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| | == Coordinator == | | == Coordinator == |
| − | * Kensaku Kawamoto, M.D., Ph.D. - CDS Co-Chair (kensaku.kawamoto@utah.edu) | + | * Kensaku Kawamoto, M.D., Ph.D., M.H.S. - CDS Co-Chair (kensaku.kawamoto@utah.edu) |
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| | | | |
| − | == vMR Specifications == | + | == vMR Standards == |
| | | | |
| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_vMR_Domain_Analysis_Model_Release_1.pdf vMR Domain Analysis Model, Release 1]
| + | See http://wiki.hl7.org/index.php?title=HL7_CDS_Standards for links to the latest versions of the HL7 vMR standards. |
| − | | |
| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_vMR_Domain_Analysis_Model_Release_1_Supplemental_Files.zip Supplemental Files for vMR Domain Analysis Model, Release 1]
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| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_vMR_GELLO_Implementation_Guide_2011_Sept_Ballot_Revised.doc vMR GELLO Implementation Guide Ballot, September 2011 Ballot Cycle, Revised Based on Ballot Comments]
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| − | | |
| − | | |
| − | == Known Issues to be Addressed in Future Specifications ==
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| − | | |
| − | - bodySiteCode within BodySite should be optional rather than mandatory. A specific body site may be implied by the type of procedure, problem, etc., such that only the laterality is of interest (e.g., bilateral laterality for a mastectomy).
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| − | - The relationship between a clinical statement and an entity may need to have a relationshipTimeInterval, similar to the relationship between two entities. This change may be logically desirable and also may simplify implementations by having entities have similar attributes whether they are related to a clinical statement or entity source.
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| − | - The isValid attribute of SubstanceAdministrationEvent cannot be directly used for a multi-component vaccination, where one component may be valid and another may not. This can be dealt with using the current model by having a parent SubstanceAdministrationEvent for the combination vaccine and child administration events for the individual components. Need to verify that this approach meets the needs of the community.
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| | == Cross-Institutional CDS Needs Analysis and Associated Manuscript == | | == Cross-Institutional CDS Needs Analysis and Associated Manuscript == |
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| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_Cross_Institutional_CDS_Data_Needs_Analysis_Final.zip CDS data needs analysis, vFinal] | + | [http://wiki.hl7.org/index.php?title=File:HL7vMR_Cross_Institutional_CDS_Data_Needs_Analysis_Master_File_vFinal.xls CDS data needs analysis, vFinal] |
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| | [http://wiki.hl7.org/images/4/43/HL7vMR_Cross_Institutional_CDS_Data_Needs_Analysis_Manuscript_v2010-03-15c_submitted.doc Manuscript presented at 2010 AMIA conference] | | [http://wiki.hl7.org/images/4/43/HL7vMR_Cross_Institutional_CDS_Data_Needs_Analysis_Manuscript_v2010-03-15c_submitted.doc Manuscript presented at 2010 AMIA conference] |
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| | + | == Minutes == |
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| − | == SVN == | + | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2013-07-30.docx Minutes 2013-07-30] |
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| − | https://svn.medical-objects.com.au/vmr/
| + | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2013-04-30.doc Minutes 2013-04-30] |
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| − | Read only username/password: hl7/hl7
| + | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2013-04-02.doc Minutes 2013-04-02] |
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| − | Default checkout directory at c:\vmr
| + | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2013-03-19.doc Minutes 2013-03-19] |
| | | | |
| − | To get read/write access, email Andrew McIntyre
| + | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2013-03-12.doc Minutes 2013-03-12] |
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| − | | + | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2013-02-19.doc Minutes 2013-02-19] |
| − | == Minutes ==
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| | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2011-07-21.doc Minutes 2011-07-21] | | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2011-07-21.doc Minutes 2011-07-21] |
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| | + | == Archived/Historical Content == |
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| − | == Sept 2011 Ballot, Comments, and Comment Reconciliation (ARCHIVE) ==
| + | See http://wiki.hl7.org/index.php?title=Virtual_Medical_Record_(vMR)_Archive |
