and form consensus on issues of interest among multiple groups. This Council will be unique to Health Level Seven in that the focus is on the clinical content, not the technology of the standards.

2323Aug 2008


CIC’s Role

1. Actively engage clinicians in standardizing their domains2. Provide a community for those standardizing their domain3. Provide a forum and process for harmonization of data elements

and clinical information model4. Maintain awareness of, employ, and teach the best methodology

for clinical content representation5. Provide a process for clinical content representation and access

to experience6. Provide infrastructure, process and imprimatur associated with an

international SDO7. Access port through which clinical content can be made available

to HL7 technical community, i.e., for development of messages, documents, profile, services, etc.

Near-term products with a long-term outlook

2424Aug 2008


Questions/comments?


25252525Aug 2008Aug 2008

Methodology for Developing Standards and DAMs

Anita Walden


26262626Aug 2008Aug 2008

Terms You May Hear


27272727Aug 2008Aug 2008

Version 2.x

• APPROVED AS AN ANSI STANDARD JUNE 26, 2003.

• The HL7 version 2 standard has the aim to support hospital workflows.

• HL7 version 2 defines a series of electronic messages to support administrative, logistical, financial as well as clinical processes

• Most widely implemented standard for healthcare information in the world.


29292929Aug 2008Aug 2008

Version 3.0

Uses an object-oriented development methodology and a Reference Information Model (RIM) to create messages. The RIM is an essential part of the HL7 Version 3 development methodology, as it provides an explicit representation of the semantic and lexical connections that exist between the information carried in the fields of HL7 messages.


31313131Aug 2008Aug 2008

• Class : 1. A kind or category of things or concepts. 2. A definition of objects, in terms of properties (attributes, methods, and relationships) that all objects of the class have in common.

• Model : A representation of a problem or subject area that uses abstraction to express the relevant concepts. A model is often a collection of schema and other documentation.


32323232Aug 2008Aug 2008

Data Element

• In metadata, the term data element is an atomic unit of data that has:An identification such as a data element name A clear data element definition One or more representation terms Optional enumerated values Code (metadata) A list of synonyms to data elements in other metadata

registries Synonym ring


33333333Aug 2008Aug 2008

Data Element Example

Data Element Name

Clinical Data Definition

Permissible Values Set

Identification of Patient TB Status

Identification of Patient's Status

Suspected case of active TB; Confirmed case of active TB; LTBI; Contact of case of TB;


34343434Aug 2008Aug 2008

Reference Information Model (RIM)

• The Reference Information Model (RIM) is the cornerstone of the HL7 Version 3 development process. An object model created as part of the Version 3

methodology, the RIM is a large pictorial representation of the clinical data (domains) and identifies the life cycle of events that a message or groups of related messages will carry.

It is a shared model between all the domains and as such is the model from which all domains create their messages.


35353535Aug 2008Aug 2008

Other Terms You May Hear

• Balloting – Voting process. Before a standard is ANSI-approved, it must be balloted by the HL7 membership.

• Public Comment – Releasing developed standards to the community for review and comment

• CDISC – Clinical Data Interchange Standards Consortium – An organization that develops and supports standards for clinical research use

• EHR – Electronic Health Record• Message* – Atomic unit of data transferred between electronic systems. It

is comprised of a group of segments in a defined sequence.• Project Scope Statement – Form completed by project team to outline the

project. This form is used by HL7 to review approve official HL7 projects that may be balloted as an official HL7 standard

• SNOMED CT (Systematized Nomenclature of Medicine -- Clinical Terms)- Terminology for diseases, findings, procedures, microorganisms, pharmaceuticals. reducing the variability in the way data is captured, encoded and used for clinical care of patients and research.


36363636Aug 2008Aug 2008

Domain Analysis Model

• The DAM is a set of requirements which are submitted to design and implementation procedures and processes (e.g., HL7 specification development). It is a structured way to describe and document the information requirements of a particular area of interest (or domain).

