Modelling Taskforce Report
Dr Linda Bird
19th January 2013
Agenda
• Background
• Overview of modelling approach
• Laboratory Results Report
• Submitted models
• Comparative analysis
• Modelling patterns
• Clinical Models
• Terminology binding
• Demographics Model
• Future work and discussion
Background
Taskforce Members
Core Members:
• Linda Bird (chair)
• Tom Beale
• Dave Carlson
• Stephen Chu
• Stan Huff
• Mike Lincoln
• Rahil Qamar Siddiqui
• Gerard Freriks
• Josh Mandel
• Mark Shafarman
• Michael van der Zel
Secretary:
• Eithne Keelaghan
Technical Resources:
• Peter Hendler
• Galen Mulrooney
• Daniel Karlsson
• Cecil Lynch
• Joey Coyle
• Grahame Grieve
• Dipak Kalra
• David Moner
Clinical Modelling Resource:
• William Goossen
• Jay Lyle
• Ian McNicoll
• Anneke Goossen
• Heather Leslie
• Sarah Ryan
• Harold Solbrig
• Marcelo Rodrigues dos Santos
Mission
To develop a CIMI modelling methodology,
style guide and a set of models, which
together demonstrate and test the approach
to CIMI clinical modelling.
Terms of Reference
This taskforce has been established to:
• Further develop CIMI's modelling methodology;
• Create an initial set of CIMI clinical models;
• Further test and develop CIMI technical models,
including:
– CIMI reference model
– Archetype Object Model 1.5, and
– CIMI terminology.
Modelling Taskforce History (2012)
May 10 - 12
Meeting in Pleasanton  Modelling Taskforce was established
May to Sep
Taskforce infrastructure and planning; Modelling methodology;
Observation modelling pattern; Heart rate model
Sept 14 - 16
Meeting in Rockville  Modelling priorities: Lab Results Report
(followed by Immunizations and Body Temperature)
Oct to Dec
Replanning and review of submitted Lab Result models
Design Lab Results model structure and modelling patterns
Lab Results - Comparative analysis spreadsheet
CIMI Terminology subgroup established October 2012
• Terminology binding use cases, requirements, options, proposal
• Lab Results terminology semantic bindings
• Lab Results terminology reference sets started
• Terminology server requirements
Review of CIMI Demographics Reference Model & model analysis
Dec 2 – 4
Taskforce meeting in Groningen  Lab Results comparative analysis,
mindmaps, implementation, terminology binding, reference model,
instances and planning
Overview of
CIMI
Modelling
Approach
CIMI Architectural Overview
CIMI Reference Model - Core
class CIMI Core Reference Model (logical)
LOCATABLE
LINK
+
+
+
meaning :TEXT
target :EHR_URI
type :TEXT
+
+
+
0..*
ARCHETYPED
+archetype_details
+link
archetype_node_id :String
name :TEXT
uid :UID_BASED_ID [0..1]
0..1
+
+
+
archetype_id :ARCHETYPE_ID
template_id :TEMPLATE_ID [0..1]
rm_version :String = 1.0.8 {readOnly}
+participation
PARTICIPATION
0..*
+content
COMPOSITION
+
+
+
category :CODED_TEXT
language :CODED_TEXT
territory :CODED_TEXT
+
+
+
+
function :CODED_TEXT
time :INTERVAL_VALUE<DATE_TIME> [0..1]
mode :CODED_TEXT
details :ITEM [0..*]
CONTENT_ITEM
0..*
0..*
+item
+party
ITEM
1..*
+data
+item
1..1
1..*
PARTY_PROXY
SECTION
ENTRY
+
language :CODED_TEXT
CLUSTER
+
structure_type :CODED_TEXT [0..1]
ELEMENT
+
+
null_flavor :CODED_TEXT [0..1]
value :DATA_VALUE [0..1]
CIMI Reference Model – Data Values
class CIMI Data Value Types (logical)
IDENTIFIER
+
+
+
YESNO
+
id :String
type :CODED_TEXT
issuer :String
EHR_URI
value :Boolean
CODED_TEXT
+
+
+
+
+
URI
PLAIN_TEXT
+
value :String
PARSABLE
+
+
+target
TEXT
formalism :CODED_TEXT
value :String
DATA_VALUE
+
+
value :String
language :CODED_TEXT [0..1]
+
+
T : ORDERED
ORDERED_VALUE
0..1 +upper<T>
0..1
MatchRefSet
symbol :CODED_TEXT
value :Integer
value :Integer
value_status :String [0..1]
QuantifiedValueStatusRefSet
AMOUNT
+
+
>
=
<
?
