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Modelling Patterns Review & Suggestions Dr Linda Bird 16th August 2012 Modelling Layers CLUSTER ENTRY SECTION COMPOSITION Add Implementation Purpose Context Dispensed Medications GUI Neonatal Blood Pressure in EHR Current Medication List in EHR Discharge Summary Doc or Message Add Care Setting Context G.P. Dispensed Medication Item Home Blood Pressure Outpatient Clinic Current Medication List Inpatient Discharge Summary Add Specialty Context Paediatric Medication Item Neonatal Blood Pressure Nephrologist Medication List Cardiology Discharge Summary Add Use Case Context Dispensed Medication Item Standing Blood Pressure Current Medication List Medication Reconciliation Report Clinical Models Medication Item Blood Pressure Medication List Discharge Summary Modelling Patterns Schedule, Address, Material Observation, Action Clinical List Event Summary, Assessment Reference Model Modelling Patterns Review • • • • • • • • • openEHR NHS LRA SNOMED CT results4Care DCMs IMH CEMs MOHH LIM VA’s Discernables EN13606 Association HL7 v3 RIM Modelling Patterns Types 1. Clinical Statement Types 2. Isosemantic model structure – key concept, qualifiers, modifiers 3. 4. 5. 6. 7. Clinical processes events links History of Events Order state machine and care flow mapping Composition/Document Clinical Model Patterns – Reference Range Set, Schedule, Material (Device, Medication), Score/Assessment Scale NHS LRA Care Components Reference Model class extract package constrained classes EXTRACT_CRITERIA RECORD_COMPONENT AUDIT_INFO {leaf} - {leaf} all_versions: BL [0..1] archetype_ids: II [0..*] max_sensitivity : CS [0..1] multimedia_included : BL [0..1] other_constraints: ED [0..1] time_period : IVL [0..1] - constraints {all_versionsDefault} {all_versionsDefined} {other_constraintsDefined} -criteria committer: II.Uuid.Ref ehr_system: II previous_version: II [0..1] reason_for_revision: CD.CV [0..1] time_committed: T S version_set_id: II [0..1] version_status: CS [0..1] -feeder_audit 0..1 0..1 constraints {version status LRA vocab} {reason for revision LRA vocab} 0..* -committal - LINK archetype_id: ST [0..1] meaning: CD.CV [0..1] name: ST orig_parent_ref: II [0..1] policy_ids: II [0..*] rc_id: II.Uuid sensitivity: CS [0..1] synthesised: BL -links 0..* follow_link: BL nature: CS target: II.Uuid.Ref constraints {follow_link default value false} {links allowed only one target in LRA} {target exists} {nature LRA vocab} constraints {synthesised defaults to false} {sensitivity LRA vocab} 1..1 0..1 -content EHR_EXTRACT {leaf} - 0..* - 0..* - contribution_id: II [0..1] session_time: IVL_T S territory: CS [0..1] 0..1 obs_time: IVL_T S [0..1] -members constraints -parts {item category undefined in LRA} {emphasis undefined in LRA} 0..* 0..* constraints {name value} {composer is of type FUNCT IONAL_ROLE} {there exists one and only one other_participations instance representing the record target (i.e. subject of care)} 0..1 constraints {rm_id is 13606} ITEM 0..* {leaf} -all_compositions authorising_party: II [0..1] ehr_id: II ehr_system: II rm_id: ST subject_of_care: II time_created: T S -items CONTENT COMPOSITION SECTION ELEMENT CLUSTER {leaf} demographics -demographic_extract 0..* -composer 0..1 0..1 - -attestations 1..* healthcare_facility: II.Uuid.Ref [0..1] mode: CS [0..1] -other_participations performer: II.Uuid.Ref ATTESTATION_INFO constraints {sections may only contain (by value) other sections} structure_type: CS constraints {name value} {cluster structure type LRA vocab} {meaning is undefined} {leaf} - act_id: II [0..1] uncertainty_expressed: BL.Null RELATED_PARTY 0..1 attested_view: ED [0..1] proof: ED [0..1] reason_for_attestation: CD.CV target: II.Uuid.Ref [1..