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Difference between revisions of "Virtual Medical Record (vMR)"

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== Coordinator  ==
 
== Coordinator  ==
* Kensaku Kawamoto, M.D., Ph.D. - CDS Co-Chair (kawam001@mc.duke.edu)
+
* Kensaku Kawamoto, M.D., Ph.D., M.H.S. - CDS Co-Chair (kensaku.kawamoto@utah.edu)
  
== vMR Project calls ==
 
Next call 1/7/10 (Th)
 
  
Thursdays (every week) from 4pm to 5pm US Eastern Time ET
+
== vMR Standards ==
  
Announcements are sent over the CDS list.
+
See http://wiki.hl7.org/index.php?title=HL7_CDS_Standards for links to the latest versions of the HL7 vMR standards.
  
Live Meeting
 
Dial-in: 770-657-9270, Passcode 687054
 
  
https://www302.livemeeting.com/cc/vaoi/join?id=JTZP25&role=present&pw=gP%3DB5%40D
+
== Project Scope Statement ==
 +
[http://wiki.hl7.org/images/1/1c/HL7vMR_Project_Scope_Statement_v2010-03-08.doc Project Scope Statement, v2010-03-08]
  
  
'''Minutes'''
+
== Cross-Institutional CDS Needs Analysis and Associated Manuscript ==
  
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2009-12-03.doc‎ Minutes 2009-12-03]
+
[http://wiki.hl7.org/index.php?title=File:HL7vMR_Cross_Institutional_CDS_Data_Needs_Analysis_Master_File_vFinal.xls CDS data needs analysis, vFinal]
  
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2009-11-19.doc‎ Minutes 2009-11-19]
+
[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/index.php?title=Image:HL7vMR_Call_Minutes_2009-11-12.doc‎ Minutes 2009-11-12]
 
  
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2009-11-05.doc‎ Minutes 2009-11-05]
+
== Minutes ==
  
 +
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2013-07-30.docx Minutes 2013-07-30]
  
''' Strawman vMR Model '''
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2013-04-30.doc Minutes 2013-04-30]
  
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_vMR_Refactor_Proposal_Medical_Objects_v2009-12-17.zip vMR Strawman version 2009-12-17 (zip file)]
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2013-04-02.doc Minutes 2013-04-02]
  
- XMI file can be uploaded into any UML editor
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2013-03-19.doc Minutes 2013-03-19]
  
- .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
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2013-03-12.doc Minutes 2013-03-12]
  
 +
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2013-02-19.doc Minutes 2013-02-19]
  
''' Archived Strawman vMR Models '''
+
[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_vMR_Strawman_Model_v2009-11-12.zip‎ vMR Strawman version 2009-11-12 (zip file)]
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2011-07-14.doc Minutes 2011-07-14]
  
 +
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2011-07-07.doc Minutes 2011-07-07]
  
''' Strawman vMR Model Change Log '''
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2011-06-30.doc Minutes 2011-06-30]
  
- (please note changes to model as well as rationale, along with date and author information)
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2011-06-23.doc Minutes 2011-06-23]
  
{|style="text-align:left" border="1"
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2011-06-16.doc Minutes 2011-06-16]
|+ Strawman vMR Model Change Log
 
|- style="background:#ffdead;"
 
!Date!!Changes to model!!Rationale!!Author information
 
|-
 
! 2009-11-12
 
| Initial post of strawman model based existing Duke vMR.
 
|
 
| Ken Kawamoto and Guilherme Del Fiol, Duke University
 
|-
 
! 2009-11-12
 
| Added Family History and Allergy classes.  Added concept of population-based query.
 
| Modifications based on group discussion.
 
| vMR working group.
 
|-
 
! 2009-12-17
 
| Updated model with closer alignment to HL7 version 3 structures and data types.
 
| Based on group consensus.
 
| Andrew McIntyre, Medical Objects
 
|}
 
  
 +
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2011-06-02.doc Minutes 2011-06-02]
  
'''Other Working/Reference Documents'''
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2011-05-26.doc Minutes 2011-05-26]
  
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_SampleCCDDocument-QSG-level-3.zip Sample CCD Document]
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2011-04-21.doc Minutes 2011-04-21]
  
[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]
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2011-04-14.doc Minutes 2011-04-14]
  
[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]
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2011-04-07.doc Minutes 2011-04-07]
  
[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]
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2011-03-31.doc Minutes 2011-03-31]
  
[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]
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2011-03-24.doc Minutes 2011-03-24]
  
[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]
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2011-03-17.doc Minutes 2011-03-17]
  
