Derivation of the HL7 RIM Ontology

Derivation of the HL7 RIM Derivation of the HL7 RIM OntologyOntology

A Top-Down MethodologyA Top-Down Methodology

Concept - “a thing in the Concept - “a thing in the minds eye”minds eye”

Hmmm Hmmm - - “Frank “Frank needs needs an ace an ace of of hearts”hearts”

The Concept The Concept ChallengeChallenge

Thing

Concept

• marine animal• eats smaller things• nice to eat

Symbols (Many)

Thing (1)Can’t put the “thing”

on this slide since the instance

exists only in physical space

Concept (1)

Adapted from Charlie Mead & the Semantic Triangle

“Frank the Shark” (in English)

Predicate Logic in Predicate Logic in RDF, RIM, and SNOMEDRDF, RIM, and SNOMED

Subject Predicate Object

Observ-ation

hasParticipation

Subject

Patient

Fracture of Femur

hasFinding Site

Structure of Neck of

Femur

RDF:

SNOMED:

RIM:

SNOMED in the HL7 RIMSNOMED in the HL7 RIM

Subject Predicate Object

Observ-ation

hasParticipation

Subject

Patient

Fracture of Femur

hasFinding Site

Structure of Neck of Femur

hasAssociated Morphology

Compression Fracture

hasResult

HL7 RIM

SNOMED

Propositions & Propositions & AssertionsAssertions

Propositions in RDF triplesPropositions in RDF triples Subject | Predicate | ObjectSubject | Predicate | Object Propositions may be true or falsePropositions may be true or false

Assertions are believed by the Assertions are believed by the author to be trueauthor to be trueSubject Predicate Object

Observ-ation hasParticipation

Subject

Patient

Fracture of Femur

hasFinding Site

Structure of Neck of Femur

hasAssociated Morphology

Compression Fracture

hasResult HL7 RIM

SNOMED

Ontologies: Mass & Ontologies: Mass & Energy Energy

Proposition:Proposition:e=mce=mc22

Mass and Energy Mass and Energy (e=mc(e=mc22) )

EnergyEnergy

Mass

Analogy: Mass to Entity/Energy to Analogy: Mass to Entity/Energy to ActAct

Entityid : SET<II>classCode : CSdeterminerCode : CSimportanceStatusText : EDqty : SET<PQ>telecom : SET<TEL>description : EDstatusCode : CScode : CEnm : SET<EN>riskCode : CE

Act

id : SET<II>moodCode : CSclassCode : CStxt : EDstatusCode : CSactivityTime : GTSeffectiveTime : GTSconfidentialityCode : SET<CV>repeatNumber : IVL<INT>interruptible_ind : BLpriorityCode : SET<CV>independent_ind : BLavailability_dttm : GTScode : CDtransfer_reasonCode : CV

0…*

0…*

Ontologies: Materials & Ontologies: Materials & LaborLabor

Proposition:Proposition:Cost = Materials + LaborCost = Materials + Labor


Act


0…*

0…*

Association ClassAssociation ClassEntity

id : SET<II>classCode : CSdeterminerCode : CSimportanceStatusText : EDqty : SET<PQ>telecom : SET<TEL>description : EDstatusCode : CScode : CEnm : SET<EN>riskCode : CE

Act


0…*

0…*Associations Class

RIM - BackboneRIM - Backbone

EntityEntity People, Places, Physical ThingsPeople, Places, Physical Things

AssociationsAssociations Roles & RelationshipsRoles & Relationships

ActAct Collections of EventsCollections of Events


1

playedRoleplayer

scopedRolescoper

0..1

0..*

Participation

typeCode : CStmr : IVL<TS>note_text : EDsignatureCode : CVfunctionCode : CDawarenessCode : CVsignatureText : EDencounter_accommodationCode : CVstatusCode : CSmodeCode : CV

0..*0..*

RoleclassCode : CSeffectiveTime : IVL<TS>id : SET<II>statusCode : CSpositionNumber : LIST<INT>qty : PQcertificateText : EDaddr : SET<AD>telecom : SET<TEL>code : CE

0..*

0..*

1

Act


1

AssociativeAssociativeClassesClasses

Review of UML TermsReview of UML TermsEntity

id : SET<II>classCode : CSdeterminerCode : CSimportanceStatusText : EDqty : SET<PQ>telecom : SET<TEL>description : EDstatusCode : CScode : CEnm : SET<EN>riskCode : CE