*] time: T S constraints {target must exist within extract} {attester is of type FUNCT IONAL_ROLE} {reason for attestation LRA vocab} -attester 0..1 1..1 -info_provider extended PARTICIPATION value: ANY ENTRY {leaf} - - 0..* constraints {function is undefined in LRA} {mode LRA vocab} {service setting is undefined in LRA} 0..* - -other_participations FUNCTIONAL_ROLE IDENTIFIED_ENTITY {leaf} 0..1 0..1 constraints {uncertainty expressed has nullFlavor} {meaning undefined} {entry items may only contain elements} {subject_of_information_category undefined in LRA} {subject_of_information_category no default in LRA} {act_status is undefined in LRA} {no relationship type conflict in LRA} {name value} {information_provider is of type FUNCT IONAL_ROLE} {leaf} -subject_of_information 0..1 - party: II.Uuid.Ref [0..1] relationship: CD.CV.SCT constraints {relationship code type LRA vocab} NHS LRA – ELEMENT patterns class extract package derived classes UNBOUND_DATA_ELEMENT {leaf} constraints {name value} {meaning undefined} COMPONENT_RELATIONSHIP_ELEMENT {leaf} BOUND_DATA_ELEMENT constraints {meaning is coded data} {meaning is defined and is not null} MATERIAL_ENTITY_ELEMENT {leaf} constraints {meaning is a material} {name value} {value is type QTY} {obs_time is undefined in LRA} constraints {name value} {value defines dependency} {must have exactly 2 links} {value is coded data} {one link to subject} {one link to object} {coded meaning from LRA vocab} {meaning is defined} RECORD_ARTEFACT_ELEMENT {leaf} constraints {name value} {meaning is a record artefact} {value must be null} {name value} {meaning is a general activity procedure} NHS LRA – ELEMENT Domain Models Finding Observations • AllergyOrAdverseReactionEvent • AllergyOrAdverseReactionPropensity • DiagnosisName • GenericFindingObservation • GenericProblemAndIssue • RisksExpectationsOrGoals Property Observations • BloodPressureObservation • BloodSugarObservation • BodyHeightObservation • BodySurfaceAreaObservation • BodyWeightObservation • DiastolicPressureObservation • GenericPropertyObservation • PulseRateObservation General Activities GenericAdmissionEvent GenericDischargeEvent GenericProcedure SpecimenCollection Material Activities GenericSpecimen MeasurementDevice ProductOrSubstance Investigation Activities BloodPressureMeasurement BodyHeightMeasurement TemperatureMeasurement Unbound Data AdviceForPatient CourseTiming FutureEventTime InterpretationRange NHS LRA – ENTRY Domain Models • • • • • • • • • • • • • • • • • GenericClinicalNarrative GenericAdmissionEvent GenericFinding HealthcareActionPlan GenericProblemAndIssue GenericProcedure GenericProperty MedicationReviewPlan ProductOrSubstance ProductOrSubstanceRelatedActivity ProvisionOfInformationAndAdvice RecommendationActivity AllergyOrAdverseReactionEvent GenericAdmissionProspect AllergyOrAdverseReactionPropensity GenericDischargeEvent BloodPressure • • • • • • • • • • • • • • • • BloodSugar GenericTransfer BodyHeight GenericTransferProspect BodySurfaceArea RisksExpectationsAndGoals BodyWeight ProvisionOfAdviceAndInformation Diagnosis FluidIntakeRate GenericAssessment SubjectOfCareObservations GenericInvestigation PulseRate Temperature TreatmentDevice NHS LRA – e.g. Temperature ENTRY omposite structure Temperature «UNBOUND_DATA_ELEMENT» Text «FUNCTIONAL_ROLE_CHOICE» InformationProviderChoice HasAnnotation «OBJECT» 0..* 0..* -items «SUBJECT» 0..1 «PROPERTY_OBSERVATION_ELE... TemperatureObserv ation 0..1 IsResultantObservationOf -items «SUBJECT» 1 «ENTRY» Temperature «RELATED_PARTY_CHOICE» SubjectOfInformationChoice -items 0..1 - name: SC {readOnly} rc_id: II synthesised: BL uncertainty_expressed: BL {readOnly} 0..1 0..1 «INVESTIGATION_ACTIVITY_EL... TemperatureMeasurement «OBJECT» «SUBJECT» 0..1 HasClinicalContext -items 0..* 0..* «FINDING_OBSERVATION_ELEM... GenericFindingObserv ation «OBJECT» 0..* «SUBJECT» 0..* «FUNCTIONAL_ROLE_CHOICE» OtherParticipationsChoice 0..