1. CIMI/IHTSDO DCM tooling ecosystem thoughts
Thomas Beale
openEHR Foundation
Stan Huff, MD
Intermountain Healthcare

2. Introduction
These slides describe a possible semantic health modelling environment for CIMI / IHTSDO, featuring:
Next generation archetype / template tools
Integrated terminology subset authoring
Model management tool - CKM
AML-enabled UML tooling
With underlying IHTSDO terminologies, including SNOMED CT and LOINC

3. Introduction
They also describe the possible technical relationships between central CIMI artefacts and downstream environments.
Getting to this or a similar tooling environment will require investment and commitment of multiple organisations.
These slides try to provide a basis for thinking about the work tasks and scale.

4. Introduction
The core formalism for archetypes and templates is the Archetype formalism. Specifications:
Archetype Definition Language 2
Archetype Object Model 2
Artefact Identification

5. Introduction CIMI archetypes are based on the CIMI reference model
Currently available CIMI archetypes here on Github

6. CIMI Tooling ecosystem (summary)
Terminology
Modelling
Transformation
Development
CIMI/IHTSDO modelling environment
CIMI Modellers
ADL Work bench (AWB)
Clinical Modellers Workbench (CMW)
CIMI archetypes (XMI)
UML/AML-tool based environment
AML Bridge
(future)
CIMI extension
Terminology
Service
CIMI-based
Other sites / users
XSDs
Other sites / users
Concrete format-based sites
SNOMED, LOINC etc
Valuesets
CIMI Editors,
Reviewers
FHIR
proprietary
CKM
Note that the whole IHTSDO environment, which is substantial in itself is abstracted to the simple representation on the left for simplicity.
IHTSDO releases
CIMI archetypes
IHC CEMs
Intermountain Legacy environment (current tools)
CEML CEMs
Import
Export
openEHR /13606
openEHR / archetypes
openEHR/13606 sites / vendors (current tools)
Other DCMs
e.g. FHIM (VHA)
CDA tpls / v3 msgs

7. Potential Project phases

8. Notes
The following slides mention broad possible phases, each 3-6 months in duration
Could be broken down differently / more finely
Order is not significant here, i.e. some development can occur in parallel

9. Notes
‘CKM’ represents ‘Clinical Knowledge Manager’, a tool in use by openEHR.org, and various e-health programmes:
openEHR CKM
Nehta (Australia)
Norway MoH
Brazil National Health Terminology Centre
Slovenia MoH
Scottish NHS and UK clinical groups
It supports team-based online development and lifecycle management of archetypes, templates and terminology subsets

10. AWB++, CKM, some exports CKM ADL Workbench (AWB) CIMI Modellers
CIMI/IHTSDO modelling environment
CIMI Modellers
Ref-set building
ADL Workbench (AWB)
Ref-set builder
Basic bridge
CIMI Editors,
Reviewers
CIMI extension
Terminology
Service
Review
Publication
Governance
Concrete format-based sites
RM Manager
Technical Transform
XSDs, FHIR, other
SNOMED, LOINC etc
Valuesets
CKM
CIMI archetypes
Querying,
Subsets,
etc
IHC CEMs
Intermountain Legacy environment (current tools)
conv
CEML CEMs
Import
Export
IHTSDO releases
archetype
CEM
conv
openEHR /13606
openEHR/13606 sites / vendors (current tools)
openEHR / archetypes

11. CMW core tool platform CKM CIMI Modellers CMW ADL/AOM tool platform
CIMI/IHTSDO modelling environment
CIMI Modellers
CMW
ADL/AOM tool platform
Archetype Editor
Template Editor
Terminology Query-builder
Terminology Binding
Ref-set building
Clinical Modeller UI
Ref-set builder
AWB
CIMI Editors,
Reviewers
CTS2
Terminology
Service
CIMI extension
Review
Publication
Governance
XSDs
Other sites / users
Other sites / users
RM Manager
Technical Transform
FHIR
Concrete format-based sites
proprietary
SNOMED, LOINC etc
Valuesets
CKM
CIMI archetypes
Querying,
Subsets,
etc
conv
IHC CEMs
Intermountain Legacy environment (current tools)
CEML CEMs
Import
Export
IHTSDO releases
other
archetype
CEM
conv
openEHR /13606
openEHR / archetypes
openEHR/13606 sites / vendors (current tools)
conv
Other DCMs
e.g. FHIM (VHA)
CDA tpls / v3 msgs

12. CMW Clinical Modeller UI & ref-set builder
CIMI/IHTSDO modelling environment
CIMI Modellers
IHTSDO tools
Integration?
CMW
Clinical Modeller UI
Archetype Editor
Template Editor
Terminology Query-builder
AWB
Terminology Binding
ADL/AOM tool platform
CIMI Editors,
Reviewers
CTS2
Terminology
Service
CIMI extension
Review
Publication
Governance
XSDs
Other sites / users
Other sites / users
RM Manager
Technical Transform
FHIR
Concrete format-based sites
proprietary
SNOMED, LOINC etc
Valuesets
CKM
CIMI archetypes
Querying,
Subsets,
etc
conv
IHC CEMs
Intermountain Legacy environment (current tools)
CEML CEMs
Import
Export
IHTSDO releases
other
archetype
CEM
conv
openEHR /13606
openEHR / archetypes
openEHR/13606 sites / vendors (current tools)
conv
Other DCMs
e.g. FHIM (VHA)
CDA tpls /
V3 msgs