[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]
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2011-03-10.doc Minutes 2011-03-10]
  
 +
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2011-03-03.doc Minutes 2011-03-03]
  
'''ISO 21090 Datatypes References'''
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2011-02-24.doc Minutes 2011-02-24]
  
These links reference the HL7 SVN server. If required, supply a username of "anonymous" and a blank password.
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2011-02-17.doc Minutes 2011-02-17]
  
[http://gforge.hl7.org/svn/hl7v3/trunk/dt/iso/ISO%2021090%20Healthcare%20Datatypes.pdf ISO 21090 Healthcare Datatypes Published Standard]
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2011-02-10.doc Minutes 2011-02-10]
  
[http://gforge.hl7.org/svn/hl7v3/trunk/dt/iso/iso-21090-datatypes.xsd ISO 21090 Healthcare Datatypes XML Schema]
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2011-02-03.doc Minutes 2011-02-03]
  
 +
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2011-01-27.doc Minutes 2011-01-27]
  
'''HL7 V3 Datatypes SVN'''
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2011-01-20.doc Minutes 2011-01-20]
  
The HL7 V3 Datatypes SVN is browsable from [http://gforge.hl7.org/gf/project/hl7v3/scmsvn/?action=browse&path=/trunk/dt/ here].
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2011-01-07.doc Minutes 2011-01-07]
  
'''Snip from Abstract datatypes standard as to why we are using ISO datatypes'''
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2010-12-16.doc Minutes 2010-12-16]
  
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.
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2010-12-02.doc Minutes 2010-12-02]
  
 +
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2010-11-18.doc Minutes 2010-11-18]
  
''' What should be the primary objectives of this effort for the short term (next 3-6 months)? '''
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2010-11-11.doc Minutes 2010-11-11]
  
Tentative:  
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2010-11-04.doc Minutes 2010-11-04]
Generation of community consensus on
 
# what types of patient data may be used as inputs for CDS;
 
# what types of inferences may be returned as outputs by a CDS engine; and
 
# the simplest possible information models for these data
 
  
 +
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2010-10-28.doc Minutes 2010-10-28]
  
''' What should be our approach to fulfilling the objectives in a timely manner? '''
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2010-10-21.doc Minutes 2010-10-21]
  
- Create straw-man UML diagrams for vMR
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2010-09-16.doc Minutes 2010-09-16]
- Discuss/modify UML diagrams as initial approach to arriving at common vMR consensus
 
- Explore ballotable formats
 
Potential initial ballot: UML Domain Analysis Model (DAM)
 
Potential further ballot: HL7 v3 model based on DAM
 
- Need to be aware of U.S. meaningful use criteria (e.g., for use of SNOMED for problem lists), other international requirements
 
  
 +
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2010-09-09.doc Minutes 2010-09-09]
  
''' What should be our decision making process? '''
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2010-09-02.doc Minutes 2010-09-02]
  
- Use standard HL7 processes (attempt consensus; if needed, majority vote to decide on most issues at this stage in the process)
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2010-08-26.doc Minutes 2010-08-26]
  
 +
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2010-08-19.doc Minutes 2010-08-19]
  
''' Other current work of note to this project'''
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2010-08-12.doc Minutes 2010-08-12]
  
# GELLO
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2010-07-29.doc Minutes 2010-07-29]
# Infobutton
 
# NQF's Quality Data Set (QDS)
 
# IHE - PCC Content Modules
 
# SAEAF
 
# RIMBAA
 
  
 +
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2010-07-22.doc Minutes 2010-07-22]
  
''' What is a vMR? '''
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2010-07-08.doc Minutes 2010-07-08]
  
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.  
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2010-07-01.doc Minutes 2010-07-01]
  
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.
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2010-06-24.doc Minutes 2010-06-24]
  
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.
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2010-06-10.doc Minutes 2010-06-10]
  
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").  
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2010-05-27.doc Minutes 2010-05-27]
  
'''SAEAF Framework'''
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2010-05-06.doc Minutes 2010-05-06]
  
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.  
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2010-03-25.doc Minutes 2010-03-25]
  
{|style="text-align:left" border="1"
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2010-03-18.doc Minutes 2010-03-18]
|+ vMR modelled in SAEAF
 
|- style="background:#ffdead;"
 
