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Clinical Models - What Are They Good For?
 

Clinical Models - What Are They Good For?

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Dr Hugh Leslie

Dr Hugh Leslie
CMO, Ocean Informatics Ltd

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  • I want to take you on a journey – moving from the left of the screen to the right.
  • I am a clinician – interested in the C in CDA
  • Increasing complexity & richness of clinical information exchange.Look to the future to make sure what we do now can support what we want to do in the futureIndividual CDA specs are developed for use cases – models end up being different even though they are modelling the same thing.
  • Estimated 7500 clinical systems in the USA alone developed with clinical input to cliniciansComplex technical artifacts are difficult for most clinicians to review and understand without additional training. Getting clinicians in a room is expensive, difficult (time poor)
  • More sophisticated systems need more sophisticated content - fractalVendors – rapidly increasing cost of businessNational Programs – coming to grips with need for models and terminology for national EHR programs
  • To build this clinical content, there is a need for an approach that allows a large number of clinicians and domain experts to collaborate in a cost and time effective way to create content. This content should be approachable for clinicians who have little technical expertise and should not be limited to health informaticians. The outputs from this process should be technical artifacts that can be directly used in information systems without any need for translation of paper specifications.
  • How do we get there? Step back from CDA.To get interoperability we need clinical information that is Consistent ie modelled in the same way everywhere, of high quality –validated by clinicians and using metrics to measure quality and strongly governed – versioned, released like software artefacts.
  • Doesn’t terminology solve the issues of clinical content? Can’t we just code something and get on with it?
  • Clinical models give context to terminology (and semantics generally)You can’t do it with terminology alone (and you can’t do it with clinical models alone…)
  • Doesn’t terminology solve the issues of clinical content? Can’t we just code something and get on with it?
  • There has been and still is, an enormous effort going on in terms of defining data elements as single reuseable entities. Example of VIC Health – minimum datasets.
  • National data collections are seriously importantDefining datasets is importantLets find a way to define them so that the context is clear.
  • So its about recording clinical information faithfullyIts about maximal data set and universal use caseIncludes needed terminology bindings and terminology valuesets
  • Ideal set of archetypes is a venn diagram with no overlap. Almost never a single data element.
  • Its about maximal data set - includes needed terminology bindings and terminology valuesetsMuch easier to get agreement than minimum datasets.
  • So its about recording clinical information faithfullyNot about creating an esoteric and academic model of something that represents that thing.
  • The universal use case.
  • Can be used directly in systems to create and persist data as well as other artefacts – top of an information tool chain.
  • Can be used to do real stuff.Can be used directly in systems to create and persist data as well as other artefacts – top of an information tool chain.
  • Can be used directly in systems to create and persist data as well as other artefacts – top of an information tool chain.
  • Can be used directly in systems to create and persist data as well as other artefacts – top of an information tool chain.
  • Can be used directly in systems to create and persist data as well as other artefacts – top of an information tool chain.
  • CKM demo to show:A couple of models and viewsGovernance aspectsCrowd sourced information
  • We have a set of clinical models that are vetted, governed and fit for purpose – how do we take these and use them everywhere? What is the link to CDA for instance?
  • Template designerQueryingFinish with MeHR

Clinical Models - What Are They Good For? Clinical Models - What Are They Good For? Presentation Transcript