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| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_vMR_Domain_Analysis_Model_2011_Sept_Ballot.pdf vMR Domain Analysis Model Ballot, September 2011 Ballot Cycle]
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| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_vMR_Domain_Analysis_Model_2011_Sept_Ballot_Supplemental_Files.zip Supplemental Files for vMR Domain Analysis Model Ballot, September 2011 Ballot Cycle]
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| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_V3DAM_CDS_VMR_R1_I2_2011SEP_Consolidated.xls Ballot Reconciliation Spreadsheet for vMR Domain Analysis Model Ballot, September 2011 Ballot Cycle]
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| − | | |
| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_vMR_GELLO_Implementation_Guide_2011_Sept_Ballot.pdf vMR GELLO Implementation Guide Ballot, September 2011 Ballot Cycle]
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| − | | |
| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_V3IG_CDS_VMR_GELLO_R1_D1_2011SEP_consolidated.xls Ballot Reconciliation Spreadsheet for vMR GELLO Implementation Guide Ballot, September 2011 Ballot Cycle]
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| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_vMR_GELLO_Implementation_Guide_2011_Sept_Ballot_Revised.doc vMR GELLO Implementation Guide Ballot, September 2011 Ballot Cycle, Revised Based on Ballot Comments]
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| − | | |
| − | == May 2010 Ballot, Comments, and Comment Reconciliation (ARCHIVE) ==
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| − | | |
| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_May_2010_ballots.zip May 2010 vMR ballots]
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| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_2010_05_Reconciled_Ballot_Comments_Amalgamated.zip Reconciled comments on May 2010 informative ballots for vMR Domain Analysis Model, v2 implementation guide, and GELLO implementation guide]
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| − | | |
| − | ''' Archived vMR Domain Analysis Models '''
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| − | | |
| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_Proposed_vMR_XML_Schemas.zip Prpoosed vMR XML Schemas]
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| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_vMR_Proposal_2011_07_14.zip vMR Proposal, v2011-07-14]
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| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_vMR_Proposal_2011_07_07.zip vMR Proposal, v2011-07-07]
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| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_vMR_Proposal_2011_07_01.zip vMR Proposal, v2011-07-01]
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| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_vMR_Proposal_2011_06_30.zip vMR Proposal, v2011-06-30]
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| − | | |
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| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_vMR_Proposal_2011_01_27.zip vMR Proposal, v2011-01-27]
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| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_OpenCDSvMR_2011_01_27.zip OpenCDS vMR Model, v2011-01-27]
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| − | | |
| − | | |
| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_OpenCDSvMR_2011_01_19.zip OpenCDS vMR Model, v2011-01-19]
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| − | | |
| − | | |
| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_OpenCDSvMR_2011_01_04.zip OpenCDS vMR Model, v2011-01-04]
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| − | | |
| − | | |
| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_OpenCDSvMRforProblems_2010-12-02.zip OpenCDS vMR Problem Model, v2010-12-02]
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| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_vMR_Domain_Analysis_Model_Ballot_v2010-03-28.doc May 2010 informative ballot for vMR Domain Analysis Model, v2010-03-28]
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| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_vMR_Domain_Analysis_Model_v2010-03-22.zip vMR Domain Analysis Model version 2010-03-22 (zip file containing .eap Enterprise Architect File, XMI cross-platform UML file, and JPG image files of models)]
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| − | | |
| − | [http://wiki.hl7.org/images/6/65/HL7vMR_vMR_Domain_Analysis_Model_v2010-03-19a.zip vMR Domain Analysis Model version 2010-03-19a (zip file containing .eap Enterprise Architect File, JPG image files of models, and Word document on modeling notes)]
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| − | | |
| − | - The Domain Analysis Model (DAM) will serve as the source of implementation technology-specific vMRs (e.g., for HL7 version 3, HL7 version 2, and GELLO). Its CDS input model is based on the multi-institutional CDS data needs analysis referenced above.
