"The World of Clinical Information Models" 30-jan-2014

Michael van der ZelClinical Information Systems Architect

CSI?

CSI “Stairway to Heaven”● Techniek – letters; chinees, arabisch

你好 أهل وسهل

● Structure – technische samenstelling● Syntax – zin samenstelling, leesrichting● Semantics – woordbetekenis● Context – doel en aannames voor gebruik● Proces – afspraken over uitvoeren Br

on: B

ernd

Blo

bel,

Univ

ersi

ty o

f Reg

ensb

urg

The baseline Infostructure in 2013. Will it fly? How long? With how much effort?

CIMI Mission & Goals● Mission

– Improve the interoperability of healthcare systems through shared implementable clinical information models.

● Goals

– Establish and maintain a shared repository of detailed clinical information models

– Establish appropriate governance, finance, and organizational structure for the group

– Capture background, context, and discussions relevant to decisions made in creating and using the model

– Establish a fair and open process for curating the content in the model repository

– Promote the creation of software tools that translate the models to other commonly used model representation languages (OWL, UML, HL7 MIF, graphic format, HTML, etc.)

– Promote the creation of software tools that generate implementation artifacts (XML schemas, Java class definitions, CDA templates, GreenCDA, etc.)

Note: implementable means models that can be transformed into

software artifacts.

Betrokken Organisaties

Ministry of Health Holdings Singapore, LifeLines (NL), Health Intersections, ONC (USA), NHS

Connecting for Health (UK), SMArt, Electronic Record Services, EN13606 Association (EU),

B2i Healthcare (AU), Cambio Healthcare Systems, Canada Health Infoway (CA), CDISC, GE Healthcare (USA), HL7, IHTSDO, Intermountain Healthcare (US), JP Systems, Kaiser Permanente (US), Mayo Clinic

(US), National Institutes of Health (US), Ocean Informatics (UK/AU), OpenEHR,

Results4Care (EU), South Korea Yonsei University, Tolven, Veterans Health Administration (VA USA), ...

N.B. Amerika, Europa, Australie, Azie, … en de rest?

CIMI

Translators

HTML

UMLopenEHR Archetype

V2 “|”

Repository of Shared

Models in a Single

Language

CEMs

DCMs

CDA Templates

openEHRArchetypes

CENArchetypes

LRA Models

CMETs, HMDsRMIMs

V2 XML

V3 XML

FHIR

CEN Archetype

CDA

SOAPayload

CEMLRA

OWL

COMPOSITION

+ category: CODEABLE_T EXT+ language: CODE_PHRASE+ territory: CODE_PHRASE

CONTENT_ITEM

ENTRY

+ language: CODE_PHRASE

SECTION

ARCHETYPED

+ archetype_id: ARCHETYPE_ID+ tem plate_id: TEMPLATE_ID [0 ..1]+ rm_version: String

LOCATABLE

+ archetype_node_id: String+ nam e: T EXT+ uid: UID_BASED_ID [0 ..1]

LINK

+ m eaning: TEXT+ target: EHR_URI+ type: T EXT

ITEM

+ nul l_ flavor: CODEABLE_T EXT [0..1 ]

ELEMENT

CLUSTER

+ structure_type: CODE_PHRASE [0..1]

DATA_VALUE

PARTICIPATION

+ function: T EXT+ m ode: CODEABLE_T EXT+ time: DAT E_T IM E [0..1 ]

PARTY_PROXY

+i tems1..*

+participations

0..*

+i tem s0..*

+data1..*

+l inks

0..*

+value

0..1

+party

1..1

+archetype_detai ls

0..1

+content 0..*

CIMI RM 1.0.2

Than

ks to

Sta

n H

uff,

Inte

rmou

ntai

n H

ealth

care

Initial Loading of Repository

StandardTerminologies

«roo tconcept»BloodPressurePanel

«roo tconcept»BloodPressurePanel

CD

«qual i fi er,enum era...BodyPosition

«enum »+ Head o f bed ra ised+ Lying on l eft side+ Lying on right side+ P rone+ Sea ted+ S tand ing+ Sup ine

CD

«qual i fi er,enum era...BodyPosition

«enum »+ Head o f bed ra ised+ Lying on l eft side+ Lying on right side+ P rone+ Sea ted+ S tand ing+ Sup ine