  • Clinical Models What are they? What are they good for?Dr Hugh Leslie MDCMO Ocean Informatics
  • data phenomena001101010010101001011110101011010010101010100 “We are analog beings111101001100101001 trapped in a digital world…100010011001010011 We are010101011000000000 compliant, flexible, tolerant.000000000 Yet we have constructed000000001111111111 a world of machines that111100100000000000 requires us to be000000000 rigid, fixed, intolerant.” Norman Donald 4.2
  • CDA
  • ClinicalDAClinicaDA ClinicDA CliniDA ClinDA CliDA ClDA CDA
  • The clinical content dilemma Clinical System CDA Message
  • Who needs standardised content?• Sophisticated solutions• Vendors• National Programs
  • A fresh approach... Clinical System CDA Message
  • ConsistencyQuality/Safety Governance
  • What about terminology?
  • ePatient Dave(http://epatientdave.com/)
  • Aortic Aneurysm
  • Diagnosis of: Risk of: Family History of: No history of: Age/Date of onset: Date of diagnosis: Diagnosed by: Diagnostic criteria: 44054006|Diabetes mellitus type 2Age/Date of remission: Severity of:Clinical significance of: Aetiology: Exacerbation of: Related problems: Terminology always requires context to make sense
  • Another thing about context…
  • Data elements• 11179• HL7 DAMs• Minimum data sets
  • COLD
  • Its quite COLDin Auckland today
  • I have a really bad COLDwith a runny nose and fever.
  • The diagnosis is: COLD(Chronic obstructive lung disease)
  • The patient had a very COLD emotional response
  • Definitions of single data elementsrarely survive outside a particular context
  • So reallyWhat is a clinical model? Detailed Clinical Model (DCM) CIMI model HL7 template/IHE profile Archetype
  • To a clinician, an archetype is:A definition of an atomic health concept thatas much as possible completely expresseseverything that you would ever want torecord about that particular thing in anysituation.
  • To a clinician, an archetype is:A definition of an atomic health concept thatas much as possible completely expresseseverything that you would ever want torecord about that particular thing in anysituation.
  • To a clinician, an archetype is:A definition of an atomic health concept thatas much as possible completely expresseseverything that you would ever want torecord about that particular thing in anysituation.
  • To a clinician, an archetype is:A definition of an atomic health concept thatas much as possible completely expresseseverything that you would ever want torecord about that particular thing in anysituation.
  • To a clinician, an archetype is:A definition of an atomic health concept thatas much as possible completely expresseseverything that you would ever want torecord about that particular thing in anysituation.
  • To a technician, an archetype is:A computable expression of a domain contentmodel in the form of structured constraintstatements, based on the openEHR referencemodel.A logical information modelReuseable
  • To a technician, an archetype is:A computable expression of a domain contentmodel in the form of structured constraintstatements, based on the openEHR referencemodel.A logical information modelReuseable
  • To a technician, an archetype is:A computable expression of a domain contentmodel in the form of structured constraintstatements, based on the openEHR referencemodel.A logical information modelReuseable
  • To a technician, an archetype is:A computable expression of a domain contentmodel in the form of structured constraintstatements, based on the openEHR referencemodel.A logical information modelReuseable
  • To a technician, an archetype is:A computable expression of a domain contentmodel in the form of structured constraintstatements, based on the openEHR referencemodel.A logical information modelReuseable
  • CKM – introductionDr Heather Leslie MDDirector Modelling - Ocean Informatics
  • So we have some archetypes… where do we go from here?
  • A single tool chain… Code Skeletons UI Forms DataReference Archetypes Templates Sets Model XML Messages Schemas etc Terminology Semantic HTML Mappings/ Subsets Queries Display
  • openEHR TemplatesTemplates are a use case specific constraint andaggregation of one or more archetypes to createany clinical specification.Templates have less need for governance as longas the archetypes that make them up are tightlygoverned.
  • openEHR TemplatesTemplates are a use case specific constraint andaggregation of one or more archetypes to createany clinical specification.Templates have less need for governance as longas the archetypes that make them up are tightlygoverned.
  • openEHR TemplatesTemplates are a use case specific constraint andaggregation of one or more archetypes to createany clinical specification.Templates have less need for governance as longas the archetypes that make them up are tightlygoverned.
  • openEHR TemplatesTemplates are a use case specific constraint andaggregation of one or more archetypes to createany clinical specification.Templates have less need for governance as longas the archetypes that make them up are tightlygoverned.
  • openEHR TemplatesTemplates are a use case specific constraint andaggregation of one or more archetypes to createany clinical specification.Templates have less need for governance as longas the archetypes that make them up are tightlygoverned.
  • Archetypes• Blood pressure• Weight• Height• Medication• Apgar score• Adverse reaction• Problem/Diagnosis
  • Templates• Discharge summary• Antenatal visit• Specialist letter• Shared health summary• eReferral• CCR• Prescription
  • Semantic architecture • Clinician and stakeholder input Semantic KeyArchetypes • Agreement based on requirements • Jurisdiction, Users, Vendor inputTemplates • Agreement through standardisation • Standard transformation per archetypeCommun- ication • Variety of formats
  • Demo