1. Embrace the Elephant A few provocative questions…

2. Say ‘Hello’ to the pachyderm CIMI is terribly (fatally?) behind schedule Participation continues to fall off Deliverables continue to slip

3. Why Isn’t CIMI (much) Further Along? The premise was relatively simple. There was widespread agreement on both the approach and need. There was a simple and straight forward mission statement. There was a clear set of goals. What have we missed?

4. Possible Causes Not as much agreement as we first thought? – There is disagreement… (to be continued) Not as much demand as first perceived? – If anything, the fact that CIMI still exists belies this. It is absolutely needed Financial / organizational issues? – We can’t underestimate the impact, but we did (and, imo, still do) have a lot of willing contributors… if there is value to be had

5. Possible Causes (continued) Technology problems? – Why? Are we trying to do something that hasn’t been done before? Is the problem was more complex than we first thought? – Not sure I belive this, as there are multiple demonstrated, working solutions

6. My Take (and it is no accident that it is an elephant…) Mission Creep  ! – We have failed to be guided (and constrained by) our core mission and goals – We set out to accomplish a single task – are we still working on a single task? We are making the task much too hard. Our goal is to publish and sanction content – Not to build software – Not to create standards – We are trying to get existing models out, vetted and in use as quickly as possible.

7. CIMI Mission Statement Improve the interoperability of healthcare systems through shared implementable clinical information models. (A single curated collection.)

8. Goals Shared repository of detailed clinical information models Using a single formalism (now support two!) Based on a common set of base data types With formal bindings of the models to standard coded terminologies Repository is open and models are free for use at no cost

9. Assertions 1.Assertion: Any decision we make needs to be justified in terms of our mission and goals – Take, for example: “The reference model should have no semantics that are specific just to healthcare”. How do we justify this?

10. CIMI Mission Statement Improve the interoperability of healthcare systems through shared implementable clinical information models. (A single curated collection.)

11. Assertions (continued) 2. Assertion: We are not trying to be everything to everyone. – The goal of being one thing to a small community is more than enough – The wider community needs what we want to deliver – get something out there and others will “take the ball and run”

12. Is this needed? CIMI supports isosemantic clinical models: – We will keep isosemantic models in the CIMI repository that use a different split between pre-coordination versus post coordination (different split between terminology and information model) – One model in an isosemantic family will be selected as the preferred model for interoperability (as opposed to everyone supporting every model) – Profiles of models for specific use cases will be created by authoritative bodies: professional societies, regulatory agencies, public health, quality measures, etc.)

13. Assertions (continued) Perhaps we can support isosemantic models… … but maybe we should begin by supporting monosemantic models?

14. Assertions (continued) 3. Assertion: We can afford to make (a lot of) mistakes. We already have a wealth of content. – Make a model – Transform the content – Find the issues – Repeat We aren’t building a standard – We can afford to be arbitrary – Mistakes can be corrected quickly – The cost of correcting most mistakes is very small

15. Assertions (continued) 4.It has to be simple – Models should be able to be created using existing, generic tools XML Mind Maps ADL – Validation should be doable using existing technology ADL Workbench XMl Schema and Schematron MDHT

16. The Good News CIMI is still relevant and needed – Other technological solutions are in the pipeline… – … but they are not alternatives to CIMI – We possess content. Large collections of clinical models that can and should be made avaliable ASAP What we have done to date is necessary – But we need to focus on our core deliverables We don’t have to be perfect – We actually don’t even have to do it right… – … we just need to do it

17. Where to From Here ADL and AOM are pretty much ready to go – Start using them now We have a draft repository – Make it official. Start publishing. Start review. Entries in Entries – Decide what CIMI needs. Flexibility is definitely not a goal

18. Proposed RM Goals There should be a single, obvious way to represent any given CIMI model – It should be consistent across all models – It should support a proven, sound philosophy with respect to Modifiers Qualifiers Metadata and minimum information sets

19. Proposed RM Goals It should be possible to write, read and discuss a CIMI model instance without calling on any: – Expensive, non-standard or difficult to use tools – Non-existant tools It should be possible to validate and publish a CIMI model instance using tools that exist today.

20. Next Steps RM – re-examine goals and re-vote – RM should produce a consistent, safe and non- redundant model – It can be healthcare specific – It should be obvious from the model itself If it isn’t documented it doesn’t exist If it is documented, the documentation is accepted at face value.