Transcript No Slide Title
A Brief Review of CIMI Plans and Goals
Stanley M. Huff, MD Stanley M Huff, MD Chief Medical Informatics Officer
Huff # 1
The Ultimate Value Proposition of CIMI • Sharing of: – Data – Information – Applications – Decision logic – Reports – Knowledge Huff # 2
Clinical System Approach
Intermountain can only provide the highest quality, lowest cost health care with the use of advanced clinical decision support systems integrated into frontline workflow
Decision Support Modules
• Antibiotic Assistant • Ventilator weaning • ARDS protocols • Nosocomial infection monitoring • MRSA monitoring and control • Prevention of Deep Venous Thrombosis • Infectious disease reporting to public health • Diabetic care • Pre-op antibiotics • ICU glucose protocols • Ventilator disconnect • Infusion pump errors • Lab alerts • Blood ordering • Order sets • Patient worksheets • Post MI discharge meds
Strategic Goal
• Be able to share applications, reports, alerts, protocols, and decision support with anyone in the WORLD
Order Entry API
(adapted from Harold Solbrig)
. . .
Application COS Interface Service Data
From Ben Adida and Josh Mandel
What Is Needed to Create a New Paradigm?
• Standard set of detailed clinical data models coupled with… • Standard coded terminology • Standard API’s (Application Programmer Interfaces) for healthcare related services • Open sharing of models, coded terms, and API’s • Sharing of decision logic and applications
Clinical modeling activities
• Netherlands/ISO Standard • CEN 13606 • United Kingdom – NHS • Singapore • Sweden • Australia • openEHR Foundation • Canada • US Veterans Administration • US Department of Defense • Intermountain Healthcare • Mayo Clinic • HL7 – Version 3 RIM, message templates – TermInfo – CDA plus Templates – Detailed Clinical Models – greenCDA • Tolven • NIH/NCI – Common Data Elements, CaBIG • CDISC SHARE • Korea • Brazil # 9
Clinical Information Modeling Initiative
Mission
Improve the interoperability of healthcare systems through shared implementable clinical information models.
Huff # 10
Clinical Information Modeling Initiative
Goals
• Shared repository of detailed clinical information models • Using a single formalism • Based on a common set of base data types • With formal bindings of the models to standard coded terminologies • Repository is open and models are free for use at no cost Huff # 11
Goal: Models that support multiple contexts • Message payload • Service payload • Decision logic (queries of EHR data) • EHR data storage • Clinical trials data (clinical research) • Normalization of data for secondary use • Creation of data entry screens • Natural Language Processing
Information Model Ideas
CEMs DCMs CDA Templates openEHR Archetypes
Repository of Shared Models in a Single Formalism
Standard Terminologies
Realm Realm Specific Specializations Specializations Specializations CEM Translators Translators Translators V2 “|” LRA V2 XML HTML V3 XML V3 Next UML ADL
CEN Archetypes LRA Models CMETs, HMDs RMIMs
Initial Loading of Repository CDA OWL CDISC SOA SHARE CEN Archetype Payload
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Roadmap (some parallel activities)
• Choose a single formalism • Choose the initial set of agreed data types • Define strategy for the core reference model and our modeling style and approach –
Development of “style” will continue as we begin creating content
Roadmap (continued)
• Create an open shared repository of models –
Requirements
–
Find a place to host the repository
–
Select or develop the model repository software
• Create model content in the repository –
Start with existing content that participants can contribute
–
Must engage clinical experts for validation of the models
Roadmap (continued)
• Create a process (editorial board?) for curation and management of model content • Resolve and specify IP policies for open sharing of models • Find a way of funding and supporting the repository and modeling activities • Create tools/compilers/transformers to other formalisms –
Must support at least ADL, UML/OCL, Semantic Web, HL7
• Create tools/compilers/transformers to create what software developers need –
Examples: XML schema, Java classes, CDA templates, greenCDA, RFH, SMART RDF, etc.
Selected Decisions
Decisions (London, Dec 1, 2011)
• We agree to create and use a single logical representation (the CIMI core reference model) comprising one or more models as the basis for interoperability across formalisms.
• We approve ADL 1.5 as the initial formalism in the repository using OpenEHR Constraint Model noting that modifications are required. • The corresponding Archetype Object Model will be included and adapted as the CIMI UML profile • The CIMI UML profile will be developed concurrently as a set of UML stereotypes, XMI specification and transformations
Definition of “Logical Model”
• Models show the structural relationship of the model elements (containment) • Coded elements have explicit binding to allowed coded values • Models are independent of a specific programming language or type of database • Support explicit, unambiguous query statements against data instances
Definition of “Logical Model” (cont)
• Models shall specify a single unit of measure (unit normalization) • Models can support inclusion of processing knowledge – Models can support recommend defaults – Models can specify assumed values of attributes (meaning of absence of the item) • Examples can be created for the model
Isosemantic Models Precoordinated Model (CIMI deprecated Model)
HematocritManualModel HematocritManual (LOINC 4545-0) data 37 %
Post coordinated Model (CIMI preferred Model)
HematocritModel Hematocrit (LOINC 20570-8) data 37 % quals HematocritMethodModel data Manual Hematocrit Method # 21
Isosemantic Models
• CIMI is committed to isosemantic clinical models in terms of
both
: – The ability to transform CIMI models into iso-semantic representations in other languages/standards (e.g. OWL, UML, HL7); – The ability to transform CIMI models between iso-semantic representations that use a different split between terminology pre-coordination versus structure.
Isosemantic Models (cont)
• CIMI will select one model within each isosemantic family that will be the preferred model for interoperability • (Profiles of exact models for specific uses will be created by the users: professional societies, regulatory agencies, public health, quality measures, etc.)
Terminology
• SNOMED CT will be the primary reference terminology • LOINC was also approved as a reference terminology – In the event of overlap, SNOMED CT will be the preferred source • CIMI will propose extensions to the reference terminologies when needed concepts do not exist – CIMI will maintain the extensions until they are accepted by the RT organization
Terminology (cont)
• The primary version of models will only contain references (pointers) to value sets • We will create tools that read the terminology tables and create versions of the models that contain enumerated value sets
Some Principles
• CIMI
DOES
care about implementation. There must be at least one way to implement the models in a popular technology stack that is in use today. The models should be as easy to implement as possible.
• Only use will determine if we are producing anything of value – Approve “Good Enough” RM and DTs – Get practical use ASAP – Change RM and DTs based on use
Pleasanton May 10-12, 2012
• Resolution: The reference model presented by the Reference Model Task Force is endorsed as a starting point and establishes the direction that CIMI wishes to take. We expect that this model will be tested and modified as modeling work continues.
Pleasanton May 10-12, 2012
• Reference model and associated data types were approved – We expect that this model will be tested and modified as modeling work continues.
• Agreed that there must be a computable semantic relationship between elements in a model
Goals for Rockville Meeting
• Continue modeling work • Approve a proposal for creating an Editorial Board • Decide on what tools to use to make models • Create a team to do an end-to-end proof of concept – Possible targets: FIHR, SMArt, CDA template, HL7 V2, others?
• Updates and information sharing: OMG AML RFI, CDL to ADL conversion, finding a parent organization, FIHR, member survey
Conflicts of Interest
Huff # 30