• A description of the domain or environment


37373737Aug 2008Aug 2008

DAM Methodology and Process


38383838Aug 2008Aug 2008

Domain Analysis Model Content

• Document Business Process - Clinicians• Storyboard- Patient Scenarios – Clinician • Glossary/data elements – Clinician/Data Manager• Activity diagram – Clinician/Data Manager• Use case model – Clinician/Modeler• Message content (data requirements)-Modeler• Class model (aka Domain Analysis Model)-Modelers • State diagram -Modeler• Business rules – Clinicians/Data Managers/Modelers


39393939Aug 2008Aug 2008

Storyboard/Scenario ExampleDarlene Dobson goes to the local office of her state Department of Motor Vehicles to renew her drivers license and fills out a Drivers License Renewal form. The license clerk requests her current drivers license and using the drivers license number, S057864389, inquires on the status of her current drivers license, sees that it is active but scheduled to expire in three weeks, verifies that Darlene’s date of birth and current address are the same as the data currently in the system, enters Darlene’s responses from the form indicating that she has not been convicted of a moving motor vehicle violation in the previous three years and that she does not have any health issues that affect her driving ability. After that information is entered the system sends an inquiry to the state court system for moving motor vehicle violations in the previous three years and after receiving a response that there have been none, requests payment information. Darlene indicates she would like to pay with a MasterCard debit card and gives the card to the license clerk. The clerk enters the MasterCard number and expiration date. The registry system sends an electronic request to MasterCard to have the $35 drivers license renewal fee debited from Darlene’s account and credited to the Department’s bank account. After receiving an acceptance response from the MasterCard system, the registry system prints Darlene’s new drivers license good for three years and a payment receipt. Given that the entire visit only took 10 minutes, Darlene leaves the office with a smile on her face.


40404040Aug 2008Aug 2008

Use Case

Requirements Analysis:Building a Domain Analysis Model HL7 Training;May 1, 2007,Norman Daoust,HDF Contributorfor Ioana Singureanu,


41414141Aug 2008Aug 2008

act ACS Ev aluation

Interv iew & History Clinical Presentation

Perform cardiacbiomarker testing

Characterize Chest Pain

Ev aluate Results

Initiate ECG monitoring

Non-cardiacevent

SymptomsSuggestive

of ACS

Initiate Anti-IschemicMedical Therapy

ACSDiagnosis?

Repeat cardiac biomarkertesting

Observe

Perform stress test Ev aluate LV function

Not ACS,discontinue

ACSprotocol

Unstable Angina / NonST-Segment Elev ation MI

AdministerAntiplatelet/Anticoagulant

Therapy

Admit toHospital

ACSDiagnosis?

ACSDiagnosis?

Discharge Plan

Discharge

ST Segment Elev ation MI

FollowSTEMI

Guidelines

ECG Report

Lab Results

Stress Test

Report

LV Function Results

Stable Angina

Follow ChronicStable Angina

Guidelines

ST Elevation?

Monitor Patient

Continue to ACS

Treatment diagram

Transfer

Patient identified incommunity setting

Patient identified inclinical setting

[Yes]

[Possible orConfirmed]

[Undiagnosed]

[ACS]

[No]

[Yes]

[Yes]

[Ifordered]

[Ifordered]

[No][No]

[No]

[No]

CV Activity Model


42424242Aug 2008Aug 2008

CV Class Model Example

class CV_Catheterization

CardiacCatheterizationLaboratoryVisit

- deathInLabIndicator: boolean- eventDateTime: DateTime

CardiacCatheterizationLaboratoryVisitDetail

- observationTypeCode: CodedElement- observationValue: ANY

CardiacCatheterizationProcedure

- pciDelayIndicator: boolean- pciDelayReason: CodedElement- pciIndicator: boolean- referringEmergencyDeptDateTime: DateTime- sTEMIPCIArrivalDateTime: DateTime- xferInForPrimaryPCIIndicator: boolean- xferOutForPrimaryPCIIndicator: boolean

CV_General::ProcedurePerformer

- name: string- uPIN: string

CV_General::Indication


LesionObserv ation


CV_General::Procedure

- procedureDate: Date- procedureTypeCode: CodedElement- urgencyStatus: CodedElement

