Kaiser Permanente Standards SummitSeptember 7-8 , 2011Stanley M. Huff, MD

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A Brief Review of CIMI Plans and Goals

Phoenix CIMI MeetingsJanuary 18, 2013

Stanley M Huff, MDChief Medical Informatics Officer

The Ultimate Value Proposition of CIMI

• Sharing of:– Data

– Information

– Applications

– Decision logic

– Reports

– Knowledge

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Clinical System Approach

Intermountain can only provide the highest quality, lowest cost

health care with the use of advanced clinical decision

support systems integrated into frontline workflow

Decision Support Modules

• Antibiotic Assistant• Ventilator weaning• ARDS protocols • Nosocomial infection

monitoring• MRSA monitoring and

control• Prevention of Deep

Venous Thrombosis• Infectious disease

reporting to public health

• Diabetic care• Pre-op antibiotics• ICU glucose protocols• Ventilator disconnect• Infusion pump errors• Lab alerts• Blood ordering• Order sets• Patient worksheets• Post MI discharge meds

Strategic Goal

• Be able to share applications, reports, alerts, protocols, and decision support with anyone in the WORLD

Order Entry API (adapted from Harold Solbrig)

. . .

COS

Service

Interface

Data

Application

From Ben Adida and Josh Mandel

What Is Needed to Create a New Paradigm?

• Standard set of detailed clinical data models coupled with…

• Standard coded terminology

• Standard API’s (Application Programmer Interfaces) for healthcare related services

• Open sharing of models, coded terms, and API’s

• Sharing of decision logic and applications

Clinical modeling activities

• Netherlands/ISO Standard• CEN 13606• United Kingdom – NHS• Singapore• Sweden• Australia• openEHR Foundation• Canada• US Veterans Administration• US Department of Defense• Intermountain Healthcare• Mayo Clinic

• HL7– Version 3 RIM, message

templates– TermInfo– CDA plus Templates– Detailed Clinical Models– greenCDA

• Tolven• NIH/NCI – Common Data

Elements, CaBIG• CDISC SHARE• Korea• Brazil

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Clinical Information Modeling Initiative

Mission

Improve the interoperability of healthcare systems through shared

implementable clinical information models.

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Clinical Information Modeling Initiative

Goals• Shared repository of detailed clinical

information models

• Using a single formalism

• Based on a common set of base data types

• With formal bindings of the models to standard coded terminologies

• Repository is open and models are free for use at no cost

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Goal: Models that support multiple contexts

• Message payload

• Service payload

• Decision logic (queries of EHR data)

• EHR data storage

• Clinical trials data (clinical research)

• Normalization of data for secondary use

• Creation of data entry screens

• Natural Language Processing

Information Model Ideas

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Repository of SharedModels in

a Single Formalism

Repository of SharedModels in

a Single Formalism

DCMs

CDA Templates

openEHRArchetypes

CENArchetypes

LRA Models

CMETs, HMDsRMIMs

CEMs

StandardTerminologies

Initial Loading of Repository

Realm Specific

Specializations

Realm Specific

Specializations

Realm Specific

Specializations

Realm Specific

Specializations

Realm Specific

Specializations

Realm Specific

Specializations

Realm Specific

Specializations

Realm Specific

Specializations

Realm Specific

Specializations

Realm Specific

Specializations

V2 “|”V2 “|”

HTMLHTML

UMLUML

ADLADL

V2 XMLV2 XML

V3 XMLV3 XML

V3 NextV3 Next

CEN Archetype

CEN Archetype

CDACDA

SOAPayloadSOAPayload

CEMCEMLRALRA

OWLOWLCDISC SHARECDISC SHARE

TranslatorsTranslatorsTranslatorsTranslatorsTranslatorsTranslators

Roadmap (some parallel activities)

• Choose a single formalism

• Choose the initial set of agreed data types

• Define strategy for the core reference model and our modeling style and approach– Development of “style” will continue as we

begin creating content

Roadmap (continued)

• Create an open shared repository of models– Requirements– Find a place to host the repository– Select or develop the model repository software

• Create model content in the repository– Start with existing content that participants can

contribute– Must engage clinical experts for validation of the

models

Roadmap (continued)

• Create a process (editorial board?) for curation and management of model content

• Resolve and specify IP policies for open sharing of models• Find a way of funding and supporting the repository and

modeling activities• Create tools/compilers/transformers to other formalisms

– Must support at least ADL, UML/OCL, Semantic Web, HL7

• Create tools/compilers/transformers to create what software developers need– Examples: XML schema, Java classes, CDA templates,

greenCDA, RFH, SMART RDF, etc.

