A RIM based model for clinical decision support

Andrew McIntyreMedical-Objects

vMR – RIM based ModelsUses ISO 21090 Data types

Need to add methods to classes for GELLOUses GELLO (extended OCL) base types (iso21090

uses ocl)Aiming for low hanging fruit eg:

Problem List (Past History)Procedures (Surgical History)Family HistoryAllergiesCurrent MedicationMedication HistoryLab ObservationsSocial History (Alcohol/Tobacco)

vMR – Base ModelCCD being used as source model

Transformable to and from CCRDocumentedSpecified in US realmPotential to develop v2 version (Australia)

IssuesFamily History Model not as rich as desired

Allow extensions for Genomics data items (optional)Currently using v1 datatypes

As is “Virtual” medical record can be mapped

vMR - UsesDesigned for Decision Support

Little interest in display dataDemands terminology for safe usage

SNOMED-CT/ICD-9/ICD-10

Several Use casesLocal decision supportDecision support servicesQuality assessmentsGello uses it as its Model

vMR - Example GELLO usage

vMR – GELLO Examples

vMR – UML Overview

vMR – Why use “Simplified Model”GELLO usability

Navigating to eg: patient would take complex statementIdentifying specific clinical data easilyGELLO should be written by clinical peopleSimplify GELLO

Interfacing with “Legacy” systemsAllow CDS to occur with legacy data

Avoid overly complex transformations – “sweet spot hard to find”

Allow Clinicians to understand ModelMany attributes of RIM are not needed for a snapshot

view

vMR – Simplication ExamplesDirect ACT<->Patient Link

vs Person playing role of patientAlso link Provider/OrganisationCCD has single patient

Excludes use on conjoined twins!Current Medications Medication HistoryCCD ACT relationships exposed as typed PropertiesFamily History exposed as object model with direct

links to sub-observationsCCD could be reconstructed from vMR (except for

text)

vMR – Data sources GELLO v1 described a simple vMR as example

Implemented against HL7 v2 data as trial In real use in

GLIF ISO 13606-2 Archetypes Calculated results in editors

RIMBA relationshipRIMBA is ultimate vMR

Only likely to need thin Facade to complyDatatypes alignYour experience and input is welcome