Clinical Information Modeling Initiative, Detailed Clinical Models and Integrating the Healthcare Enterprise. CIMI and IHE are neutral, maybe they can strengthen eachother...

1. IHE StuurGroepVergadering
17-apr-2012
CIMI, DCM en IHE
Michael van der Zel
Michael van der Zel <m.van.der.zel at umcg.nl> 17-apr-2012 1/20

2. “Always in motion, the future is”
Michael van der Zel <m.van.der.zel at umcg.nl> 17-apr-2012 2/20

3. CIMI, DCM en IHE?
Michael van der Zel <m.van.der.zel at umcg.nl> 17-apr-2012 3/20

4. #
Begin
CEM V2 “|”
Standard
Terminologies LRA
V2 XML
HTML
CEMs
V3 XML
DCMs
Repository
V3 Next
of Shared UML
CDA Models in
Templates
a Single openEHR
Translators
Language Archetype
openEHR
Archetypes CDA
OWL
CEN LRA
Archetypes CMETs, HMDs SOA
Models RMIMs
CEN Payload
Initial Loading of Repository Archetype
Michael van der Zel <m.van.der.zel at umcg.nl> 17-apr-2012 4/20

5. ● Mission
Mission & Goals
● Improve the interoperability of healthcare systems through shared implementable
clinical information models. Note: implementable means
models that can be transformed
● Goals into software artifacts.
● Establish and maintain a shared repository of detailed clinical information
models
● Establish appropriate governance, finance, and organizational structure for the
group
● Capture background, context, and discussions relevant to decisions made in
creating and using the model
● Establish a fair and open process for curating the content in the model
repository
● Promote the creation of software tools that translate the models to other
commonly used model representation languages (OWL, UML, HL7 MIF, graphic
format, HTML, etc.)
● Promote the creation of software tools that generate implementation artifacts
(XML schemas, Java class definitions, CDA templates, GreenCDA, etc.)
Michael van der Zel <m.van.der.zel at umcg.nl> 17-apr-2012 5/20

6. Organisaties
Ministry of Health Holdings Singapore, LifeLines,
Health Intersections, ONC, NHS Connecting for Health,
SMArt, Electronic Record Services, EN13606 Association,
B2i Healthcare, Cambio Healthcare Systems,
Canada Health Infoway/Inforoute Santé Canada, CDISC,
GE Healthcare, HL7, IHTSDO, Intermountain Healthcare,
JP Systems, Kaiser Permanente, Mayo Clinic,
National Institutes of Health (USA), Ocean Informatics,
OpenEHR, Results4Care, South Korea Yonsei University,
Tolven, Veterans Health Administration (USA), ...
N.B. Amerika, Europa, Australie, Azie, … en de rest niet? En IHE?
Michael van der Zel <m.van.der.zel at umcg.nl> 17-apr-2012 6/20

7. Vergaderen
● F2F (± 50 man) – 2011‑jan Orlando (HL7),
2011‑may McLean, 2011‑sep San Diego (HL7),
2011‑oct Sydney (IHTSDO), 2011‑nov London,
2012‑jan San Antonio (HL7), 2012‑may Pleasanton
● Wekelijkse Telecons
● Current Task Forces (groepjes van ± 7 man)
● Glossary
● Reference Model
● Clinical Modeling
● Interim Executive Board
Michael van der Zel <m.van.der.zel at umcg.nl> 17-apr-2012 7/20

8. “Beveiliging” @ DoD Contracter
Fototoestel & telefoon inleveren …
… maar hoe heb ik deze foto dan gemaakt ;-)
Michael van der Zel <m.van.der.zel at umcg.nl> 17-apr-2012 8/20

9. Reference Model TF
● Linda Bird (Chair) – Ministry of Health Holdings, Singapore
● Thomas Beale – Ocean Informatics
“vader” van OpenEHR / ADL
● Gerard Freriks, EN13606 Association
op basis van bovengenoemde ADL en afgeleid van OpenEHR
● Grahame Grieve – Health Intersections
“vader” van HL7 & ISO21090 datatypes
● Richard Kavanagh – NHS Connecting for Health
● Josh Mandel, SMArt
● Galen Mulrooney, ONC & VA, U.S.A.
● Michael van der Zel – Results4Care, LifeLines, UMCG
DCM ISO 13972 & UML, HL7 DCM's
Michael van der Zel <m.van.der.zel at umcg.nl> 17-apr-2012 9/20