Lesion

- bifurcationIndicator: boolean- dateOfMostRecentTreatment: Date- graftLocation: string- length: float- postStenosisPct: int- postTIMIflow: int- preStenosisPct: int- preTIMIflow: int- previouslyTreatedIndicator: boolean- risk: char- segmentLocation: string- thrombusIndicator: boolean

Segment

- segmentCode: CodedElementLesionTreatment

- reperfusionDateTime: DateTime- treatmentType: CodedElement

LesionTreatmentAdverseEvent

- treatmentEventCode: CodedElement- treatmentEventValue: ANY

CV_General::ProcedureInterpretation


Graft

- graftTypeCode: CodedElement

LesionTreatmentAdverseEventDetail

- observationTypeCode: CodedElement- observationvalue: ANY

Artery

- name: string

IntracoronaryDev ice

- barcode: string- devicePrimaryIndicator: boolean- deviceSequenceNumber: int- deviceTypeCode: CodedElement- diameter: float- length: float

Vessel

- typeCode: codedElement

CV_General::ProcedureFindings


CV_General::ProcedureAdv erseEv ents

- eventDateTime: DateTime- observationTypeCode: CodedElement- observationValue: ANY

CardiacCatheterizationLaboratoryInstruments

- instrumentTypeCode: CodedElement

CV_General::ProcedureGroup

- groupTypeCode: CodedElement

1

0..*

1

0..*

1..*

1

1 0..*

1 1..*

1

0..*

1

0..*

1 0..*

0..* 1..*

1

0..*

0..*0..*

1

0..*

10..*

1

0..*

1

1..*

0..1

0..*

1 0..*

1..*

0..1


43434343Aug 2008Aug 2008

Methodology for Developing DAMs• Gather existing information

Data Elements/Definitions Forms/Data Dictionaries

• Engage and meet w/ Stakeholders to discuss project and gather additional existing information Initial Face to Face meeting with Domain Stakeholders

• Create small working group to define data elements and definitions Weekly-Bi/Weekly Teleconferences or webinars, 2- Face 2 Face mtgs a year to accomplish largest amount of work

• Subset work- break up data elements into smaller chunks of work Some domains are too large to accomplish all at once Focus on domain data elements only-General Data Elements are

developed by others groups• Public Comment – the entire community should have opportunity to

review defined data elements Have webinars to review work with broader community

• Publicize activities• Develop a standards and DAM maintenance plan


44444444Aug 2008Aug 2008

• Identify tools used to develop UML /ActivityModels

• Use common class models examples CVTB

• Platform independent

Methodology for Developing DAMs (cont.)


45454545Aug 2008Aug 2008

Roles

• Stakekholders –provide clinical content and information

• Project Manager – facilitate process• Data Manager or Informaticists – gather

requirements, create artifacts• Modeler – design models


46464646Aug 2008Aug 2008

Key to Success

• Identify a Project Manager Keeps the process movingEnsures all key stakeholders are involved Identifies scopeCommunicates needs, status Facilitates meetingsEnsures products are produced w/in timeframeKeeps project within budget and scope


47474747Aug 2008Aug 2008

Meetings Recommendations• Initial kick of meeting of all stakeholders

Inform them of project Gather information Identify stakeholder working groups participants

• Weekly or bi-weekly Web/Teleconferences Created and Define Data Elements Participants – stakeholders, project manager,

informaticists/data manager Modeler will attend once data elements have been developed

• 1-2 Face to Face mtgs a year to accomplish large chuncks of work

• Present work at conferences and working group mtgs• Attend HL7 CIC mtgs • Attend HL7 CIC Data Element Facilitation mtgs

Biweekly mtg to assist groups with the process, monitor status and keep consistency between DAMs


48484848Aug 2008Aug 2008

Tooling Recommendations

• Communication toolsConference phone #Web Conferencing system

• Modeling toolsExamples: Visio/Enterprise Architecture/Rational

Software Model

• Spreadsheet - data gatheringExcel

• Website for accessing data standard


49494949Aug 2008Aug 2008

Helpful Hints for a Sound Process • Providing stakeholders with information to respond to

will speed up the process. Giving them blank slate will take more time for decision

making Scope Data Elements/Definitions

• Identify where data elements and DAMs will be stored for public access Engage those groups early on