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| − | | |
| − | - .eap file can be opened by free Enterprise Architect viewer, available at http://www.sparxsystems.com.au/bin/EALite.exe, which is within http://www.sparxsystems.com.au/products/ea/downloads.html
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| − | | |
| − | - XMI file can be uploaded into any UML editor
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| − | | |
| − | | |
| − | == Big Picture/Direction Proposals (ARCHIVE) ==
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| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_Keith_Boone_Proposal_v2010-07-29.doc vMR proposal by Keith Boone, v2010-07-29]
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| − | [http://wiki.hl7.org/images/1/1d/HL7vMR_Big_Picture_Proposal_v2010-06-07.doc Big picture proposal by David Shields, v2010-06-07]
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| − | | |
| − | | |
| − | == Federal Health Information Model (FHIM) -- reference content ==
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| − | | |
| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_FHIM_XMI_v2010-07-08.zip FHIM in XMI format, v2010-07-08]
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| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_FHIM_UML_v2010-07-08.zip FHIM in UML format, v2010-07-08]
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| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_FHIM_in_Rational_Software_Modeler_Format_v2010-06-24.zip FHIM in Rational Software Modeler format, v2010-06-24]
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| − | | |
| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_FHIM_in_Rational_Software_Modeler_Format_v2010-06-24.zip FHIM in Rational Software Modeler format, v2010-06-24]
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| − | | |
| − | | |
| − | == Documents related to Family History Modeling within vMR ==
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| − | | |
| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_Family_History_vMR_Proposal_v2010-07-08.pdf Family History vMR proposal by Andrew McIntyre, v2010-07-08]
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| − | | |
| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_Family_History_vMR_Proposal_v2010-07-08.pdf Family History vMR proposal by Andrew McIntyre, v2010-07-08]
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| − | | |
| − | | |
| − | | |
| − | == Documents related to Problem Modeling within vMR ==
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| − | | |
| − | | |
| − | [http://wiki.hl7.org/index.php?title=Image:Problem.zip zip file containing a freemind mind map file with some images this links to ]
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| − | This mindmap contains the Problem attributes from the AMIA paper and some other systems including ASTEC
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| − | | |
| − | | |
| − | == vMR V2 Implementation Guide (Draft) ==
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| − | | |
| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_V3_Family_History_Instance_Example_v2010-07-08.zip V3 Family History instance example from HL7 Clinical Genomics Work Group]
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| − | | |
| − | | |
| − | | |
| − | == vMR GELLO Implementation Guide (ARCHIVE) ==
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| − | | |
| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_GELLO_ImplementationGuide_v2010-03-28.doc May 2010 informative ballot for vMR GELLO Implementation Guide, v2010-03-28]
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| − | | |
| − | | |
| − | [http://wiki.hl7.org/images/a/aa/HL7vMR_vMR_UML_Model_for_GELLO_ASTEC_Input_v2010-03-17.zip vMR UML Model for GELLO based on ASTEC project team input, version 2010-03-17 (zip file containing .eap Enterprise Architect File and PNG image file of input model)]
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| − | | |
| − | | |
| − | - The UML Model for GELLO will be derived from the Domain Analysis Model (DAM). This model will not be balloted in the May 2010 HL7 ballot cycle.
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| − | | |
| − | - .eap file can be opened by free Enterprise Architect viewer, available at http://www.sparxsystems.com.au/bin/EALite.exe, which is within http://www.sparxsystems.com.au/products/ea/downloads.html
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| − | | |
| − | - XMI file can be uploaded into any UML editor
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| − | ''' Archived vMR UML Models for GELLO '''
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| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_vMR_Refactor_Proposal_Medical_Objects_v2009-12-17.zip vMR UML Model for GELLO, Medical-Objects, version 2009-12-17]
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| − | | |
| − | | |
| − | == Working/Reference Content ==
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| − | | |
| − | | |
| − | [[Discussion of RIM to VMR mapping]]
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| − | | |
| − | | |
| − | '''Other Working/Reference Documents'''
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| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_Green_CCD_GELLO_Model_v2011_04_21.txt GreenCCD GELLO Class Model with VMR-related annotations, v2011-04-21]
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| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_Green_CCD_GELLO_Model_v2011_04_14.txt GreenCCD GELLO Class Model with VMR-related annotations, v2011-04-14]
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| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_COCT_MT530000UV_GELLO_Model.txt Clinical Statement GELLO Class Model]
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| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_Green_CCD_GELLO_Model_v2011_04_07.txt GreenCCD GELLO Class Model with VMR-related annotations, v2011-04-07]
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| − | | |
| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_Direction_Proposal_Medical_Objects_v2011-003-03.zip VMR direction proposal, Medical Objects, v2011-03-03]
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| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_Topology_Proposal_v2011_02_24.pdf vMR topology proposal, v2011-02-24]