PQ

«da ta»DiastolicBloodPressureMeas

PQ

«da ta»DiastolicBloodPressureMeas

PQ

«da ta»MeanArterialPressureMeas

PQ

«da ta»MeanArterialPressureMeas

CD

«qual i fie r,enum era ti ...MethodDevice

«enum »+ In take M ethod Device+ In travenous Ca thete r+ T ube

CD

«qual i fie r,enum era ti ...MethodDevice

«enum »+ In take M ethod Device+ In travenous Ca thete r+ T ube

PQ

«da ta»SystolicBloodPressureMeas

PQ

«da ta»SystolicBloodPressureMeas

«roo tconcep t»Bloodpressure«roo tconcep t»Bloodpressure

Bloeddrukmeetwaarde

«da ta»Bovendruk

Bloeddrukmeetwaarde

«da ta»Bovendruk

Bloeddrukmeetwaarde

«da ta»Onderdruk

Bloeddrukmeetwaarde

«da ta»Onderdruk

Bloeddrukmeetwaarde

«da ta ,deri va ti on»GemiddeldeArterieleDruk

Bloeddrukmeetwaarde

«da ta ,deri va ti on»GemiddeldeArterieleDruk

CD

«qual i fie r,enum era ...Meetmethode

«enum »+ Niet-invasie f+ Invasie f

CD

«qual i fie r,enum era ...Meetmethode

«enum »+ Niet-invasie f+ Invasie f

CD

«qua l i fier,enum era ...Meetlocatie

«enum »+ Rech terbovenarm+ L inke rbovenarm+ Rech terd i j+ L inke rd i j+ Rech terpo ls+ L inke rpo ls+ V inger+ Rech terenkel+ L inke renke l

CD

«qua l i fier,enum era ...Meetlocatie

«enum »+ Rech terbovenarm+ L inke rbovenarm+ Rech terd i j+ L inke rd i j+ Rech terpo ls+ L inke rpo ls+ V inger+ Rech terenkel+ L inke renke l

CD

«sta te,enum era tion»Body Position

«enum »+ S taand+ L iggend+ Zi ttend+ Ach teroverleunend+ La te raa lL iggend+ T rende lenburg

CD

«sta te,enum era tion»Body Position

«enum »+ S taand+ L iggend+ Zi ttend+ Ach teroverleunend+ La te raa lL iggend+ T rende lenburg

CD

«qual i fie r,enum era ...BodyLocationPrecoord

CD

«qual i fie r,enum era ...BodyLocationPrecoord

PQ

«da ta»Diastolic

PQ

«da ta»Diastolic

?

CD

«qua l i fier,enum era...Location of

measurement

«enum »+ Finger+ In tra -arte ria l+ Le ft ankle+ Le ft arm+ Le ft thigh+ Le ft wrist+ Right ankle+ Right a rm+ Right th igh+ Right wrist+ T oe

CD

«qua l i fier,enum era...Location of

measurement

«enum »+ Finger+ In tra -arte ria l+ Le ft ankle+ Le ft arm+ Le ft thigh+ Le ft wrist+ Right ankle+ Right a rm+ Right th igh+ Right wrist+ T oe

?

PQ

«da ta»Mean Arterial Pressure

PQ

«da ta»Mean Arterial Pressure

?

CD

«qua l i fi er,enum era...Method

«enum »+ Auscu l ta tion+ Invasive+ M ach ine+ Palpa ti on

CD

«qua l i fi er,enum era...Method

«enum »+ Auscu l ta tion+ Invasive+ M ach ine+ Palpa ti on

?

CD

«sta te»Position

«enum »+ Lying+ Lying wi th ti l t to l e ft+ Recl ining+ S i tting+ S tanding

CD

«sta te»Position

«enum »+ Lying+ Lying wi th ti l t to l e ft+ Recl ining+ S i tting+ S tanding

?

PQ

«da ta»Systolic

PQ

«da ta»Systolic

?

«rootconcep t»Blood Pressure«rootconcep t»

Blood Pressure

?Source : n l .n ictiz.B loodpressure -v0 .101 Source

CE BloodPressurePane l .xm l wi th M ode l Value Se ts (2011-feb -13 ).xls

Source h ttp://dcm .nehta .o rg .au /ckm /openEHR-EHR-OBSERVAT ION.body_we ight.v1 .xm l

0..1

1

0..1

0 ..1

1

0..1

0..1

0..1

0 ..1

0..1

0 ..10..1

Klinische Bouwsteen Imported Intermountain Healthcare Imported OpenEHR Archetype

Noticeable differences:● No distinction between state & qualifier.● Labels.● Code binding external.● Cardinality always “0..1”?● Valuesets.

Noticeable differences:● Systolic & Diastolic cardinality● Labels.● With SCT code bindings.● Valuesets.

Noticeable differences:● Cardinality always “0..1”?● Labels.● No code bindings.● Valuesets.

“Some (models) are more equalthan others”

– George Orwell

Than

ks to

Lin

da B

ird, M

OH H

oldi

ngs,

Sin

gnap

ore

Diagnosis Example

Isosemantic Cube

Problem Clinical Model

Concept

Clinical Model Cubes

Granularity

Number of Data Elements →

Systolic Bp

Questionnaire

Medical Condition(e.g. Diabetes Record)

Full BP

Apgar Score

Propensity toAdverse Reaction

Wearables & Implantables

blood flowheart ratevascular pressureadrenal secretionoxygen intakedigestionbone growthcirculationexcretion

cellular repairimmune system responsedetoxificationprotein synthesishomeostasis regulationinsulin productionnervous system responserespiration

heart regulationmaintenance of tissue moisturethyroid secretionnutrient absorptionsalivary secretioncarbon dioxide removalocular transmissioncochlear transmission

H+ WebSeries https://www.youtube.com/watch?v=otlbZQ4zv_I

H+ “Where information meets biology”

“All models are wrong, some are useful”

– George Box

@ m.van.der.zel AT umcg.nl