* -items 0..* «OBJECT» «UNBOUND_DATA_ELEMENT» UnboundGenericFinding 0..* «OBJECT» HasClinicalContext «OBJECT» 0..* 0..* NHS LRA – e.g. Temperature ENTRY • • • • • • • • Subject of Information (Participation) Information Provider (Participation) OtherParticipation (Participation) TemperatureObservation (PropertyObservation) TemperatureMeasurement (InvestigationActivity) Text (UnboundDataElement) UnboundGenericFinding (UnboundDataElement) GenericFindingObservation (FindingObservation) NHS LRA – e.g. TemperatureObservation ELEMENT composite structure TemperatureObserv ation «INVESTIGATION_ACTIVITY_ELEME... TemperatureMeasurement «PROPERTY_OBSERVATION_ELEMEN... TemperatureObserv ation - archetype_id: ST [0] meaning: CD.CV name: SC {readOnly} obs_time: IVL<TS> [0..1] orig_parent_ref: II [0] policy_ids: SET<II> [0] rc_id: II sensitivity: INT [0] synthesised: BL value: PQ IsResultantObservationOf «OBJECT» 0..1 «SUBJECT» 0..1 - archetype_id: ST [0] meaning: CD.CV.SCT name: SC {readOnly} obs_time: IVL_TS [0..1] orig_parent_ref: II [0] policy_ids: SET<II> [0] rc_id: II.Uuid sensitivity: INT [0] synthesised: BL value: ANY {readOnly} «FINDING_OBSERVATION_ELEMENT» GenericFindingObserv ation HasClinicalContext «SUBJECT» 0..* 0..* «OBJECT» 0..* «SUBJECT» 0..1 HasAnnotation - archetype_id: ST [0] meaning: CD.CV name: SC {readOnly} obs_time: IVL<TS> [0..1] orig_parent_ref: II [0] policy_ids: SET<II> [0] rc_id: II sensitivity: INT [0] synthesised: BL value: ANY {readOnly} «OBJECT» «UNBOUND_DATA_ELEMENT» UnboundGenericFinding 0..* «OBJECT» «UNBOUND_DATA_ELEMENT» Text - archetype_id: ST [0] name: SC {readOnly} obs_time: IVL<TS> [0] orig_parent_ref: II [0] policy_ids: SET<II> [0] rc_id: II.Uuid sensitivity: INT [0] synthesised: BL value: ED.Text «SUBJECT» - archetype_id: ST [0] name: SC {readOnly} obs_time: IVL<TS> [0..1] orig_parent_ref: II [0] policy_ids: SET<II> [0] rc_id: II sensitivity: INT [0] synthesised: BL value: ANY 0..* «OBJECT» HasClinicalContext 0..* 0..* «OBJECT» NHS LRA – e.g. TemperatureObservation ELEMENT (mindmap) openEHR – ENTRY patterns SNOMED CT • OBSERVABLE ENTITY • CLINICAL FINDING – Finding method: PROCEDURE – Interprets: PROCEDURE – Interprets: OBSERVABLE ENTITY • PROCEDURE – Has focus: CLINICAL FINDING SNOMED CT – Observable (draft) SNOMED CT – Observable (draft) results4Care DCMs • • • • Root concept Data Qualifier State IMH CEMs • Observed, StandardLabObs, Procedure, Order, Intolerance, Allergy, Adverse Reaction Summary, Admit/AdminDiagnosis • Key, Item, Qualifier, Modifier, Attribution MOHH LIM • ENTRY – Observation Entry (Observable Name/Value) • Heart Rate/ Blood Pressure / Blood Glucose – Clinical Finding • Problem Diagnosis Entry • Adverse Reaction Entry • Alert Entry – Activity • Pharmacy Activity Entry – Pharmacy Order Entry – Pharmacy Dispense Entry – Pharmacy Administration Entry • Investigation Activity Entry – Investigation Order Entry – Investigation Result Entry • Procedure Entry (Reference Pattern) • CLUSTER – Pharmacy Item / Investigation Test Item IsoSemantic Models – Example Instances e.g. “Suspected Lung Cancer” IsoSemantic Models – Compositional Grammar Problem Diagnosis = $ProblemDiagnosisName: 246090004|associated_finding|= (404684003|clinical_finding|: 63698007|finding_site|=($BodySite: 272741003|laterality|=$Laterality), 246112005|severity|=$Severity), 408729009|finding_context|=$FindingContext EN13606 Association HL7 v3 RIM Modelling Patterns Types 1. Clinical Statement Types 2. Isosemantic model structure – key concept, qualifiers, modifiers 3. 4. 5. 6. 