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| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_Green_CDA_Pre_Publication_Package_from_SD_v2011-02-17.zip Green CDA pre-publication package from Structured Documents Work Group, v2011-02-17]
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| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_Green_CDA_EAP_and_GELLO_v2011-02-17.zip Green CDA derived EAP and GELLO files, v2011-02-17]
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| − | [http://wiki.hl7.org/index.php?title=File:HL7vMR_Direction_Proposal_Medical_Objects_v2011-02-17.docx VMR direction proposal, Medical Objects, v2011-02-17]
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| − | | |
| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_vMR_Domain_Analisys_Model_ASTEC_2010-10-26.zip ASTEC VMR model, 2010-10-26]
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| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_Medical-Objects_VMR_2010-10-13.zip Medical-Objects VMR proposed model, 2010-10-13]
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| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_CDS_Inputs_and_Outputs_Analysis_from_2008_vMR_Ballot_for_Comments.pdf CDS Inputs and Outputs Analysis from September 2008 VMR Ballot for Comments]
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| − | [http://www.hl7.org/documentcenter/ballots/2008sep/downloads/V3_CDS_VMR_R1_O1_2008SEP.zip September 2008 VMR Ballot for Comment]
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| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_Use_Case_Example_from_Keith_Boone%2C_v2010-09-02.doc vMR Use Case Example from Keith Boone, 2010-09-02]
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| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_GELLO_Use_Cases.doc GELLO vMR Use Cases]
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| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_Model_Transformation_White_Paper_from_Galen_Mulrooney.doc Model transformation white paper from Galen Mulrooney]
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| − | [http://wiki.hl7.org/images/8/86/HL7vMR_HL7_V3_Pedigee_Schemas_and_Sample.zip HL7 V3 Pedigree schemas and sample]
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| − | | |
| − | [http://wiki.hl7.org/images/c/c6/HL7vMR_Project_Scope_Statement_v2010-01-28.doc Updated vMR Project Scope Document endorsed unanimously by 13 vMR project participants on 1/28/10 project call]
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| − | [http://wiki.hl7.org/images/c/c6/HL7vMR_Project_Scope_Statement_v2010-01-27.doc Updated vMR Project Scope Document circulated to CDS list for comment on 1/27/10]
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| − | [http://wiki.hl7.org/images/f/f9/HL7vMR_2010_01_21_CDS_Work_Group_Draft_Minutes.doc 1/21/10 face-to-face CDS Work Group Minutes draft, in which consensus committee vision and direction for vMR work is documented in Q3 notes]
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| − | | |
| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_vMR_Instance.zip Representing data from CDA sample in a vMR instance, 2010-01-28]
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| − | [http://wiki.hl7.org/images/7/73/HL7vMR_Peer_Review_Comments_v2010-01-20.doc Peer Review Comments, 2010-01-20]
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| − | [http://wiki.hl7.org/images/9/9a/HL7vMR_Representing_VMR_Data_in_HL7_V2_Messages.doc Representing vMR Data in HL7 V2 Messages]
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| − | [http://wiki.hl7.org/images/f/f3/HL7vMR_CCD_Instance_As_V2_Message.txt Example CCD Instance as HL7 V2 Message]
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| − | [http://wiki.hl7.org/images/0/05/HL7vMR_CCD_vMR_Distinctions_v2010-01-20.doc Thoughts on Distinctions Between CCD and vMR, v2010-01-20 ]
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| − | [http://wiki.hl7.org/images/0/02/HL7vMR_UK_NHS_Wales_Individual_Health_Record_Model.zip UK NHS Individual Health Record (IHR) Model and Background, v2010-01 ]
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| − | | |
| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_vMR_Derived_from_CDA.zip Strawman vMR derived from CDA, 2010-01-07]
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| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_vMR_gello_model.txt Strawman vMR expressed in GELLO format, 2010-01-07]
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| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_SampleCCDDocument-QSG-level-3.zip Sample CCD Document]
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| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_vMR_Refactor_Proposal_Medical_Objects_v2009-12-03.png vMR Refactor Proposal from Medical Objects, v2009-12-03]
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| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_vMR_Comments_on_Refactor_Proposal_and_Discussion_v2009-12-03.doc Comments on 12/03/09 refactor proposal and results of group discusioon on 12/03/09]
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| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_vMR_Refactor_Proposal_Medical_Objects_v2009-11-19.png vMR Refactor Proposal from Medical Objects, v2009-11-19]
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| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_vMR_Strawman_Model_vs_PCC_Content_Modules_v2009-11-16.xls.zip Comparison of vMR Strawman Model vs PCC Content Modules, v2009-11-16.xls.zip]
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| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_vMR_Family_History_GELLO_Use_Cases_v2009-11-19.pdf vMR Family History GELLO Use Cases, v2009-11-19]
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| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_vMR_Family_History_Model_From_GELLO_Use_Cases_v2009-11-19.png vMR Family History Model From GELLO Use Cases, v2009-11-19]
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| − | | |
| − | | |
| − | '''ISO 21090 Datatypes References'''
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| − | | |
| − | These links reference the HL7 SVN server. If required, supply a username of "anonymous" and a blank password.
