CIMI Modelling Taskforce – Meeting Minutes
Thursday 12th July 2012 @ 20:00-22:00 UTC
Attendees
Core Members:
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Linda Bird - Ministry of Health Holdings, Singapore
Stephen Chu – NEHTA, Australia
Gerard Freriks – EN13606 Association
Stan Huff – GE/Intermountain
Mike Lincoln – VA
Josh Mandel – SMArt
Mark Shafarman – HL7
Michael van der Zel – Results4Care & LifeLines (University Hospital Groningen)
Technical Resources:
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Peter Hendler – Kaiser Permanente
Dipak Kalra – University College London
David Moner – EN13606 Association
Galen Mulrooney, ONC (U.S.A.)
Clinical Modelling Resources:
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Heather Leslie – Ocean Informatics
Jay Lyle – VA
Ian McNicoll – Ocean Informatics
Sarah Ryan
Marcelo Rodrigues dos Santos – UFMG
Hendry Wijaya – MOHHoldings, Singapore
Absentees
Core Members:
 Tom Beale – Ocean Informatics
 Dave Carlson - VA
 Rahil Qamar Siddiqui – NHS Connecting for Health
Technical Resources:
 Grahame Grieve – Health Intersections
 Daniel Karlsson – Linkopings University
 Cecil Lynch - Accenture
Clinical Modelling Resource:
 Anneke Goossen – Results4Care
 William Goossen – Results4Care
Agenda
Appointment of secretary
Weekly Update & News
Review of Proposed Deliverables
Comments from Peter and Mark
Weekly action plan
Review of artefacts and outstanding issues (time permitting)
Brief Summary
Appointment of secretary
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Galen Mulrooney volunteered to act as secretary
o Roles and responsibilities of the CIMI Modelling Taskforce Secretary include:
 Attend scheduled weekly meetings
 Take roll call and minutes during weekly meetings
 Post meeting minutes and related documents onto Wiki (after
review)
 Distribute the agenda for weekly meetings (as agreed with chair)
 Send meeting reminders, and follow up action items assigned to
members, to ensure completion.
 Work with chair on general communications and organisation tasks.
Weekly Update and News
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EA XMI export errors and submit to Sparx support for resolution
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IHTSDO and the Regenstrief Institute have announced that they are exploring a longterm collaborative relationship with the objective of developing coded content to
support order entry and result reporting. The two organizations plan to build closer
links between the SNOMED CT and LOINC terminologies, reducing duplication of
effort and enhancing the effectiveness of computerized transmission of medical
information. See: www.ihtsdo.org/snomed_ct-loinc. LOINC will have primary
responsibility for creating Observables. The LOINC parts will be matched up to
SNOMED concepts
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Review Call for Models
All CIMI members and interested parties are invited to contribute a set of existing
clinical models and reference patterns to CIMI. These models will be used by the
CIMI Modelling taskforce to develop an initial set of CIMI Clinical Models, which will
be made freely available to all. The following items are requested:
1. A set of existing clinical models (in human-readable format and computable
format, if available) for the following:
 Heart Rate
 Body Mass Index (including calculation)
 Apgar Score
 Glucose Tolerance Test Result
 Adverse Reaction
 Medication order
 Problem list
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Care Giver Reported Nausea
Wound Culture Result (including sensitivities)
Please include appropriate metadata for each model (including the name,
topic, author, status, description, use, misuse), as well as details of the
structure, definition, constraints and value sets for each component of the
model. The contribution of additional clinical models (particularly those
considered high priority) would also be welcomed.
2. A set of reference patterns (in human-readable format and computable
format, if available) upon which the above models are based – for example,
observation, evaluation, instruction, action, activity, finding observation,
property observation, procedure, list, schedule, address, name. For each of
these reference patterns, please include appropriate metadata for each
model (as above), as well as details of the structure, definitions, constraints
and value sets for each component of the model. The contribution of
additional reference patterns would also be welcomed.
3. One point of contact (including name and email address) who is able to
answer further queries about the models submitted, if required.
It would be appreciated if these artefacts could be submitted by Friday 28th July
2012, to enable the CIMI Modelling taskforce to commence their analysis of these
artefacts. Please contact Virginia Riehl (Virginia.riehl@verizon.net) to obtain access
to the repository to which you can upload your modelling artefacts.
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Virginia has set up 400 GB of storage in a SugarSync (https://www.sugarsync.com )
folder called “CIMI Model Drop Off”, which we can use. It is access-controlled, so
Linda will need to send Virginia a list of email addresses of those who wish access.
We could link to this from a Wiki 'summary' page, but if we want to allow open
access to the models, we will need an alternative. Josh questioned why we want
access-controls. Why not use BitBucket (https://bitbucket.org ) or github
(https://github.com )? The CIMI models themselves (when developed) will need to
be open-access ... but do the contributed models need to be?
Should we publish the models on the wiki? General consensus is yes. Michael will
post the ones he has.
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Stan: IHC is working to move the CEML models from CDL to ADL; there’s a weekly
call which people can join if interested. Send Stan an email if interested.
