MOHH – Models Submission Dr Linda Bird 9 th August 2012

Strategic vision of patients moving seamlessly across the healthcare system, receiving coordinated patient-centric care at the most appropriate settings. Enabled by the National Electronic Health Record (EHR) Singapore’s Future Healthcare Landscape

Standards Products Diagnosis - SNOMED CT and Singapore Extension (SE) Drugs - Singapore Drug Dictionary (SDD) Allergic Reactions– SNOMED CT + SE Allergens - SNOMED CT + SDD Laboratory Results – LOINC Data Dictionary – MOHH Data Dictionary Procedures - TBD Reason for visit - SNOMED CT Symptoms and Problems - SNOMED CT and Singapore Extension Laboratory Reports – Smart SNOMED CT Laboratory Orders – SNOMED CT Radiology Orders - SNOMED CT

LIM Development Process

Requirements Clinician Verification Graphical Represent- ations Clinician Input Clinical Modelling Framework Singapore Logical Information Model Clinical Modelling Language (LOM) Clinical Modelling Language (LOM) Logical Reference Model (ISO ) Logical Reference Model (ISO ) Computable Implementation Specification Constrain Instance of Terminology Server References Terminology Ontology Bind values Bind semantics Store Generate Lim Repository Lim Repository Store representation References Input Generate

Clinician Validation of the LIM LIM ID LIM Name LIM Cardin ality LIM Definition LIM Example (for Exchange) LIM Example (for Display) Laboratory Test Item 1 A class describing the laboratory test that was performed. Test Name1 The name of the laboratory test within a panel of tests. ("xxx", "LDH measurement") ("xxx", "Blood sodium measurement") "LDH measurement" "Blood sodium measurement" Sequence Number 0..1 A number that identifies and sequences this laboratory test item within a given panel. "1" "2" Additional Description 0..1 A descriptor used in combination with the Test Name to fully define the description of the laboratory test. POCT Indicator 0..1 The POCT (Point-of-care Testing) indicator at the laboratory test item level. ("xx, "Point of Care Test") "Point of Care Test" Type0..1The type of the test.

WYSIWYG NDDS snippet NXDS LXML XSD NXDS LXML Instance

IsoSemantic Models – Example of Problem e.g. “Suspected Lung Cancer”

IsoSemantic Models – Example Instances e.g. “Suspected Lung Cancer”

IsoSemantic Models – Compositional Grammar Problem Diagnosis = $ProblemDiagnosisName: |associated_finding|= ( |clinical_finding|: |finding_site|=($BodySite: |laterality|=$Laterality), |severity|=$Severity), |finding_context|=$FindingContext

IsoSemantic Models – Equivalence Testing Problem Diagnosis = $ProblemDiagnosisName: |associated finding| = ( |Clinical Finding|: | finding site | = ($BodySite: |laterality| = $Laterality), | severity| = $Severity), | finding context | = $FindingContext GP Problem Diagnosis = |Cancer| : |associated finding| = ( |Clinical Finding| : | finding site | = |Lung|), | finding context | = |Suspected| Polyclinic Problem Diagnosis = |Suspected cancer|: |associated finding| = ( |Clinical Finding|: | finding site | = |Lung|) RH Problem Diagnosis = |Suspected lung cancer|

Bi-directional Semantic Interoperability NEHR Source Data GP - Source Data Design Patterns - Diagnosis DP-based GP - Source Data National Term Research Semantics Transformed GP - Source Data in RH format Transformed GP - Source Data in Polyclinic format Maps In

ENTRY – Observation Entry (Observable Name/Value) Heart Rate/ Blood Pressure / Blood Glucose – Clinical Finding Problem Diagnosis Entry Adverse Reaction Entry Alert Entry – Activity Pharmacy Activity Entry – Pharmacy Order Entry – Pharmacy Dispense Entry – Pharmacy Administration Entry Investigation Activity Entry – Investigation Order Entry – Investigation Result Entry Procedure Entry (Reference Pattern) CLUSTER – Pharmacy Item / Investigation Test Item Submission Overview

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