1. CIMI Modelling Taskforce Progress Report
Dr Linda Bird, IHTSDO
Implementation Specialist

2. Background Modelling Taskforce was established to:
Develop CIMI's modelling methodology
Create an initial set of CIMI clinical models
Further test and develop CIMI technical models, including:
CIMI reference model
Archetype Object Model 1.5, and
CIMI terminology.

3. Taskforce Outputs Technical: Clinical: CIMI Reference Model
Reference Model Patterns
Archetype Object Model updates
Terminology binding approach
Modelling methodology and style
Clinical:
Clinical patterns (observation & Activity )
Heart Rate model
Laboratory Results models
Laboratory Specialisation models
Demographics models

4. CIMI Architectural Overview
Existing Clinical Models
Requirements
DCM CEM CDA
openEHR ISO / CEN
LRA CMET RMIM
Clinical Verification
Transform
CIMI Reference Model
Clinical Model Editor (AOM/AML)
Clinical Visualisation M2
Instance of
Constrains
Generate
Generate
Implementation Models
CIMI Repository
Conforms to M0
CIMI Model Examples
International Clinical Model
Realm-Specific Clinical Model
Generate
HL7 v2 HL7 v3 HL7 CDA
HL7 FHIR SOA OWL
openEHR ISO/CEN
XML Schema
Specialise & Extend
Value
Value set
Meaning
Value set
Meaning
Value set
Meaning
CIMI Terminology Server
International Reference Terminology
Map
National Reference Terminology
Map
Implementation-Specific Terminology
Terminology Authoring Tool

5. CIMI Architectural Overview
CIMI Reference Model
Archetype Object Model
instance of
constrains
instance of
CIMI
Model
Repository M0
conforms to
CIMI Model Examples
International Clinical Models
coded values
value set
meaning
CIMI
Terminology
Server
CIMI International
Reference Terminology
(SNOMED CT + CIMI Extension + LOINC + other code systems)

6. Modelling Approach Modular for reusability of models
Composable to meet specific use-cases
Pattern-based for consistency between models
Constraint-based to allow specialisation
Logical for implementation in multiple formats
Maximal for completeness
Extensible to support local requirements
Bound to terminology for isosemanticity & interoperability

7. Modelling Methodology
Foundations
CIMI Reference Model
Archetype Object Model / Archetype Modelling Language
CIMI Modelling Patterns
CIMI Style Guide
Modelling Approach
Analyse clinical models submitted (with value sets)
Identify maximal set of data elements
Remove ‘out of scope’ data elements
Select appropriate CIMI Modelling Patterns
Define CIMI models (Mindmap, ADL, UML)
Add Terminology bindings
Value set bindings (maximal set from submitted models)
Model meaning bindings (Domain and attribute)
Add Example Model Data Instances
Technical Validation
Clinical Verification / Review
Confirm mappings from submitted models

8. CIMI Reference Model v1.0.0

9. CIMI Reference Model v2.0.2

10. CIMI Reference Model v2.0.2

11. CIMI Reference Model v2.0.2

12. Reference Model Patterns
ITEM GROUP
ITEM GROUP
ELEMENT
Clinical Document
Clinical Statement
Cluster
Compound
Clinical Statement
Indivisible
Clinical Statement

13. Clinical Patterns ITEM GROUP ITEM GROUP ELEMENT Clinical Document
Clinical Statement
Cluster
Action
Compound
Clinical Statement
Indivisible
Clinical Statement
Observation Set
Observation
Clinical Activity

14. Laboratory Models ITEM GROUP ITEM GROUP ELEMENT Clinical Document
Clinical Statement
Cluster
Action
Compound
Clinical Statement
Indivisible
Clinical Statement
Observation Set
Observation
Clinical Activity
Laboratory Panel
Laboratory Test

15. Laboratory Model Specialisations
Laboratory Panel
Laboratory Test
Automated differential panel
Blood by automated count panel
Complete blood count panel
Complete blood count with automated differential panel
Complete blood count with manual differential panel
Complete blood count without differential panel
Erythrocyte morphology panel
Gas and carbon monoxide panel
Leukocyte morphology panel
Manual differential panel
Platelet morphology panel
Smear morphology panel
Laboratory Test Ordinal
Laboratory Test Quantitative
Acanthocytes presence in blood by light microscopy
Anisocytosis presence in blood by light microscopy
Auer rods presence in blood by light microscopy
Background stain presence in blood by light microscopy
Base deficit in blood
Base excess in blood by calculation
Basophils count per volume in blood
Basophils per 100 leukocytes in blood
Erythrocytes in blood automated
Lymphocytes count per volume in blood

