1. Integration of Information Models and Tools Project
2017Q1 Status
Project Scope Statement (PSS) HL7 Project #1316
For Achieving Computable Interoperability with an
HL7/ISO Healthcare “Common Logical Information Model (CLIM)”
Presented to
OSEHRA
Presented by
Steve Hufnagel, HL7 CIMI Workgroup
(IIM&T Facilitators)
April 18, 2017
Regardless of acquisition strategy, it is important to build upon information models and tools to manage interoperability
CHRONOLOGY:
2008 Federal Health Information Models start
2011 Clinical Information Model Initiative (CIMI) start at IHTSDO
CIMI transitions to HL7
2016 Jan-Sep CIMI Sponsored HL7 IIMT&E Investigative Study
CIMI-FHIM Integration Task Force
“CIMI-FHIM-SOLOR-CQF Integration” Preliminary Report
/18 Health Interoperability and Exchange Alliance (HIEA) Technical Forum
FHA “CIMI-FHIM-SOLOR-CQF Integration” Report PPT-Brief to FHA Federal Partners
“CIMI-FHIM-SOLOR-CQF Integration” Final Report
HL7 Meeting in Baltimore, MD
HSPC 2017 Meetings
Mar 27-29, 2017 New Orleans, LA
Aug Washington DC or Chicago
 HL Meetings
Jan 22-27, San Antonio, TX
May 5-12, 2017 Madrid
Sep 9-15, 2017, San Diego, CA
HL7 IIM&T Project will produce clear, complete, concise, correct, consistent, traceable and easy-to-maintain standards
and FHIR-CDA-NIEM implementation artifacts for Federal Agencies and their partners, venders and integrators
HL7 IIM&T Project will produce clear, complete, concise, correct, consistent, traceable and easy-to-maintain standards
and FHIR-CDA-NIEM implementation artifacts for Federal Agencies and their partners, venders and integrators
See
Notes
Page

2. Approach
Our clinical goal is to help people live the healthiest lives possible by enabling a “Learning Health System” supporting areas such as, but not limited to, Precision Medicine, Clinical Decision Support, Genomics, Research, etc.
This requires data that is computable, usable, extensible, and interpretable across disparate systems - a state that currently does not exist
The proposed solution capitalizes on the inroads made with the exchange of data, standards and standards adoption, but brings back a focus on the data in order to make additional and necessary advancements
Our aim is to Increase FHIM-CIMI / Information Models & Related Tools Awareness, Use, Usability, their foundational Relationship to other Efforts / Resources – all to streamline / unify our efforts and ultimately extend Semantic Interoperability.
Our view is this holds relevance regardless of acquisition strategy
The benefit of a standardized reusable modeling-foundation is computable-interoperability aka interpretability across time, locations, systems and care contexts, assuming the re-usable “stack” is standardized and has widespread implementation. This information-model “stack” foundation is mission-essential for
collection, communication, aggregation and interpretation of patient data to accelerate secondary uses in public health, disease surveillance, post-approval monitoring, and patient-centered outcomes research.
health-related services including telecare, clinical decision support, research, and quality measurement, improving healthcare access, quality, and uniformity.
patients, clinicians, and the public to realize major benefits from improved care coordination, reduction of medical errors, and decreased costs resulting in healthier lives.
HL7 IIM&T Project will produce clear, complete, concise, correct, consistent, traceable and easy-to-maintain standards
and FHIR-CDA-NIEM implementation artifacts for Federal Agencies and their partners, venders and integrators
See
Notes
Page

3. IIM&T Relevance – Vendor Perspective
When asked why vendors follow / support the HL7 IIM&T:
First, regardless of how closely a client aligns with vendor product, there is requested tailoring. In that space, IIM&T can serve up reusable resources
Second, and the strongest value is addressing new areas; areas vendors have not yet addressed and therefore giving a standards-based, SME-driven, enterprise-level resource
Will unify communities, minimize unnecessary variability, accelerate implementations and reduce vendor costs
Finally, addressing integration efforts and pursuing new territory will also serve as catalyst to needed “Intelligence Thinking” / discussions