13. Notes
‘AML’ = Archetype Modelling Language, a new OMG RfP which will become a standard in ~18 months.
AML is a UML profile based on the openEHR Archetype Object Model (AOM 2) specification.
Note that it is reference model independent and has no technical relationship or specificity to any openEHR information model.
AML, implemented in a UML tool will enable archetype modelling – i.e. it will bring archetype modelling to the IT mainstream

14. AML bridge CKM CIMI Modellers CMW ADL/AOM tool platform Terminology
CIMI/IHTSDO modelling environment
CIMI Modellers
IHTSDO tools
Integration?
CMW
UML/AML-tool based environment
CIMI archetypes (XMI)
Clinical Modeller UI
S/W devs
Archetype Editor
Template Editor
Terminology Query-builder
AML-enabled UML tool
AML Bridge
Software components
AWB
Terminology Binding
Generation tools
ADL/AOM tool platform
CIMI Editors,
Reviewers
CTS2
Terminology
Service
Review
Publication
Governance
CIMI extension
XSDs
Other sites / users
Other sites / users
RM Manager
Technical Transform
FHIR
Concrete format-based sites
proprietary
SNOMED, LOINC etc
Valuesets
CKM
CIMI archetypes
Querying,
Subsets,
etc
conv
IHC CEMs
Intermountain Legacy environment (current tools)
CEML CEMs
Import
Export
IHTSDO releases
other
archetype
CEM
conv
openEHR /13606
openEHR / archetypes
openEHR/13606 sites / vendors (current tools)
conv
Other DCMs
e.g. FHIM (VHA)
CDA tpls /
V3 msgs

15. Representative DOWNSTREAM ENVIRONMENTS

16. Notes
Here we try to show some details of how CIMI archetypes, templates and subsets could be used by downstream environments, each of which have their own reference model(s), and potentially content modelling formalisms.

17. Intermountain Legacy environment
CIMI/IHTSDO modelling environment
CMW
AWB
Intermountain legacy environment
Dev’t artefacts
XSD
S/W devs
ceType ??
Local customisation
Development tools
CTS2
Terminology
Service
CIMI extension
CKM
Deploy
Technical Transforms
CEML CEMs
Here the downstream environment is close to seamless with the upstream environment; further specialisation could occur there using tools that are conceptually similar (CEML-based tools)
Model-based system
app
HIS
FHIRWS
SNOMED, LOINC etc
Valuesets
CIMI archetypes
conv ??
IHTSDO releases
other
archetype
CEM

18. Archetype-based sites / vendors
CIMI/IHTSDO modelling environment
CMW
openEHR/13606 product / project environment
Dev’t artefacts
API
XSD
S/W devs
FHIR UI
AWB
Local archetypes & templating
Development tools
Technical Transforms
Deploy
Specialised archetypes & templates
Model-based system
app
openEHR EHR/HIS
FHIR& IHE WS
CTS2
Terminology
Service
CIMI extension
Runtime OPTS
CKM
Highly seamless environment in which CIMI archetypes are converted to openEHR; can be specialised and template using same tools as CIMI i.e. CMW but based on openEHR RM.
SNOMED, LOINC etc
Valuesets
CIMI archetypes
openEHR community Review
IHTSDO releases
Norway CKM
other
archetype
CEM
conv
Brasil CKM
openEHR / archetypes
Nehta CKM
openEHR.org CKM
Slovenia CKM
Moscow CKM

19. Other environment – e.g. FHIM/MDHT/CDA
CIMI/IHTSDO modelling environment
CMW
AWB
MDHT/FHIM/CDA
CTS2
S/W devs
Terminology
Service
CIMI extension
CKM
CDA template
MDHT
Dev tools
CIMI archetypes get converted to CDA templates; potential specialisation etc in CDA based tools?
SNOMED, LOINC etc
Valuesets
CIMI archetypes
conv
Deploy
app
app
app
IHTSDO releases
HIS
other
archetype
CEM

20. Other environment – HL7v3 messages
CIMI/IHTSDO modelling environment
CMW
AWB
MDHT/FHIM/CDA
CTS2
S/W devs
Terminology
Service
CIMI extension
CKM
HL7 v3 RMIM
Modeller
Dev tools
CIMI archetypes get converted to HL7v3 RMIM; potential specialisation etc in RMIM based tools?
SNOMED, LOINC etc
Valuesets
CIMI archetypes
conv
Deploy
app
app
app
IHTSDO releases
HIS
other
archetype
CEM

21. CIMI  FHIR environment
CIMI/IHTSDO modelling environment
CMW
AWB
CTS2
FHIR artefact dev environment
Terminology
Service
CIMI extension
S/W devs
CKM
Conversion to FHIR profiles; 2 possibilities: direct use by developers; or further local profiling / extension.
FHIR
conv
FHIR profiles
Dev tools
SNOMED, LOINC etc
Valuesets
CIMI archetypes
Deploy
FHIR WS
IHTSDO releases
HIS