QUANTIFIED
+
+
upper_unbounded :Boolean
lower_unbounded :Boolean
upper_included :Boolean
lower_included :Boolean
ORDINAL
+
+
COUNT
match :Character
purpose :CODED_TEXT [0..1]
INTERVAL_VALUE
+
+
+
+
+lower<T>
alternate_text :String [0..1]
data :Byte [0..*] (Array)
integrity_check :Byte [0..*] (Array)
media_type :CODED_TEXT
uri :URI [0..1]
TERM_MAPPING
0..*
MULTIMEDIA
1..1
+mapping
ENCAPSULATED
+
+
+
+
+
code :String
terminology_id :TERMINOLOGY_ID
terminology_version :String [0..1]
term :String [0..1]
term_id :String [0..1]
=
<
>
<=
>=
~
accuracy :Real [0..1]
accuracy_is_percent :Boolean [0..1]
TEMPORAL
PROPORTION
QUANTITY
+
+
+
+
numerator :Real
denominator :Real
precision :Integer [0..1]
type :CODED_TEXT
+
+
+
value :Double
units :CODED_TEXT
precision :Integer [0..1]
DATE
DURATION
+
duration_text :String [0..1]
+
value :String
TIME
+
value :String
DATE_TIME
+
value :String
CIMI Reference Model – Demographics
class CIMI Demographics Model (logical)
«archetype_parent»
LOCATABLE
+
+
+
PARTY_RELATIONSHIP
+
+
+
+
PARTY
+relationship
source :PARTY_REF
target :PARTY_REF
time_validity :INTERVAL_VALUE<DATE> [0..1]
details :ITEM [0..*]
archetype_node_id :String
name :TEXT
uid :UID_BASED_ID [0..1]
+
+
+
0..*
uid :HIER_OBJECT_ID
reverse_relationship :LOCATABLE_REF [0..*]
details :ITEM [0..*]
ROLE
ACTOR
+role
+
+
time_validity :INTERVAL_VALUE<DATE> [0..1]
role_type :CODED_TEXT
+
actor_type :CODED_TEXT
Archetype Object Model (AOM)
CIMI Modelling Layers
CLUSTER
ENTRY
SECTION
COMPOSITION
Implementation
Purpose Context
Dispensed
Medications GUI
Neonatal Blood
Pressure in EHR
Current Medication
List in EHR
Laboratory Report
Message
Care Setting
Context
G.P. Dispensed
Medication Item
Home Blood
Pressure
Outpatient Clinic
Current Medication
List
Inpatient Discharge
Summary
Use Case Context
Dispensed
Medication Item
Standing Blood
Pressure
Current Medication
List
Full Blood Count
Results Report
Specialty Context
Paediatric
Medication Item
Neonatal Blood
Pressure
Cardiology
Medication List
Biochemistry
Laboratory Results
Report
Clinical Models
Medication Item
Blood Pressure
Medication List
Laboratory Results
Report
Patterns
Material Entity,
Observable, Action,
Schedule, Address,
Observation,
Action
Clinical List
Clinical Report,
Event Summary
Reference Model
CIMI’s Modeling Approach
•
•
•
•
•
•
•
•
Modular for reusability
Composable for meeting use-cases
Pattern-based for consistency
Maximal for completeness
Logical for implementation in multiple formats
Constraint-based to allow specialisation
Extensible for local requirements
Bound to terminology for isosemanticity &
interoperability
Modelling Methodology
• Foundations
1.
