1. # 1 Practical modeling issues: Representing coded and structured patient data in EHR systems AMIA Fall Conference Novermber 13, 2010 Stanley M Huff, MD Chief Medical Informatics Officer

2. # 2 Acknowledgements Tom Oniki Joey Coyle Craig Parker Yan Heras Cessily Johnson Roberto Rocha Lee Min Lau Alan James Many, many, others…

3. # 3 A diagram of a simplified clinical model

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13. # 13 Mods and Quals of the Value Choice Mods - Component CEs which change the meaning of the Value Choice. Quals - Component CEs which give more information about the Value Choice.

14. # 14 The use of Qualifiers

15. # 15 The use of Qualifiers

16. # 16 The use of Modifiers

17. # 17 The use of Modifiers

18. # 18 Constraint Definition Language (CDL)

19. # 19 Model Source Expression (CDL) model BloodPressurePanel is panel { key code(BloodPressurePanel_KEY_ECID); statement SystolicBloodPressureMeas systolicBloodPressureMeas optional systolicBloodPressureMeas.methodDevice.conduct(methodDevice) systolicBloodPressureMeas.bodyLocationPrecoord.conduct(bodyLocationPrecoord) systolicBloodPressureMeas.bodyPosition.conduct(bodyPosition) systolicBloodPressureMeas.relativeTemporalContext.conduct(relativeTemporalContext) systolicBloodPressureMeas.subject.conduct(subject) systolicBloodPressureMeas.observed.conduct(observed) systolicBloodPressureMeas.reportedReceived.conduct(reportedReceived) systolicBloodPressureMeas.verified.conduct(verified); statement DiastolicBloodPressureMeas diastolicBloodPressureMeas optional …. statement MeanArterialPressureMeas meanArterialPressureMeas optional …. qualifier MethodDevice methodDevice optional; md.code.domain(BloodPressureMeasurementDevice_DOMAIN_ECID); qualifier BodyLocationPrecoord bodyLocationPrecoord optional; blp.code.domain(BloodPressureBodyLocationPrecoord_DOMAIN_ECID); modifier Subject subject optional; attribution Observed observed optional; attribution ReportedReceived reportedReceived optional; attribution Verified verified optional; }

20. # 20 Type name and key code (CDL) model BloodPressurePanel is panel { key code(BloodPressurePanel_KEY_ECID); statement SystolicBloodPressureMeas systolicBloodPressureMeas optional systolicBloodPressureMeas.methodDevice.conduct(methodDevice) systolicBloodPressureMeas.bodyLocationPrecoord.conduct(bodyLocationPrecoord) systolicBloodPressureMeas.bodyPosition.conduct(bodyPosition) systolicBloodPressureMeas.relativeTemporalContext.conduct(relativeTemporalContext) systolicBloodPressureMeas.subject.conduct(subject) systolicBloodPressureMeas.observed.conduct(observed) systolicBloodPressureMeas.reportedReceived.conduct(reportedReceived) systolicBloodPressureMeas.verified.conduct(verified); statement DiastolicBloodPressureMeas diastolicBloodPressureMeas optional …. statement MeanArterialPressureMeas meanArterialPressureMeas optional …. qualifier MethodDevice methodDevice optional; md.code.domain(BloodPressureMeasurementDevice_DOMAIN_ECID); qualifier BodyLocationPrecoord bodyLocationPrecoord optional; blp.code.domain(BloodPressureBodyLocationPrecoord_DOMAIN_ECID); modifier Subject subject optional; attribution Observed observed optional; attribution ReportedReceived reportedReceived optional; attribution Verified verified optional; } The name of this model Binding to a single observable concept

21. The name of the terminology domain that the element is bound to # 21 Binding to a domain (value set) qualifier MethodDevice methodDevice optional; md.code.domain(BloodPressureMeasurementDevice_DOMAIN_ECID); qualifier BodyLocationPrecoord bodyLocationPrecoord optional; blp.code.domain(BloodPressureBodyLocationPrecoord_DOMAIN_ECID); modifier Subject subject optional;

22. # 22 Goal: Open Sharing of Models and Terms GE owns and holds the copyright for the models and terminology Intermountain has a perpetual license to distribute and sublicense the models and terminology for free GE and Intermountain are sharing the models in perpetuity without cost Models are posted to a website for free download (terminology to follow) No cost license to protect Intermountain and GE use Anyone is allowed to make and own derivative works

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35. # 35 Compiler CE Source File CE Translator In Memory Form HTML SMArt RDF? openEHR Archetype? HL7 RIM Static Models? Java Class XML Template -.xsd OWL? UML?

36. # 36 Clinical Element Models and the HL7 RIM

37. # 37 CEM and HL7 RIM <code code="ASSERTION" Allergy to PCN manifesting as hives <value xsi:type="CD" code="106190000" (Allergy) <name code="246075003" (Causative agent) <value code="373270004" (Penicillin -class of antibiotic) <actRelationship typeCode="MFST" <code code="ASSERTION" <value xsi:type="CD" code="247472004" (Hives) CE type key data.val qual key data.val qual (new) CE type key data.val aggObs

38. # 38 HL7 Allergy as a CEM Assertion AllergyStatement data Hives Manifestation quals data Penicillin CausativeAgent data Allergy Causative Agent

39. # 39 Isosemantic Models

40. # 40 Decomposition Mapping data 138 mmHg SystolicBPRightArmSitting SystolicBPRightArmSittingObs data 138 mmHg quals SystolicBP SystolicBPObs data Right Arm BodyLocation data Sitting PatientPosition Precoordinated Model (User Interface Model) Post coordinated Model (Storage Model)