Act


0…*

0…*

“Classes”

Simple or ‘hasA’associationsymbol

“Attribute: value pair”

“Datatype”

hierarchy or ‘IsA’ association symbol

‘cardinality’ or ‘multiplicity’ symbol


1

playedRoleplayer

scopedRolescoper

0..1

0..*

Participation


0..*0..*


RoleLinkeffectiveTime : IVL<TS>typeCode : CS

1

outboundLink

0..*

source

1

1

inboundLink

0..*

target

1

0..*

0..*

1

Act


1

RecursiveRecursiveAssociativeAssociative

ClassesClassesActRelationship

typeCode : CSinversion_ind : BLsequenceNumber : INTpriorityNumber : INTpauseQty : PQcheckpointCode : CSsplitCode : CSjoinCode : CSnegation_ind : BLconjunctionCode : CS

outboundLinkis_source_for

1 0..*

has_target

0..*

target

1


1

playedRoleplayer

scopedRolescoper

0..1

0..*

Participation


0..*0..*



1

outboundLink

0..*

source

1

1

inboundLink

0..*

target

1

0..*

0..*

1

Act


1

ActRelationship



1 0..*

has_target

0..*

target

1

Act-Act-RelationshiRelationshi

p p RecursionRecursion

ActRelationship RecursionsActRelationship Recursions*Classes, Instances of Classes, & Instance *Classes, Instances of Classes, & Instance

DiagramsDiagramsActRelationship

typeCode : has component

Act

id : SET<II>moodCode : Eventcode : Chem 4

outboundLinkis_source_forhas_targettarget

Act

id : SET<II>moodCode : Eventcode : Glucose

ActRelationship



Act

id : SET<II>moodCode : Eventcode : Total Cholesterol

ActRelationship



Act

id : SET<II>moodCode : Eventcode : Sodium

ActRelationship



Act

id : SET<II>moodCode : Eventcode : Potassium


1

playedRoleplayer

scopedRolescoper

0..1

0..*

Participation


0..*0..*



1

outboundLink

0..*

source

1

1

inboundLink

0..*

target

1

0..*

0..*

1

Act


1

ActRelationship



1 0..*

has_target

0..*

target

1

InfiniteInfiniteNestingNesting

HL7 RIM Act HL7 RIM Act HierarchyHierarchy

SubstanceAdministration

routeCode : CEapproachSiteCode : SET<CD>doseQuantity : IVL<PQ>rateQuantity : IVL<PQ>doseCheckQuantity : SET<RTO>maxDoseQuantity : SET<RTO>potencyQuantity : PQsubstitutionCode : CE

Procedure

methodCode : SET<CE>approachSiteCode : SET<CD>targetSiteCode : SET<CD>

Supply

quantity : PQexpectedUseTime : IVL<TS>

Account

name : STcurrencyCode : CEinterestRateQuantity : RTO<MO,PQ>allowedBalanceQuantity : IVL<MO>

FinancialAct

netAmt : MO

PublicHealthCase

detectionMethodCode : CEtransmissionModeCode : CEdiseaseImportedCode : CE

PatientEncounter

acuityLevelCode : CEadmissionSourceCode : CEbirthEncounterInd : BLdischargeDispositionCode : CElengthOfStayQuantity : PQpreAdmitTestInd : BLreferralSourceCode : CEspecialAccommodationCode : SET<CE>specialCourtesiesCode : SET<CE>urgencyCode : CE

DiagnosticImage

subjectOrientationCode : CE

FinancialTransaction

creditExchangeRateQuantity : REALdebitExchangeRateQuantity : REALinterestRateQuantity : RTO

InvoiceElement

modifierCode : SET<CE>unitQuantity : RTO<PQ,PQ>unitPriceAmt : RTO<MO,PQ>factorNumber : REALpointsNumber : REALcoverageSourceCode : CEnotifySubjectInd : BL

FinancialContract

paymentTermsCode : CE

DeviceTask

parameterValue : LIST<ANY>

WorkingList

ownershipLevelCode : CE

structureTypeId : IIresponseCode : CS

1

0..*

1

Act

id : SET<II>moodCode : CSclassCode : CScode : CDtext : EDstatusCode : CSconfidentialityCode : SET<CE>effectiveTime : GTSactivityTime : GTSinterruptibleInd : BLavailabilityTime : TScontextLockInd : BLindependentInd : BLinterruptibleInd : BLnegationInd : BLpriorityCode : SET<CE>repeatNumber : IVL<INT>reasonCode : SET<CE>substitutionConditionCode : CElevelCode : CEuncertaintyCode : CE

