2018-02-28 Learning Health Systems Call

Facilitator	Russell Leftwich	Note taker(s)	Emma Jones
Attendee	Name	Affiliation
X	Russell Leftwich	InterSystems
	John Roberts	Tennessee Department of Health
X	Stephen Chu	Individual
	Evelyn Gallego	ONC
	Kathy Walsh	LabCorp
	Asim Muhammad	Philips Research Europe
X	Laura Heermann-Langford	Intermountain Healthcare
X	Emma Jones	Allscripts
	Jeff Brown	Cancerlinq
X	Lisa Nelson	Individual
	Dave Carlson	VA
X	Chris Melo	Phillips Healthcare
X	Michelle Miller	Cerner
	Benjamin Kummer	Columbia University
	Matt Rhan
	Michael Padula
	Joseph Quinn
	Thomson Kuhn
	Rob Hausum
	Serafina Versaggi	VA
	Ann Whiz
X	Adam Horn
	Bridget McCabe
X	Claude Nanjo
X	Bridget Burke
X	Bridget McCabe

Minutes

• Chair: Russell Leftwich
• Scribe: Emma Jones

• Motion to approve Feb 21 call minutes: Emma moved ,Lisa Second

Agenda

• CIMI Introduction Feb 28 - Claude Nanjo
• Other business

CIMI tool overview

• found at CIMI Tool
• There are rules in term of how a clinical statement is created
  • Documentation
  • explains CIMI architecture
  • StyleGuide explains all the different flavors of CIMI.
  • Claude will let LHS when new documentation is posted that will be helpful.
  • Context of clinical statement reflects actions. This is in relation to person, patient, practitioner and care team. These will not fall under clinical statement.
    • clinical statement is not imposed on everything.
    • What makes up a clinical statement are components when taken together will define a clinical statement.
• Overview of CIMI
  • CIMI is a logical model for the representation of clinical information. Hopes to become a standard of HL7
  • Spec for interoperable information exchange - can be used to specify constraints on FHIR core in the form or FHIR profiles.
    • provides type, cardinality and terminology constraints on the core reference model attributes
    • extensions to the core reference model to support clinical expressivity
  • FHIR model defines a set of core resources (80/20 principle)
  • FHIR profiles - A metamodel to define, constrain and extend core FHIR resources.
    • the structure definition are not specified by FHIR - there can be infinitive number of profiles
  • CIMI model provides requirements for specific reasons.
• What is the notion of the role of CIMI - e.g. will it replace the DAM done in HL7?
  • CIMI specimen model represents the DAM
  • Will CIMI become the place to do this work?
  • Need to consider the modeling done in CDA - not only to FHIR profiles. Lisa is working with folks doing CDA work to express them in structured definitions.
• Caveats
• 1. CIMI is a large family - has a bandwidth issue. Need a group of domain experts and interested party doing the ground work
• 2. CIMI logical clinical modeling is a mirror of HL7 RIM - means it will become very complex and based on use cases that are not commonly used. Need to be able to come to the middle of the road.

Need to concentrate on promoting best practice.

• CIMI need to scale - not all groups need to work thru CIMI to scale. Need to develop a tool.
• Goal is to have progressive layer of elaboration in the area of modeling. First develop patterns and the lower level detailed clinical models would use the patterns.
• Agree this is a good starting point.
• Idea of control - modeling is specific to how one group sees the world. Trying to collaborate and make changes becomes difficult.
  • Goal is to start with a specific domains and start using the model in real use cases.
• Stephen is working with Claude on the Adverse event work and he is "absolutely awesome"
• These are active conversations happening in CIMI
• Second use of CIMI - computable and logical model for knowledge capture and representation
  • E.g. ordersets, documentation templates, rules, etc.
  • There are an awful lot to do.
  • logical view and operations
• third use of CIMI is a computable and ligical model used for logical reasoning and analytics
  • How to capture the information and how to convey the information so it's useful
  • How does the tools that create profiles
    • Forge and Simplifier - CIMI will build the profile and publish it to simplifier.Will use CIMI to build the model.
    • When the CIMI model is build - can explain how the model maps to the FHIR. Favoring the mapping rules that will explain how CIMI maps to FHIR. The source of truth is the CIMI model.
• Concern with the translation process - If the FHIR resource has been validated and confirmed to be CIMI conformant then may not need to go thru the translation process.
  • don't have to operate off the CIMI model
  • At the Univ of Utah - have a system that is base off Epic proprietary CDS model. In the future want the CDS rules not to depend on a proprietary model such as Epic
• 3 pillars of CIMI
  • Reference model - defines the classes and attributes
  • Archytech layer - constraint layer
  • Terminology - closely alligned with SNOMED structured model. The hierachy is in CIMI but serves a structural purpose.
• Stopped at Composition enables reuse. Claude will forward the slides after next weeks call.