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

# 13

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