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Made some edits to the Mission and Terms of Reference last week; send any further
comments to Linda
Review of Proposed Deliverables
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The proposed deliverables distributed last week were discussed:
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Stephen questioned what constitutes administrative patterns – are they just
demographics? Stan mentioned encounters, appointments, and scheduling.
Stephen asked if we need to set some boundaries and scope so we don’t get
overwhelmed with our limited resources.
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Need to update the wiki. It currently refers to the Reference Model Taskforce. It
needs to be redesigned to be more public-facing and start with CIMI in general, and
have some link to TF stuff. Asked for volunteers. Stan will check with Harold Solbrig
and Sarah Ryan to see if they could take care of it. Michael suggested to have
separate pages for each taskforce
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Michael will help. The secretary should post meeting minutes there.
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Communication and Training: Need to clarify with the IEC what the rules are
regarding public announcements, etc. At the minimum, we need to vet any
communications with the IEC. Stan suggested that since Tom does this for the IEC,
maybe we just deal directly with Tom.
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Stephen asked whether C.6 means that we are developing an ontology – if so, that’s
a huge undertaking. Linda said that we’re looking to bind to existing terminologies,
and using SNOMED extension mechanism if needed, but we’re not truly building an
ontology with composition, subsumption logic, etc. All we’re really doing is saying
that if we have a body site attribute in a model, how do we bind that attribute to the
concepts in an ontology like the SNOMED. We changed the term “ontology” to
“terminology”
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Stephen expressed interest in C3-C5.
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Michael expressed interest in C1
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There’s no mention of any process documentation or any instructions on how we
intend to use the tools, nor of any sort of a modelling “style guide. We need to
capture this somewhere.
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C2 will be discussed next week. We need Thomas and David Carlson for this
discussion. We need to document value sets using some sort of interim process
(such as a spread sheet or a document), until we have a terminology server. Until
the tooling is in place, we need to ensure that we have adequate documentation of
the models, including value sets and instance examples. These instance examples
need to be in a formalism and need to be both computable and human-readable.
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There are some EN13606 Association members in Spain who would be interested in
helping with C2.
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Updated the list of clinical models that are proposed to be built in C4. Dipak
requested that a short justification be included as to why these models were
chosen. Stan indicated that a primary reason for these models was to test the ability
of both ADL 1.5 and the completeness of the reference model to represent all the
information content that are in the models. Then these models can be used to test
the ability to convert to other iso-semantic models. But first we want to make sure
that the datatypes, the reference model and the language handle some real-world
examples.
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Gerard asked how we do this when tooling for ADL 1.5 doesn’t exist yet. Stan
agreed and said that’s why we have tooling-related tasks. We need Thomas, David
Carlson, and Michael van der Zell to figure this out.
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There are some outstanding issues from the Reference Model Task Force that we
need to finish, including null data flavor, cluster.value, etc.
Comments from Peter and Mark
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Mark and Peter described an issue with the approach
Computable means not just computable in the sense of SQL, XPATH, etc, but also in terms of
ontologies, reasoners, etc. Concerned about having information outside the visibility of
reasoners.
Ian: one reason why this hasn’t happened, is that the terms often don’t exist, and it is very
difficult to ensure that the concepts are exactly the same. While we want to move to using
SNOMED or a SNOMED extension, we have to have some short-term solutions that move us
incrementally and iteratively towards that ideal. We need to be able to create models that
are useful during the interim while we work on the semantics.
Below is the original email from Peter and Mark:
1 Does CIMI want the clinical models to be "computable" only with SQL,
ADL and XPath like pattern matching or with that plus SNOMED
reasoners?
2 Does CIMI want to create and maintain a separate terminology?
The current openEHR clinical archetypes seen on the Knowledge Browser
have particular human readable names that should not be included in
any model
that is to be "computable" not only with SQL, ADL and XPath but also
with Logical Subsumption.
We don't mind the human readable names if it is understood that they
are only human friendly labels and the computable meaning of the model
comes from the linked SNOMED code.
It is assumed we can extend SNOMED (within a CIMI extension).
If we don't do this, then we are creating in effect a separate CIMI
terminology, and do we need yet another terminology system?
Most enterprises in medicine today only use the limited capabilities
of SQL Xpath and (like ADL) pattern/ path matching.
The future of enterprise computable clinical models will include the
additional useful and powerful semantics of ontologies like SNOMED and
the power of reasoners to infer relationships that would otherwise be
overlooked.
Secondary uses of reasoners and ontologies include:
Clinical effectiveness research, outcomes studies, quality reporting,
and public health.
Example of openEHR creating a separate extra SNOMED terminology
DV_CODED_TEXT matches {
defining_code matches {
[local::
at0015,
-- Adult Thigh
at0016,
-- Large Adult
at0017,
-- Adult
at1008,
-- Small Adult
at1009,
-- Paediatric/Child
at1018,
-- Infant
at1019]
-- Neonatal
Weekly action plan
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All: Review tasks allocated and start to meet and work on these
All: Start building the models; start with Heart Rate, but we can use another if
needed; however it is preferred to use the same model
Michael: put review comments on the Wiki
Stan: Contact Harold regarding wiki infrastructure
Galen: Minutes
Linda: Distribute reference model review comments
All: Review and respond to above