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"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