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| − | | |
| − | [http://gforge.hl7.org/svn/hl7v3/trunk/dt/iso/ISO%2021090%20Healthcare%20Datatypes.pdf ISO 21090 Healthcare Datatypes Published Standard]
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| − | | |
| − | [http://gforge.hl7.org/svn/hl7v3/trunk/dt/iso/iso-21090-datatypes.xsd ISO 21090 Healthcare Datatypes XML Schema]
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| − | | |
| − | Other documents:
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| − | | |
| − | [[ISO Datatypes in GELLO Format]]
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| − | | |
| − | [http://wiki.hl7.org/index.php?title=Image:HL7vMR_iso_21090_datatypes_in_gello_model.txt ISO 21090 data types in GELLO format]
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| − | | |
| − | '''HL7 V3 Datatypes SVN'''
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| − | | |
| − | The HL7 V3 Datatypes SVN is browsable from [http://gforge.hl7.org/gf/project/hl7v3/scmsvn/?action=browse&path=/trunk/dt/ here].
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| − | | |
| − | '''Snip from Abstract datatypes standard as to why we are using ISO datatypes'''
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| − | The data types defined in this specification are not intended to be implemented solely based on the details presented herein. For example, this specification does not differentiate between the information that should be represented explicitly in any technical representation such as XML and the information that should be derived from the explicit representation. This document corresponds broadly to the RM-ODP informational view ("concerned with the kinds of information handled by the system and constraints on the use and interpretation of that information"). The ISO data types specification is an ITS for these data types that corresponds to the RM-ODP computational view ("concerned with the functional decomposition of the system into a set of objects"). See [http://www.rm-odp.net/] for further information.
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| − | ''' What should be the primary objectives of this effort for the short term (next 3-6 months)? '''
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| − | Tentative:
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| − | Generation of community consensus on
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| − | # what types of patient data may be used as inputs for CDS;
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| − | # what types of inferences may be returned as outputs by a CDS engine; and
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| − | # the simplest possible information models for these data
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| − | ''' What should be our approach to fulfilling the objectives in a timely manner? '''
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| − | - Create straw-man UML diagrams for vMR
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| − | - Discuss/modify UML diagrams as initial approach to arriving at common vMR consensus
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| − | - Explore ballotable formats
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| − | Potential initial ballot: UML Domain Analysis Model (DAM)
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| − | Potential further ballot: HL7 v3 model based on DAM
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| − | - Need to be aware of U.S. meaningful use criteria (e.g., for use of SNOMED for problem lists), other international requirements
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| − | ''' What should be our decision making process? '''
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| − | - Use standard HL7 processes (attempt consensus; if needed, majority vote to decide on most issues at this stage in the process)
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| − | ''' Other current work of note to this project'''
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| − | # GELLO
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| − | # Infobutton
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| − | # NQF's Quality Data Set (QDS)
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| − | # IHE - PCC Content Modules
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| − | # SAEAF
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| − | # RIMBAA
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| − | ''' What is a vMR? '''
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| − | The vMR is based on the HL7 V3 model and datatypes. It is a "virtual" interface and is optimised for point in time clinical decision support. While it could be used as the basis for an EHR design it is intended to be simplified, to represent a snapshot and to omit important concepts that should exist in a real EHR.