• Be aware other standards development activities and their direction

• Hold meetings on a consistent schedule Inconsistency reduces participation

• Use Ontologies• Keep DAMs General not specific to a tool or process


50505050Aug 2008Aug 2008

Work Done to Date

Meredith Nahm


51515151Aug 2008Aug 2008

Information Model• Domain Analysis Model (what concepts & how grouped)•HL7 RIM based models•Content for EHR screens

Inference Model•Clinical Guidelines•Decision Support•Performance Measures

Concept Model•Ontology•Formal Logic Definitions

*Adapted from model in Rector, et al 2004 MEDINFO/IMIA. Full reference in slide notes.

Accomplishing the Goal Requires Standardizing the Clinical Domain*

Data Elements•Link concept to terminologies•Link concept to definition

Content

LanguageKnowledge


52525252Aug 2008Aug 2008

Example Inference Model*

*In reality, these rules would be written in a syntax that resembles computer code

InformationModel

ConceptModel

InferenceModelDecision Support:Decision Support:

Confirmed cases of TB should be flagged for local health authority notification (from CDC)


53535353Aug 2008Aug 2008

Example Concept ModelInformation

Model

ConceptModel

InferenceModel

Concept Model:Concept Model:

FootFoot

ToeToe

part

Lower extremityLower extremity

part


54545454Aug 2008Aug 2008

class Diagnosis

Common::RegistrationAsPatient

Specimen

+ bodySiteCode: char+ collectionDate: Date+ specimenTypeCode: char

TuberculosisDiagnosis

+ chestRadiographStatusCode: char+ computerAssistedTomographyIndicator: boolean+ confirmationMethodCode: char+ diagnosticConclusion: char+ effectiveDate: Date+ magneticResonanceImagingIndicator: boolean+ susceptibil ityTestingIndicator: boolean+ ultrasoundIndicator: boolean

BodySiteAffected

+ anatomicSiteCode: char+ primaryIndicator: boolean

Organism

+ genotypeCode: char+ mycobacteriumSpeciesCode: char

Common::SocialHistory ContactRelationship

+ contactTypeCode: char

ClinicalFindings

+ dateRecorded: Date+ durationOfCough: int+ durationOfFever: int+ underlyingPulmonaryDisease: char

BCGVaccination

+ mostRecentVaccinationDate: Date+ multipleVaccinationIndicator: boolean+ reportingMethodCode: char+ vaccinationTimingCode: char

Imaging::Image

Susceptibility

- isolateCultureMethodCode: int+ isolateLiquidMediaTypeCode: char [0..1]+ isolateSolidMediaTypeCode: char [0..1]

TuberculinSkinTest

+ blisteringStatus: char+ interpretationCode: char+ mantouxStrengtn: int+ quantitativeResult: int

Common::Patient

Common::PatientEncounter

Common::Clinician

Treatment

+ AdministrationEvent

+ AdministrationRecorder

+ CourseOfTreatment

+ DrugOrder

+ TreatmentInitiation

+ TreatmentInterruption

+ TreatmentTermination

(from Class Model)

HIVTesting

+ cd4AbsoluteCount: int+ cd4Percent: int+ specimenTypeCode: char+ testingDate: Date+ testTypeCode: char

SmearTest

+ InterpretationCode: char+ quantitativeResultCode: char+ SpecimenProcessingForSmearCode: char

InteferonGammaAssay

+ assayResultInterpretationCode: char+ elisaResult: int+ elispotResult: int

TuberculosisCulture

+ cultureMethodCode: char+ liquidMediaResultCode: char [0..1]+ liquidMediaTypeCode: char [0..1]+ SolidMediaResultCode: char+ SolidMediaTypeCode: char+ tuberculosisBacillusIndicator: boolean

Test

+ effectiveDateTime: int+ testingStatusCode: char+ typeCode: char

NucleicAcidAmplification

+ InterpretationCode: char

Imaging

+ Image

+ ImageEvolution

+ ImagingDetail

(from Class Model)

