Kaiser Permanente Standards Summit

1
A Brief Review of CIMI Plans and Goals

• Kaiser Permanente Standards Summit
• September 7-8 , 2011
• Stanley M. Huff, MD

Phoenix CIMI Meetings January 18, 2013 Stanley M
Huff, MD Chief Medical Informatics Officer
2
The Ultimate Value Proposition of CIMI

• Sharing of
• Data
• Information
• Applications
• Decision logic
• Reports
• Knowledge

3
Clinical System Approach

• Intermountain can only provide the highest
  quality, lowest cost health care with the use of
  advanced clinical decision support systems
  integrated into frontline workflow

4
Decision Support Modules

• Antibiotic Assistant
• Ventilator weaning
• ARDS protocols
• Nosocomial infection monitoring
• MRSA monitoring and control
• Prevention of Deep Venous Thrombosis
• Infectious disease reporting to public health

• Diabetic care
• Pre-op antibiotics
• ICU glucose protocols
• Ventilator disconnect
• Infusion pump errors
• Lab alerts
• Blood ordering
• Order sets
• Patient worksheets
• Post MI discharge meds

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Strategic Goal

• Be able to share applications, reports, alerts,
  protocols, and decision support with anyone in
  the WORLD

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Order Entry API (adapted from Harold Solbrig)
. . .
Application
COS
Interface
Service
Data
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From Ben Adida and Josh Mandel
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What Is Needed to Create a New Paradigm?

• Standard set of detailed clinical data models
  coupled with
• Standard coded terminology
• Standard APIs (Application Programmer
  Interfaces) for healthcare related services
• Open sharing of models, coded terms, and APIs
• Sharing of decision logic and applications

9
Clinical modeling activities

• Netherlands/ISO Standard
• CEN 13606
• United Kingdom NHS
• Singapore
• Sweden
• Australia
• openEHR Foundation
• Canada
• US Veterans Administration
• US Department of Defense
• Intermountain Healthcare
• Mayo Clinic

• HL7
• Version 3 RIM, message templates
• TermInfo
• CDA plus Templates
• Detailed Clinical Models
• greenCDA
• Tolven
• NIH/NCI Common Data Elements, CaBIG
• CDISC SHARE
• Korea
• Brazil

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Clinical Information Modeling Initiative

• Mission
• Improve the interoperability of healthcare
  systems through shared implementable clinical
  information models.

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Clinical Information Modeling Initiative

• Goals
• Shared repository of detailed clinical
  information models
• Using a single formalism
• Based on a common set of base data types
• With formal bindings of the models to standard
  coded terminologies
• Repository is open and models are free for use at
  no cost

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Goal Models that support multiple contexts

• Message payload
• Service payload
• Decision logic (queries of EHR data)
• EHR data storage
• Clinical trials data (clinical research)
• Normalization of data for secondary use
• Creation of data entry screens
• Natural Language Processing

13
Information Model Ideas
Repository of Shared Models in a Single Formalism
Initial Loading of Repository
14
Roadmap (some parallel activities)

• Choose a single formalism
• Choose the initial set of agreed data types
• Define strategy for the core reference model and
  our modeling style and approach
• Development of style will continue as we begin
  creating content

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Roadmap (continued)

• Create an open shared repository of models
• Requirements
• Find a place to host the repository
• Select or develop the model repository software
• Create model content in the repository
• Start with existing content that participants can
  contribute
• Must engage clinical experts for validation of
  the models

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Roadmap (continued)

• Create a process (editorial board?) for curation
  and management of model content
• Resolve and specify IP policies for open sharing
  of models
• Find a way of funding and supporting the
  repository and modeling activities
• Create tools/compilers/transformers to other
  formalisms
• Must support at least ADL, UML/OCL, Semantic Web,
  HL7
• Create tools/compilers/transformers to create
  what software developers need
• Examples XML schema, Java classes, CDA
  templates, greenCDA, RFH, SMART RDF, etc.

17
Selected Decisions
18
Decisions (London, Dec 1, 2011)

• We agree to create and use a single logical
  representation (the CIMI core reference model)
  comprising one or more models as the basis for
  interoperability across formalisms.
• We approve ADL 1.5 as the initial formalism in
  the repository using OpenEHR Constraint Model
  noting that modifications are required.
• The corresponding Archetype Object Model will be
  included and adapted as the CIMI UML profile
• The CIMI UML profile will be developed
  concurrently as a set of UML stereotypes, XMI
  specification and transformations

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Definition of Logical Model

• Models show the structural relationship of the
  model elements (containment)
• Coded elements have explicit binding to allowed
  coded values
• Models are independent of a specific programming
  language or type of database
• Support explicit, unambiguous query statements
  against data instances

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Definition of Logical Model (cont)

• Models shall specify a single unit of measure
  (unit normalization)
• Models can support inclusion of processing
  knowledge
• Models can support recommend defaults
• Models can specify assumed values of attributes
  (meaning of absence of the item)
• Examples can be created for the model

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Isosemantic Models
Precoordinated Model (CIMI deprecated Model)
HematocritManual (LOINC 4545-0)
HematocritManualModel
37
data
Post coordinated Model (CIMI preferred Model)
Hematocrit (LOINC 20570-8)
HematocritModel
37
data
quals
Hematocrit Method
HematocritMethodModel
Manual
data
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Isosemantic Models

• CIMI is committed to isosemantic clinical models
  in terms of both
• The ability to transform CIMI models into
  iso-semantic representations in other
  languages/standards (e.g. OWL, UML, HL7)
• The ability to transform CIMI models between
  iso-semantic representations that use a different
  split between terminology pre-coordination versus
  structure.

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Isosemantic Models (cont)

• CIMI will select one model within each
  isosemantic family that will be the preferred
  model for interoperability
• (Profiles of exact models for specific uses will
  be created by the users professional societies,
  regulatory agencies, public health, quality
  measures, etc.)

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Terminology

• SNOMED CT will be the primary reference
  terminology
• LOINC was also approved as a reference
  terminology
• In the event of overlap, SNOMED CT will be the
  preferred source
• CIMI will propose extensions to the reference
  terminologies when needed concepts do not exist
• CIMI will maintain the extensions until they are
  accepted by the RT organization

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Terminology (cont)

• The primary version of models will only contain
  references (pointers) to value sets
• We will create tools that read the terminology
  tables and create versions of the models that
  contain enumerated value sets

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Some Principles

• CIMI DOES care about implementation. There must
  be at least one way to implement the models in a
  popular technology stack that is in use today.
  The models should be as easy to implement as
  possible.
• Only use will determine if we are producing
  anything of value
• Approve Good Enough RM and DTs
• Get practical use ASAP
• Change RM and DTs based on use

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Pleasanton May 10-12, 2012

• Resolution The reference model presented by the
  Reference Model Task Force is endorsed as a
  starting point and establishes the direction that
  CIMI wishes to take. We expect that this model
  will be tested and modified as modeling work
  continues.

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Pleasanton May 10-12, 2012

• Reference model and associated data types were
  approved
• We expect that this model will be tested and
  modified as modeling work continues.
• Agreed that there must be a computable semantic
  relationship between elements in a model

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Goals for Rockville Meeting

• Continue modeling work
• Approve a proposal for creating an Editorial
  Board
• Decide on what tools to use to make models
• Create a team to do an end-to-end proof of
  concept
• Possible targets FIHR, SMArt, CDA template, HL7
  V2, others?
• Updates and information sharing OMG AML RFI, CDL
  to ADL conversion, finding a parent organization,
  FIHR, member survey

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• Conflicts of Interest