kaiser permanente standards summit september 7-8 , 2011 stanley m. huff, md
DESCRIPTION
A Brief Review of CIMI Plans and Goals. Phoenix CIMI Meetings January 18, 2013 Stanley M Huff, MD Chief Medical Informatics Officer. Kaiser Permanente Standards Summit September 7-8 , 2011 Stanley M. Huff, MD. The Ultimate Value Proposition of CIMI. Sharing of: Data Information - PowerPoint PPT PresentationTRANSCRIPT
Kaiser Permanente Standards SummitSeptember 7-8 , 2011Stanley M. Huff, MD
Huff # 1
A Brief Review of CIMI Plans and Goals
Phoenix CIMI MeetingsJanuary 18, 2013
Stanley M Huff, MDChief Medical Informatics Officer
The Ultimate Value Proposition of CIMI
• Sharing of:– Data
– Information
– Applications
– Decision logic
– Reports
– Knowledge
Huff # 2
Clinical System Approach
Intermountain can only provide the highest quality, lowest cost
health care with the use of advanced clinical decision
support systems integrated into frontline workflow
Decision Support Modules
• Antibiotic Assistant• Ventilator weaning• ARDS protocols • Nosocomial infection
monitoring• MRSA monitoring and
control• Prevention of Deep
Venous Thrombosis• Infectious disease
reporting to public health
• Diabetic care• Pre-op antibiotics• ICU glucose protocols• Ventilator disconnect• Infusion pump errors• Lab alerts• Blood ordering• Order sets• Patient worksheets• Post MI discharge meds
Strategic Goal
• Be able to share applications, reports, alerts, protocols, and decision support with anyone in the WORLD
Order Entry API (adapted from Harold Solbrig)
. . .
COS
Service
Interface
Data
Application
From Ben Adida and Josh Mandel
What Is Needed to Create a New Paradigm?
• Standard set of detailed clinical data models coupled with…
• Standard coded terminology
• Standard API’s (Application Programmer Interfaces) for healthcare related services
• Open sharing of models, coded terms, and API’s
• Sharing of decision logic and applications
Clinical modeling activities
• Netherlands/ISO Standard• CEN 13606• United Kingdom – NHS• Singapore• Sweden• Australia• openEHR Foundation• Canada• US Veterans Administration• US Department of Defense• Intermountain Healthcare• Mayo Clinic
• HL7– Version 3 RIM, message
templates– TermInfo– CDA plus Templates– Detailed Clinical Models– greenCDA
• Tolven• NIH/NCI – Common Data
Elements, CaBIG• CDISC SHARE• Korea• Brazil
# 9
Clinical Information Modeling Initiative
Mission
Improve the interoperability of healthcare systems through shared
implementable clinical information models.
Huff # 10
Clinical Information Modeling Initiative
Goals• Shared repository of detailed clinical
information models
• Using a single formalism
• Based on a common set of base data types
• With formal bindings of the models to standard coded terminologies
• Repository is open and models are free for use at no cost
Huff # 11
Goal: Models that support multiple contexts
• Message payload
• Service payload
• Decision logic (queries of EHR data)
• EHR data storage
• Clinical trials data (clinical research)
• Normalization of data for secondary use
• Creation of data entry screens
• Natural Language Processing
Information Model Ideas
# 13
Repository of SharedModels in
a Single Formalism
Repository of SharedModels in
a Single Formalism
DCMs
CDA Templates
openEHRArchetypes
CENArchetypes
LRA Models
CMETs, HMDsRMIMs
CEMs
StandardTerminologies
Initial Loading of Repository
Realm Specific
Specializations
Realm Specific
Specializations
Realm Specific
Specializations
Realm Specific
Specializations
Realm Specific
Specializations
Realm Specific
Specializations
Realm Specific
Specializations
Realm Specific
Specializations
Realm Specific
Specializations
Realm Specific
Specializations
V2 “|”V2 “|”
HTMLHTML
UMLUML
ADLADL
V2 XMLV2 XML
V3 XMLV3 XML
V3 NextV3 Next
CEN Archetype
CEN Archetype
CDACDA
SOAPayloadSOAPayload
CEMCEMLRALRA
OWLOWLCDISC SHARECDISC SHARE
TranslatorsTranslatorsTranslatorsTranslatorsTranslatorsTranslators
Roadmap (some parallel activities)
• Choose a single formalism
• Choose the initial set of agreed data types
• Define strategy for the core reference model and our modeling style and approach– Development of “style” will continue as we
begin creating content
Roadmap (continued)
• Create an open shared repository of models– Requirements– Find a place to host the repository– Select or develop the model repository software
• Create model content in the repository– Start with existing content that participants can
contribute– Must engage clinical experts for validation of the
models
Roadmap (continued)
• Create a process (editorial board?) for curation and management of model content
• Resolve and specify IP policies for open sharing of models• Find a way of funding and supporting the repository and
modeling activities• Create tools/compilers/transformers to other formalisms
– Must support at least ADL, UML/OCL, Semantic Web, HL7
• Create tools/compilers/transformers to create what software developers need– Examples: XML schema, Java classes, CDA templates,
greenCDA, RFH, SMART RDF, etc.