7. Clinical processes events links History of Events Order state machine and care flow mapping Composition/Document Clinical Model Patterns – Reference Range Set, Schedule, Material (Device, Medication), Score/Assessment Scale Clinical Statement Types Reviewed • openEHR – Observation, Evaluation, Instruction, Action, Admin Entry • MOHH – Observation, Finding, Activity (Medication, Laboratory), Administration • NHS LRA – ELEMENTs: Property Observation, Finding Observation, Activity (Investigation, Material, General), Material Entity – ENTRYs: GenericFinding, GenericProcedure, GenericProblemAndIssue, .... • Intermountain/GE – Observed, StandardLabObs, Procedure, Order, Intolerance, Allergy, Adverse Reaction Summary, Admit/AdminDiagnosis, ... • SNOMED CT – Observable Entity, Clinical Finding, Procedure, ... • HL7 v3 – Act (Observation, Procedure, Exposure, Patient Encounter, Financial Contract, Financial Transaction, Account, Invoice Element, Context Structure, Device, Task, Supply) Clinical Statement Types (Observation) • openEHR – Observation, Evaluation, Instruction, Action, Admin Entry • MOHH – Observation, Finding, Activity (Medication, Laboratory), Administration • NHS LRA – ELEMENTs: Property Observation, Finding Observation, Activity (Investigation, Material, General), Material Entity – ENTRYs: GenericFinding, GenericProcedure, GenericProblemAndIssue, .... • Intermountain/GE – Observed, StandardLabObs, Procedure, Order, Intolerance, Allergy, Adverse Reaction Summary, Admit/AdminDiagnosis, ... • SNOMED CT – Observable Entity, Clinical Finding, Procedure, ... • HL7 v3 – Act (Observation, Procedure, Exposure, Patient Encounter, Financial Contract, Financial Transaction, Account, Invoice Element, Context Structure, Device, Task, Supply) Clinical Statement Types (Finding) • openEHR – Observation, Evaluation, Instruction, Action, Admin Entry • MOHH – Observation, Finding, Activity (Medication, Laboratory), Administration • NHS LRA – ELEMENTs: Property Observation, Finding Observation, Activity (Investigation, Material, General), Material Entity – ENTRYs: GenericFinding, GenericProcedure, GenericProblemAndIssue, .... • Intermountain/GE – Observed, StandardLabObs, Procedure, Order, Intolerance, Allergy, Adverse Reaction Summary, Admit/AdminDiagnosis, ... • SNOMED CT – Observable Entity, Clinical Finding, Procedure, ... • HL7 v3 – Act (Observation, Procedure, Exposure, Patient Encounter, Financial Contract, Financial Transaction, Account, Invoice Element, Context Structure, Device, Task, Supply) Clinical Statement Types (Activity) • openEHR – Observation, Evaluation, Instruction, Action, Admin Entry • MOHH – Observation, Finding, Activity (Medication, Laboratory), Administration • NHS LRA – ELEMENTs: Property Observation, Finding Observation, Activity (Investigation, Material, General), Material Entity – ENTRYs: GenericFinding, GenericProcedure, GenericProblemAndIssue, .... • Intermountain/GE – Observed, StandardLabObs, Procedure, Order, Intolerance, Allergy, Adverse Reaction Summary, Admit/AdminDiagnosis, ... • SNOMED CT – Observable Entity, Clinical Finding, Procedure, ... • HL7 v3 – Act (Observation, Procedure, Exposure, Patient Encounter, Financial Contract, Financial Transaction, Account, Invoice Element, Context Structure, Device, Task, Supply) Clinical Statement Types (Administration) • openEHR – Observation, Evaluation, Instruction, Action, Admin Entry • MOHH – Observation, Finding, Activity (Medication, Laboratory), Administration • NHS LRA – ELEMENTs: Property Observation, Finding Observation, Activity (Investigation, Material, General), Material Entity – ENTRYs: GenericFinding, GenericProcedure, GenericProblemAndIssue, .... • Intermountain/GE – Observed, StandardLabObs, Procedure, Order, Intolerance, Allergy, Adverse Reaction Summary, Admit/AdminDiagnosis, ... • SNOMED CT – Observable Entity, Clinical Finding, Procedure, ... • HL7 v3 – Act (Observation, Procedure, Exposure, Patient Encounter, Financial Contract, Financial Transaction, Account, Invoice Element, Context Structure, Device, Task, Supply) CIMI ENTRY Pattern Suggestions • • • • Property