Detailed Clinical Model project
return to: Patient Care
further to: Detailed Clinical Models
further to: Detailed Clinical Model instance construction
further to: Detailed Clinical Model guidelines for creation
further to: DAM vs DCM vs SAEAF
further to: Governance
Contents
Introduction
The DCM series of projects are as such a follow up of the DCM meeting in Boca Raton, led by Craig Parker and the DCM Brisbane workshop in 2007 with CEN, ISO, HL7, OpenEHR and clinical involvement where the recommendations were to work on harmonization of granular and detailed clinical content and where four action areas included clinician involvement, quality of detailed clinical models, representation formalisms and establishing and maintaining repositories. This is because different communities where working in splendid isolation on the same specifications of blood pressure, pulse, breathing, Apgar score, Glasgow Coma Scale, Health and Physical, assessments and so on.
Project intent
- To create and maintain in a repository a set of detailed clinical models that can be transformed from a generic model into EHR profile, HL7 templates, V3 Clinical Statements (for use in O&O, CDA, PC R-MIMs), and that can function in ISO 13606 and OpenEHR series of standards.
- To build further on past and existing efforts on archetype development from OpenEHR and CEN 13606, template, Clinical Statement and R-MIM development in HL7, and clinical domain expressions in different associations.
- To organize clinical content in such a manner that it becomes multi useable in different standards and different technologies, thus supporting both the Joint work and semantic interoperability. The repository will be one practical outcome of the joint initiative.
Project scope
The overall goals of the DCM initiative are:
- to develop methods, tools for requirements gathering with clinicians, requirements for modelling tools,
- to enforce quality control, authorisation and governance of DCM rules,
- to identify clinical items, binding of clinical content to terminology,
- to model generically and make transforms to different formalisms,
and
- to maintain in a repository a set of DCM that are useable in different standards, formats and different technical implementations using the same generic model. The purpose is to enhance the semantic interoperability between different systems and developments.
Based on discussions in ISO Joint Working Group 9, the JWG leadership requested two projects to be started:
1. A set of examples, useful in a standard.
2. A set of criteria for good quality of DCM that are indeed clinically sound and implementable in different technical environments.
We have created a Top 10 list of DCMs and discussed its use in HL7 project 320 on DCM, where this document is an update of. Establishing DCM criteria and methodologies is currently done under ISO NIWP 13972, which was approved on July 2009.
This proposal includes the proper representation of assessment scales, indexes and scoring systems. It will use elements of other HL7 WGs or projects such as Terminfo, Structured Documents, Templates and Clinical Statement. A DCM includes the purpose of one or small set of clinical data elements, the evidence base, data element specification, proper procedure, interpretation of values, and literature references. A guideline for this has been created on behalf of Nictiz in the Netherlands.
A DCM specification must be
- usable within the HL7 Clinical Statement and HL7 template specification,
- meet HL7 terminfo requirements,
- adjustable to the CEN/IOS 13606 and OpenEHR archetype environment, and the Clinical template specification, among others.
Technical implementations that would be able to deploy DCM include GUI design, database design, HL7 message design, algorithm design, rule-based Decision Support System design, among others. In particular a DCM is to form a bridge between different technical representation formats, in particular HL7 v3 templates / clinical statements and OpenEHR archetypes. That is the harmonization aspect of DCM. In order to actually use a DCM, the transformation to HL7 must be made. This is done via mapping the DCM content to a Clinical Statement R-MIM, in any HL7 domain that uses Clinical Statement. The formalism to use a DCM in HL7 space would be that of an HL7 v3 template.