11

Observation

value : ANYinterpretationCode : SET<CE>methodCode : SET<CE>targetSiteCode : SET<CD>derivationExpr : ST

Diet

energyQuantity : PQcarbohydrateQuantity : PQ

ControlAct

Bottom-Up Modeling Bottom-Up Modeling ArtifactsArtifacts


Act


0…*

0…*

“Classes”

Simple or ‘hasA’associationsymbol

“Attribute: value pair”

“Datatype”

hierarchy or ‘IsA’ association symbol

‘cardinality’ or ‘multiplicity’ symbol

The Meaning of The Meaning of HierarchyHierarchy



Procedure


Supply


Account


FinancialAct

netAmt : MO

PublicHealthCase


PatientEncounter


DiagnosticImage




InvoiceElement


FinancialContract


DeviceTask


WorkingList



1

0..*

1

Act


11

Observation


Diet


ControlAct

Act-Supply-Diet Act-Supply-Diet HierarchyHierarchy

Supply


1

0..*

1

Act


11

Diet


Diet Act Combines Attributes in Diet Act Combines Attributes in HierarchyHierarchy1

0..*

1

Diet Act


11



From SupplyFrom Diet

The Meaning of The Meaning of HierarchyHierarchy



Procedure


Supply


Account


FinancialAct

netAmt : MO

PublicHealthCase


PatientEncounter


DiagnosticImage




InvoiceElement


FinancialContract


DeviceTask


WorkingList



1

0..*

1

Act


11

Observation


Diet


ControlAct

Observation Act = Act Attributes + Observation Act = Act Attributes + Observation AttributesObservation Attributes

1

0..*

1

Observation Act


11

From Observationvalue : ANYinterpretationCode : SET<CE>methodCode : SET<CE>targetSiteCode : SET<CD>derivationExpr : ST

Observation.code / Observation.code / Observation.valueObservation.value

What is the Question? / What is the Answer?What is the Question? / What is the Answer?1

0..*

1

Observation Act


11

From Observationvalue : ANYinterpretationCode : SET<CE>methodCode : SET<CE>targetSiteCode : SET<CD>derivationExpr : ST

‘White Blood Count’

CTP code‘xyz’

10,000

‘EstablishedDiagnosis’SNOMED

code‘14657009’

‘Malig Tumor of Breast’SNOMED

code‘254837009’

Sample GlossarySample GlossarySource Term Term Source Storyboard Sentence Nominalized

VerbGeneral Dictionary Definition

Domain Dictionary Definition

Inferred Question

SNOMED CT

Lexical Match

Meaning Match

Christine Storyboard: Single-word Term

Christine, age 46, was recently diagnosed with stage II breast cancer.

not applicable Not Applicable What was the name?

diagnosed Storyboard: Single-word Term


diagnosis The act or process of determining the nature and cause of a disease or injury through examination of the patient

The act or process of identifying or determining the nature and cause of a disease or injury through evaluation of patient history, examination, and review of laboratory data

What was the diagnosis?

Establish-ed diagnosis 14657009

breast cancer Storyboard: Multi-word Term


none none What was the diagnosis?

254837009 Malignant tumour of breast

RN Activity Diagram: Role A graduate trained nurse who has passed a state registration examination and has been licensed to practice nursing

A nurse who has graduated from an accredited school of nursing and licensed to practice by a state authority

224535009 Registered nurse

reviews chart Activity Diagram: Action State

chart review Review: An inspection or examination for purposes of evaluation

Chart: A recording, in tabular form, of clinical data relating to a case

Review of 55210009 medical

records review, 312853008

requests education appointment

Activity Diagram: Action State

education appointment request

Patient education 311401005

request Activity Diagram: Flow Class

What is an Information What is an Information Model?Model?

Describes Relationships Between Concepts (in UML)Describes Relationships Between Concepts (in UML) Class conceptsClass concepts Attribute conceptsAttribute concepts Association conceptsAssociation concepts Data-type conceptsData-type concepts

Provides Data-type Links to Vocabulary ConceptsProvides Data-type Links to Vocabulary Concepts SNOMEDSNOMED LOINCLOINC ICNPICNP ……....