4. Problem: Skyscraper Analogy
As-Is
To-Be
Not Harmonized
Not Harmonized
Harmonized
Shared Meaning
No shared terminology model or information model - not interoperable
No shared terminology model, shared information model - not interoperable
Shared terminology model and information model - interoperable future state
BLUF (Bottom Line Up Front)
As is: no shared terminology content (floor 1), no shared information models (floor 2), then they are building from the 3rd floor up. No shared value from the 3rd floor up. 
Future State: shared terminology content (floor 1), shared information models (floor 2), sharable value built on floors above. 
In a perfect world the following would be done concurrently and with close collaboration
Recommended Solution Part 1: We integrate SOLOR into FHIM
Concurrently, resolving SOLAR gaps
Recommended Solution Part 2: We integrate CIMI, FHIM and CQF 
Recommended Solution Part 3: We follow Agile refinement cycles through pilots and implementations
Recommended Solution Part : We develop adequate documentation, test cases, fixtures and supporting resources
In the real world, we are asking:
the Federal Partners to provide resources to make efficient and effective progress in the near, mid and long term.
the Federal Partners to work together to deliver—in an ongoing way—a single integrated terminology system (SOLOR), that meets all US regulatory requirements, while simplifying implementation for developers.
the FHA to facilitate Federal Partner governance and configuration management of this work
This ONC OTS to endorse this initiative and facility resources
We are asking the IPO to provide coordination and facilitation
We are asking HL7 to facilitate
international, commercial and academic peer review and
ballot governance and configuration management.
Coordination of an ISO ballot (this will be several years from now)
Analogy of the Challenge: Today’s efforts occur as if we’re always trying to build the ultimate skyscraper, starting on the 3rd Floor.
Inconsistencies exist/become extended producing transformational (mapping) efforts = models, models everywhere
The problem is that today’s healthcare systems do not capture information and its context consistently, and consequently, they cannot easily share-or-merge information from different sources to create a computable operational-picture (aka longitudinal patient-records, care plans, clinical knowledge and other shared healthcare information across time, multiple care locations and differing contexts).
If continued and unchecked, even the best of implementation accelerators, like FHIR with its extensions and profiles, allow far too much implementation variation; where, each project often creates, from scratch, yet, another information model, e.g. through a mapping exercise.
The missed opportunity is to leverage a shared logical Reference Information Model minimizing the duplicative-work, avoiding inconsistencies and avoiding the necessity to engage these SMEs, these resources and our larger community. This is the “models, models everywhere phenomenon ”. As an example,
Standards, in general, use different formats and rules for ‘simple’ things like: name, address, dates. Resulting in EHR-systems that after decades cannot uniformly exchange this ‘simple’ ubiquitous data; let alone ‘complex’ clinical health data.
the HL7 EHR Interoperability workgroup, in its analysis “Record Entry Lifecycle Event Metadata using FHIR,” found substantial provenance (who, what, when, where and how) inconsistencies among FHIR resources .
The SOLOR/LEGO team found FHIR tries to define things such as attributes for anatomy, that are not based on a particular model of anatomy, and thus you get semantic overlap, with the burden of reconciliation, which may not even be possible, if left to the end user.
*Drawn from Dr. Keith Campbell’s analogy used within The Open Group Healthcare Forum (HCF) article:
Advancing Healthcare Interoperability
HL7 IIM&T Project will produce clear, complete, concise, correct, consistent, traceable and easy-to-maintain standards
and FHIR-CDA-NIEM implementation artifacts for Federal Agencies and their partners, venders and integrators
See
Notes
Page

5. Terminology Problem SOLOR Solution Serving as Terminology Foundation
Challenge / Response
Terminology Problem SOLOR Solution
Serving as Terminology Foundation
SOLOR Benefits: Normalized structure and form of clinical terminology improves software reuse, shared tooling, reduced learning curve, shared post-coordination models, simplified data analysis … no more mapping!
Gentamicin is an example of the non-consistant terminologies
Why we can simplify now?
            • Licensing models have changed so we can implement native standards
            • LOINC and SNOMED are integrating content via a shared logical model
            • RxNorm can be extracted into a shared logical model
            • SNOMED + LOINC + RxNorm + post-coordination provides comprehensive coverage for typical clinical data representation requirements 
In distinguishing terminology and model capability: Concrete Example In SOLOR / RxNorm = description of dosage of penicillin and what it means; With the use of the FHIM it will tell you if its part of substance administration and/or adverse event. RxNorm doesn’t do that
CIMI offers a DCM the providers can use in the detailed execution of a particular domain
See Notes Page

6. IT Objective
Our IT objective is to make the appropriate data available
when it is needed, where it is needed and how it is needed.
Our IT objective is to make the appropriate data available when it is needed, where it needed and how it is needed. We plan to integrate existing models, with semantically-consistent computable-data, including provenance data (who, what, when, where, why, how) across different platforms, e.g., population health, Clinical Decision support, EHR patient documentation systems, etc. using tooling to generate various implementation styles, including HL7 Fast Healthcare Interoperable Resources (FHIR).
HL7 IIM&T Project will produce clear, complete, concise, correct, consistent, traceable and easy-to-maintain standards
and FHIR-CDA-NIEM implementation artifacts for Federal Agencies and their partners, venders and integrators
See
Notes
Page

7. Objectives (expanded)=
Promote use of free & open models; foundational to interoperability
Maintain a clean separation of clinical model semantics using SNOMED, LOINC and RxNorm
Build upon and improve existing work; in particular DAF (US Core) and FHIR core
Begin with the Integration of SOLOR+FHIM+CIMI+CQF+DAF=CLIM set of harmonized models, as the Enabling Foundation
Integrate tooling to support models to extend the utility of these asset
Use models and tools to generate standards and implementation artifacts
Advance in constructive steps through pilots and agile developments
Support with corresponding Communication, Interoperability & Governance strategies
SOLOR/FHIM/CIMI/DAF/CQF+ based FHIR Profiles
Satisfied Implementation + Clinical Communities
See Notes Page

