Virtual Medical Record (vMR): A Simplified RIM-Based Data Model for CDS HL7 Work Group Meeting, San Diego, CA September 2011 Kensaku Kawamoto, MD, PhD Director, Knowledge Management and Mobilization Assistant Professor, Department of Biomedical Informatics University of Utah [email protected]
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Virtual Medical Record (vMR): A Simplified RIM-Based Data Model for CDS HL7 Work Group Meeting, San Diego, CA September 2011 Kensaku Kawamoto, MD, PhD.
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Virtual Medical Record (vMR): A Simplified RIM-Based Data Model for CDS
HL7 Work Group Meeting, San Diego, CASeptember 2011
Kensaku Kawamoto, MD, PhD
Director, Knowledge Management and MobilizationAssistant Professor, Department of Biomedical Informatics
• A “holy grail” of clinical informatics is scalable, interoperable CDS
• Key requirement for interoperable CDS and re-use of CDS knowledge resources = use of a common patient data model– Referred to as a “Virtual Medical Record” or vMR
(Johnson et al., AMIA Annu Symp Proc, 2001)
• Lack of a common vMR is a major barrier to sharing knowledge and scaling CDS– Known as the “curly braces” problem in Arden Syntax
Example Challenge without VMR
Observation Blood PressureCode = BP Systolic = 120 mmHg
Value = 120/80 mmHg Diastolic = 80 mmHg
Observation Vital Sign Code = BP Type = BP Observation Value = 120/80 Code = SBP Units = mmHg Value = 120 mmHg Observation Code = DBP Value = 80 mmHg
vMR Goal
• Provide common information model upon which interoperable clinical decision support resources (e.g., rules) can be developed
• Desired attributes:– VMR instances can be derived from HL7 V3 artifacts, in
particular CCD and Pedigree instances– VMR instances can be populated from HL7 V2 messages,
in particular for laboratory data– Leverage Detailed Clinical Models– Capable of being easily understood and used by
clinicians/analysts without significant V3 training
Project History
• Analysis of data required by 20 CDS systems from 4 countries
• Analysis of HL7 CCD, Pedigree, Clinical Statement, and other relevant models
• Use of greenCDA/greenCCD as an example approach to simplification
• Trial implementation of vMR via OpenCDS• Under ballot for September 2011 Work Group cycle
• Template specifications– For standard data models (e.g., CCD, Pedigree, Care Plan)– For common types of CDS (e.g., drug-drug interactions,
vaccine forecasting, family history risk analysis)
• Transformations to/from standard models• Alignment with relevant ongoing HL7 work (e.g.,
CSP, RFH, detailed clinical models)• Version 1.1 based on implementation experience
(e.g., via OpenCDS)
OpenCDS
• Standards-based, open-source clinical decision support (CDS) Web service– Uses HL7 Decision Support Service (DSS) interface– Uses standard data payloads (e.g., CCD, VMR)– Uses standard internal data model (VMR)
OpenCDS – Architectural Overview
Decision Support Service
Decision Support Service
Knowledge Modules
Knowledge Modules
Institution A Institution A
Client Decision Support Apps
Client Decision Support Apps
Patient Data Sources
Patient Data Sources
Queries for required ptdata
Queries for required ptdata
Institution B Institution B
Client Decision Support Apps
Client Decision Support Apps
Patient Data Sources
Patient Data Sources
Queries for required ptdata
Queries for required ptdata
Conclusions about patientConclusions about patient
Patient data, knowledge modules to use
Patient data, knowledge modules to use
Trigger
Standard Interface:HL7/OMG Decision Support Service Standard
(http://hssp-dss.wikispaces.com)
Standard Data Models:HL7 Virtual Medical Record (vMR) Standard
University of Utah HLN Consulting, LLC Apelon, Inc. Intermountain Healthcare Veterans Health Administration Wolters Kluwer Health EBSCO Univ. of NC at Chapel Hill Main Line Health Stanford University Keona Health Mass. General Hospital
Hospital Universitario Virgen del Rocío, Spain
MaRS Innovation, Canada SmartCare, Africa Emetra AS, Norway Visumpoint, LLC Genesys, LLC df8health Religent, Inc. IsoDynamic, Inc. Calcudos.com, Inc. CogniTech Corporation
Key Components of OpenCDS
• Standard interfaces and data models– Reference implementation of HL7/OMG DSS interface– vMR data model– Data mappers (e.g., for CCD vMR)