2.
3.
4.
CIMI Reference Model
Archetype Object Model
CIMI Modelling Patterns
CIMI Style Guide
• Modelling Approach
1.
2.
3.
4.
5.
6.
Analyse clinical models submitted (with value sets)
Identify maximal set of data elements
Remove ‘out of scope’ data elements (Style Guide)
Select appropriate CIMI Modelling Patterns(Style Guide)
Define CIMI model (Mindmap, ADL, UML)
Add Terminology bindings
o
o
7.
8.
Meaning (nodes, node relationships)
Value sets (maximal set from submitted models)
Add Example Model Data Instances
Technical Validation
o
ADL, UML
9. Clinical Validation / Review
10. Confirm mappings from submitted models
Laboratory
Results
Report
Submitted Models
•
•
•
•
•
•
•
•
FHIR
Intermountain
NEHTA
MOHH
HL7
Netherlands (NFU)
EN13606 Association
Canada InfoWay
Lab Report resource
Standard Lab Obs
Pathology Test Result
Investigation Composition
Clinical Care Document
Lab Results
Lab Test
HL7 v3 POLB_MT004000UV
FHIR – Lab Report resource
Intermountain – Standard Lab Obs
NEHTA – Pathology Test Result
MOHH – Investigation Composition
HL7 Clinical Care Document - Results
NFU – Lab Results
EN13606 Association – Lab Test
Canada InfoWay – HL7 v3
POLB_MT004000UV
CIMI Laboratory Results Report Design
Lab Results Report
(Composition)
1
Lab Report Header
(Entry)
0..1
Patient Encounter
Summary (Entry)
0..*
0..*
Lab Test Request
Summary (Entry)
Lab Test Result (Entry)
0..*
0..*
Specimen
(Cluster)
Test Result
Group/Item (Cluster)
0..*
Specimen
(Cluster)
0..*
Reference
Range (Cluster)
Identify maximal set of data elements
• Comparative analysis of submitted models is used
to identify the maximal set of relevant data
elements for each model (see spreadsheet)
Data Element
Laboratory report
header
Data Type /
Cardinality
Class
ENTRY
Description
1
Information pertaining to the whole
lab report
Patient encounter
summary
ENTRY
0..1
Information about the patient
encounter to which this report is
related.
Laboratory test request
summary
ENTRY
0..*
The set of lab orders associated with
the lab results in this report.
Laboratory test result
ENTRY
1..*
Results grouped by
specimen/kind/category
Archetype Map for
Laboratory Results Report
Composition:
Laboratory Report
Header
Patient Encounter
Entry:
Summary
Laboratory Results
Report
Laboratory Test
Request Summary
Laboratory Test
Observation
Archetype Map for
Laboratory Results Report
Laboratory Results
Report
Composition:
Laboratory Report
Header
Patient Encounter
Entry:
Summary
Laboratory Test
Request Summary
Cluster:
Action
Action
Laboratory Test
Request
Laboratory Test
Observable
Action
Laboratory Test
Observation
Laboratory Test
Observable
Laboratory Test
Result Group
Specimen
Reference Range
Action
COMPOSITION modelling patterns
COMPOSITION
constrains
Clinical Report
constrains
Laboratory Results
Report
CIMI-COMPOSITION.laboratory_results_report
class CIMI Core Reference Model
LOCATABLE
LINK
+
+
+
meaning :TEXT
target :EHR_URI
type :TEXT
ARCHETYPED
+archetype_details
+links
+
+
+
0..*
archetype_node_id :String
name :TEXT
uid :UID_BASED_ID [0..1]
0..1
+
+
+
archetype_id :ARCHETYPE_ID
template_id :TEMPLATE_ID [0..1]
rm_version :String = 1.0.6 {readOnly}
+
+
+
function :CODED_TEXT
time :INTERVAL_VALUE<DATE_TIME> [0..1]
mode :CODED_TEXT
+participation
PARTICIPATION
0..*
COMPOSITION
+
+
+
category :CODED_TEXT
language :CODED_TEXT
territory :CODED_TEXT
+content 0..*
CONTENT_ITEM
constrains
constrains
+party
PARTY_PROXY
1..1
ENTRY modelling patterns
ENTRY
constrains
Clinical Entry
constrains
