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

2. 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)

3. 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

4. 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

5. vMR - Example GELLO usage

6. vMR – GELLO Examples

7. vMR – UML Overview

8. 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

9. 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)

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

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