Selected Decisions

Decisions (London, Dec 1, 2011)

• We agree to create and use a single logical representation (the CIMI core reference model) comprising one or more models as the basis for interoperability across formalisms.

• We approve ADL 1.5 as the initial formalism in the repository using OpenEHR Constraint Model noting that modifications are required.

• The corresponding Archetype Object Model will be included and adapted as the CIMI UML profile

• The CIMI UML profile will be developed concurrently as a set of UML stereotypes, XMI specification and transformations

Definition of “Logical Model”

• Models show the structural relationship of the model elements (containment)

• Coded elements have explicit binding to allowed coded values

• Models are independent of a specific programming language or type of database

• Support explicit, unambiguous query statements against data instances

Definition of “Logical Model” (cont)

• Models shall specify a single unit of measure (unit normalization)

• Models can support inclusion of processing knowledge– Models can support recommend defaults– Models can specify assumed values of attributes

(meaning of absence of the item)

• Examples can be created for the model

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Isosemantic Models

data 37 %

HematocritManual (LOINC 4545-0)HematocritManualModel

data 37 %

quals

Hematocrit (LOINC 20570-8)HematocritModel

data Manual

Hematocrit MethodHematocritMethodModel

Precoordinated Model (CIMI deprecated Model)

Post coordinated Model (CIMI preferred Model)

Isosemantic Models

• CIMI is committed to isosemantic clinical models in terms of both:– The ability to transform CIMI models into

iso-semantic representations in other languages/standards (e.g. OWL, UML, HL7);

– The ability to transform CIMI models between iso-semantic representations that use a different split between terminology pre-coordination versus structure.

Isosemantic Models (cont)

• CIMI will select one model within each isosemantic family that will be the preferred model for interoperability

• (Profiles of exact models for specific uses will be created by the users: professional societies, regulatory agencies, public health, quality measures, etc.)

Terminology

• SNOMED CT will be the primary reference terminology

• LOINC was also approved as a reference terminology– In the event of overlap, SNOMED CT will be the

preferred source

• CIMI will propose extensions to the reference terminologies when needed concepts do not exist– CIMI will maintain the extensions until they are accepted

by the RT organization

• The primary version of models will only contain references (pointers) to value sets

• We will create tools that read the terminology tables and create versions of the models that contain enumerated value sets

Terminology (cont)

Some Principles

• CIMI DOES care about implementation. There must be at least one way to implement the models in a popular technology stack that is in use today. The models should be as easy to implement as possible.

• Only use will determine if we are producing anything of value– Approve “Good Enough” RM and DTs– Get practical use ASAP– Change RM and DTs based on use

Pleasanton May 10-12, 2012

• Resolution: The reference model presented by the Reference Model Task Force is endorsed as a starting point and establishes the direction that CIMI wishes to take. We expect that this model will be tested and modified as modeling work continues.

Pleasanton May 10-12, 2012

• Reference model and associated data types were approved– We expect that this model will be tested and

modified as modeling work continues.

• Agreed that there must be a computable semantic relationship between elements in a model

Goals for Rockville Meeting

• Continue modeling work

• Approve a proposal for creating an Editorial Board

• Decide on what tools to use to make models

• Create a team to do an end-to-end proof of concept– Possible targets: FIHR, SMArt, CDA template, HL7

V2, others?

• Updates and information sharing: OMG AML RFI, CDL to ADL conversion, finding a parent organization, FIHR, member survey

Conflicts of Interest

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