Observation (property-value pair) Clinical Finding (name) Activity (orders, procedures, etc) Administration (X ?) Property Observation (Existing Definitions) • openEHR – Observation: the observation of any phenomenon or state of interest to do with the patient (eg diagnosis, goal, adverse reaction). • NHS LRA – Property Observation: Used to represent the results of investigations undertaken to find out more information about a patient's state of health or wellbeing and device or procedure related parameter settings. (Meaningvalue pairs) • SNOMED CT – Observable Entity: represents a question or procedure which can produce an answer or a result. Used to code elements on a checklist or any element where a value • EN13606 Association – Observation/Inspection: Used to define all that can be documented about a specific state of a process in the Patient System at a point in time using the faculties of seeing, hearing, tasting, touching, smelling, or directly via a medical device or service. Property Observation (Suggested CIMI Definition) Used to represent the results of observations or investigations undertaken to find out more information about a patient’s state of health or wellbeing, and device or procedure related settings. Comments: • E.g. Heart rate, Blood glucose, Glasgow Coma Scale • Represents the common name-value or question-answer pattern • Supports isosemantic representation of Observation Names that may include method, patient_state, device, location and other related information in pre or post-coordinated form. Clinical Finding (Existing Definitions) • openEHR – Evaluation: the Opinion category , including problem/diagnosis, risk assessment, scenario, goal and recommendation • NHS LRA – Finding Observation: used to represent both normal and abnormal clinical states found on examination or deduced from clinical reasoning (e.g. 'clear sputum', 'diabetes mellitus') and events to which the patient or service user may have been to subject (e.g. 'physical abuse', 'exposure to mercury'). • SNOMED CT – Clinical Finding: represent the result of a clinical observation, assessment or judgement, and include both normal and abnormal clinical states • EN13606 Association – Evaluation/Consideration: Used for the documentation about an inferred process in the patient system using observations, expertise and knowledge, or about plans with, or risk assessments about, the Patient system Clinical Finding (Suggested CIMI Definition) Used to represent clinical states found on examination or deduced from clinical reasoning (e.g. ‘diabetes mellitus’, ‘clear sputum’), and events to which the patient may have been subject (e.g. ‘physical abuse’, ‘exposure to mercury’). Comments: • E.g. Diagnosis, Adverse Reaction, Alert • Supports isosemantic representation of Clinical Finding Names that may include body location, laterality, causative agent and other related information in pre or post-coordinated form. Activity (Existing Definitions) • openEHR – Action: Information recorded due to the execution of an instruction by some agent – Instruction: Actions to be performed in the future. • NHS LRA – Activity: Used to record treatment procedures, investigation procedures, administrative procedures and the provision of advice and information to patients and carers • SNOMED CT – Procedure: Activities performed in the provision of health care • EN13606 Association – Instruction/Order: used to define all that can be documented about the intended actions with the aim to change the state or process in the Patient System – Action/Intervention: is used to define all that can be documented about events that changed (or could change) states or processes in the Patient System Activity (Suggested CIMI Definition) Used to record activities that have been, are being, or are to be performed, including