Transcript vMR – Virtual Medical Record

A RIM based model for clinical decision support
Andrew McIntyre
Medical-Objects
vMR – RIM based Models
 Uses ISO 21090 Data types
 Need to add methods to classes for GELLO
 Uses GELLO (extended OCL) base types (iso21090 uses ocl)
 Aiming for low hanging fruit eg:
 Problem List (Past History)
 Procedures (Surgical History)
 Family History
 Allergies
 Current Medication
 Medication History
 Lab Observations
 Social History (Alcohol/Tobacco)
vMR – Base Model
 CCD being used as source model
 Transformable to and from CCR
 Documented
 Specified in US realm
 Potential to develop v2 version (Australia)
 Issues
 Family History Model not as rich as desired
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Allow extensions for Genomics data items (optional)
 Currently using v1 datatypes
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As is “Virtual” medical record can be mapped
vMR - Uses
 Designed for Decision Support
 Little interest in display data
 Demands terminology for safe usage
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SNOMED-CT/ICD-9/ICD-10
 Several Use cases
 Local decision support
 Decision support services
 Quality assessments
 Gello uses it as its Model
vMR - Example GELLO usage
vMR – GELLO Examples
vMR – UML Overview
vMR – Why use “Simplified Model”
 GELLO usability
 Navigating to eg: patient would take complex statement
 Identifying specific clinical data easily
 GELLO should be written by clinical people
 Simplify GELLO
 Interfacing with “Legacy” systems
 Allow CDS to occur with legacy data
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Avoid overly complex transformations – “sweet spot hard to find”
 Allow Clinicians to understand Model
 Many attributes of RIM are not needed for a snapshot view
vMR – Simplication Examples
 Direct ACT<->Patient Link
 vs Person playing role of patient
 Also link Provider/Organisation
 CCD has single patient
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Excludes use on conjoined twins!
Current Medications
Medication History
CCD ACT relationships exposed as typed Properties
Family History exposed as object model with direct links to
sub-observations
 CCD could be reconstructed from vMR (except for text)
vMR – Data sources
 GELLO v1 described a simple vMR as example
 Implemented against HL7 v2 data as trial
 In real use in
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GLIF
ISO 13606-2 Archetypes
Calculated results in editors
RIMBA relationship
 RIMBA is ultimate vMR
 Only likely to need thin Facade to comply
 Datatypes align
 Your experience and input is welcome