1. ©2001 Sowerby Centre for Health Informatics at Newcastle Progress on Virtual Medical Record HL7 Salt Lake City

2. ©2001 Sowerby Centre for Health Informatics at Newcastle Requirements Medical record communication From existing EHR to DSS From DSS to EHR E.g. decisions, goals, inferred observations Computer understandable record Semantic interoperability Same problems as EHR system to EHR system communication

3. ©2001 Sowerby Centre for Health Informatics at Newcastle EHR  DSS communication Guideline system  EHR : queries Guideline system  EHR : query results Guideline system  Clinical system : act requests Guideline system  EHR : data recording Guideline system  EHR : decision recording Guideline system  EHR : assessment recording Guideline system  EHR : goal recording

4. ©2001 Sowerby Centre for Health Informatics at Newcastle virtual Medical Record (vMR) Required to represent standardised view of EHR for a – standard names in expressions, result sets b – writing new records to the EHR EHR Guideline Interpreter User Interface 1a 1b

5. ©2001 Sowerby Centre for Health Informatics at Newcastle What is it? Simplification of medical record only has distinctions important to DSS Aim is to find the minimal set of record types & attributes required to achieve semantic interoperability Expression language has to be able to write criteria using these

6. ©2001 Sowerby Centre for Health Informatics at Newcastle Five Basic Classes Observation Intervention Goal Plan Commitment + Patient, Guideline, Agent (Care Provider, DSS)

7. ©2001 Sowerby Centre for Health Informatics at Newcastle Attributes: All Classes Patient (instance of Patient) Care providers Coded concept Recording agent Recording time Where (n.b. no encounter class)

8. ©2001 Sowerby Centre for Health Informatics at Newcastle Observation kinds Quantitative Observation e.g. Height 1.56m Qualitative Observation e.g. ‘nocturnal cough’ Assessment e.g. ‘diagnosis Gestational Diabetes’ Extra attributes Duration of observation

9. ©2001 Sowerby Centre for Health Informatics at Newcastle Qualitative Observation Subjective ‘Primary’ observations, not inferred e.g. symptoms, signs

10. ©2001 Sowerby Centre for Health Informatics at Newcastle Quantitative Observations Objective measurements Additional attribute ‘observed quantity’ Has quantity and units of measure e.g. height, weight, hemoglobin

11. ©2001 Sowerby Centre for Health Informatics at Newcastle Observation questions Inferred flag e.g. BMI calculated from weight and height Use instead of Assessment? e.g. a diagnosis is an observation inferred by clinician ‘Consequence of’ relationship To tie observations to the intervention which generated them. Is this necessary for DSS? e.g. potassium level as result of Chem 7 !!! Implies Causality – should we represent this? Do we need observation subtypes?

12. ©2001 Sowerby Centre for Health Informatics at Newcastle Uncertain list of types Extra attributes ???Reason – obs that cause this intervention Valid time These are ‘done’ interventions Medication Authorisation Dose/admin/quantity & ingred/product/pack CMETS Investigation| Procedure | Education … Schedule appointment + others Intervention is this a useful distinction?

13. ©2001 Sowerby Centre for Health Informatics at Newcastle Goal, Plan, Commitment Important for guideline execution and history of guideline use Extra attribute: context Context = the guideline they came from Expression language has to be able to write criteria using these.

14. ©2001 Sowerby Centre for Health Informatics at Newcastle Goal A (future) observation you wish to achieve, maintain, avoid. e.g. ‘keep blood pressure < 130/85’ Need to be able to cope with these: e.g. ‘miminise side effects’ Extra Observation ‘BP 130/85’ or set{side effects} Type symbols ‘maintain, less than’, ‘avoid, any of’

15. ©2001 Sowerby Centre for Health Informatics at Newcastle Plan Planned Intervention set Planned intervention will be converted into Act with mood code

16. ©2001 Sowerby Centre for Health Informatics at Newcastle Commitment Decisions made Choice between alternatives e.g. ‘start beta blocker’

17. ©2001 Sowerby Centre for Health Informatics at Newcastle EHR SIG Initial proposed R-MIM provides most of these classes Commitment? EHR SIG have VMR as their second use case Widen their current R-MIM to do VMR

18. ©2001 Sowerby Centre for Health Informatics at Newcastle Questions Workflow – any extensions? Profiles/templates Deliberately avoided Events from EHR Can these be standardised? Need to name them in expressions e.g. Patient has encounter with care provider Add/delete/change to record – subtypes?

19. ©2001 Sowerby Centre for Health Informatics at Newcastle Next steps Clarify any extensions/changes Clarify medication info CMETS Work with HER SIG to extend R-MIM Aim for candidate R-MIM January 2002