8. Proposed Solution Integrated Model Stack - Each Plays a Role
KNART
KNART
eCQM
eCQM
DCM
DCM
eCQM
DCM
CQI
CQF
CDS
DCM
DCM
DCM
Other
Initiatives
CIMI
FHIM
DCM
DCM
As shown in this slide, each model contributes to an Integrated Model Stack, the proposed operational architecture involves the definition of clinical knowledge in the form of formally modeled information artifacts that could be used in compose-able health records, care plans and other shared clinical data. As represented in this slide, the combination of SOLOR, FHIM, CIMI DCMs and CQF KNARTs while complementary fulfill a different information modeling contribution.
SOLOR is SNOMED with extensions for LOINC and RXNorm.
FHIM is Federal Health Information Model
CIMI DCMs is Clinical Information Model Initiative Detailed Clinical Model
CQF KNARTs is Clinical Quality Framework Knowledge Artefacts
SOLOR
DCM - Detailed Clinical Models KNART– Knowledge Artifact
FHIM – Federal Health Information Model SOLOR – SNOMED, LOINC, RxNorm
See
Notes
Page

9. Clinical Example CIMI-FHIM Integration
CQF Knowledge Artifacts
SOLOR Terminology
FHIM Classes
CIMI DCMS

10. Better Implementation Products: Apps Based on Integrated/Reusable Models
CLIM
{SOLOR, FHIM, CIMI, CQF, …}
CLIM
(HL7/ISO
Balloted
Version)
ACC is American College of Cardiologists, COMM Acq is Community-acquired,
MQIP is Medicare Quality Improvement Program, OPA is Oropharyngeal Airway

11. Model Development Lifecycle
Standard
Terminologies
(SOLOR)
LEGOs
FHIM

12. FHIR Profiles from CIMI Models (using standard terminology)
Heterogeneous Systems 12

13. Approach: Argonauts and CIMI
We agree with the efforts of the Argonaut project
Current scope of the Argonaut work however, will not achieve true plug-n-play interoperability
Meaningful use common data elements
DAF (aka FHIR US Core) profiles (high level profiles)
Small number of detailed models
Vital signs (measurements only, no qualifying information)
CIMI adds detailed content for plug-n-play interoperability
Lab measurements
Patient measurements
Physical exam
Intake and Output
Assessment instruments: Apgars, Braden, Pain Scales, etc.

14. Health IT Goal: Computable Semantic-Interoperability where, this figure shows the FHIT artifact development process, using the IIM&T process.
FHIM, using SMEs,
Standards,
US Regulatory Requirements
CQI, using SMEs,
CQF, vMR & QDM
Requirements
CIMI, using SMEs,
FHIM & CQI
Domain Models
CIMI Principles & Reference Models
CIMI Principles & Reference Models
CIMI Principles & Reference Models
FHIM
Domain Models
QI Quick & DAF
Domain Models
CIMI DCMs
CQI eCQMs
CDS KNARTs
Common Stakeholders
SOLOR Terminology Editor
SNOMED CT, LOINC and RxNorm Semantics
VSAC Terminology Server
Manual or using Tools
Manual or using Tools
Manual or using Tools
The benefit of standard CIMI Principles and Reference Models is an Architectural Framework for computable semantic-interoperability aka interpretability across time, locations, systems and care contexts, assuming the re-usable “stack” is standardized and has widespread implementation. Seamless tools can result in efficiency and effectiveness. This information-model “stack” foundation is mission-essential for
collection, communication, aggregation and interpretation of patient data to accelerate secondary uses in public health, disease surveillance, post-approval monitoring, and patient-centered outcomes research.
health-related services including telecare, clinical decision support, research, and quality measurement, improving healthcare access, quality, and uniformity.
patients, clinicians, and the public to realize major benefits from improved care coordination, reduction of medical errors, and decreased costs resulting in healthier lives.
Interoperability Specifications and Implementation Artifacts
CDA, NIEM, FHIR (US Core, QI Core, Profiles, Extensions)
HL7 IIM&T Project will produce clear, complete, concise, correct, consistent, traceable and easy-to-maintain standards
and FHIR-CDA-NIEM implementation artifacts for Federal Agencies and their partners, venders and integrators
See
Notes
Page