StatusSummaryInformation

+ bacillusCalmetteGuerinStatusCode: char+ extrapulmonaryTuberculosisIndicator: boolean+ hivStatusIndicator: boolean+ hivStatusMethodCode: char+ hivTestingIndicator: boolean+ predisposingMedicalHistoryIndicator: boolean+ pulmonaryTuberculosisStatusCode: boolean+ statusEffectiveDate: Date+ studyEnrollmentIndicator: boolean+ treatmentStatusCode: char [0..1]+ tuberculosisCaseTypeCode: char

Name: DiagnosisAuthor: Mead WalkerVersion: 1.0Created: 7/1/2001 12:00:00 AMUpdated: 1/25/2008 10:57:25 AM

TuberculosisSymptom

+ dateOfOnsetOfTuberculosisSymptom: date+ tuberculosisSymptomCode: char

Common::MedicalHistory

SusceptibilityResult

+ compoundConcentration: int+ resultCode: char

ChallengedSubstance

+ tuberculosisDrug: char

IsolateTesting

+registrationAsPatient 1

+encounterCollection 0..*

+person1+specimenCollection 0..*

+person

1

+medicalHistoryCollection

0..*

+sourcePerson1

+contactRelationshipCollection

0..*

+person 1

+registrationAsPatientCollection 0..*

+person 1

+bcgVaccinationCollection0..*

+Person

1

+socialHistoryCollection

0..*

+person

1

+clinicalFindingsCollection

0..1

+Person1

+StatusSummaryInformation

0..1

+person

1

+tuberculosisDiagnosisCollection

0..*

+person 1

+hivTestingCollection

+susceptibil ity 1

+tuberculosisDrugCollection

0..*

+organismCollection 0..*

+IsolateTesting

1

+organism

1

Resistance Tested

+susceptibil ityResultCollection

0..*

+tuburculosisDiagnosis 1

+bodySiteAffectedCollection 0..*

+specimen 0..1

+testCollection 0..*

+targetPerson0..1

+contactRelationshipCollection

0..*

+clinician

1

+hivTestingCollection

0..*

+tuberculosisDrug 1

+susceptibil ityResultCollection 0..*

+susceptibil ityResultCollection 0..*

+susceptibil ity 1

+clinician

1

+testCollection

0..*

+testCollection 0..*

+person1

+person 1

+imageCollection

0..*

+clinician

1

+tuberculosisSymptomCollection

+clinician

1

+bcgVaccinationCollection

0..*

+clinician 1

Orderer

+ImageCollection 0..*

+clinician 1

Interpreter

+ImageCollection

+clinician

1

+clinicalFindings 0..1

+clinician

1

+tuberculosisDiagnosisCollection0..*

+cliniciancollection 1..*

+patientEncounterCollection 0..*

+clnician

1

+socialHistoryCollection 0..*

+patientEncounter

0..1

+testCollection

0..*

+person

1

+TuberculosisSymptomCollection

0..*

+clinician

1

+medicalHistoryCollection

0..*

Example Information Model

InformationModel

ConceptModel

InferenceModel


55555555Aug 2008Aug 2008

Information Models & Level of Abstraction

• Act• Procedure• Percutaneous

Coronary Intervention


56565656Aug 2008Aug 2008

What is the RIM?

Entity

classCodedeterminerCodeIdcodequantitynamedescstatusCodeexistanceTimetelecomriskCodehandlingCode

Role

classCodeIdCodenegationIndAddrtelecomstatusCodeeffectiveTimecertificateTextQuantitypositionNumber

RoleLink

typeCodeeffectiveTime

source1

0.. n

1 target

0.. noutboundLink

inboundLink

player

playedRole

scoper

scopedRole

0.. n0.. 1

0.. n0.. 1

Participation

typeCodefunctionCodecontextControlCodesequenceNumbernegationIndnoteTesttimemoodCodeawarenessCodesignatureCodesignatireTextperformedIndsubstitutionCondition- Code

