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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 (
* Kensaku Kawamoto, M.D., Ph.D., M.H.S. - CDS Co-Chair (
== Project Scope Statement ==
== vMR Standards ==
[ Project Scope Statement, v2010-03-08]
See for links to the latest versions of the HL7 vMR standards.
== Cross-Institutional CDS Needs Analysis and Associated Manuscript Proposal ==
[ CDS data needs analysis, vFinal]
[ Manuscript proposal, v2010-03-15c (submitted for 2010 AMIA conference)]
== Project Scope Statement ==
[ Project Scope Statement, v2010-03-08]
== vMR Project calls ==
Next call July 29, 2010
Thursdays (every week) from 4:30pm to 5:30pm US Eastern Time ET
== Cross-Institutional CDS Needs Analysis and Associated Manuscript ==
Announcements are sent over the CDS list.
[ CDS data needs analysis, vFinal]
Live Meeting
[ Manuscript presented at 2010 AMIA conference]
Dial-in: 770-657-9270 begin_of_the_skype_highlighting              770-657-9270      end_of_the_skype_highlighting begin_of_the_skype_highlighting              770-657-9270      end_of_the_skype_highlighting, Passcode 687054
== Minutes ==
== Minutes ==
[‎ Minutes 2010-07-22]
[ Minutes 2013-07-30]
[‎ 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]
== Big Picture/Direction Proposals ==
[ vMR proposal by Keith Boone, v2010-07-29]
[ Big picture proposal by David Shields, v2010-06-07]
== May 2010 Ballot Comments ==
[ Comments on May 2010 informative ballots for vMR Domain Analysis Model, v2 implementation guide, and GELLO implementation guide]
== vMR Domain Analysis Model (Draft) ==
[ May 2010 informative ballot for vMR Domain Analysis Model, v2010-03-28]
[ 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)]
- 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.
- .eap file can be opened by free Enterprise Architect viewer, available at, which is within
- XMI file can be uploaded into any UML editor
''' Archived vMR Domain Analysis Models '''
[ 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)]
== Federal Health Information Model (FHIM) -- being explored for use as basis for vMR ==
[ FHIM in XMI format, v2010-07-08]
[ FHIM in UML format, v2010-07-08]
[ FHIM in Rational Software Modeler format, v2010-06-24]
[ FHIM in Rational Software Modeler format, v2010-06-24]
== Documents related to Family History Modeling within vMR ==
[ Family History vMR proposal by Andrew McIntyre, v2010-07-08]
[ Family History vMR proposal by Andrew McIntyre, v2010-07-08]
== vMR V2 Implementation Guide (Draft) ==
[ V3 Family History instance example from HL7 Clinical Genomics Work Group]
== vMR GELLO Implementation Guide (Draft) ==
[ May 2010 informative ballot for vMR GELLO Implementation Guide, v2010-03-28]
[ 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)]
- 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.
- .eap file can be opened by free Enterprise Architect viewer, available at, which is within
- XMI file can be uploaded into any UML editor
''' Archived vMR UML Models for GELLO  '''
[ vMR UML Model for GELLO, Medical-Objects, version 2009-12-17]
== Working/Reference Content ==
[[Discussion of RIM to VMR mapping]]
'''Other Working/Reference Documents'''
[ Minutes 2013-04-30]
[ Model transformation white paper from Galen Mulrooney]
[ Minutes 2013-04-02]
[ HL7 V3 Pedigree schemas and sample]
[ Minutes 2013-03-19]
[ Updated vMR Project Scope Document endorsed unanimously by 13 vMR project participants on 1/28/10 project call]
[ Minutes 2013-03-12]
[ Updated vMR Project Scope Document circulated to CDS list for comment on 1/27/10]
[ Minutes 2013-02-19]
[ 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]
[ Minutes 2011-07-21]
[ Representing data from CDA sample in a vMR instance, 2010-01-28]
[ Minutes 2011-07-14]
[ Peer Review Comments, 2010-01-20]
[ Minutes 2011-07-07]
[ Representing vMR Data in HL7 V2 Messages]
[ Minutes 2011-06-30]
[ Example CCD Instance as HL7 V2 Message]
[ Minutes 2011-06-23]
[ Thoughts on Distinctions Between CCD and vMR, v2010-01-20 ]
[ Minutes 2011-06-16]
[ UK NHS Individual Health Record (IHR) Model and Background, v2010-01 ]
[ Minutes 2011-06-02]
[ Strawman vMR derived from CDA, 2010-01-07]
[ Minutes 2011-05-26]