treatments, investigations, administrative procedures and the provision of advice or information. Comments: • E.g. Medication Activity (Requested, Dispensed, Administered), Investigation Activity (Requested, Performed) • Supports isosemantic representation of Activity Names, which may include body location, priority, context and other related information in pre or post-coordinated form. CIMI Modelling Patterns (Suggested Definitions) Property Observation (property-value): Used to represent the results of observations or investigations undertaken to find out more information about a patient’s state of health or wellbeing, and device or procedure related settings. • E.g. Heart rate, Blood glucose, Glasgow Coma Scale Clinical Finding (name): Used to represent clinical states found on examination or deduced from clinical reasoning (e.g. ‘diabetes mellitus’, ‘clear sputum’), and events to which the patient may have been subject (e.g. ‘physical abuse’, ‘exposure to mercury’). • E.g. Diagnosis, Adverse Reaction, Alert Activity: Used to record activities that have been, are being, or are to be performed, including treatments, investigations, administrative procedures and the provision of advice or information. • E.g. Medication Activity (Requested, Dispensed, Administered), Investigation Activity (Requested, Performed) CIMI Call For Clinical Models • • • • • • • • • Heart Rate - Property Observation Body Mass Index – Property Observation Apgar Score – Property Observation Glucose Tolerance Test Result – Property Observation Adverse Reaction – Clinical Finding Medication order - Activity Problem list – List (Section) of Clinical Finding (+ ?) Care Giver Reported Nausea – Clinical Finding Wound Culture Result – Activity + Property Observation? LINKS between Models (Suggestions) • Property Observation to: – Finding: ‘has interpretation’ – Activity: ‘results in’ • Activity to: – Activity: ‘has instruction’, ‘depends on’, ‘must occur before’, etc – Clinical Finding: ‘has focus’, ‘results in’ – Property Observation: ‘results in’ • Clinical Finding to: – Property Observation: ‘reason for’ – Activity: ‘finding method’, ‘is indication for’ Where to from here? – Review of Existing Approaches (e.g. NHS, ISO, SNOMED) – Proposal for CIMI NHS LRA – Component Relationship Vocabulary (draft) EN13606:3 Link Nature Code Meaning LINK-A0 is related to LINK-B0 is confirmed by LINK-C0 is related to the same problem or health issue LINK-D0 is related to the same plan of care, act or episode LINK-E0 is a related documentation EN13606:3 Link Role Code LINK-A1 LINK-A2 LINK-A2i LINK-A3 LINK-B1 LINK-B2 LINK-B3 LINK-B3i LINK-B4 LINK-B5 LINK-B6 LINK-B6i LINK-C1 LINK-C1i LINK-C2 LINK-C3 LINK-C3i LINK-C4 LINK-C4i LINK-C5 LINK-C5i LINK-C6 LINK-C6i Meaning unspecified link suggests (tentatively related to) is suggested by re-occurrence or repeat of endorses (agrees with, confirms, verifies) disagrees with (e.g. another opinion) permits (sanctions, authorises) permitted by assumes responsibility for declines (refuses, cancels) consents to consented by cause (interpretation) caused by revised interpretation evidence for justified by evidence against countered by indicated by indication for contra-indicated by contra-indication for Code Meaning LINK-C7 trigger for LINK-C7i triggered by LINK-C8 manifestation of LINK-C8i manifested by LINK-C9 sequel (consequence, progression) LINK-C10 intended (aim, goal, target, hoped for, desired) LINK-C11 anticipated (predicted) LINK-C12 to be avoided (at risk of, fear of, prophylaxis) LINK-D1 outcome LINK-D2 has pre-condition LINK-D3 evaluation (assessment, milestone) LINK-D4 contributes to or fulfils goal, plan or act LINK-D5 revised state of the same act LINK-D6 sub-task of LINK-E1 documented by (is documented within) LINK-E1i documents (describes, reports) LINK-E2 summarises