Clinical Report
Header
constrains
constrains
Clinical Activity
Observation
constrains
Request
constrains
constrains
constrains
constrains
Observation
Request
constrains
Laboratory Report
Header
Patient Encounter
Summary
Laboratory Test
Request Summary
Laboratory Test
Observation
CIMI-ENTRY.clinical_entry
class CIMI Core Reference Model
LOCATABLE
LINK
+
+
+
meaning :TEXT
target :EHR_URI
type :TEXT
0..*
ARCHETYPED
+archetype_details
+links
+
+
+
archetype_node_id :String
name :TEXT
uid :UID_BASED_ID [0..1]
0..1
+
+
+
archetype_id :ARCHETYPE_ID
template_id :TEMPLATE_ID [0..1]
rm_version :String = 1.0.6 {readOnly}
+participation
PARTICIPATION
0..*
+
+
+
CONTENT_ITEM
1..*
+data
ENTRY
+
language :CODED_TEXT
function :CODED_TEXT
time :INTERVAL_VALUE<DATE_TIME> [0..1]
mode :CODED_TEXT
ITEM
+party
PARTY_PROXY
1..1
CIMI-ENTRY.laboratory_report_header
ENTRY
Clinical Entry
CIMI-ENTRY.patient_encounter_summary
ENTRY
Clinical Entry
CIMI-ENTRY.laboratory_test_request_summary
ENTRY
Clinical Entry
CIMI-ENTRY.laboratory_test_observation
ENTRY
Clinical Entry
Archetype Map for
Laboratory Results Report
Laboratory Results
Report
Composition:
Laboratory Report
Header
Patient Encounter
Entry:
Summary
Laboratory Test
Request Summary
Cluster:
Action
Action
Laboratory Test
Request
Laboratory Test
Observable
Action
Laboratory Test
Observation
Laboratory Test
Observable
Laboratory Test
Result Group
Specimen
Reference Range
Action
CLUSTER modelling patterns
CLUSTER
constrains
constrains
constrains
Observable
constrains
Material Entity
Finding
constrains
Laboratory Test
Observable
Laboratory Test
Result Group
Reference Range
constrains
Action
constrains
Specimen
Specimen Collection
Site
Laboratory Test
Request
CIMI-CLUSTER.laboratory_test_observable
class CIMI Core Reference Model
LOCATABLE
LINK
+
+
+
meaning :TEXT
target :EHR_URI
type :TEXT
ARCHETYPED
+archetype_details
+links
+
+
+
0..*
archetype_node_id :String
name :TEXT
uid :UID_BASED_ID [0..1]
0..1
+
+
+
archetype_id :ARCHETYPE_ID
template_id :TEMPLATE_ID [0..1]
rm_version :String = 1.0.6 {readOnly}
+
+
+
function :CODED_TEXT
time :INTERVAL_VALUE<DATE_TIME> [0..1]
mode :CODED_TEXT
+participation
PARTICIPATION
0..*
ITEM
CONTENT_ITEM
1..*
+items
CLUSTER
+
structure_type :CODED_TEXT [0..1]
+party
PARTY_PROXY
1..1
Use of
CIMI-CLUSTER.laboratory_test_observable
CLUSTER modelling patterns
Finding
CLUSTER
Finding
Finding Group
Laboratory Test
Result Group
Finding Item
Laboratory Test
Result Item
Reference Range
CIMI-CLUSTER.laboratory_test_result_group
CLUSTER
CIMI-CLUSTER.laboratory_test_result_item
CLUSTER
CIMI-CLUSTER.laboratory_test_result_item
CLUSTER
Finding Item
CIMI-CLUSTER.reference_range
CLUSTER
Finding Item
CLUSTER modelling patterns
Material Entity
CLUSTER
Material Entity
Specimen
Anatomical Location
Specimen Collection
Site
CIMI-CLUSTER.specimen
CLUSTER
CIMI-CLUSTER.specimen_collection_site
CLUSTER
Anatomical Location
CLUSTER modelling patterns
Action
CLUSTER
Action
Encounter Action
Collect Action
Observe Action
Receive Action
Interpret Action
Author Action
Approve Action
Issue Action
Report Action
Cancel Action
Custodian Action
Request Action
Laboratory Test
Request Action
Requested Action
CIMI-CLUSTER.approve_action
CLUSTER
CIMI-CLUSTER.approve_action
CLUSTER
Action
CIMI-CLUSTER.request_action
CLUSTER
Action
CIMI-CLUSTER.laboratory_test_
request_action
CLUSTER
Action
Request Action
CIMI-CLUSTER.collect_action
CLUSTER
Action
Laboratory Results Report (Template)
CIMI-COMPOSITION-TEMPLATE.
