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MOHH – Models Submission
Dr Linda Bird
9th August 2012
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Strategic vision of patients moving seamlessly across the
healthcare system, receiving coordinated patient-centric care
at the most appropriate settings.
RH
CH
NHPolyclinics
FPs Home Care
Rehab & support services
Screening & Prevention
Palliative Care
RH
CH
NHPolyclinics
FPs Home Care
Rehab & support services
Screening & Prevention
Palliative Care
RH
CH
NHPolyclinics
FPs Home Care
Rehab & support services
Screening & Prevention
Palliative Care
RH
CH
NHPolyclinics
FPs Home Care
Rehab & support services
Screening & Prevention
Palliative Care
RH
CH
NHPolyclinics
FPs Home Care
Rehab & support services
Screening & Prevention
Palliative Care
RH
CH
NHPolyclinics
FPs Home Care
Rehab & support services
Screening & Prevention
Palliative Care
Enabled by the National
Electronic Health Record
(EHR)
Singapore’s Future Healthcare Landscape
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Standards Products• Diagnosis - SNOMED CT and
Singapore Extension (SE)• Drugs - Singapore Drug Dictionary
(SDD)• Allergic Reactions– SNOMED CT +
SE • Allergens - SNOMED CT + SDD• Laboratory Results – LOINC• Data Dictionary – MOHH Data
Dictionary• Procedures - TBD• Reason for visit - SNOMED CT• Symptoms and Problems - SNOMED
CT and Singapore Extension• Laboratory Reports – Smart SNOMED
CT• Laboratory Orders – SNOMED CT• Radiology Orders - SNOMED CT
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LIM Development Process
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Requirements
Clinician Verification
Graphical Represent-
ationsClinician Input
Clinical Modelling Framework
Singapore Logical
Information Model
Clinical Modelling Language
(LOM)
Logical Reference Model(ISO13606+21090)
Computable Implementation
Specification
Cons
train
Inst
ance
of
Terminology Server
References
Terminology Ontology
Bind
va
lues
Bind
sem
antic
s
Store
Generate
Lim Repository
Store representation
Refe
renc
es
Input
Generate
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Clinician Validation of the LIM
LIM ID LIM Name
LIM Cardinality
LIM Definition LIM Example (for Exchange)
LIM Example (for Display)
Laboratory Test Item 1 A class describing the laboratory test that was
performed.
Test Name 1 The name of the laboratory test within a panel of tests.
("xxx", "LDH measurement")("xxx", "Blood sodium measurement")
"LDH measurement""Blood sodium measurement"
Sequence Number 0..1 A number that identifies and sequences this
laboratory test item within a given panel."1""2"
"1""2"
Additional Description 0..1
A descriptor used in combination with the Test Name to fully define the description of the laboratory test.
POCT Indicator 0..1 The POCT (Point-of-care Testing) indicator at the
laboratory test item level.("xx, "Point of Care Test")
"Point of Care Test"
Type 0..1 The type of the test.
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WYSIWYG
NDDS snippet
NXDS LXML XSD
NXDS LXML Instance
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IsoSemantic Models – Example of Problem
e.g. “Suspected Lung Cancer”
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IsoSemantic Models – Example Instances
e.g. “Suspected Lung Cancer”
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IsoSemantic Models – Compositional Grammar
Problem Diagnosis = $ProblemDiagnosisName: 246090004|associated_finding|= (404684003|clinical_finding|:
63698007|finding_site|=($BodySite: 272741003|laterality|=$Laterality), 246112005|severity|=$Severity),
408729009|finding_context|=$FindingContext
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IsoSemantic Models – Equivalence Testing
Problem Diagnosis = $ProblemDiagnosisName: 246090004 |associated finding| = (404684003|Clinical Finding|:
363698007 | finding site | = ($BodySite: 272741003|laterality| = $Laterality),
246112005 | severity| = $Severity), 408729009 | finding context | = $FindingContext
GP Problem Diagnosis = 86049000|Cancer| : 246090004 |associated finding| = (404684003|Clinical Finding| :
363698007 | finding site | = 39607008|Lung|), 408729009 | finding context | = 415684004|Suspected|
Polyclinic Problem Diagnosis = 162572001 |Suspected cancer|: 246090004 |associated finding| = (404684003|Clinical Finding|:
363698007 | finding site | = 39607008|Lung|)
RH Problem Diagnosis = 86049000|Suspected lung cancer|
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Bi-directional Semantic Interoperability
NEHR
Prob/Dx :”Osteoarthritis”
Severity : “Severe”
Location : “Knee Joint”
Side : “Left”
Source Data
Prob/Dx :”Osteoarthritis”
Severity : “Severe”
Location : “Knee Joint”
Side : “Left”
GP - Source Data
Design Patterns - Diagnosis
DP-based GP - Source Data
National Term
Research Semantics
Problem/Diagnosis : “Severe
osteoarthitis of the left knee”
Transformed GP - Source Data in RH format
Diagnosis : ”Osteoarthritis
of the left knee”
Degree : “Severe”
Transformed GP - Source Data in Polyclinic format
Maps I
n
Maps out
Severe osteoarthritis of the left knee
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• ENTRY– Observation Entry (Observable Name/Value)
• Heart Rate/ Blood Pressure / Blood Glucose– Clinical Finding
• Problem Diagnosis Entry• Adverse Reaction Entry• Alert Entry
– Activity• Pharmacy Activity Entry
– Pharmacy Order Entry– Pharmacy Dispense Entry– Pharmacy Administration Entry
• Investigation Activity Entry– Investigation Order Entry– Investigation Result Entry
• Procedure Entry (Reference Pattern)• CLUSTER
– Pharmacy Item / Investigation Test Item
Submission Overview
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