!!![[Enterprise|Enterprise View]]!![[Information|Information View]]!![[Computational|Computational View]]!![[Engineering|Engineering View]]!![[Technology View]]
 
|-
 
!Conceptual
 
|
 
|[[HL7/ISO Datatypes]]  [[Classes in the vMR Model]]
 
|[[vMR Examples]]
 
|
 
|
 
|-
 
!Platform Independent
 
|
 
|[[vMR UML Model]]
 
|[[ISO 21090 datatypes]]
 
|[[GELLO Class definition]]
 
|
 
|-
 
!Platform Specific
 
|
 
|[[LRA Models]]
 
|[[CCD]] [[RMIM View]]
 
|
 
|
 
|}
 
  
 +
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2010-03-11.doc Minutes 2010-03-11]
  
'''More on the 'virtual' in vMR'''
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2010-03-04.doc Minutes 2010-03-04]
  
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.
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2010-02-18.doc Minutes 2010-02-18]
  
 +
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2010-02-11.doc Minutes 2010-02-11]
  
'''Distinction from reference models'''
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2010-01-28.doc Minutes 2010-01-28]
  
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.
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2010-01-07.doc Minutes 2010-01-07]
  
Additional classes can be included such as ProblemList, FamilyHistory and Procedures.  
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2009-12-17.doc Minutes 2009-12-17]
  
 +
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2009-12-03.doc Minutes 2009-12-03]
  
'''Potential vMR sources'''
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2009-11-19.doc Minutes 2009-11-19]
  
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:
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2009-11-12.doc Minutes 2009-11-12]
  
# SAGE vMR model
+
[http://wiki.hl7.org/index.php?title=Image:HL7vMR_Call_Minutes_2009-11-05.doc Minutes 2009-11-05]
# HL7 Care Record Model
+
 
# Logical Record Architecture (NHS)
+
 
# Different participating institutions’ vMR models
+
== Archived/Historical Content ==
# Comment-only HL7 vMR ballot
+
 
# RMIMs such as Clinical Genomics
+
See http://wiki.hl7.org/index.php?title=Virtual_Medical_Record_(vMR)_Archive

Latest revision as of 19:34, 22 September 2014

Coordinator

  • Kensaku Kawamoto, M.D., Ph.D., M.H.S. - CDS Co-Chair (kensaku.kawamoto@utah.edu)


vMR Standards

See http://wiki.hl7.org/index.php?title=HL7_CDS_Standards for links to the latest versions of the HL7 vMR standards.


Project Scope Statement

Project Scope Statement, v2010-03-08


Cross-Institutional CDS Needs Analysis and Associated Manuscript

CDS data needs analysis, vFinal

Manuscript presented at 2010 AMIA conference


Minutes

Minutes 2013-07-30

Minutes 2013-04-30

Minutes 2013-04-02

Minutes 2013-03-19

Minutes 2013-03-12

Minutes 2013-02-19

Minutes 2011-07-21

Minutes 2011-07-14

Minutes 2011-07-07

Minutes 2011-06-30

Minutes 2011-06-23

Minutes 2011-06-16

Minutes 2011-06-02

Minutes 2011-05-26

Minutes 2011-04-21

Minutes 2011-04-14

Minutes 2011-04-07

Minutes 2011-03-31

Minutes 2011-03-24

Minutes 2011-03-17

Minutes 2011-03-10

Minutes 2011-03-03

Minutes 2011-02-24

Minutes 2011-02-17

Minutes 2011-02-10

Minutes 2011-02-03

Minutes 2011-01-27

Minutes 2011-01-20

Minutes 2011-01-07

Minutes 2010-12-16

Minutes 2010-12-02

Minutes 2010-11-18

Minutes 2010-11-11

Minutes 2010-11-04

Minutes 2010-10-28

Minutes 2010-10-21

Minutes 2010-09-16

Minutes 2010-09-09

Minutes 2010-09-02

Minutes 2010-08-26

Minutes 2010-08-19

Minutes 2010-08-12

Minutes 2010-07-29

Minutes 2010-07-22

Minutes 2010-07-08

Minutes 2010-07-01

Minutes 2010-06-24

Minutes 2010-06-10

Minutes 2010-05-27

Minutes 2010-05-06

Minutes 2010-03-25

Minutes 2010-03-18

Minutes 2010-03-11

Minutes 2010-03-04

Minutes 2010-02-18

Minutes 2010-02-11

Minutes 2010-01-28

Minutes 2010-01-07

Minutes 2009-12-17

Minutes 2009-12-03

Minutes 2009-11-19

Minutes 2009-11-12

Minutes 2009-11-05


Archived/Historical Content

See http://wiki.hl7.org/index.php?title=Virtual_Medical_Record_(vMR)_Archive