Selected Decisions
Decisions (London, Dec 1, 2011)
• We agree to create and use a single logical representation (the CIMI core reference model) comprising one or more models as the basis for interoperability across formalisms.
• We approve ADL 1.5 as the initial formalism in the repository using OpenEHR Constraint Model noting that modifications are required.
• The corresponding Archetype Object Model will be included and adapted as the CIMI UML profile
• The CIMI UML profile will be developed concurrently as a set of UML stereotypes, XMI specification and transformations
Definition of “Logical Model”
• Models show the structural relationship of the model elements (containment)
• Coded elements have explicit binding to allowed coded values
• Models are independent of a specific programming language or type of database
• Support explicit, unambiguous query statements against data instances
Definition of “Logical Model” (cont)
• Models shall specify a single unit of measure (unit normalization)
• Models can support inclusion of processing knowledge– Models can support recommend defaults– Models can specify assumed values of attributes
(meaning of absence of the item)
• Examples can be created for the model
# 21
Isosemantic Models
data 37 %
HematocritManual (LOINC 4545-0)HematocritManualModel
data 37 %
quals
Hematocrit (LOINC 20570-8)HematocritModel
data Manual
Hematocrit MethodHematocritMethodModel
Precoordinated Model (CIMI deprecated Model)
Post coordinated Model (CIMI preferred Model)
Isosemantic Models
• CIMI is committed to isosemantic clinical models in terms of both:– The ability to transform CIMI models into
iso-semantic representations in other languages/standards (e.g. OWL, UML, HL7);
– The ability to transform CIMI models between iso-semantic representations that use a different split between terminology pre-coordination versus structure.
Isosemantic Models (cont)
• CIMI will select one model within each isosemantic family that will be the preferred model for interoperability
• (Profiles of exact models for specific uses will be created by the users: professional societies, regulatory agencies, public health, quality measures, etc.)
Terminology
• SNOMED CT will be the primary reference terminology
• LOINC was also approved as a reference terminology– In the event of overlap, SNOMED CT will be the
preferred source
• CIMI will propose extensions to the reference terminologies when needed concepts do not exist– CIMI will maintain the extensions until they are accepted
by the RT organization
• The primary version of models will only contain references (pointers) to value sets
• We will create tools that read the terminology tables and create versions of the models that contain enumerated value sets
Terminology (cont)
Some Principles
• CIMI DOES care about implementation. There must be at least one way to implement the models in a popular technology stack that is in use today. The models should be as easy to implement as possible.
• Only use will determine if we are producing anything of value– Approve “Good Enough” RM and DTs– Get practical use ASAP– Change RM and DTs based on use
Pleasanton May 10-12, 2012
• Resolution: The reference model presented by the Reference Model Task Force is endorsed as a starting point and establishes the direction that CIMI wishes to take. We expect that this model will be tested and modified as modeling work continues.
Pleasanton May 10-12, 2012
• Reference model and associated data types were approved– We expect that this model will be tested and
modified as modeling work continues.
• Agreed that there must be a computable semantic relationship between elements in a model
Goals for Rockville Meeting
• Continue modeling work
• Approve a proposal for creating an Editorial Board
• Decide on what tools to use to make models
• Create a team to do an end-to-end proof of concept– Possible targets: FIHR, SMArt, CDA template, HL7
V2, others?
• Updates and information sharing: OMG AML RFI, CDL to ADL conversion, finding a parent organization, FIHR, member survey
Conflicts of Interest
Huff # 30