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Clinical Models - What Are They Good For?
Clinical models can be defined as reusable representations of clinical concepts that express relevant data for any given situation. They include detailed clinical models, openEHR archetypes, and templates. Archetypes define atomic health concepts and aim to express all relevant data for recording that concept. Templates are use case specific constraints and aggregations of archetypes used to create clinical specifications. Together, archetypes and templates provide a standardized yet flexible approach to representing clinical information.
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Clinical Models - What Are They Good For?
- 1. Clinical Models What are they? What are they good for? Dr Hugh Leslie MD CMO Ocean Informatics
- 2. data phenomena 001101010 010101001 011110101 011010010 101010100 “We are analog beings 111101001 100101001 trapped in a digital world… 100010011 001010011 We are 010101011 000000000 compliant, flexible, tolerant. 000000000 Yet we have constructed 000000001 111111111 a world of machines that 111100100 000000000 requires us to be 000000000 rigid, fixed, intolerant.” Norman Donald 4.2
- 3.
- 4. ClinicalDA ClinicaDA ClinicDA CliniDA ClinDA CliDA ClDA CDA
- 5. The clinical contentdilemma Clinical System CDA Message
- 6. Who needs standardised content? • Sophisticated solutions • Vendors • National Programs
- 7. A fresh approach... Clinical System CDA Message
- 8.
- 9.
- 10.
- 11.
- 12. 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 2 Age/Date of remission: Severity of: Clinical significance of: Aetiology: Exacerbation of: Related problems: Terminology always requires context to make sense
- 13. Another thing aboutcontext…
- 14. Data elements • 11179 •HL7 DAMs • Minimum data sets
- 15.
- 16. Its quite COLD in Auckland today
- 17. I have areally bad COLD with a runny nose and fever.
- 18. The diagnosis is: COLD (Chronic obstructive lung disease)
- 19. The patient hada very COLD emotional response
- 20. Definitions of singledata elements rarely survive outside a particular context
- 21. So really What isa clinical model? Detailed Clinical Model (DCM) CIMI model HL7 template/IHE profile Archetype
- 22. To a clinician,an archetype is: A definition of an atomic health concept that as much as possible completely expresses everything that you would ever want to record about that particular thing in any situation.
- 23. To a clinician,an archetype is: A definition of an atomic health concept that as much as possible completely expresses everything that you would ever want to record about that particular thing in any situation.
- 24. To a clinician,an archetype is: A definition of an atomic health concept that as much as possible completely expresses everything that you would ever want to record about that particular thing in any situation.
- 25. To a clinician,an archetype is: A definition of an atomic health concept that as much as possible completely expresses everything that you would ever want to record about that particular thing in any situation.
- 26. To a clinician,an archetype is: A definition of an atomic health concept that as much as possible completely expresses everything that you would ever want to record about that particular thing in any situation.
- 27. To a technician,an archetype is: A computable expression of a domain content model in the form of structured constraint statements, based on the openEHR reference model. A logical information model Reuseable
- 28. To a technician,an archetype is: A computable expression of a domain content model in the form of structured constraint statements, based on the openEHR reference model. A logical information model Reuseable
- 29. To a technician,an archetype is: A computable expression of a domain content model in the form of structured constraint statements, based on the openEHR reference model. A logical information model Reuseable
- 30. To a technician,an archetype is: A computable expression of a domain content model in the form of structured constraint statements, based on the openEHR reference model. A logical information model Reuseable
- 31. To a technician,an archetype is: A computable expression of a domain content model in the form of structured constraint statements, based on the openEHR reference model. A logical information model Reuseable
- 32. CKM – introduction DrHeather Leslie MD Director Modelling - Ocean Informatics
- 33. So we havesome archetypes… where do we go from here?
- 34. A single toolchain… Code Skeletons UI Forms Data Reference Archetypes Templates Sets Model XML Messages Schemas etc Terminology Semantic HTML Mappings/ Subsets Queries Display
- 35. openEHR Templates Templates area use case specific constraint and aggregation of one or more archetypes to create any clinical specification. Templates have less need for governance as long as the archetypes that make them up are tightly governed.
- 36. openEHR Templates Templates area use case specific constraint and aggregation of one or more archetypes to create any clinical specification. Templates have less need for governance as long as the archetypes that make them up are tightly governed.
- 37. openEHR Templates Templates area use case specific constraint and aggregation of one or more archetypes to create any clinical specification. Templates have less need for governance as long as the archetypes that make them up are tightly governed.
- 38. openEHR Templates Templates area use case specific constraint and aggregation of one or more archetypes to create any clinical specification. Templates have less need for governance as long as the archetypes that make them up are tightly governed.
- 39. openEHR Templates Templates area use case specific constraint and aggregation of one or more archetypes to create any clinical specification. Templates have less need for governance as long as the archetypes that make them up are tightly governed.
- 40. Archetypes • Blood pressure • Weight • Height • Medication • Apgar score • Adverse reaction • Problem/Diagnosis
- 41. Templates • Discharge summary • Antenatal visit • Specialist letter • Shared health summary • eReferral • CCR • Prescription
- 42. Semantic architecture • Clinician and stakeholder input Semantic Key Archetypes • Agreement based on requirements • Jurisdiction, Users, Vendor input Templates • Agreement through standardisation • Standard transformation per archetype Commun- ication • Variety of formats
- 43.
Editor's Notes
- #3 I want to take you on a journey – moving from the left of the screen to the right.
- #4 I am a clinician – interested in the C in CDA
- #5 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.
- #6 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)
- #7 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
- #8 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.
- #9 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.
- #10 Doesn’t terminology solve the issues of clinical content? Can’t we just code something and get on with it?
- #13 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…)
- #14 Doesn’t terminology solve the issues of clinical content? Can’t we just code something and get on with it?
- #15 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.
- #21 National data collections are seriously importantDefining datasets is importantLets find a way to define them so that the context is clear.
- #23 So its about recording clinical information faithfullyIts about maximal data set and universal use caseIncludes needed terminology bindings and terminology valuesets
- #24 Ideal set of archetypes is a venn diagram with no overlap. Almost never a single data element.
- #25 Its about maximal data set - includes needed terminology bindings and terminology valuesetsMuch easier to get agreement than minimum datasets.
- #26 So its about recording clinical information faithfullyNot about creating an esoteric and academic model of something that represents that thing.
- #27 The universal use case.
- #28 Can be used directly in systems to create and persist data as well as other artefacts – top of an information tool chain.
- #29 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.
- #30 Can be used directly in systems to create and persist data as well as other artefacts – top of an information tool chain.
- #31 Can be used directly in systems to create and persist data as well as other artefacts – top of an information tool chain.
- #32 Can be used directly in systems to create and persist data as well as other artefacts – top of an information tool chain.
- #33 CKM demo to show:A couple of models and viewsGovernance aspectsCrowd sourced information
- #34 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?
- #44 Template designerQueryingFinish with MeHR