15. IIM&T Roadmap
Stan Huff
CIMI
ONC, FHA,
DoD, VA, IPO,
FHIM (Wed, Fri)
HL7 CIMI (Thu)
Julia Skapik
CQI & CDS
FDA, CDC
Core SMEs
Organizations
SOLOR (Tue)
Meetings
HL7, ISO
Steve Wagner
FHIM
HL7 Working Groups
HSPC
Keith Campbell
SOLOR
Open Group
HSPC Meetings
HL7-ISO Standards,
Tools and Training
HL7 IIM&T Project
FHIM
FHIM – CIMI-CQI Harmonization
IPO Technical Forum
HL7 Comment-only Ballot
HL7 Informative Standard
HL7 Trial Use Standard
HL7 Trial Use Standard
HL7 Normative Standard
HL7-ISO Standard
CIMI
FHA Managing Board
FHIR US Core /
QI Core Integration
The Roadmap shows the facets needed for the successful execution of the HL7 Integration of Information Models and Tools (IIM&T) Project.
The “Core Subject Matter Experts (SMEs)” provide leadership and governance.
The “Organizations” are the stakeholders and proponents
The “Meetings” help to keep stakeholders informed and engaged on an ongoing basis
The “Models and Tools” are being harmonized to produce clear, complete, concise, correct, consistent, traceable and easy-to-maintain standards and FHIR-CDA-NIEM implementation artifacts for Federal Agencies and their partners, venders and integrators
The “Projects” are the proving-ground to independently verify and validate the IIM&T methodologies and technologies.
The “Communications” are the essential outreach to evangelize IIM&T products and processes.
CQI
Newsletters
Models and Tools
Projects
Communications
SOLOR
CDS
Pediatric Bilirubin
ONC – FHIR
Modeling Meetings
SIGG
Device interfaces MDEpiNet
FHIR
HL7 & ISO Ballot &
Standards Reviews
Others
Skin Wound Assessment
HL7 IIM&T Project will produce clear, complete, concise, correct, consistent, traceable and easy-to-maintain standards
and FHIR-CDA-NIEM implementation artifacts for Federal Agencies and their partners, venders and integrators
Integration of Information Models and Tools (IIM&T) project at HL7, resulting in clear, complete, concise, correct, consistent and traceable standards & implementation artifacts, which are easy-to-use by Federal Agencies and their partners, venders and integrators.
See
Notes
Page

16. 2017Q1 IIM&T Status Schedule is at risk under current resourcing FHIM, SOLOR, CQI, CIMI, SIGG Projects and SMEs need sustained resourcing 16
The Integration of Information Models and Tools (IIM&T) project was successfully formed, defining essential requirements, specifications and principles as an Architectural Framework, aka Reference Architecture, of layered-models, to enable the production of clear, complete, concise, correct, consistent, traceable and easy-to-maintain standards and FHIR-CDA-NIEM implementation artifacts developed for Federal Agencies and their partners, venders and integrators; where in 2016,
CIMI transitioned to being an HL7 workgroup in Jan 2016, after having been an IHTSDO workgroup since 2010.
A CIMI-sponsored investigative-study was conducted from Jan thru Sept 2016; where, the investigative-study final-report and draft IIM&T Project Scope Statement (PSS) were delivered at the Sep 2016 HL7 Workgroup meeting for peer-review.
ONC, FHA and IPO co-sponsored a two-day Health Interoperability and Exchange Alliance (HIEA) Technical Forum in Aug 2016 to share the investigative-study results among IIM&T stakeholders-and-proponents and to coalesce issues, recommendations and a way-forward roadmap into a final-report and HL7 PSS.
FHA Managing Board briefings were provided in October and November to obtain Federal Partner concurrence with The HL7 PSS.
CIMI Basic Meta Model (BMM) specifications were formulated for the January comments-only ballot to get peer-review. These were based on OpenEHR and ISO13606 BMM; but, were adapted to be more stable, flexible and easier-to-use.
In 2017Q1 the Pilot-project were used to drive refinement:
HL7 Project Scope Statement was peer-reviewed and updated in-accordance-with HL7 co-sponsoring workgroups feedback.
HL7 comments-only ballot (Jan), which included the CIMI Basic Meta Model specifications
FHIM was harmonized with CIMI BMM
QI Quick was harmonized with CIMI BMM
Skin-Wound Assessment-Models
During the rest of 2017 Pilot-projects drive refinement:
HL7 Informative ballot (May)
Architectural Framework
Skin Wound DCMs
HL7 Trial Use Standard (Sep)
Clinical Statements
Procedures
Orders
FHIR US Core and QI Core
FHIR Profiles and Extensions
Pilot-projects drive refinement
2018 HL7 Standard for Trial Use Update
2019 HL7 Normative Standard
2020 HL7-ISO Standard
Integrated Tools refinement
Practitioners’ Guide updates
Comprehensive Training Materials updates
Reference FHIR, CDA, NIEM extensions, profiles, test and implementation artifacts refined and updated
Integration of Information Models and Tools (IIM&T) project at HL7, resulting in clear, complete, concise, correct, consistent and traceable standards & implementation artifacts, which are easy-to-use by Federal Agencies and their partners, venders and integrators.
HL7 IIM&T Project will produce clear, complete, concise, correct, consistent, traceable and easy-to-maintain standards
and FHIR-CDA-NIEM implementation artifacts for Federal Agencies and their partners, venders and integrators
See
Notes
Page