16. CIMI Terminology Binding
SNOMED CT is the primary reference terminology
LOINC is also used as a reference terminology
CIMI will create SNOMED CT extension concepts when required using the CIMI namespace ( )
Models will contain only references to value sets
CIMI supports isosemantic models
One model in an isosemantic family will be selected as the preferred model for interoperability
A preference will be given to structure over precoordination (unless precoordinated form is more clinically recognised)

17. Isosemantic Models Precoordinated Model (CIMI approved Model)
PrecoordProblemModel
finding
Suspected breast cancer [ ]
Post coordinated Model (CIMI preferred Model)
PostcoordProblemModel
Assoc morphology [ ]
Malignant Neoplasm [ ]
Finding site [ ]
Breast structure [ ]
Finding context [ ]
Suspected [ ]
Subject rel context [ ]
Subject of record [ ]

18. CIMI use of SNOMED CT Fixed coded values referenced in models
Value sets referenced in models
Model meaning of models
Pattern for model structure
Translation of precoordinated model content to postcoordinated model content

19. Types of Terminology Binding
Value set binding
To record the set of possible values which can populate a given coded data element or attribute in the information model
Fixed values: A coded data element bound to a single code
Simple: A data element has a single value set
Compositional: The value of a data element is composed from other values
Model meaning binding
To define the meaning of an information model artefact using a concept or expression from the terminology
Domain and Attribute: Concept domain with qualifying attributes
Expression Template: The composed meaning of a data group

20. Terminology Binding Approach
Value Set Binding
Fixed value – for example:
|Panel code|.value: at =
|Result value|.value.units: at =
Simple value set – for example:
|Method|.value: ac = or
|Method|.value: ac = ^
Model Meaning Binding
Simple model binding – for example:
|Automated differential panel|: id =
We need ADL syntax (grammatical cue) to say that we are binding to a single exact code, as opposed to a value set. (done)
Options:
a. Propose that we use the SNOMED expression grammar – use “^” to mean “member of set” as opposed to no ^ means “equals” exact code. (Don’t do this.)
b. Thomas – we can directly specialize an “ac” code in a parent to an “at” code in the child.

21. Terminology Binding Approach
How (ADL)
Codes assigned in Definition section
URI attached to code in Terminology section
If concept does not exist create in CIMI SNOMED CT extension
definition
ITEM_GROUP[id ] matches { Laboratory panel
Item matches {
ELEMENT[id ] Panel code
ELEMENT[id ] matches { Diagnostic service
value matches {TEXT[ac1.0.2}}
terminology
term_bindings = <
[“snomedct”] = <
[“at2"] = <
[“ac1.0.2"] = <
["id "] = <

22. Coded Text
We need to state (in the ADL?) how a URI constrains the parts of a coded text - for example:
means:
Uri:
Terminology_id:
Code:
Terminology_version: -
Term: -
What then does a valid instance look like?
Terminology_version: /version/
Term: “The preferred designation”

23. Model Meaning Binding Domain and attribute approach – for example:
id1.1.1
id1.2.1
id1.2.2
id1.2.3

24. Model Meaning Binding Domain and attribute approach – for example:
id1.1.1
id1.2.1
id1.2.2
id1.2.3
id1.2.4

25. Model Meaning Binding Expression template – for example: id1.1.1
|fracture of bone|:
|associated morphology| = [[ $Type ]],
|finding site| = ([[ $Location ]]:
|laterality| = [[ $Laterality ]])

26. Compositional Value Set Binding
Domain and attribute approach – for example:
id1.2.1
[[ $Code ]]:
|associated morphology| = [[ $Type ]],
|finding site| = ([[ $Location ]]:
|laterality| = [[ $Laterality ]])

27. Other Discussions
We will do terminology binding for coded items in the RM in the first level reference archetypes rather than add terminology binding syntax in the RM. (Needs further thought)