| Date post: | 07-Dec-2014 |
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Information Models & FHIRIt’s all about content!
Koray Atalag MD, PhD, [email protected]
Vice Chair HL7 New ZealandChair openEHR New Zealand
openEHR Localisation Program LeaderMember HISO
Programmes of research in • Health informatics & technology
• Clinical trials
• Cardiovascular disease
• Addictions
• Nutrition & physical activity
Research services
Teaching• PG Diploma in Health Informatics
• MSc & PhD
(Clinical) Information ModelsMyths and Facts
• They are NOT reference information models; – as in HL7 v3 RIM, openEHR/ISO13606 or FHIR resource ontology!
• They are pure representations of health information
• They may employ a number of formats and methods; inc.– Mindmaps, pdf, UML, XML/XSD, Archetypes, FHIR resources and even
OO language implementations
• For max semantic interoperability & computability: formal reference information model – but can be very generic!
• Latest buzzword: Detailed Clinical Models (DCM)
What’s in the name?
Terminology: Labels/codes attached to atomic concepts (mostly without explicit context)
– Diabetes Mellitus, ear ache, left hip, CT scan etc.
Some have hierarchy (ICD) & relationships (SNOMED)
Boundary Problem Terminology binding
Information Model: structure and semantics of concrete clinical concepts w/ context
– Blood pressure measurement, lab test result, discharge summary, adverse reaction, prescription etc.
The Hard Way:
Coronary arteriosclerosi
s
Structural disorder of
heart
Heart disease
Cardiac finding
Cardiovascular finding
Finding by site
Clinical finding
SNOMED CT Concept
Mediastinal finding
Finding of region of thorax
Finding of trunk structure
Finding of body region
Viscus structure finding
Disorder of mediastinum
Disorder of thorax
Disorder of trunk
Disorder by body site
Disease
Disorder of body system
Disorder of body cavity
Disorder of cardiovascular
system
Disorder of coronary
artery
Coronary artery finding
Arterial finding
Blood vessel finding
General finding of soft
tissue
Disorder of soft tissue of
thoracic cavity
Disorder of soft tissue of body cavity
Disorder of soft tissue
Disorder of artery
Vascular disorder
Arteriosclerotic vascular disease
Soft tissue lesion
Degenerative disorder
Structure with terminology: SNOMEDInconsistencies due to different post-coordination of concepts
In a vasculitis physical examination: “Vascular exams: Carotid Right/Tender”
247348008 | tenderness (finding) | :363698007 | finding site | = 69105007 | Carotid artery structure (body structure) | : 24028007 | Right (qualifier value) |
_____________________________________________________________________________
301390006 | tenderness of cardiovascular structure | : 363698007 | finding site | = 69105007 | Carotid artery structure (body structure) |: 272741003 | laterality | = 24028007 | Right (qualifier value) |
_______________________________________________________________________________309655006 | On examination-artery (finding) | :
69105007 | Carotid artery structure (body structure) | : 24028007 | Right (qualifier) |:247348008 | tenderness |
_______________________________________________________________________________401050002 | Carotid artery finding (finding) | :
363698007 | finding site | = 69105007 | Carotid artery structure (body structure) | :272741003 | laterality | = 24028007 | Right (qualifier value) | :247348008 | tenderness |
Problem/Diagnosis Archetype (Nehta)
Archetype terminology binding
Open specs, tools and content for representing health information & building EHR– Based on 18+ years of international implementation experience
including Good European Health Record Project– Origin of ISO/CEN 13606 EHR standard
Not-for-profit organisation - established in 2001 www.openEHR.org
“Inside Systems” vs HIE Separation of clinical
and technical worlds• Big international community
& Archetypes• FHIR resources and Archetypes are closely related
– should avoid reinvention at all costs!• Archetype FHIR resource conversion is expected
to be seamless– Archetypes are maximal datasets; as opposed to– FHIR resources include most commonly used items
(e.g. 80%) with an option to extend as needed (e.g. 20%)
• An opportunity exists for FHIR to leverage openEHR content, tooling and expertise
FHIR: Adverse Reaction Resource
FHIR: Adverse Reaction Resource
FHIR: Adverse Reaction Resource
ADR Archetype (from CKM tool)
ADR Archetype (from CKM tool)
ADR Archetype (from CKM tool)
ADR Archetype (from CKM tool)
ADR Archetype (from CKM tool)
Getting closer…
HISO 10040 Interoperability Reference Architecture
10040.1R-CDRs
XDS
10040.2 CCR
SNOMED CTopenEHR
10040.3CDA
Acknowledge Alastair Kenworthy
What is a Content Model?• IT IS A REFERENCE LIBRARY – of validated information models for health
information exchange (and more!)
• Consists of maximal datasets (as opposed to minimal)– normalised using a standard EHR record organisation (openEHR)– Expressed as reusable and computable models – Archetypes
• Top level organisation follows CCR
• Only relevant items bound to SNOMED, ICD, LOINC etc.
• Further detail provided by:– Existing relevant sources (CCDA, Nehta, epSoS, HL7 FHIR etc.)– Extensions (of above) and new Archetypes (NZ specific)
• Each HIE content (CDA/FHIR/v2) will include one or more models and formally conform
Usage of the Content Model
Extending ECM• Addition of new models• Making existing models more specific
– powerful Archetype specialisation mechanism:– Lab result > HbA1C result, Lipid profiles etc.
Problem
Diagnosis
Diabetesdiagnosis
Text or Coded TermClinical descriptionDate of onsetDate of resolutionNo of occurrences
Coded Term+GradingDiagnostic criteriaStage
+Diagnostic criteria Fasting > 6.1 GTT 2hr > 11.1 Random > 11.1
First level specialisation
Second level specialisation
Exploiting Content Model for Secondary Use
Single Content Model
CDA
FHIR
HL7 v2/3
EHR Extract
UML
XSD/XMI
Mindmap
PAYLOAD
System A
Data Source A
MapTo
Content Model
System B
Data Source B
Native openEHR Repository
Secondary Use
MapTo
Content Model
Automated Transforms
No Mapping