17. Clinical Impact – Benefits & Advantages Model Driven Development (MDD)
Consistent Representation of
UML Implementation Guides:
Provide a consistent approach for constraint-
based profiling using UML, thereby enabling
a common model-driven process and tooling.
Applicable to: CDA, FHIR, FHIM, CIMI, etc.
Support Design Tasks:
Import existing HL7 specs to UML
Integrate with terminology services to
define and reference value sets and codes
Generate instance validation tools from
specification models
Publish implementation guides in
multiple formats (PDF, XHTML, etc.)
Development Cost Reduction:
Less time and resource investment for
analysis and implementation of CDA & FHIR
implementation guides
Maintenance Cost Reduction:
Access to high-quality, domain specific
APIs generated from specification models,
providing programmatic access to
content and validation of conformance rules
Interoperability Mapping:
Content mapping, traceability & gap analysis
between models via reference to
common semantic metadata
Health
Information
Exchange
Clinical Decision
Support
Population – Health
Care Coordination
Research & Analytics
Quality – Outcome
Cost Measurements
Quality/Cost = Value
Learning Health
System
Specification
Designers
Developers /
Implementers
MDD
(MDHT & MDMI)
CLINICAL
IMPACT

18. 2017Q1 IIM&T Pilot-Projects Status
Collaboration Pilot-Projects (2017Q1); where, #1, #2, #3 indicate May-2017 Ballot inclusion-priority:
FHIM integration of CIMI Clinical BMM & Archetypes (Patterns) #1 [Galen Mulrooney]
US Core / QI Core integration of CIMI BMM & Archetypes (Patterns) #1 [Claude Nanjo]
Refine PROCEDURE and CONTEXT based on Pilots #1 (Galen Mulrooney and Claude Nanjo)
Patient Care Project #1253 "CIMI Clinical Model Proof of Concept" (Skin Wound Assessment) #1
Pediatric Bilirubin Management CDS #2, needs code generation library [Ken Kawamoto]
Zika measure #3 [Ken Kawamoto and Claude Nanjo]
Immunization Management EHR Functional Model Profile #3 (Steve Hufnagel and Gary Dickinson)
Family Planning Annual Report (FPAR) – HSPC pilot with ACOG #3 [Stan Huff, Susan Matney]
Device interfaces MDEpiNet #3 [Julia Skapik, ONC and Terri Reed, FDA]
FHIR JET (Joint Exploratory Team) #3 Nona Hall, IPO, VA, DoD.
The benefit of a standardized reusable modeling-foundation is computable-interoperability aka interpretability across time, locations, systems and care contexts, assuming the re-usable “stack” is standardized and has widespread implementation. This information-model “stack” foundation is mission-essential for
collection, communication, aggregation and interpretation of patient data to accelerate secondary uses in public health, disease surveillance, post-approval monitoring, and patient-centered outcomes research.
health-related services including telecare, clinical decision support, research, and quality measurement, improving healthcare access, quality, and uniformity.
patients, clinicians, and the public to realize major benefits from improved care coordination, reduction of medical errors, and decreased costs resulting in healthier lives.
HL7 IIM&T Project will produce clear, complete, concise, correct, consistent, traceable and easy-to-maintain standards
and FHIR-CDA-NIEM implementation artifacts for Federal Agencies and their partners, venders and integrators
See
Notes
Page

19. Acknowledgement Collaboration that Grows with a Strong SME Base
CIMI Co-Chairs
Linda Bird BIT, IHTSDO
Galen Mulrooney, FHA and VA contractor
Richard Esmond, PenRad LLC
Stanley Huff, Intermountain Healthcare
Members of the following SDOs
IHTSDO, POC: Linda Bird BIT
HL7 Work Groups (CBCC, CIC, CDS, CQI, DEV, EHR, FMG, HSI, SOA, Vocab)
The Open Group Healthcare Forum, Jason Lee POC
ISO/CEN, POCs: Gerard Freriks, William Goossen, Gary Dickinson
Federal Agency staff and contractors
Department of Defense, Veterans Administration, Interagency Program Office
Federal Drug Agency, Center for Disease Control, SAMHSA
ONC OST and Federal Health Architecture
Apprio Inc., Cognitive Medicine, Iris Health Solutions LLC, JPSystems, MITRE
Members of the following Healthcare Organizations
Intermountain Healthcare, Mayo, PenRad, Inc., Results4Care
Health Services Platform Consortium (HSPC),
American College of Gynecology (ACOG)
Faculty, Staff and Students
Duke University, The University of Utah
The benefit of a standardized reusable modeling-foundation is computable-interoperability aka interpretability across time, locations, systems and care contexts, assuming the re-usable “stack” is standardized and has widespread implementation. This information-model “stack” foundation is mission-essential for
collection, communication, aggregation and interpretation of patient data to accelerate secondary uses in public health, disease surveillance, post-approval monitoring, and patient-centered outcomes research.
health-related services including telecare, clinical decision support, research, and quality measurement, improving healthcare access, quality, and uniformity.
patients, clinicians, and the public to realize major benefits from improved care coordination, reduction of medical errors, and decreased costs resulting in healthier lives.
HL7 IIM&T Project will produce clear, complete, concise, correct, consistent, traceable and easy-to-maintain standards
and FHIR-CDA-NIEM implementation artifacts for Federal Agencies and their partners, venders and integrators
See
Notes
Page

