CIMI Modelling Taskforce ReportDr Linda Bird11th April 2013

LABORATORY MODELS

• FHIR Lab Report resource• Intermountain Standard Lab Obs• NEHTA Pathology Test Result• MOHH Investigation Composition• HL7 Clinical Care Document• Netherlands (NFU) Lab Results• EN13606 Assoc Lab Test• Canada InfoWay HL7 v3 POLB_MT004000UV

Submitted Models

Archetype Map forLaboratory Results Report

Laboratory Results Report

Composition:

Archetype Map forLaboratory Results Report

Laboratory Results Report

Composition:

Entry:

Laboratory Report Header

Patient Encounter Summary

Laboratory Test Request Summary

Laboratory Test Observation

Archetype Map forLaboratory Results Report

Laboratory Results Report

Composition:

Entry:

Cluster:

Laboratory Report Header

Patient Encounter Summary

Laboratory Test Request Summary

Laboratory Test Observation

Action

Laboratory Test Request

Laboratory Test Observable

Laboratory Test Result Group

Laboratory Test Observable

Action

Action

Reference Range

Specimen

Action

CompositionLaboratory Results Report

Laboratory Results Report

Clinical Report

COMPOSITION

constrains

constrains

CIMI-COMPOSITION.laboratory_results_report

Clinical Report

COMPOSITION

constrains

constrains

EntryLaboratory Report Header

Clinical Report Header

ENTRY

constrains

constrains

Clinical Entry

constrains

Laboratory Report Header

CIMI-ENTRY.laboratory_report_header

Clinical Report Header

ENTRY

constrains

constrains

Clinical Entry

constrains

EntryPatient Encounter Summary

Patient Encounter Summary

Clinical Activity

ENTRY

constrains

constrains

Clinical Entry

constrains

CIMI-ENTRY.patient_encounter_summary

Clinical Activity

ENTRY

constrains

constrains

Clinical Entry

constrains

EntryLaboratory Test Request Summary

Laboratory Test Request

Summary

Clinical Entry

Observation Request

Request

Clinical Activity

ENTRY

constrains

constrains

constrains

constrains

constrains

CIMI-ENTRY.laboratory_test_request_ summary

Clinical Entry

Observation Request

Request

Clinical Activity

ENTRY

constrains

constrains

constrains

constrains

constrains

EntryLaboratory Test Observation

Laboratory Test Observation

Observation

ENTRY

constrains

constrains

Clinical Entry

constrains

CIMI-ENTRY.laboratory_test_observation

Observation

ENTRY

constrains

constrains

Clinical Entry

constrains

Archetype Map forLaboratory Results Report

Laboratory Results Report

Composition:

Entry:

Cluster:

Laboratory Report Header

Patient Encounter Summary

Laboratory Test Request Summary

Laboratory Test Observation

Action

Laboratory Test Request

Laboratory Test Observable

Laboratory Test Result Group

Laboratory Test Observable

Action

Action

Reference Range

Specimen

Action

ClusterLaboratory Test Observable

Laboratory Test Observable

CLUSTER

constrains

Observable

constrains

CIMI-CLUSTER. laboratory_test_observable

CLUSTER

constrains

Observable

constrains

ClusterLaboratory Test Result Group

CLUSTER

constrains

Finding

constrains

Finding Group

constrains

Laboratory Test Result Group

CIMI-CLUSTER. laboratory_test_result_group

CLUSTER

constrains

Finding

constrains

Finding Group

constrains

ClusterLaboratory Test Result Item

CLUSTER

constrains

Finding

constrains

Finding Item

constrains

Laboratory Test Result Item

CIMI-CLUSTER. laboratory_test_result_item

CLUSTER

constrains

Finding

constrains

Finding Item

constrains

ClusterReference Range

Reference Range

CLUSTER

constrains

Finding

constrains

Finding Item

constrains

CIMI-CLUSTER.reference_range

CLUSTER

constrains

Finding

constrains

Finding Item

constrains

ClusterSpecimen

Specimen

CLUSTER

constrains

Material Entity

constrains

CIMI-CLUSTER.specimen

CLUSTER

constrains

Material Entity

constrains

ClusterSpecimen Collection Site

CLUSTER

constrains

Material Entity

constrains

Anatomical Location

constrains

Specimen Collection Site

CIMI-CLUSTER.specimen_collection_site

CLUSTER

constrains

Material Entity

constrains

Anatomical Location

constrains

CLUSTER Laboratory Actions

Observe Action

Action

Interpret Action

Approve Action

Report Action

Cancel Action

Author Action

Issue Action

Custodian Action

Laboratory Test Request Action

Receive Action

Collect Action

Requested ActionRequest Action

Encounter Action

CLUSTER

ClusterLaboratory Test Request Action

Laboratory Test Request Action

CLUSTER

constrains

Action

constrains

Request Action

constrains

CIMI-CLUSTER. laboratory_test_request_action

CLUSTER

constrains

Action

constrains

Request Action

constrains

ClusterApprove Action

CLUSTER

constrains

Action

constrains

Approve Action

CIMI-CLUSTER.approve_action

CLUSTER

constrains

Action

constrains

LABORATORY MODELSPECIALISATIONS

Laboratory Model Specialisations

1. Complete Blood Count with Manual Differential Panel

2. Complete Blood Count with Auto Differential Panel

3. Complete Blood Count without Differential

4. Gas and Carbon Monoxide Panel

Complete Blood Count

Laboratory Test Observation

Observation

ENTRY

constrains

constrains

Clinical Entry

constrains

constrains

Complete Blood Count

Complete Blood Count

Complete Blood Count

Complete Blood Count

Complete Blood Count Specialisations

Laboratory Test Observation

Observation

ENTRY

constrains

constrains

Clinical Entry

constrains

constrains

Complete Blood Count

Complete Blood Count Without

Differential

Complete Blood Count With Auto

Differential

Complete Blood Count With

Manual Differential

constrainsconstrains

constrains

Complete Blood Count Without Differential

Complete Blood Count Without Differential

Complete Blood Count With Manual Differential

Complete Blood Count With Manual Differential Panel

Complete Blood Count With Manual Differential Panel

Complete Blood Count With Manual Differential Panel

Complete Blood Count With Auto Differential

Complete Blood Count With Auto Differential Panel

Complete Blood Count With Auto Differential Panel

Complete Blood Count With Auto Differential Panel

Gas and Carbon Monoxide Panel

DEMOGRAPHICS MODELS

Participation & Party Reference Model class CIMI Core Model

PARTICIPATION

function :CODED_TEXTdetails :ITEM [0..*]

CORE_LOCATABLEPARTY

details :ITEM [0..*]

participation

0..*party

1..1

class CIMI Participation Model

«archetype_parent»LOCATABLE

+ archetype_node_id :String+ name :String

PARTY_RELATIONSHIP

+ type :CODED_TEXT+ details :ITEM [0..*]

PARTY

+ details :ITEM [0..*]

ROLE

+ type :CODED_TEXT

ACTOR

+ type :CODED_TEXT

+role

0..*

+source+relationship

0..*+target

1..1

When is demographics demographics?

• Question: When is CIMI information modelled using the ‘PARTY’ model, and when is it modelled using the core reference model?

• Proposed Criteria:– Does the information relate to a specific healthcare event or not?

• Does it record the results of an observation, evaluation, assessment, or activity?• If yes, then use Core Reference Model• E.g. Age is specific to a point in time, Living Dependency is an assessment and Biologic Sex is

an observation– Is this information only relevant to the Subject of Care, or do we need to record

this about other Parties participating in the record as well?• If needed about other Parties, then usually use Party model• E.g. Address may be relevant for Next of Kin; Disability may be relevant for a Dependent

– How is it commonly used in systems?• Source models are used to determine common implementation practice

Demographics Source Models

• HL7 v3 RIM• NHS LRA• NEHTA (Participation)• FHIM (Federal Health Information Model)

Demographics model• HL7 FHIR (Organisation, Person, Patient,

Agent, Group)• openEHR• ISO13606 (Standard and new draft)• ISO-22220• MOHH (Singapore)• DCM (The Netherlands)• Intermountain Healthcare

CIMI Demographics Models

• CLUSTER– Location– Address– Electronic Contact– Party Name

• PARTY– ACTOR

• Person• Organisation

– ROLE• Person Role• Healthcare Consumer• Healthcare Provider

– Healthcare Provider Individual– Healthcare Provider Organisation

Location

CLUSTER

constrains

Address

CLUSTER

constrains

Address Detailed

Address

CLUSTER

constrains

constrains

Electronic Contact

CLUSTER

constrains

Party Name

CLUSTER

constrains

constrains

Actor Name

constrains

Party Name

Person Name

constrains

Party

PARTY

constrains

Actor

PARTY: ACTOR

constrains

Party

constrains

Person

Partyconstrains

Actor

constrains

Organisation

Partyconstrains

Actor

constrains

Role

PARTY: ROLE

constrains

Party

constrains

Person Role

Partyconstrains

Role

constrains

Healthcare Consumer

Partyconstrains

Role

constrains

constrains

Person Role

Healthcare Provider

Partyconstrains

Role

constrains

Healthcare Provider Individual

Partyconstrains

Role

constrains

constrains

Healthcare Provider

Healthcare Provider Organisation

Partyconstrains

Role

constrains

constrains

Healthcare Provider

FUTURE WORK

Future Work

• Foundations– Reference model

• Documentation and implementation– Archetype object model

• Extensions to support terminology– Modelling patterns

• Documentation and terminology bindings• Add new patterns to support new models

– Style guides• Complete content

• Models– Laboratory Results models

• Add instances, specialisations and complete terminology bindings– Immunization models– Temperature and other priorities

• Implementation– Generate ADL 1.5 for all modelling patterns and models– Build modelling foundations in tooling infrastructure– Create associated tooling, including instance generation and visualisations– Create transformations to priority implementation formats

• Governance– Establish modelling development, review and publication processes and procedures

• 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-modelling-taskforce

?hl=en-GB• Issue tracking (github)

– https://github.com/clinicalmodels/cimi/

Online References

QUESTIONS