laboratory_results_report
Full Blood Count
CIMI-ENTRY.complete_blood_count
CIMI’s Modeling Approach
•
•
•
•
•
•
•
•
Modular for reusability
Composable for meeting use-cases
Pattern-based for consistency
Maximal for completeness
Logical for implementation in multiple formats
Constraint-based to allow specialisation
Extensible for local requirements
Terminology-bound for isosemanticity &
interoperability
Terminology
Use Cases for Terminology in Models
1. Management and quality control of model libraries
a)
b)
Searching model libraries (e.g. Find all archetypes with a meaning << Observable Entity)
Identifying semantic overlap between models (e.g. 2 models that contain a cluster
whose elements have the same or similar meanings)
c)
Inconsistency of model interdependencies
(e.g. the meaning of a constrained archetype
is not subsumed by the meaning of the base archetype)
2. Transforming between isosemantic representations of the model: both
a)
b)
Different levels of precoordination (e.g. ‘Left leg’ versus ‘Leg’ + Laterality= “Left’)
Different representation models (e.g. All ENTRYs with meaning << |Observable entity| to be
mapped to a HL7 v3 Observation)
3. Querying data instances of models (including clinical decision support)
which use different representations – for example:
a)
Different level of precoordiation versus structure (e.g. ‘Left leg’ versus ‘Leg’ +
b)
Different modeling design choices (e.g. Representing a medication’s Indication as a data
c)
Subsumption testing of values
Laterality= “Left’)
element, versus an ‘indication’ link to a Diagnosis archetype)
4. Supporting data validation and semantic interoperability (e.g.
between systems which use different native information structures)
Exchanging data
Requirements for using Terminology in Models
1. Standard (reproducible) way of doing terminology bindings
2. The ability to represent the valid set of values for a given coded element.
3. The ability to state the association between the intended interpretation of
nodes in the model and concepts in the terminology
4. Terminology bindings that are agnostic as to whether nodes are
connected using a hierarchy or using links.
5. Terminology bindings that allow the values to be represented in a way that
is agnostic to the degree of precoordination versus structure.
6. Terminology bindings that enable the transformation between isosemantic
representations of the same model
7. Terminology bindings that allow consistency to be checked within models,
and between models related by specialisation or used to fill slots (using
an underlying ontology).
8. Support for semantic node labelling.
Management and Quality Control of Model Libraries
Example Scenarios
•
Search for:
– An archetype whose meaning (without context) is subsumed by ‘Cardiovascular
Observable’.