20. Take Away Highlights Change and Challenges are a Constant
Our Learning Health System will bring about change
The evolution inside our Organizations will bring about change
Regardless of acquisition strategy, ensure Interoperability Strategies account for the foundational role of Information Modeling/Terminology Services
Follow & facilitate efforts such as the HL7 Integration of Models enabled by Tooling in order to bolster implementation assets such as but not limited to FHIR
Engage / expand your SME base; expand stakeholder base in order to sustain / expand resourcing
Follow progress via Newsletter, attendance to meetings

21. Reference Documents
 “It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.” [Theodore Roosevelt, Apr 23, 1910, Sorbonne, Paris, France]
HL7 IIM&T Project Scope Statements
IIM&T Technical Forum Summary
IIM&T Work Breakdown Structure
IIM&T Briefing Slides
IIM&T Newsletters
IIM&T Reports
CIMI web-site
CIMI BMM Browser
CIMI Architype-Model Browser
CIMI Wiki
CIMI Minutes
CIMI Ballot Materials
CIMI Architecture and Style Guides
CIMI Practitioners Guide
US CORE Wiki
Skin and Wound Assessment Pilot Wiki
SNOMED CT:
Expression Constraint Guide Questions? Contact Facilitators at: or
 Some networks block the use of clickable links; where, you must copy the link into a browser to access the content.
If links don’t work on a Government Network or VPN, try accessing them directly (without VPN)

22. Acronyms
BMM
CIMI Basic Meta Model components
ISAAC
VA tool for SOLOR
CEM
Intermountain Clinical Element Models
ISO
International Standards Organization
CIMI
HL7 Clinical Information Model Initiative
JIF
VA/DOD Joint Incentive Fund
CLIM
HL7 Common (Clinical) Logical Information Model
KNART
CDS Knowledge Artifact
CQI
HL7 Clinical Quality Information
LOINC
Logical Observation Identifiers Names and Codes
CQF
HL7 Clinical Quality Framework
MDHT
Model Driven Health Tools
DAF
ONC Data Access Framework
MDMI
Model Driven Message Interoperability
DCM
Detailed Clinical Model
ONC/OST
US Office of the Natl. Coordinator / Office of Science and Tech.
eCQM
CQI Electronic Clinical Quality Measure
PMP
Program Management Plan
STU
HL7 Standard for Trial Use
PSS
Project Scope Statement
EDW
Electronic Data Warehouse
QUICK
CQI Quality Information and Clinical Knowledge logical model.
FDA
US Federal Drug Agency
RXNORM
US National Library of Medicine naming system for drugs
FHA
US Federal Health Architecture
SIGG
Standards Interoperability Guide Generator
FHIM
US Federal Health Information Model
SOLOR
SNOMED extension for LOINC & RXNorm
FHIR
HL7 Fast Health Information Resource
TLC
ONC/OST Technical Learning Center
HIEA
DoD VA IPO Health Interoperability Exchange Alliance VA
US Veterans Administration
HcDir
ONC-FHA Provider Healthcare Directory.
VCS
Version Control System for collaboration
IPO
US DoD and VA Interagency Program Office
VSAC
NLM Value Set Authority
BMM is CIMI Basic Meta Model components See
CDA is HL7 Clinical Data Architecture. See
C-CDA is HL7 Consolidated CDA. See
CEM is Intermountain Clinical Element Models e
CDS is HL7 Clinical Decision Support workgroup. See
CIMI is HL7 Clinical Information Model Initiative. See
CIMI Principles See
CIMI Reference Models (aka Information Architecture) See
CLIM is HL7 Clinical Logical Information Model Package of CIMI-Harmonized SOLOR, FHIM, CQF, CIMI DCMs and CQI KNARTs
where, independent organizations maintain the component models and HL7 periodically configuration manages, ballots and standardizes them.
CQF is ONC Clinical Quality Framework. See
CQI is HL7 Clinical Quality Information workgroup. See
DAF is ONC Data Access Framework (US Core). See
DCM is CIMI Detailed Clinical Models. See
eCQM is Electronic Clinical Quality Measure
FHIM is Federal Health Information Model; where, FHIM specifies healthcare domains and their data modules and their data elements.
FHIR is HL7 Fast Healthcare Information Resource standard and workgroup. See
HcDir is ONC-FHA Provider Healthcare Directory. See
IIM&T Is CIMI-sponsored HL7 Integration of Information Models & Tools Project.
JET is DoD-VA Joint Exploratory Team.
KNART is CDS Knowledge Artifact. See
MDHT is SIGG Model Driven Health Tool. See
MDMI is SIGG Model Driven Message Interoperability.
The present MDMI Referent Index (RI) scope is the US Core; where, FHIM is used for data-element value-sets.
FHA’s MDMI RI supports all MU2 data elements and >90% of the C-CDA model.
See and and
NIEM is National Information Exchange Package. It provides browser-cased “interoperability” among Federal agencies. See
QI Core is FHIR Quality Improvement Core Implementation Guide . See
QUICK is CQI Quality Information and Clinical Knowledge logical model.
See
RI is SIGG-MDMI Referent Index. See
SIGG is FHA Standards Implementation Guide Generator
SOLOR is VA’s SnOmed LOinc, Rxnorm; where, HSPC hosts the SOLOR project to provide the terminology foundation for model development.
VSAC is NLM Value Set Authority Center.
HL7 IIM&T Project will produce clear, complete, concise, correct, consistent, traceable and easy-to-maintain standards
and FHIR-CDA-NIEM implementation artifacts for Federal Agencies and their partners, venders and integrators
See
Notes
Page
See Notes Page