LINK-E3 supplements LINK-E4 excerpts LINK-E5 derived from LINK-E6 has reference ranges LINK-E7 identified within (study product) SNOMED CT • OBSERVABLE ENTITY • CLINICAL FINDING – Finding method: PROCEDURE – Interprets: PROCEDURE – Interprets: OBSERVABLE ENTITY • PROCEDURE – Has focus: CLINICAL FINDING ... And many other ‘Linkage’ concepts SNOMED CT Concept Model • Clinical Finding – Finding site <<442083009|Anatomical or acquired body structure| – Associated morphology << 4975500|Morphologically abnormal structure| – Associated with <<404684003|Clinical Finding|, 71388002|Procedure|, 272379006|Event|, 410607006|Organism|, 105590001|Substance|, 260787004|Physical object|, 78621006|Physical force|, 373873005 |Pharmaceutical / biologic product| Severity <= 272141005 |Severities| – – Clinical course <= 288524001|Courses| – Episodicity <= 288526004|Episodicities| – Interprets << 363787002|Observable entity|, 108252007|Laboratory procedure|, – – – – – – 386053000|Evaluation procedure| Has interpretation << 260245000|Findings values| Pathological process == 263680009|Autoimmune|, <<441862004|Infectious process| Has definitional manifestation << 404684003|Clinical finding| Occurrence < 282032007|Periods of life| Finding method <= 71388002|Procedure| Finding informer <<420158005|Performer of method|, 419358007|Subject of record or other provider of history| SNOMED CT Concept Model • Procedure – – – – – – – – – – Procedure site << 442083009|Anatomical or acquired body structure| Procedure morphology <<49755003|Morphologically abnormal structure| Method <<129264002|Action| Procedure device <<49062001|Device| Access <=309795001|Surgical access values| Direct Substance <<105590001|Substance|, 37387305|Pharmaceutical / biologic product| Priority <=272125009|Priorities| Has focus <<404684003|Clinical finding|, 71388002|Procedure| Has intent <=363675004|Intents (nature of procedure values)| Recipient category <<125676002|Person|, 35359004|Family|, 133928008|Community|, 105455006|Donor for medical or surgical procedure|, 389109008|Group| – Revision status <<261424001|Primary operation|, 255231005|Revision - value|, 257958009|Part of multistage procedure| – – – – Route of administration <<284009009|Route of administration value| Surgical approach <=103379005|Procedural approach| Using energy <<78621006|Physical force| Using substance <<105590001|Substance| LINKS between Models (Suggestions) • Property Observation to: – Finding: ‘has interpretation’ – Activity: ‘results in’ • Activity to: – Activity: ‘has instruction’, ‘depends on’, ‘must occur before’, etc – Clinical Finding: ‘has focus’, ‘results in’ – Property Observation: ‘results in’ • Clinical Finding to: – Property Observation: ‘reason for’ – Activity: ‘finding method’, ‘is indication for’ Where to from here? – Review of Existing Approaches (e.g. NHS, ISO, SNOMED) – Proposal for CIMI CIMI Modelling Pattern Attributes (Suggestion) – All • Participations: subject, information provider • Elements: Timing • Elements: Clinical Status – Property Observation • • • • Participations: observer Cluster (Isosemantic ): Property (name, descriptors) Cluster: Result (name, value, details, interpretation, reference range) Links: observing activity, interpretation, is indication of, other – Finding • • • • Participations: finder Cluster (Isosemantic ): Finding Item (name, descriptors) Cluster: Finding Details (details) Links: finding method, finding procedure, is indication of – Activity • • • • • Participations: performer Cluster (Isosemantic): Activity Item (name, descriptors) Element: Activity Identifier(s) Cluster: Activity Details (details) Links: has instruction, depends on, must occur before Property Observation Heart Rate Example Clinical Finding Activity Thank You This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. © All Rights Reserved