•
Validate archetype specialisations:
– To ensure that there is a valid relationship between the meanings of the base and the
constrained archetypes – for example:
o Not valid: ‘Pulse rate’ (meaning = |pulse finding|) based on ‘Heart rate’ (meaning
= |heart rate|) Meaning from different hierarchies
o Valid: ‘Pulse rate’ (meaning = |pulse|) based on ‘Heart rate’ (meaning = |heart
rate|)
Meaning of constrained archetype subsumed by meaning of base
archetype
o Valid??: ‘Family history of diagnosis’ based on ‘Diagnosis’ archetype
Is this valid, or not? (N.B.: Participation could change)
•
Validate archetype slot fillers:
– To ensure that the meaning of the slot and the meaning of the archetype that fills it are
consistent – for example:
o Valid: Using a ‘Problem diagnosis’ archetype (meaning = |clinical finding|) to fill a
‘Cardiovascular problem/diagnosis’ slot (meaning = |cardiovascular finding|).
o Using a ‘Problem diagnosis’ archetype to fill the following slots in a discharge
summary:
 ‘Family history’, ‘Past history’, ‘Current problem/diagnosis’, or ‘Problems’
o Using a ‘Medication’ archetype to fill the following slots in a discharge summary :
 ‘Ceased medication’, ‘Current medication’, or ‘Past Medication’
Terminology Binding Approach
• The meaning of each node is separated into 3 parts: verb, noun, modifier
– Relationship: The relationship from the parent node to this node
– Object: The ‘class’ of things defined by this node’s values
– Modifier: Subject-relationship, temporal and procedure/finding context;
State/Certainty/Negation; Mood code
• Note: ‘Subject’ of ‘Subject-rel-object’ triple is the parent node
CIMI Terminology Binding Approach
STRUCTURE
BINDING
TERMINOLOGY
Meaning
Cluster:
Medication
Value Set
Relationship
Object
Modifier
(Linkage
concept)
Pharm/biol
product
(Context
values)
-
Element:
Medication
Name
(Linkage
concept)
Pharm/biol
product
(Context
values)
Medication
Ref_Set
Element:
Active
ingredient
Has active
ingredient
Substance
(Context
values)
Substance
Ref_Set
Element:
Basis of
Strength
Has basis of
strength
substance
Substance
(Context
values)
Substance
Ref_Set
Element:
Strength
Has strength
Measurement
Finding
(Context
values)
-
Dose form
Has dose
form
Drug dose
form
(Context
values)
Dose_Form
Ref_Set
Has indication
Clinical
Finding
(Context
values)
Indication
Ref_Set
Element:
Element:
Indication
Constraining archetype meaning (Object)
STRUCTURE
BINDING
TERMINOLOGY
Meaning
Cluster:
Methotrexate
Medication
Value Set
Relationship
Object
Modifier
(Linkage
concept)
Methotrexate
Product
(Context
values)
-
Element:
Medication
Name
(Linkage
concept)
Methotrexate
Product
(Context
values)
Methotrexate
Ref_Set
Element:
Active
ingredient
Has active
ingredient
Substance
(Context
values)
Substance
Ref_Set
Element:
Basis of
Strength
Has basis of
strength
substance
Substance
(Context
values)
Substance
Ref_Set
Element:
Strength
Has strength
Measurement
Finding
(Context
values)
-
Dose form
Has dose
form
Drug dose
form
(Context
values)
Dose_Form
Ref_Set
Has indication
Clinical
Finding
(Context
values)
Methotrexate
Indications
Ref_Set
Element:
Element:
Indication
Constraining archetypes (Relationship)
STRUCTURE
BINDING
TERMINOLOGY
Meaning
Cluster:
Medication
with Prim Ind
Value Set
Relationship
Object
Modifier
(Linkage
concept)
Pharm/Biol
Product
(Context
values)
-
Element:
Medication
name
(Linkage
concept)
Pharm/Biol
Product
(Context
values)
Medication
Ref_Set
Element:
Active
ingredient
Has active
ingredient
Substance
(Context
values)
Substance
Ref_Set
Element:
Basis of
Strength
Has basis of
strength
substance
Substance
(Context
values)
Substance
Ref_Set
