1. Using Detailed Clinical Models to bridge the gap between clinicians and HIT: ISO NIWP 191 open for voting ISO WG1, Edinburgh, 26/27 April 2009 William Goossen PhD RN Results 4 Care

2. Why do we need DCM? Specifying clinical data elements for use in EHR and electronic messages undisputed (ISO resolution clinical involvement, JWG, HL7 CIC) Numerous attempts are ongoing in splendid isolation, in particular within working groups of standards organisations themselves No scientific approach in reviewing and referring to existing materials, Debate who is the best versus few testing results Explosive growth of such developments, each with its own purpose and methods applied, with different levels of quality and usefulness.

3. Key: Re-usability of work Costs for EHR and messaging projects Non-availability of clinicians for standards work (please let them do where they are good at) Need for exchange of patient data for both continuity of care, lifetime records and secondary data use Require to make optimal use of resources

4. Requirements of DCM Primairy process Continuity of care Q- indicator Decision Support Clinical trial Epidemiology Financial & Management © info@results4care.nlinfo@results4care.nl

6. Assumption From the clinical perspective: the technical format is not that important, thus: OpenEHR archetypes = HL7 v3 template = HL7 v3 R-MIM = clinical data definition = 13606 archetype = XML representation = detailed clinical model, if conceptual level is addressed In other words: medically it should be equivalent. Of course from technical viewpoint – the level 2 modelling – it is not (completely) true, but an approach to work with. Clinical Specification Generic Information model Different technical / standard implementations

7. Project vital signs Input:Clinical use cases Measure vital signs (manual or through device) Document vital signs in EHR Exchange vital signs data continuity of care Reuse data on vital signs for purpose X Input:Data elements from various repositories: review and include codes DCM model review Blood pressure, temperature, breathing frq HL7 v3 conformance statements as in CDA HL7 v3 template clinical statement in XML

8. CEDSR

10. Contact / questions: W.T.F. Goossen RN PhD Results 4 Care B.V. De Stinse 15 3823 VM Amersfoort The Netherlands Phone: + 31 654614458 Fax: +31 33 2570169 Mail: wgoossen@results4care.nlwgoossen@results4care.nl www.results4care.nl