10. Wat is “Reference Model”?
●
“A third use of a reference model is to improve
communication between people. A reference model
breaks up a problem into entities, or "things that exist all
by themselves." This is often an explicit recognition of
concepts that many people already share, but when
created in an explicit manner, a reference model is useful
by defining how these concepts differ from, and relate to,
one another. This improves communication between
individuals involved in using these concepts.”
● Vaak delen we wel de concepten, maar niet de naam die
we eraan geven.
Bron: http://en.wikipedia.org/wiki/Reference_model
Michael van der Zel <m.van.der.zel at umcg.nl> 17-apr-2012 10/20

11. Gelaagdheid
● Particles “Neutrons, Protons, Electrons”
● Atoms – Bloeddruk, Order
● Molecules – Lab Order
● Organisms – Overdracht Organisms
● Eco-Systems Molecules
– Samenwerking
Atoms
Particles
Michael van der Zel <m.van.der.zel at umcg.nl> 17-apr-2012 11/20

12. Mijn conclusies
●
Bibliotheek van Klinische Bouwstenen los van techniek,
maar wel omzetbaar naar een willekeurige techniek
●
Vorm & Werkwijze op basis van algemene methode
& tools ipv healthcare specifiek (ADL) → UML
●
OMG UML Healthcare Profile RFP!
● Doel lijkt sterk politiek: partijen om de tafel die anders niet
met elkaar spreken 13606, OpenEHR, HL7, e.a.
● N.B. IHE mist in dat lijstje?
Michael van der Zel <m.van.der.zel at umcg.nl> 17-apr-2012 12/20

13. Dus..
● Standaarden inzetten, (her)gebruiken, evt maken
→ “collective wisdom”
● Bruggen bouwen via modellen
● Harmoniseren, mappen of tooling
● “There can be only one”? – Highlander
Michael van der Zel <m.van.der.zel at umcg.nl> 17-apr-2012 13/20

14. CIMI & DCM Inzetten Voor
● DCM ISO 13972 → Parelsnoer Klinische Bouwblokken
→ www.eenheidvantaal.nl
● NICTIZ/NFU Generieke Overdrachtsgegevens
● UMCG LifeLines
● Results4Care verschillende projecten
● LUMC en UMCU
● ...
Michael van der Zel <m.van.der.zel at umcg.nl> 17-apr-2012 14/20

15. Vragen!?
● Moet IHE hier een rol in spelen?
● IHE is de standaard voor standaarden, doel CIMI is
clinical content, en daar komen implementaties van, e.g.
in OpenEHR, HL7, Tolven, etc.
● “IHE Clinical Content Blocks” oid?
Michael van der Zel <m.van.der.zel at umcg.nl> 17-apr-2012 15/20

16. Meer info
● www.cimiwiki.org
●
results4care.wikispaces.com/DCM_UML_StyleGuide
●
results4care.wikispaces.com/DCM+and+CIMI
● www.openehr.org/wiki/display/stds/openEHR+CIMI+Page
● www.eenheidvantaal.nl
Michael van der Zel <m.van.der.zel at umcg.nl> 17-apr-2012 16/20

17. Backup slides
Michael van der Zel <m.van.der.zel at umcg.nl> 17-apr-2012 17/20

18. High-level Architectural
Framework
Michael van der Zel <m.van.der.zel at umcg.nl> 17-apr-2012 18/20

19. Gelaagdheid (details)
Michael van der Zel <m.van.der.zel at umcg.nl> 17-apr-2012 19/20

20. Scope of our modeling effort
not computable enough
Conceptual “Overdracht bloeddruk en diagnose van specialist naar HA”
“Upper” Logical CCD Meaning
not bound to RM Meaning
binding
CCR Structure binding
Systolic Datatype
Datatype
Element-ID
Element-ID
BP DCM
Diastolic
DX DCM
technical solution specific
Logical
CDA
bound to RM
Implementable XML HL7 v2 pipes 
Structure

Terminology
Michael van der Zel <m.van.der.zel at umcg.nl> 17-apr-2012

Archiving? 20/20