Element:
Strength
Has strength
Measurement
Finding
(Context
values)
-
Element:
Dose form
Has dose
form
Drug dose
form
(Context
values)
Dose_Form
Ref_Set
Element:
Primary
Indication
Has primary
indication
Clinical
Finding
(Context
values)
Indication
Ref_Set
Example: Diagnosis
STRUCTURE
BINDING
TERMINOLOGY
Meaning
Cluster:
Diagnosis
Value Set
Relationship
Object
Modifier
(Linkage
concept)
Clinical
Finding
(Context
values)
-
Element:
Diagnosis
name
(Linkage
concept)
Clinical
Finding
(Context
values)
Diagnosis
Ref_Set
Element:
Onset
datetime
Time aspect
Date of onset
(Context
values)
-
Element:
Diagnosis
datetime
Time aspect
Date of
diagnosis
(Context
values)
-
Element:
Clinical status
Finding
context
Finding
context value
(Context
values)
Clinical Status
Ref_Set
Element:
Comments
Has comment
Clinical
Finding
(Context
values)
-
Example: Slot filling (Primary diagnosis)
STRUCTURE
Cluster:
Element:
Cluster:
BINDING
TERMINOLOGY
Discharge
Summary
Medical record
number
Primary diagnosis
Meaning
Relationship
Object
Modifier
Has primary
diagnosis
Clinical
Finding
(Context
values)
Meaning
Cluster:
Diagnosis
Element:
Diagnosis
name
Element:
Onset
datetime
Relationship
Object
Modifier
(Linkage
concept)
Clinical
Finding
(Context
values)
Value Set
-
Value Set
-
Example: Slot filling (Family History)
STRUCTURE
Cluster:
BINDING
TERMINOLOGY
Discharge
Summary
Meaning
Element:
Cluster:
Medical record
number
Family history
Relationship
Has diagnosis
Object
Modifier
Clinical
Finding
Family history
(Person in
family of
subject)
Meaning
Cluster:
Diagnosis
Element:
Diagnosis
name
Element:
Onset
datetime
Relationship
Object
Modifier
(Linkage
concept)
Clinical
Finding
(Context
values)
Value Set
-
Value Set
-
Example: Slot filling (Secondary Disease)
STRUCTURE
Cluster:
BINDING
TERMINOLOGY
Discharge
Summary
Meaning
Element:
Cluster:
Medical record
number
Secondary disease
Relationship
Object
Modifier
Has secondary
disease
Disease
(Context
values)
Meaning
Cluster:
Diagnosis
Element:
Diagnosis
name
Element:
Onset
datetime
Relationship
Object
Modifier
(Linkage
concept)
Clinical
Finding
(Context
values)
Value Set
-
Value Set
-
Example: Slot Filling (Ceased Medications)
STRUCTURE
BINDING
TERMINOLOGY
Discharge
Summary
Meaning
Medical record
number
Ceased
medications
Relations
hip
Object
Administer
Pharm /
biologic
product
Modifier
Ceased
Rules
Value
Set
Ceased medications.Status =
“Ceased”
-
Rules
Value
Set
Meaning
Medication
Medication
name
Active
ingredient
Relations
hip
Object
Modifier
(Linkage
concept)
Pharm /
biologic
product
(Context
values)
-
Future work
& references
Future Work
• Develop CIMI Modelling Style Guide
• Demographics:
– Finalise CIMI Demographics RM & Party Models
• Lab Results Report:
– Finish terminology bindings for Lab Results Report
– Create Lab Results specialisations (e.g. CBC)
– Create Lab Results Report instance examples
• Implementation:
– Create ADL & Implementation artefacts (FHIR etc)
• Other models: Immunizations, Temperature
Online References
• CIMI Web Page
– http://informatics.mayo.edu/CIMI
• Google doc repository
– http://content.clinicalmodels.org
• Google groups email list (cimi-modelling-taskforce)
– http://groups.google.com/group/cimi-modellingtaskforce?hl=en-GB
• Issue tracking (github)
– https://github.com/clinicalmodels/cimi/
Issues for Discussion
• Volunteer time – Limited time resources
• Tooling:
– Urgently need tooling to generate ADL
– Need tooling for model display and validation
– Need terminology tooling for CIMI value sets
– Need repository for sharing models
• Model review process:
– Need formal model review processes and governance
Questions