Project Team
| Role | Name | Notes | ||
| Project facilitator | William Goossen | williamtfgoossen@cs.com | ||
| Publishing facilitator | Jane Curry | janecurry@healthinfostrategies.com | Relation with Template Registry | |
| Publishing facilitator | Jean Duteau | jean.duteau@gpinfornatics.com | To be discussed by William and Jean | |
| Vocabulary facilitator | HL7 Vocabulary Work Group | |||
| Modeling facilitator | Michael van der Zel | m.van.der.zel@ict.umcg.nl | ||
| Domain expert representative 1 | Kevin Coonan | kevin.coonan@gmail.com | ||
| Domain expert representative 2 | Anneke Goossen | agoossen@results4care.nl | ||
| Data Analyst facilitator | ||||
| Business requirement analyst | ||||
| Requirements process facilitator | Frank Oemig | hl7@oemig.de | ||
| Implementor | Ewout Kramer | e.kramer@furore.com |
Action items
| Action | Description | Timeline | Status |
| Analyse and model Glasgow Coma Scale for DSTU | An DCM for the Glascow Coma Scale is in enterprise archtect available for ballot.Also available is an export document so clinicians can give comment on the clinical content. | Informative ballot september 2010 | In progress. |
| Revise Barthel index in PC DSTU and ISO 13606-3 | An DCM for the Barthel index is in enterprise architect available for ballot. Also available is an export document so clinicians can give comment on the clinical content. | Informative ballot september 2010 | In progress |
| Translate Dutch example scales into English | Examples are available. Different scales with different modeling issues should be choosen for balloting. the different examples must be modeled in EA. An export document must be made and available. | Informative ballot september 2010 | To be discussed during the HL7 WGM in Rio de Janeiro |
| Identify use cases for larger scales and make new R-MIM for nested scales based on PC DSTU and Oemig’s set of scores and model and Coonans clinical examples | Last revisions underway before filing DSTU status. | Informative ballot september 2010 | Status to be discussed in HL7 WGM in May 2010. |
| Proof of concept with Top 10 of items | Together with CIC (clinical), Terminfo (apply Snomed CT and or LOINC), Templates (authorization and registry) for 10 items (now 9).Simultaneous work. Send out the material now and ask for review feedback. | Informative ballot september 2010 | In Progress. Material is available on the HL7 wiki. General feedback has been given. Yes must go on. |
| Analyse the feedback on the actions above | Feedback given on the content of the DCM. Feedback given on the methodology of DCM. | Afther the ballot of september 2010. | |
| Develop a guideline for creating a DCM | Simultaneous work with work for the ISO standard and NIctiz. Include quality criteria for DCM. | Informative ballot september 2010 | In progress |
Project process
Project objectives and deliverables
DCM Release 1 will support the following goals:
- Develop methods and tools requirements for binding of clinical content to terminology, to generic models and to different technical implementations using the same generic model. The first ballot will include a guideline for DCM creation.
- Identify a means to involve clinical groups to determine and specify relevant clinical content. This in line with the HL7 clinical interoperability council work and Domain Analysis Modelling (DAM), and HDF among others.
- Set up a methodology for verification, validation and quality, control and review cycle of clinical materials and their representation in terminology and information models so clinicians can trust the EHR and the message content presented to them. This will become part of the ISO 13972.
- Create a superset from which various applications, e.g. the CDA H&P, Detailed Clinical Models, DEEDS, etc. can draw data element identifiers in particular to provide a value set suitable for use in a clinical statement's Observation.code.
- Generate clinical value sets in both SNOMED-CT and in LOINC, according to Terminfo guidelines. This includes appropriate use of principles how information model and terminology model interact properly.
- Define and apply quality criteria for DCM clinical content, terminology, classification and unique coding, language translations, generic information modelling independent of a particular standard, transformations via tooling from generic models to standards specific modelling,
- Give guidelines for the linkage from a Domain Analyses Model to a HL7 D-MIM / R-MIM / template and/or archetype
- Develop transformation of generic model into HL7 v3 RIM / R-MIM / Clinical statement modelling and message development
- Develop transformation of generic model into CEN/ISO / OpenEHR archetypes
- Develop methods and tools to combine DCM into larger clinical templates
- Develop tools to combine archetypes / R-MIMs / DCM into different technologies
- Support actual use of DCM as clinical statements in messages (v2 and v3) and CDA (HL7 Patient Care / SD (CDA) / Clinical statement / O&O).
- Provide a forum to develop and maintain actual instances and artifacts for clinical content.
- Apply relevant metadata such as in the HL7 templates specification and ISO metadata ISO 11179.
- Set requirements, organise and develop a repository for DCM, serving the different clinical and standards organisations.
- Facilitate the re-use of materials and resources and prevent unnecessary duplication of efforts.
- The goal will be to ballot the DCM set Release 1 for normative status in first half of 2011 followed closely by implementation guide(s) that help promote interoperability across vendor implementations and across standards.
- At the end of this project, the DCM collection will be enhanced to better support the long-term goal of an automated standards-based information technology (IT) environment for the exchange of information supporting the process for clinical data collection and exchange to support continuity of care, aggregation of data and lifetime storage and retrieval, more or less independent of the actual technical implementations.
- Work products intended to produce a standard should be in terms of HL7 V3 deliverables, including but not limited to the following:
- Make an inventory of examples already in the current HL7 v3 ballot domains
- Clinical data specification guidelines and criteria
- Methods how to apply
- Storyboard, storyboard examples
- State Transition Diagrams, trigger events where appropriate
- Interaction Diagram, interactions
- Message Information Models, Refined Message Information Models consistent with Clinical Statement and its derivates such as Care Statement
- Hierarchical Message Definitions and XML examples that can be used as plug in for CDA and Care Provision Record message.
- Implementation Guide for DCM within different standards and technical contexts
- Tool criteria and tools for conversions
- Repository of DCM, joint with CEN / ISO and OpenEHR including requirements from terminfo, template, 13606 and OpenEHR deliverables if applicable
- Feasibility studies for using DCM in the different technologies.