23. Questions? Your Thoughts?
Thank You
Acronyms offered for Integration Effort
Acronym
Definition
ICE
Integrated Components for Everything
Integrated Clinical Entities
ICCE
Integrated Clinical Components for Everything
FUEL
Federated Ubiquitous Expression Language
FHUIL (pronounced “Fuel”)
Federal Healthcare Universal Interoperability Language
CLIM
Common Logical Information Model

24. Pulse Check
To gauge the relevance of this topic and / or the manner it is delivered, the following will be asked at the beginning & end of this brief:
Using a rating scale of 1 – 5 (1 = strongly disagree or N/A; 5 = strongly agree) rate the following:
I am aware of information models and the foundational role they have in supporting semantic interoperability for a Learning Health System
I feel I am well versed on the challenges that confront achieving semantic interoperability
I am a user of / participant in the efforts and resources supporting information modeling
Information models are part of our organization’s strategic plan to extend semantic interoperability
I know I can make a difference and can describe at least one way to further semantic interoperability

25. Backup Slides FHIM Status Attributes of Success OMICs definitions
The benefit of a standardized reusable modeling-foundation is computable-interoperability aka interpretability across time, locations, systems and care contexts, assuming the re-usable “stack” is standardized and has widespread implementation. This information-model “stack” foundation is mission-essential for
collection, communication, aggregation and interpretation of patient data to accelerate secondary uses in public health, disease surveillance, post-approval monitoring, and patient-centered outcomes research.
health-related services including telecare, clinical decision support, research, and quality measurement, improving healthcare access, quality, and uniformity.
patients, clinicians, and the public to realize major benefits from improved care coordination, reduction of medical errors, and decreased costs resulting in healthier lives.
HL7 IIM&T Project will produce clear, complete, concise, correct, consistent, traceable and easy-to-maintain standards
and FHIR-CDA-NIEM implementation artifacts for Federal Agencies and their partners, venders and integrators
See
Notes
Page

26. Pulse Check
To gauge the relevance of this topic and / or the manner it is delivered, the following will be asked at the beginning & end of this brief:
Using a rating scale of 1 – 5 (1 = strongly disagree or N/A; 5 = strongly agree) rate the following:
I am aware of information models and the foundational role they have in supporting semantic interoperability for a Learning Health System
I feel I am well versed on the challenges that confront achieving semantic interoperability
I am a user of / participant in the efforts and resources supporting information modeling
Information models are part of our organization’s strategic plan to extend semantic interoperability
I know I can make a difference and can describe at least one way to further semantic interoperability

27. Relevance: Precision Medicine Perspective
GIS for Spatial ‘Omics’ information Maps
Our ability to interoperate, certify, and standardize omics data in clinical settings is key to the ultimate success of precision medicine.

28. 2017Q1 FHIM Status End State: Model Driven Development of Enhanced FHIR Resources (Extensions and Profiles)
HL7 Integration (Harmonization) of Information Models & Tools Project
Continuing to re-factor the FHIM to harmonize with CIMI, CDS, and CQI
Completed re-factoring of Provenance and “Attribution” to fit the “Clinical Statement” pattern. This affected every clinical package in the FHIM
Completed re-factoring of Subject of Information / Subject of Record to fit the “Clinical Statement” pattern. This affected every clinical package in the FHIM
Completed analysis of the Statement Topic / Context pattern to harmonize with CDS, CQI, and SOLOR. This re-factoring separates the subject matter in each class from its context.
Began to implement the re-factoring in Encounters and Pharmacy. Estimated completion date for the entire FHIM is March 31st.
Harmonizing FHIM with FHIR STU 3
STU 3 has drastically changed since the last review in September. We are combing through the current STU 3 (which has now been locked down for publication) and identifying changes needed to the FHIM.
Preparing to refresh the Security / Privacy Model
Security / Privacy has evolved substantially since the last time it was modeled in the FHIM. This is in part driven by FHIR STU 3, but also by ONC sponsored initiatives and implantation experience at SMART on FHIR. We will review the latest materials from HL7 and from the VA.
The benefit of a standardized reusable modeling-foundation is computable-interoperability aka interpretability across time, locations, systems and care contexts, assuming the re-usable “stack” is standardized and has widespread implementation. This information-model “stack” foundation is mission-essential for
collection, communication, aggregation and interpretation of patient data to accelerate secondary uses in public health, disease surveillance, post-approval monitoring, and patient-centered outcomes research.
health-related services including telecare, clinical decision support, research, and quality measurement, improving healthcare access, quality, and uniformity.
patients, clinicians, and the public to realize major benefits from improved care coordination, reduction of medical errors, and decreased costs resulting in healthier lives.
HL7 IIM&T Project will produce clear, complete, concise, correct, consistent, traceable and easy-to-maintain standards
and FHIR-CDA-NIEM implementation artifacts for Federal Agencies and their partners, venders and integrators
See
Notes
Page

