This post is inspired by a slightly out-of-control discussion among people in the CIMI group. It’s a good discussion. The latest question that has come up is whether a DCM (Detailed Clinical Model) is a ‘model of use’ (i.e. some kind of data set) or a ‘model of meaning’ (i.e. some kind of ontological definition).
I am back this week from a week in Salt Lake City, visiting Dr Stan Huff’s group at Intermountain Health, a globally recognised centre of excellence for clinical computing. I should have been 10 years ago, but better late than never. Stan has quietly been pioneering model-based health computing for nearly 20 years, featuring Clinical Element Models (CEMs) and terminology.
Intermountain / Caradigm CEM browser
It started with the ASN.1 models used in the (still deployed) 3M system, and progressed through the CEML form (a light-weight XML format developed by Joey Coyle, who just submitted a PhD thesis on the topic) to the current CDL format. CDL stands for Constraint Definition Language, and was co-developed by GE and Intermountain for the Qualibria product. Continue reading
A lot of ontology work has been going on for some years that comes loosely under the BFO and OBO activities, which stand to improve how computing in health is done. BFO is the Basic Formal Ontology, and OBO is the Open Biological and Biomedical Ontologies. Work from these efforts is currently being used to better structure the upper level of SNOMED CT, in cooperation with the IHTSDO, its owning organisation.
This week I had the opportunity to read a new paper by André Q Andrade, Maurício B Almeida and Stefan Schulz, entitled “Revisiting ontological foundations of the OpenEHR Entry Model” (PDF). This paper seeks to analyse the openEHR ‘clinical investigator ontology’ which Dr Sam Heard and I published in a MedInfo 2007 paper, using the Information Artefact Ontology (IAO) as the reference. Continue reading
I made a new beta release of the ADL Workbench today, a tool whose core is a parser and 3-pass validator for archetypes written in the openEHR Archetype Definition Language. Today’s release includes visualisation that really shows how archetypes form a layer above standard information models. The basic idea of archetypes, for those who don’t know, is to be able to configure particular structures of reference model instances to represent specific domain content. For example, the following shows the Indirect Oximetry archetype. The tree column shows the information model (or as we call it in e-health more often, ‘reference model’) classes and properties in blue. So an Indirect Oximetry is a structure made from OBSERVATION, HISTORY, POINT_EVENT, etc and a bunch of ELEMENTs, each having specific meanings in the context of the oximetry Observation.
In his recent blog post, Eric Browne highlights what may be a problem in the design of the Australian PCEHR, due to the well-known CDA feature allowing dual forms of content – text and structured, supposedly equivalent – to be stored in the one document. If Eric’s examples are representative of real data in the future PCEHR system, there is definitely a problem. In any case, there is a general problem, to do with common misuse of the CDA architecture, which itself should be changed to remove such possibilities. Continue reading
The Clinical Information Modelling Initiative (CIMI) group led by Dr Stan Huff (Intermountain Health, Utah) met here in London 29 Nov – 1 Dec to make a final decision on formalism, from the two remaining – openEHR archetypes and various forms of UML (previous posts on CIMI: DCMs & RM, on formalisms). Instead of simply choosing one, the group made a more strategic choice of designating openEHR ADL/AOM 1.5 as the core formalism, with a corresponding profile of UML being developed to enable the more numerous UML-based developers (e.g. VA, NHS etc) to use archetypes within their UML toolchains.
Here is the public announcement resulting from this meeting.
Following the DCM meeting convened by Dr Stan Huff (Intermountain Healthcare) in Washington in July, reported in an earlier blog post, there is a further meeting this week in San Diego, which will discuss the issues of ‘data types’ and ‘reference models’ for the purpose of DCM (detailed clinical models).
I created two slideshows to explain my views on these matters (DCM_and_data_types and DCM_and_reference_model [both PDF]). Below is an extract of my arguments in these slideshows, based on experience, for adopting a particular approach to data types and reference model within the stated mission the DCM forum, which is to find formalism and attendant models in which to express universally shareable detailed clinical models. Naturally, my view on ‘the answer’ to that question is ‘openEHR (ADL/AOM) archetypes, templates and terminology’, but what I am providing below is not an argument supporting that, but one proposing how to proceed with respect to the ‘underlying models’.
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Every so often, someone asks: why can’t the health sector get its act together with ICT? Tell me why health is ‘different’?
Dilbert - advances in healthcare
Every so often a new and interesting answer to this question pops up… Continue reading
I will be attending a ‘Fresh Look’ meeting in Washington next week. The idea is to make some progress on the topic of ‘detailed clinical models’ (DCMs). Some of the goals include setting up a repository of DCMs, establishing governance, and defining a roadmap for tooling. Underlying all this is a huge list of formalisms and models, including OWL, UML, ADL, HL7 MIF, XSD, LRA, RMIMs, CDA templates, greenCDA and so on.
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