Not a Data Model!Not a Data Model! Not concerned with application performance in a relational Not concerned with application performance in a relational

databasedatabase Not concerned with ease of application programmingNot concerned with ease of application programming Is concerned with communicating knowledge of domainIs concerned with communicating knowledge of domain

What is an Information What is an Information Model?Model?

Describes Relationships Between Concepts Describes Relationships Between Concepts (in UML)(in UML) Class conceptsClass concepts Attribute conceptsAttribute concepts Association conceptsAssociation concepts Data-typeData-type concepts concepts

Provides Provides Data-typeData-type Links to Vocabulary Links to Vocabulary ConceptsConcepts SNOMEDSNOMED LOINCLOINC ICNPICNP ……....

+timing-code-vocabulary-vtext-stext

Action

-code-vocabulary-vtext-stext

Indirect Object

-onBehalfOf

Building an Information Building an Information ModelModel

--an iterative process--an iterative process Identify Basic ConceptsIdentify Basic Concepts Define Basic Concepts in GlossaryDefine Basic Concepts in Glossary Identify Relationships Between ConceptsIdentify Relationships Between Concepts

AttributesAttributes MultiplicitiesMultiplicities AssociationsAssociations

Abstract Basic Concepts into Hierarchies Abstract Basic Concepts into Hierarchies Identify attributes that can be sharedIdentify attributes that can be shared Define Abstract Concepts in GlossaryDefine Abstract Concepts in Glossary

Identify Basic ConceptsIdentify Basic Concepts Subjects Subjects

(actors)(actors) PatientPatient NurseNurse PhysicianPhysician Patient care Patient care

aideaide ……

VerbsVerbs AskedAsked ReviewedReviewed DecidedDecided PrintedPrinted MovedMoved DocumentedDocumented SpokeSpoke VerbalizedVerbalized AssessAssess ……

ObjectsObjects PatientPatient StrategiesStrategies Breast Breast

cancercancer NauseaNausea VomitingVomiting InterventionIntervention VideoVideo ……

Identify Abstract Identify Abstract ConceptsConcepts

Subjects Subjects (actors)(actors) PatientPatient NurseNurse PhysicianPhysician Patient care Patient care

aideaide ……

VerbsVerbs AskedAsked ReviewedReviewed DecidedDecided PrintedPrinted MovedMoved DocumentedDocumented SpokeSpoke VerbalizedVerbalized AssessAssess ……

ObjectsObjects PatientPatient StrategiesStrategies Breast Breast

cancercancer NauseaNausea VomitingVomiting InterventionIntervention VideoVideo ……

Verbs = “Actions”Subjects = “Persons”Subjects = “Do’ers”

Objects = “?”

Define Abstract Concepts in Define Abstract Concepts in GlossaryGlossary

Do’er is someone who performs an actionDo’er is someone who performs an action Action is a word that describes what a Action is a word that describes what a

do’er is doing to the objectdo’er is doing to the object Object is a direct object or an indirect Object is a direct object or an indirect

object of a sentenceobject of a sentence A direct object of a sentence is the thing A direct object of a sentence is the thing

being done tobeing done to An indirect object of a sentence is the ….An indirect object of a sentence is the ….

Data-Types Data-Types

What “kinds of” values can an attribute What “kinds of” values can an attribute have?have? Timing (date-timestamps; frequency text; etc)Timing (date-timestamps; frequency text; etc) Code (alphanumeric text strings from code Code (alphanumeric text strings from code

field of published vocabulary)field of published vocabulary) Vocabulary (string with official identifier for Vocabulary (string with official identifier for

published vocabulary)published vocabulary) Vtext (string with English text corresponding Vtext (string with English text corresponding

to code in published vocabulary)to code in published vocabulary) Stext (string with exact text from storyboard)Stext (string with exact text from storyboard)


Action

Identify Relationships Identify Relationships Between ConceptsBetween Concepts


Action


Object of Action

-name-role-code-vocabulary-vtext

Do’er-actsOn

Do’ersDo’ers PatientPatient NurseNurse PhysicianPhysician Patient care aidePatient care aide ……

ActionsActions AskedAsked ReviewedReviewed DecidedDecided PrintedPrinted MovedMoved DocumentedDocumented SpokeSpoke VerbalizedVerbalized AssessAssess ……

Objects (direct & Objects (direct & indirect)indirect)

PatientPatient StrategiesStrategies Breast cancerBreast cancer NauseaNausea VomitingVomiting InterventionIntervention VideoVideo ……


