Representing Multiple Standards in a
Single DAM: Use of Atomic Classes
Salvatore Mungal1; Mead Walker2; David F Kong3;
Rebecca Wilgus3; Dana Pinchotti4; James E Tcheng3;
William Barry1; Brian McCourt3
1Duke
Cancer Institute, Durham, NC, 2Mead Walker Consulting,
Downingtown, PA, 3Duke Clinical Research Institute, Durham, NC,
4American College of Cardiology Foundation, Washington, DC
Agenda
• Aim: To create a Cardiology DAM
• Background
– Movement towards Interoperability
– The issues
• Atomic class resolution
• Results
• Conclusion
Background
• The National Cardiovascular Research Infrastructure
team and many stakeholders created a consensusbased, authoritative and harmonized set of clinical
data standards to meet the diverse requirements
necessary to streamline collection and secondary
reporting of health care data.
• Data element (DE) components included names,
definitions, permissible value names and definitions,
data types, citations, links to the source vocabulary
and inter-DE relationships and represented the smallest
meaningful unit of instantiated data.
• DAM creation
– From these DEs, a multi-disciplinary team created a UML-based
representation following NCI’s modeling guidelines to facilitate
ISO 11179 compliant metadata publication.
Background
• Overcoming methodological and tooling challenges, we
formulated a UML-based metadata model allowing
multiple representations (such as HL7 RIM and the
CDISC Study Data Tabulation Model (STDM)) within in a
single Domain Analysis Model (DAM) and subsequent
dissemination via an ISO 11179 compliant metadata
repository.
Interoperability
Overlapping perspectives on
nomenclature and formalisms
toward interoperability in
healthcare.
• Use of ISO 11179 metadata standard via NCI’s caDSR
(ontologies and terminologies) with the addition of
CDISC and HL-7 standards lay the foundation for
interoperability in healthcare.
Issues
• The typical ad hoc mapping of disparate document-based standards
and controlled terminology are insufficient for representing the
complex relationships such that barriers to reuse are greatly
reduced.
• The dynamic, multidimensional and interrelated nature of
information consumed and generated during the patient care
process dictates that data elements must be able to be used,
unconstrained, in each scenario.
• Initial attempts to represent a data element in a common model of
aggregated contexts were informative; however, modeling every
instantiation or permutation led to a very high level of complexity and
redundancy. We observed a large number of attributes (DEs)
were duplicated - as many as 19 times with over 1800 CDEs
created.
• Maintenance of the UML DAM was intractable.
• Many other approaches such as the abstraction, inheritance and
instance classifiers failed to satisfy functional requirements of the
model.
Issues
• Illustration of the CABGIndications and CABGComplications classes
associated to the CABG class showing the acuteMI attributes
before use of Atomic classes.
Atomic Class Resolution
• Conversion to the Acute Myocardial Infarction atomic class. Note the
Indication and Complication associations to the CABG class.
Results
• The CV DAM R2 yielded approximately 349 CDEs.
• The DEs are organized into approximately 165 atomic classes within
18 parent classes and 4 sub-domains of cardiology.
• By leveraging atomic classes, our data model with 349 unique DEs
was dispersed and replicated to over 1800 attributes in the original
model but condenses to a more parsimonious and generalizable
model with only 815 elements (from the replicated 349 CDEs).
Conclusion
• Modeling different representations of harmonized vocabulary-based
DEs in a single DAM serving disparate groups became intractable,
but the use of atomic classes in a CDELibrary curtails this.
• The use of atomic classes reduces maintenance efforts because
updates to any DEs are cascaded to all uses in the model.
• Using the atomic classes in the CDELibrary, it is relatively easy to
formulate a different representation through standard modeling
methods. This, plus the publication in a public metadata repository,
offers a readily consumable, common source for data specifications
serving diverse stakeholders.
• This DAM with use of atomic classes in a CDELibrary will facilitate
future semantic and syntactic interoperability across healthcare and
secondary reporting initiatives.
Thank you!