vMR – Virtual Medical Record A RIM based model for clinical decision support Andrew McIntyre Medical-Objects

vMR – RIM based Models Uses ISO 21090 Data types Need to add methods to classes for GELLO Uses GELLO (extended OCL) base types (iso21090 uses ocl) Aiming for low hanging fruit eg: Problem List (Past History) Procedures (Surgical History) Family History Allergies Current Medication Medication History Lab Observations Social History (Alcohol/Tobacco)

vMR – Base Model CCD being used as source model Issues Transformable to and from CCR Documented Specified in US realm Potential to develop v2 version (Australia) Issues Family History Model not as rich as desired Allow extensions for Genomics data items (optional) Currently using v1 datatypes As is “Virtual” medical record can be mapped

vMR - Uses Designed for Decision Support Several Use cases Little interest in display data Demands terminology for safe usage SNOMED-CT/ICD-9/ICD-10 Several Use cases Local decision support Decision support services Quality assessments Gello uses it as its Model

vMR - Example GELLO usage

vMR – GELLO Examples

vMR – UML Overview

vMR – Why use “Simplified Model” GELLO usability Navigating to eg: patient would take complex statement Identifying specific clinical data easily GELLO should be written by clinical people Simplify GELLO Interfacing with “Legacy” systems Allow CDS to occur with legacy data Avoid overly complex transformations – “sweet spot hard to find” Allow Clinicians to understand Model Many attributes of RIM are not needed for a snapshot view

vMR – Simplication Examples Direct ACT<->Patient Link vs Person playing role of patient Also link Provider/Organisation CCD has single patient Excludes use on conjoined twins! Current Medications Medication History CCD ACT relationships exposed as typed Properties Family History exposed as object model with direct links to sub-observations CCD could be reconstructed from vMR (except for text)

vMR – Data sources GELLO v1 described a simple vMR as example Implemented against HL7 v2 data as trial In real use in GLIF ISO 13606-2 Archetypes Calculated results in editors

RIMBA relationship RIMBA is ultimate vMR Only likely to need thin Facade to comply Datatypes align Your experience and input is welcome