Detailed Clinical Model instance construction

Patient Care

further to: Detailed Clinical Models

further to: Detailed Clinical Model guidelines for creation

further to: DAM vs DCM vs SAEAF

The HL7 steering committee, domain experts TSC, and the HL7 board approved the Patient Care Proposal HL7 Project Scope Statement_PatientCare2008DCM-ID320.doc

Work has started in preparation of the Vancouver meeting where on Tuesday Sept 16, examples of the format, the Glasgow Coma Scale and Blood Pressure where presented, consisting of a word document describing the clinical details, a xls spreadsheet holding all data elements, meaning, data type and code from code system / terminology and a UML model.

Generic comment from attendees: => continue the work we must look at meta information we must look at consistency in UML modelling and harmonising with existing examples. we must look at appropriate coding etc. ergo: work started and needs to continue, but discussions on all elements will evolve discussing more examples.

William Goossen 17 sept 08

Discussion

We envision further work on the materials below. One item currently under discussion is the level of granularity of DCM. The smallest item seems one atomic data element which is fully specified with respect to concept, data element, data type, unique code for the data element from an (mostly external) code system. Another level is more molecular, such as the examples of Apgar score that has 5 atomic data items and one atomic total score item. Or in the Blood Pressure where a set of atomic data items are clustered around the concept. At this stage it is considered not a DCM, but a collection of DCM if a health and physical or a discharge summary is drawn up. Manners how to link DCM to each other still have to be determined.

Open for Comment

These items are currently owned by Nictiz in the Netherlands, with Results 4 Care authorship. The materials are currently informative.

Currently we have the following DCM examples:

• Apgar Score
• Barthel Index
• Blood Pressure
• Body Height
• Body Temperature
• Body Weight
• Braden Scale
• Glasgow Coma Scale
• Heart Rate
• Respiration

In-Progress DCM (examples)

• Chief complaint, presenting problem, and/or reason for visit
• History of present illness
• Review of systems / symptoms
• Prior/past medical history of disease / disorder
  • History of specific infectious disease
  • History of coronary artery disease
  • History of reactive airway or other obstructive lung disease (asthma, COPD)
  • History of cancer
  • Obstetric and current pregnancy history
  • History of psychiatric disorder
  • History of stroke
  • History of diabetes
  • History of drug allergy or intolerance
  • Birth and gestation history (primarily of interest in pediatrics)
  • Clinical sex
• History of specific procedure
• Physical exam finding
• Current medication use
• Entries in a health concern tracker / problem list / diagnostic impression / differential diagnosis
• Evaluation or treatment plan

In-Progress DCM for e-Diabetes in the Netherlands

Nictiz developed about 25 DCM for diabetes care. These are developed around the e-Diabetes dataset distributed in HL7. However, the DCM are only available in Dutch at this time. This is available in English upon request, with time permitted. The data set with HL7 v3 Care Provision mappings are available in English (partly) and are part of the multi workgroup diabetes project.

• list:

DCM from Top 10 re-useable: Blood pressure Weight Length

Generic DCM: CMET PatientNL / CMET PersonNL Family assessment Smoking, alcohol, exercise Contact moments, consults Allergies, contra indications Cardiovascular pathology Patient access, quality of life

DCM specific for e-Diabetes: Social support in context of diabetes Diabetes baseline medical data Circumference 24 hr Blood pressure, Ankle-arm index Hypo-/ hyperglycemia Target values Foot investigation, Eye investigation SIMMS classification Medication use (insulin), Blood glucose meter

External Links / Internal Links

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• [Patient Care WG page]