29. Acknowledgement Collaboration that Grows with a Strong SME Base
Terminology Modeling Project
Completed Terminology modeling of the “Assessment” (aka Questionnaire) domain
Completed Terminology modeling of the Laboratory concepts that were tabled awaiting the outcome of the Public Health Laboratory project
Tabled Enrollment/Eligibility/Coordination of Benefits terminology modeling. The majority of these concepts currently reference proprietary value sets, but FHIR is working on an international version that will be worth reviewing.
Began a scrub of previously modeled terminology concepts to ensure that they’re still up to date given all the changes in FHIR (and HL7 v 2.9 is imminent, which changes how HL7 references v2 value sets)
Preparing to engage the Security / Privacy information modeling to incorporate proper value sets
The benefit of a standardized reusable modeling-foundation is computable-interoperability aka interpretability across time, locations, systems and care contexts, assuming the re-usable “stack” is standardized and has widespread implementation. This information-model “stack” foundation is mission-essential for
collection, communication, aggregation and interpretation of patient data to accelerate secondary uses in public health, disease surveillance, post-approval monitoring, and patient-centered outcomes research.
health-related services including telecare, clinical decision support, research, and quality measurement, improving healthcare access, quality, and uniformity.
patients, clinicians, and the public to realize major benefits from improved care coordination, reduction of medical errors, and decreased costs resulting in healthier lives.
HL7 IIM&T Project will produce clear, complete, concise, correct, consistent, traceable and easy-to-maintain standards
and FHIR-CDA-NIEM implementation artifacts for Federal Agencies and their partners, venders and integrators
See
Notes
Page

30. FHIM Information Domains 2017Q1 Modeling Status
Information Modeling Status
Terminology Modeling Status
AdverseEventReporting
Complete
Allergies
Assessment
Audiology And Speech Pathology
To Be Modeled
BehavioralHealth
Partially Complete
BloodBank
CarePlan
ClinicalDecisionSupport
In Progress
ClinicalDocument
Consultation
Dental
Dietetics
Encounter
EnrollEligibilityCOB
HealthConcern
HomeBasedPrimaryCare
Imaging
Immunizations
Lab
OncologyRegistry
Orders
FHIM Information Domains
Information Domain
Information Modeling Status
Terminology Modeling Status
PatientEducation
Complete
Person
Medications/Pharmacy
Prosthetics
To Be Modeled
Provider
Public Health Reporting
In Progress
SecurityAndPrivacy
SocialWork
SpinalCord
Surgery
VitalSigns
WomensHealth
Common
Datatypes
In production 2

31. Attributes of Success
Information model and Tooling Mapping versus development distinction and respective Utility
Jump start projects and standards development efforts with (formal) information Modeling Assets
Advocacy to support follow-on efforts / Implementation Practicality
Sustain Core SME Framework / Expand / Invest in building upon current SME base
Apply insights / recommendations from all efforts to date, e.g., Info Modeling Tech Forum
Build out near term, mid term & long term efforts with Pilots
Assess / layout resourcing implications tied to report
Capitalize on collaboration with FHIR colleagues and maintain Process Engagement Strategy
Quarterly reporting to maintain predictable stakeholder contact, awareness and engagement
Promote HL7 Balloted CLIM & SIGG-tools use by EHR developers, implementers and vendors
Expand Communications / Outreach; Governance; Strategic Interoperability Planning
Supportive of Integration
Leverage opportunities to expand FHIM usability and use by larger communities, e.g., HL7
Repurpose efforts / Replace building models to build models via active engagements
Enhance SME base, User Community Partnerships & Stakeholder Community Contacts
Guide a shifting in commitments & to gauge progress.

32. DEFINITION - OMICS
‘OMICS’ as defined by the Institute of Medicine is the study of related sets of biological molecules in a comprehensive fashion. Examples of omics disciplines include genomics, transcriptomics, proteomics, and metabolomics.
Genomics is a division of genetics that involves sequencing and analyzing the genome which contains all of the DNA found in a single cell. Studying variability within the genome helps researchers and clinicians better understand health and disease.