1. "The World of Clinical Information Models"
30-jan-2014
Michael van der Zel
Clinical Information Systems Architect

2. CSI?

3. ●
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
Bron: Bernd Blobel, University of Regensburg
CSI “Stairway to Heaven”

4. The baseline Infostructure in 2013. Will it fly? How long? With how much effort?

5. ●
Mission
–
●
CIMI Mission & Goals
Improve the interoperability of healthcare systems through shared
implementable clinical information models. Note: implementable means models
Goals
that can be transformed into
software artifacts.
–
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.)

6. 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?

7. m ean in g : T EXT
ta rg e t: EHR_URI
type : T EXT
+l in ks
LOCATABLE
0 ..*
+
+
+
+
+
+
0..1
+p arti ci p a ti o n s
ca teg o ry: CODEABL E_T EXT
l an gua g e : CODE_ PHRASE
territory: CO DE_ PHRASE
+conte nt 0 ..*
a rch etyp e _ id : ARCHET YPE_ID
tem p l ate _i d : T EM PL AT E_ID [0 ..1]
rm _ ve rsi o n: Strin g
PARTICIPATION
0..* +
+
+
COMPOSITION
+
+
+
CIMI
ARCHETYPED
+arch e typ e _de tai l s
arche typ e _n od e_ i d : Stri ng
na m e: T EXT
ui d : UID_ BASED_ ID [0 ..1]
+p arty
PARTY_PROXY
fu ncti on : T EXT
m od e : CO DEABLE_ T EXT
ti m e : DAT E_T IM E [0 ..1 ]
1 ..1
CONTENT_ITEM
CEM
0..*
+i te m s
1 ..*
+d ata
CIMI RM 1.0.2
nul l _ fl avor: CODEABL E_T EXT [0 ..1 ]
+i te m s
SECTION
ENTRY
+
l a n gu age : CODE_ PHRASE
+val u e
ITEM
+
DATA_VALUE
0 ..1
1 ..*
Standard
Terminologies
CLUSTER
+
structure_ typ e: CODE_ PHRASE [0 ..1]
ELEMENT
CEMs
DCMs
CDA
Templates
openEHR
Archetypes
CEN
Archetypes
Repository of
Shared
Models in
a Single
Language
LRA
Models
CMETs, HMDs
RMIMs
Initial Loading of Repository
V2 “|”
LRA
V2 XML
HTML
V3 XML
FHIR
UML
openEHR
Archetype
Translators
CEN
Archetype
CDA
OWL
SOA
Payload
Thanks to Stan Huff, Intermountain Healthcare
LINK
+
+
+

8. Imported Intermountain Healthcare
Klinische Bouwsteen
« roo tco nce p t»
Bloodpressure
?
« roo tco nce pt»
BloodPressurePanel
S o u rce : n l.nictiz.B lo o dp re ssure -v0 .10 1
Imported OpenEHR Archetype
S o u rce
CE B l oo d P re ssu re P an e l.xm l with
M o de l V alu e S e ts (20 1 1-fe b -1 3 ).xls
«rootcon ce p t»
Blood Pressure
S o u rce h ttp://d cm .ne hta .o rg .au /ckm /
o p en E HR-E HRO B S E RVA T ION.b ody_ we ig ht.v1 .xm l
1
0..1
B lo e dd ru kmeetw a a rd e
CD
«d a ta»
Bov endruk
« q ua l ifier,e nu m e ra ...
Meetlocatie
« en u m »
+ Rech terb o ve n a rm
+ Li n ke rb o ven a rm
+ Rech terd i j
+ Li n ke rd ij
+ Rech terp o ls
+ Li n ke rp o ls
+ V in ger
+ Rech tere n kel
+ Li n ke re n ke l
1
B lo e dd ru kmeetw a a rd e
«d a ta»
Onderdruk
0..1
0..1
CD
«q u alifie r,enu m e ra ...
Meetmethode
« en um »
+ Ni et-in vasie f
+ In va si e f
0 ..1
0 ..1
PQ
CD
«d a ta »
SystolicBloodPressureMeas
«q u alifie r,e nu m e ra ...
BodyLocationPrecoord
CD
?
«q u alifie r,enu m e ra ti ...
MethodDev ice
0..1
?
PQ
PQ
« da ta»
Diastolic
0..1
B lo e dd ru kmeetw a a rd e
?
PQ
«d a ta ,d eri va ti o n»
GemiddeldeArterieleDruk
«d a ta »
MeanArterialPressureMeas
CD
0..1
« sta te,e n u m era tio n »
Body Position
CD
0 ..1
« q uali fi er,e n um era...
BodyPosition
«e n u m »
+ Hea d o f b ed ra ise d
+ Lyin g o n l eft side
+ Lyin g o n rig ht sid e
+ P ro ne
+ S ea te d
+ S ta nd in g
+ S up in e
« en u m »
+ S ta and
+ Li g g end
+ Zi tte nd
+ A ch tero verle u n end
+ La te raa l L ig ge nd
+ T re nde le n b urg
Noticeable differences:
●
Systolic & Diastolic cardinality
●
Labels.
●
With SCT code bindings.
●
Valuesets.
Noticeable differences:
●
No distinction between state & qualifier.
●
Labels.
●
Code binding external.
●
Cardinality always “0..1”?
●
Valuesets.
?
CD
« q ua l ifier,e num e ra...
Location of
measurement
« enu m »
+ In take M eth o d De vice
+ In traven o us Ca th ete r
+ T ube
«d a ta»
DiastolicBloodPressureMeas
0..1
PQ
« da ta»
Systolic
PQ
« da ta»
Mean Arterial Pressure
CD
« q ua li fi er,e num e ra...
Method
«e n u m »
+ A uscu lta tio n
+ In va sive
+ M ach in e
+ P alp a ti o n
« en u m »
+ Fi n g er
+ In tra -arte rial
+ Le ft ankl e
+ Le ft arm
+ Le ft thi g h
+ Le ft wrist
+ Rig ht a n kl e
+ Rig ht a rm
+ Rig ht thi g h
+ Rig ht wrist
+ T oe
?
?
CD
«sta te »
Position
« en u m »
+ Lyi ng
+ Lyi ng wi th ti lt to l e ft
+ Recl ini n g
+ S ittin g
+ S ta ndi ng
Noticeable differences:
●
Cardinality always “0..1”?
●
Labels.
●
No code bindings.
●
Valuesets.
“Some (models) are more equal
than others”
– George Orwell

9. Thanks to Linda Bird, MOH Holdings, Singnapore
Diagnosis Example

10. be l
Cu d e
t i c Mo
an al
e m i n ic
os Cl
Is
le m
ob
Concept
r
P

11. Clinical Model
Cubes

12. Granularity
Medical Condition
(e.g. Diabetes Record)
Questionnaire
Apgar Score
Propensity to
Adverse Reaction
Full BP
Systolic Bp
Number of Data Elements →

13. Wearables & Implantables
H+ “Where information meets biology”
blood flow
heart rate
vascular pressure
adrenal secretion
oxygen intake
digestion
bone growth
circulation
excretion
heart regulation
maintenance of tissue moisture
thyroid secretion
nutrient absorption
salivary secretion
carbon dioxide removal
ocular transmission
cochlear transmission
H+ WebSeries https://www.youtube.com/watch?v=otlbZQ4zv_I
cellular repair
immune system response
detoxification
protein synthesis
homeostasis regulation
insulin production
nervous system response
respiration

14. “All models are wrong,
some are useful”
– George Box
@ m.van.der.zel AT umcg.nl