Indirect Object


Direct Object

Identify Relationships Identify Relationships Between ConceptsBetween Concepts


Action


Object of Action


Do’er-actsOn

Do’ersDo’ers PatientPatient NurseNurse PhysicianPhysician Patient care aidePatient care aide ……

ActionsActions AskedAsked ReviewedReviewed DecidedDecided PrintedPrinted MovedMoved DocumentedDocumented SpokeSpoke VerbalizedVerbalized AssessAssess ……

Objects (direct & Objects (direct & indirect)indirect)

PatientPatient StrategiesStrategies Breast cancerBreast cancer NauseaNausea VomitingVomiting InterventionIntervention VideoVideo ……


Indirect Object

-onBehalfOf

Storyboard Information Storyboard Information Model Model

Instance DiagramsInstance Diagrams Test the combination of Information Test the combination of Information

Model and vocabularies against the Model and vocabularies against the storyboardstoryboard

Use the Storyboard Glossary to Use the Storyboard Glossary to provide the vocabulary for the provide the vocabulary for the instance diagramsinstance diagrams

Nursing Domain Nursing Domain Information ModelInformation Model


Action


Site

-hasSite


Route

-hasRoute


Means


Object of Action

-hasMeans

-actsOn


Recipient of Care-hasRecipientOfCare

OtherObjects

-degree-potentiality-acuity-timing

Judgement

-timing-focusType

Focus


Subject of information

-hasSubjectOfInformation

-hasSite


Provider Role

-Result

Finding

Diagnosis

Supply

-hasSupply*

focusType Value Set =

• Patient Functioning• Environment• ICF and other similar concepts in other vocabularies

Finding includes theconcepts of Goal andOutcome dependingon relationship timingand other actions

Subject is coded forindividual, family,or other physical entity


-hasFocus

-hasJudgement

Example Instance DiagramExample Instance Diagram“Susan , an RN , reviews Christine's “Susan , an RN , reviews Christine's

chart”chart”


Action


Site

-hasSite


Route

-hasRoute


Means


Object of Action

-hasMeans

-actsOn



OtherObjects


Judgement

-timing-focusType

Focus




-hasSite


Provider Role

-Result

Finding

Diagnosis

Supply

-hasSupply*






-hasFocus

-hasJudgement

SusanRN

224535009S

RegisteredNurse 55210009

Review ofReviews

S2B.2.1.1.1.1.1.1.22

ChristinePatient

ICNP

ICNPRecord chart

chart

Mapping from Nursing to Mapping from Nursing to HL7HL7

From Nursing From Nursing DomainDomain To HL7 RIMTo HL7 RIM

Provider RoleProvider Role Entity (Person) + Entity (Person) + RoleRole

Care RecipientCare Recipient Entity (Person) + Entity (Person) + RoleRole

Action + Object of Action + Object of ActionAction

ActAct

SupplySupply MaterialMaterial

Diagnosis.resultDiagnosis.result Observation.valueObservation.value

Finding.resultFinding.result Observation.valueObservation.value

RouteRoute SubstAdmin.routeCoSubstAdmin.routeCodede

Example Instance DiagramExample Instance Diagram“Susan , an RN , reviews Christine's “Susan , an RN , reviews Christine's

chart”chart”


Action


Site

-hasSite


Route

-hasRoute


Means


Object of Action

-hasMeans

-actsOn



OtherObjects


Judgement

-timing-focusType

Focus




-hasSite


Provider Role

-Result

Finding

Diagnosis

Supply

-hasSupply*






-hasFocus

-hasJudgement

SusanRN

224535009S

RegisteredNurse 55210009

Review ofReviews

S2B.2.1.1.1.1.1.1.22

ChristinePatient

ICNP

ICNPRecord chart

chart


1

playedRoleplayer

scopedRolescoper

0..1

0..*

Participation


0..*0..*

--adapted from RIM V1.18



1

outboundLink

0..*

source

1

1

inboundLink

0..*

target

1

0..*

0..*

1

ActRelationship


Act


1


1 0..*

has_target

0..*

target

1

MappingMappingto theto theRIMRIM

SusanRN 224535009 S

RegisteredNurse

2B.2.1.1.1.1.1.1.22Patient ICNP

312853008 Medical Record Review S

Reviewed Chart

Christine

Derivation of the HL7 RIM Ontology

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