MOHH – Models Submission

Dr Linda Bird

9th August 2012

Strategic vision of patients moving seamlessly across the

healthcare system, receiving coordinated patient-centric care

at the most appropriate settings.

RH

CH

NHPolyclinics

FPs Home Care

Rehab & support services

Screening & Prevention

Palliative Care

RH

CH

NHPolyclinics

FPs Home Care

Rehab & support services

Screening & Prevention

Palliative Care

RH

CH

NHPolyclinics

FPs Home Care

Rehab & support services

Screening & Prevention

Palliative Care

RH

CH

NHPolyclinics

FPs Home Care

Rehab & support services

Screening & Prevention

Palliative Care

RH

CH

NHPolyclinics

FPs Home Care

Rehab & support services

Screening & Prevention

Palliative Care

RH

CH

NHPolyclinics

FPs Home Care

Rehab & support services

Screening & Prevention

Palliative Care

Enabled by the National

Electronic Health Record

(EHR)

Singapore’s Future Healthcare Landscape

Standards Products• Diagnosis - SNOMED CT and

Singapore Extension (SE)• Drugs - Singapore Drug Dictionary

(SDD)• Allergic Reactions– SNOMED CT +

SE • Allergens - SNOMED CT + SDD• Laboratory Results – LOINC• Data Dictionary – MOHH Data

Dictionary• Procedures - TBD• Reason for visit - SNOMED CT• Symptoms and Problems - SNOMED

CT and Singapore Extension• Laboratory Reports – Smart SNOMED

CT• Laboratory Orders – SNOMED CT• Radiology Orders - SNOMED CT

LIM Development Process

Requirements

Clinician Verification

Graphical Represent-

ationsClinician Input

Clinical Modelling Framework

Singapore Logical

Information Model

Clinical Modelling Language

(LOM)

Logical Reference Model(ISO13606+21090)

Computable Implementation

Specification

Cons

train

Inst

ance

of

Terminology Server

References

Terminology Ontology

Bind

va

lues

Bind

sem

antic

s

Store

Generate

Lim Repository

Store representation

Refe

renc

es

Input

Generate

Clinician Validation of the LIM

LIM ID LIM Name

LIM Cardinality

LIM Definition LIM Example (for Exchange)

LIM Example (for Display)

Laboratory Test Item 1 A class describing the laboratory test that was

performed.

Test Name 1 The name of the laboratory test within a panel of tests.

("xxx", "LDH measurement")("xxx", "Blood sodium measurement")

"LDH measurement""Blood sodium measurement"

Sequence Number 0..1 A number that identifies and sequences this

laboratory test item within a given panel."1""2"

"1""2"

Additional Description 0..1

A descriptor used in combination with the Test Name to fully define the description of the laboratory test.

POCT Indicator 0..1 The POCT (Point-of-care Testing) indicator at the

laboratory test item level.("xx, "Point of Care Test")

"Point of Care Test"

Type 0..1 The type of the test.

WYSIWYG

NDDS snippet

NXDS LXML XSD

NXDS LXML Instance

IsoSemantic Models – Example of Problem

e.g. “Suspected Lung Cancer”

IsoSemantic Models – Example Instances

e.g. “Suspected Lung Cancer”

IsoSemantic Models – Compositional Grammar

Problem Diagnosis = $ProblemDiagnosisName: 246090004|associated_finding|= (404684003|clinical_finding|:

63698007|finding_site|=($BodySite: 272741003|laterality|=$Laterality), 246112005|severity|=$Severity),

408729009|finding_context|=$FindingContext

IsoSemantic Models – Equivalence Testing

Problem Diagnosis = $ProblemDiagnosisName: 246090004 |associated finding| = (404684003|Clinical Finding|:

363698007 | finding site | = ($BodySite: 272741003|laterality| = $Laterality),

246112005 | severity| = $Severity), 408729009 | finding context | = $FindingContext

GP Problem Diagnosis = 86049000|Cancer| : 246090004 |associated finding| = (404684003|Clinical Finding| :

363698007 | finding site | = 39607008|Lung|), 408729009 | finding context | = 415684004|Suspected|

Polyclinic Problem Diagnosis = 162572001 |Suspected cancer|: 246090004 |associated finding| = (404684003|Clinical Finding|:

363698007 | finding site | = 39607008|Lung|)

RH Problem Diagnosis = 86049000|Suspected lung cancer|

Bi-directional Semantic Interoperability

NEHR

Prob/Dx :”Osteoarthritis”

Severity : “Severe”

Location : “Knee Joint”

Side : “Left”

Source Data

Prob/Dx :”Osteoarthritis”

Severity : “Severe”

Location : “Knee Joint”

Side : “Left”

GP - Source Data

Design Patterns - Diagnosis

DP-based GP - Source Data

National Term

Research Semantics

Problem/Diagnosis : “Severe

osteoarthitis of the left knee”

Transformed GP - Source Data in RH format

Diagnosis : ”Osteoarthritis

of the left knee”

Degree : “Severe”

Transformed GP - Source Data in Polyclinic format

Maps I

n

Maps out

Severe osteoarthritis of the left knee

• ENTRY– Observation Entry (Observable Name/Value)

• Heart Rate/ Blood Pressure / Blood Glucose– Clinical Finding

• Problem Diagnosis Entry• Adverse Reaction Entry• Alert Entry

– Activity• Pharmacy Activity Entry

– Pharmacy Order Entry– Pharmacy Dispense Entry– Pharmacy Administration Entry

• Investigation Activity Entry– Investigation Order Entry– Investigation Result Entry

• Procedure Entry (Reference Pattern)• CLUSTER

– Pharmacy Item / Investigation Test Item

Submission Overview

This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH)

and should not be circulated beyond MOHH without permission.© All Rights Reserved

Thank You