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| − | In particular concepts such as audit trail, result history and display forms are omitted and only data relevant to making decisions based on the current patient state are represented. The hard bit is excluding as much complexity as possible while ensuring that any decisions made are safe and based on adequate data.
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| − | It is intended that each EHR system would create an "Adaptor" or "Facade" to present patient data in a consistent form so that the clinical decision logic can be common across many systems. Obviously some systems will be missing data and it is likely that the data will not be in a HL7 V3 form and this is where the word virtual comes in, there needs to be a translation layer to transform data into a form that complies with the VMR. There are many potential ways to do this ranging from creating a CDA document, a HL7 V3 message, a SOAP service or even creating HL7 V2 message(s) that contain the required structured data to allow the creation of a vMR interface. A direct database access layer is also possible. So documents, messages, services, archetypes/templates, CCD instances and database queries for example could all populate the vMR.
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| − | The aim is to allow a CDS language access to a standard model to reliably access patient data about the current patient's "Observations" (eg haemoglobin) or "Family History" or eg "Surgical History"/"Problem List". This is the single patient "Context" but other contexts are relevant. Access to population based data is very important for public health monitoring (perhaps context "Population"?) and in the case of templates access to data during the editing process (context "Template").
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| − | '''SAEAF Framework'''
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| − | The project is currently under active development and these ideas are not fixed or standardized but give some idea as to what a vMR should be. An attempt to try and conceptualize the requirements using the HL7 "SAEAF" famework - the "Services Aware Enterprise Application Framework" is below. The SAEAF framework, when used in an agile manner shows great promise in structuring thoughts on the topic and allowing alignment when people come at the problems from different world views.
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| − | {|style="text-align:left" border="1"
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| − | |+ vMR modelled in SAEAF
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| − | |- style="background:#ffdead;"
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| − | !!![[Enterprise|Enterprise View]]!![[Information|Information View]]!![[Computational|Computational View]]!![[Engineering|Engineering View]]!![[Technology View]]
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| − | |-
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| − | !Conceptual
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| − | |[[HL7/ISO Datatypes]] [[Classes in the vMR Model]]
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| − | |[[vMR Examples]]
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| − | |-
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| − | !Platform Independent
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| − | |[[vMR UML Model]]
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| − | |[[ISO 21090 datatypes]]
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| − | |[[GELLO Class definition]]
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| − | |-
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| − | !Platform Specific
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| − | |
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| − | |[[LRA Models]]
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| − | |[[CCD]] [[RMIM View]]
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| − | |}
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| − | '''More on the 'virtual' in vMR'''
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| − | Noone has an exact implementation of the vMR. It will always need to be mapped to local structures. It needs to handle missing data items, for example if the local structure doesn't have a smoking history for patient, the vMR needs to know it doesn't have it - it is null. Another example would be if the Allergies section of a populated instance of a patient's electronic medical record is not filled in - is this 'No - there are no allergies' or is this a null value? A test for the vMR is that is needs to be addressable by CDS languages such as GELLO. (The vMR is for clinical decision support). It exists for CDS, then it is gone.
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| − | '''Distinction from reference models'''
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| − | As an artefact of the HL7 standards community it might seem that this notion of a vMR is confused with that of a specialization of the RIM such as a RMIM. Remember it is a simpler, snapshot view and it's a slightly different view at that. So instead of top level Entities and Acts, we have explicit links, such as Patient (Entity) ''has'' Observation (Act). The vMR has a context which would often be a patient context, but it could be a population one. This context builds a specific patient class property rather than following the RIM links (ie Person playing the role patient..). So the link is clearer (perhaps) and stuff at the RMIM level can be exposed as top level constructs.
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| − | Additional classes can be included such as ProblemList, FamilyHistory and Procedures.
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| − | '''Potential vMR sources'''
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| − | So what's to be in and what's to be out? Ideally we'd be in the Goldilocks zone with a one pager that keeps most people happy. We should borrow the SNOMED-CT editorial policy of 'URU' - understandable, reproducible and useful. Here is a list of some potential vMR class sources:
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| − | # SAGE vMR model
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| − | # HL7 Care Record Model
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| − | # Logical Record Architecture (NHS)
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| − | # Different participating institutions’ vMR models
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| − | # Comment-only HL7 vMR ballot
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| − | # RMIMs such as Clinical Genomics
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