v mr u pdate – p hase 1 c hanges “ s o many changes, so little time ” 03/12/2013

VMR UPDATE – PHASE 1CHANGES“SO MANY CHANGES, SO LITTLE TIME”03/12/2013

NEW ISO DATATYPE

ED – EncapsulatedData Allows for support of richer documentation than

just free text Used in Documentation type to support various

types of proposal comments (see upcoming slide on proposal changes)

NEW EXTENDED VMR DATATYPES CodedIdentifier

Associate an II with a relevant concept from a terminology CodedNameValuePair

Any coded name-attribute pair Used to support attribute extension

Documentation Currently used in ‘comment’ attribute to support various

comment types. Dose

Encapsulation of administeredDose and doseType to support multiple cardinality

DietQualifier Generic way to add diet components to post-coordinated

diets such as levels of fat, carbohydrates, fluids, fibers, nutrients, etc…

PROCEDUREPROPOSAL ENHANCED WITH NEW ATTRIBUTES

Needed to support more kinds of orderables originationMode frequency timing prnReason comment (0-*)

Can support any number of comments Comments are typed – e.g., ‘Consult Note’,

‘Provider Instructions’, ‘PRN Instruction’, other… Supports both free text and structured text

SUBSTANCEADMINISTRATIONPROPOSAL ENHANCED WITH NEW ATTRIBUTES

Needed to support more kinds of orderables originationMode comment prnReason infuseOver timing Note – no ‘frequency’ as this is already

captured by dosingPeriod and dosingPeriodIntervalIsImportant

SUBSTANCEADMINISTRATIONBASE GENERALIZED

More than one dose can now be defined E.g., starting dose, maintenance dose

NEW PROCEDURE PROPOSALS

LaboratoryProposal ImagingProposal RespiratoryCareProposal DietProposal PatientCareProposal? Will probably be

dropped as it is now covered by ProcedureProposal. May be revived in Phase 2.

NEW SUBSTANCEADMINISTRATIONPROPOSALS

ComplexIVProposal PCAProposal

NEW ATTRIBUTES TO SUPPORT INFOBUTTON

CdsContext has the following new fields cdsSubTopic cdsEncounterType

IMPORTANT MODEL ENHANCEMENTS

New extensible mechanism for class attributes Entity, ClinicalStatement, and CdsContext now include

a new ‘attribute’ field of cardinality 0-* Attribute is a CodedNameValuePair consisting of:

name – CD (1-1) value – ANY (1-1)

In schema, each have an ‘extension’ container section RTO type fixed to support ratios of QTY rather

than PQ Needed to support more types of ratios such as ratios

of integers found in titers. Fixed in XSD to support ratios of PQs. Only ‘decimal’

supported in v1. RTO_PQ and RTO_INT added to XSD

IMPORTANT MODEL ENHANCEMENTS

IVL_PQ now support optional lower and upper bounds in XSD Allows the expression of unbounded upper and

lower ranges Probably an oversight in current version of vMR

AdministrableSubstance.strength No longer a ratio of decimals Now supports ratios of PQs Probably an oversight in current version of vMR

CHANGES TO CLINICALSTATEMENT

ClinicalStatement.templateId now a CodedIdentifier Allows code to be associated with II

II now supports ‘identifierName’ – string (0-1) Templates can have a name just like we people

do ClinicalStatement.evaluatedPersonId

Bidirectional association between a CS and its owner.

Same change made to Entity class Supports flattening of data

ClinicalStatement.id now optional Need to add documentation to IG to specify that

it is required

IMPORTANT MODEL ENHANCEMENTS

GoalBase.targetGoalValue, ObservationResult.observationValue are now of type ANY Supports polymorphism

BodySite.bodySiteCode changed to optional Needed to support term precoordination use

case where laterality only is post-coordinated

CONSIDERED FOR PHASE 1 BUT DEFERRED FOR PHASE 2 ImagingEvent

RadiationDose RadiationDuration

Frequency Need consistency between SubstanceAdministration and

ProcedureProposals Need optional coded field such as ‘TID’, ‘qac’

Immunization enhancements isValid validAdministrationTimeInterval

Class extension mechanism Should ClinicalStatement be concrete rather than abstract?

Other mechanism? Finer grained model? Bidirectional association between source and targets of

relationships “I am the object of which relationship?”

CONSIDERED FOR PHASE 1 BUT DEFERRED FOR PHASE 2

Chemotherapy Intervention/Patient Education Tube Feeding Other proposal types? Need a round 2

potentially.

QUESTIONS FOR PHASE 2 Fleshing out ‘Events’ for QDM. What do we need to

support eMeasures How much can we assume about terminologies? CD is

nice but has limits if no value sets exist. Can we enhance the vMR’s inferencing capabilities

Rethinking the hierarchies Bridging by composition

Equivalence relationships To OWL or not to OWL More pilot feedback Did we hit the 80%? Keeping vMR agile and backward compatibility And last but not least …

Templates and profiles

FOR MORE INFORMATION…

Please see our change log at: https://docs.google.com/spreadsheet/ccc?

key=0AkVg6OcD6S5NdHkxaVZUSDJzVTZuQUZkM3NmdUlkM3c#gid=0

THANK YOU!