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

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 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.