[ Strawman vMR expressed in GELLO format, 2010-01-07]
[ Minutes 2011-04-21]
[ Sample CCD Document]
[ Minutes 2011-04-14]
[ vMR Refactor Proposal from Medical Objects, v2009-12-03]
[ Minutes 2011-04-07]
[ Comments on 12/03/09 refactor proposal and results of group discusioon on 12/03/09]
[ Minutes 2011-03-31]
[ vMR Refactor Proposal from Medical Objects, v2009-11-19]
[ Minutes 2011-03-24]
[ Comparison of vMR Strawman Model vs PCC Content Modules,]
[ Minutes 2011-03-17]
[ vMR Family History GELLO Use Cases, v2009-11-19]
[ Minutes 2011-03-10]
[ vMR Family History Model From GELLO Use Cases, v2009-11-19]
[ Minutes 2011-03-03]
[ Minutes 2011-02-24]
'''ISO 21090 Datatypes References'''
[ Minutes 2011-02-17]
These links reference the HL7 SVN server. If required, supply a username of "anonymous" and a blank password.
[ Minutes 2011-02-10]
[ ISO 21090 Healthcare Datatypes Published Standard]
[ Minutes 2011-02-03]
[ ISO 21090 Healthcare Datatypes XML Schema]
[ Minutes 2011-01-27]
Other documents:
[ Minutes 2011-01-20]
[[ISO Datatypes in GELLO Format]]
[ Minutes 2011-01-07]
[ ISO 21090 data types in GELLO format]
[ Minutes 2010-12-16]
'''HL7 V3 Datatypes SVN'''
[ Minutes 2010-12-02]
The HL7 V3 Datatypes SVN is browsable from [ here].
[ Minutes 2010-11-18]
'''Snip from Abstract datatypes standard as to why we are using ISO datatypes'''
[ Minutes 2010-11-11]
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 [] for further information.
[ Minutes 2010-11-04]
[ Minutes 2010-10-28]
''' What should be the primary objectives of this effort for the short term (next 3-6 months)? '''
[ Minutes 2010-10-21]
[ Minutes 2010-09-16]
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
[ Minutes 2010-09-09]
''' What should be our approach to fulfilling the objectives in a timely manner? '''
[ Minutes 2010-09-02]
- Create straw-man UML diagrams for vMR
[ Minutes 2010-08-26]
- 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
[ Minutes 2010-08-19]
''' What should be our decision making process? '''
[ Minutes 2010-08-12]
- Use standard HL7 processes (attempt consensus; if needed, majority vote to decide on most issues at this stage in the process)
[ Minutes 2010-07-29]
[ Minutes 2010-07-22]
''' Other current work of note to this project'''
[ Minutes 2010-07-08]
[ Minutes 2010-07-01]
# Infobutton
# NQF's Quality Data Set (QDS)
# IHE - PCC Content Modules
[ Minutes 2010-06-24]
''' What is a vMR? '''
[ Minutes 2010-06-10]
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.  
[ Minutes 2010-05-27]
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.
[ Minutes 2010-05-06]
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.
[ Minutes 2010-03-25]
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").  
[ Minutes 2010-03-18]
'''SAEAF Framework'''
[ Minutes 2010-03-11]
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.  
[ Minutes 2010-03-04]
{|style="text-align:left" border="1"
[ Minutes 2010-02-18]
|+ vMR modelled in SAEAF
|- style="background:#ffdead;"
!!![[Enterprise|Enterprise View]]!![[Information|Information View]]!![[Computational|Computational View]]!![[Engineering|Engineering View]]!![[Technology View]]
|[[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]]
[ Minutes 2010-02-11]
'''More on the 'virtual' in vMR'''
[ Minutes 2010-01-28]
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.
[ Minutes 2010-01-07]
[ Minutes 2009-12-17]
'''Distinction from reference models'''
[ Minutes 2009-12-03]
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.
[ Minutes 2009-11-19]
Additional classes can be included such as ProblemList, FamilyHistory and Procedures.  
[ Minutes 2009-11-12]
[ Minutes 2009-11-05]
'''Potential vMR sources'''
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:
== Archived/Historical Content ==
# SAGE vMR model
# HL7 Care Record Model
# Logical Record Architecture (NHS)
# Different participating institutions’ vMR models
# Comment-only HL7 vMR ballot
# RMIMs such as Clinical Genomics

Latest revision as of 19:34, 22 September 2014


  • Kensaku Kawamoto, M.D., Ph.D., M.H.S. - CDS Co-Chair (

vMR Standards

See 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 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