Act

classCodemoodCodeIdcodenegationIndderivationExprtitletextstatusCodeeffectiveTimeactivityTimeavailabilityTimepriorityCodeconfidentialityCoderepeatNumberinterruptablrIndlevelCodeindependentInduncertaintyCodereasonCodelanguageCode

ActRelationship

typeCodeinversionIndcontextControlCodecontextConductionIndsequenceNumberpriorityNumberpauseQuantitycheckpointCodesplitCodejoinCodenegationIndconjunctionCodelocalVariableNameseperatableInd

inboundRelationship

outboundRelationship0.. n

0.. n

source1

1

target

1

0.. n1

0.. n

Reference Information Model (RIM):Provides consistency across domains and levels of granularity

HL7 Reference Information Model, normative content, Version: V 02-02 (11/22/2003), ModelID: RIM_0202. available from hl7.org


57575757Aug 2008Aug 2008

Can be Represented in the HL7 RIM

HL7 Reference Information Model, normative content, Version: V 02-02 (11/22/2003), Model ID: RIM_0202. available from hl7.org

5858Aug 2008


Important Take-Away Messages

• Models must be consistent across clinical areas For example, blood pressure must be represented

and defined the same way. A gift of data elements and ontology!

Modeling should be consistent. A gift of the RIM!

• Synchronization enables: Computable guidelines Information exchange and use

• Challenges We use natural language imprecisely Different areas need different granularity

InformationModel

ConceptModel

InferenceModel


59595959Aug 2008Aug 2008

How This Helps

• Reporting to quality improvement registries• Computable guidelines / Electronic updating

guideline changes to decision support• Joint Commission reporting• Aggregating data• Chart review


60606060Aug 2008Aug 2008

Participating in CIC

Crystal Kallem

6161Aug 2008


How to Participate & Stay Informed

• CIC meeting on January 18th, 9am-5pm• Monthly conference calls

2009 schedule will soon be posted to the CIC web page and distributed through the CIC email list service

• CIC list service for email communications http://www.hl7.org/listservice/index.cfm

• CIC web page http://www.hl7.org/Special/committees/index.cfm?

src=sig_frames.cfm&src2=cic/index.cfm

• CIC wiki (logon: wiki / wikiwiki) http://wiki.hl7.org/index.php?title=CIC

6262Aug 2008


CIC Work in Progress

• Outreach to clinical professional societies• Ambassador program module to “get the word out”• Communication toolkit

• Clinical domain analysis models • Tuberculosis• Acute coronary syndrome• Diabetes• Mental health

• Master data element repository

6363Aug 2008


How Can You Help

• Contribute clinical subject matter expertise• Participate in CIC projects• Advocate and endorse CIC activities• Link related industry projects to CIC

6464Aug 2008


Benefits of a Partnership

• Together, we can: Enable each other Create standards that are invisible in the success of

clinical interoperability Influence policy and politics Share successes


65656565Aug 2008Aug 2008

Tomorrow’s CIC Meeting AgendaTime Topic Location

Q1: 9:00-10:30 Welcome/introductionsAgenda reviewInstructions for co-chair electionsInformation sharingDiscussion/Q&A

Salon V

10:30-11:00 Break

Q2: 11:00-12:30 Information sharing (cont.)Discussion/Q&A

Salon V

12:30-1:45 Lunch

Q3: 1:45-3:00 Work session Framework for CIC Expected end products/servicesDiscussion/Q&A

Salon V

3:00-3:30 Cookie Break!

Q4: 3:30-5:00 Metadata registriesAgenda planning for next meeting

Salon V

6666Aug 2008


Additional Information

• Visit the HL7 Clinical Interoperability Council (CIC) web site at: http://www.hl7.org/Special/committees/index.cfm?src=sig_frames.cfm&src2=cic/index.cfm

• CIC Co-chairs: Sam Brandt, MD

SIEMENS Medical [email protected]

Ed Hammond, PhDDuke University Medical [email protected]

Crystal Kallem, RHIAAmerican Health Information Management [email protected]

Meredith NahmDuke Translational Medicine [email protected]

6767Aug 2008


Thank you for coming!

Q & A


68686868Aug 2008Aug 2008

Extra Slides(not active at this time)

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