MRMC Conference Call July 21, 2010 Stanley M Huff, MD Chief Medical Informatics Officer

1. Isosemantic Family of Models for Systolic Blood Pressure MRMC Conference Call July 21, 2010 Stanley M Huff, MD Chief Medical Informatics Officer

2. Mods - Component CE’s which change the meaning of the Value Choice. Quals - Component CE’s which give more information about the Value Choice. Core Clinical Element Abstract Model

3. Simplified Representation

4. Most Pre – Coordinated Model PatientSystolicBPRightArmSittingAdultCuff PatientSystolicBPRightArmSittingAdultCuffObs 138 mmHg data quals AbnormalFlag abnormalFlag DeltaFlag deltaFlag ReferenceRangeNar referenceRangeNar “Standard Qualifiers” In Subsequent Models RelativeTemporalContext relativeTemporalContext Observed observed ReportedReceived reportedReceived Verified verified

5. Post Coordinated “Subject” SystolicBPRightArmSittingAdultCuff SystolicBPRightArmSittingAdultCuffObs 138 mmHg data mods Subject subject plus “Standard Qualifiers”

6. Post Coordinated “Subject” and “BodyLocation” SystolicBPSittingAdultCuff SystolicBPSittingAdultCuffObs 138 mmHg data mods Subject subject quals BodyLocationPrecoord bodyLocationPrecoord Right Arm data plus “Standard Qualifiers”

7. Expanded BodyLocation SystolicBPSittingAdultCuffObs SystolicBPSittingAdultCuff 138 mmHg data mods Subject subject quals BodyLocation bodyLocation BodySite bodySite Arm data BodyLaterality bodyLaterality Right data plus “Standard Qualifiers”

8. Post Coordinated “Subject” and “BodyLocation” Expression SystolicBPSittingAdultCuff SystolicBPSittingAdultCuffObs 138 mmHg data mods Subject subject quals BodyLocationExpression bodyLocationExpression “hasBodySite = Arm AND hasLaterality = Right” data plus “Standard Qualifiers”

9. Post Coordinated subject, loc, device SystolicBPSitting SystolicBPSittingObs 138 mmHg data mods Subject subject quals BodyLocationPrecoord bodyLocationPrecoord MethodDevice methodDevice plus “Standard Qualifiers”

10. Post Coordinated subject, loc, device, position SystolicBP SystolicBPObs 138 mmHg data mods Subject subject quals BodyLocationPrecoord bodyLocationPrecoord MethodDevice methodDevice BodyPosition bodyPosition plus “Standard Qualifiers”

11. Fully Atomic SysBP Model SystolicBPObs SystolicBP 138 mmHg data Subject subject BodyLocation bodyLocation BodySite bodySite bodyLaterality BodyLaterality MethodDevice methodDevice BodyPosition bodyPosition plus “Standard Qualifiers”

12. User interface models Convenient for data entry Typically pre-coordinated Many variations Storage models Only one model is designated as the storage model Comprehensive set of qualifiers and modifiers The storage model is referenced in reports, rules, protocols, data analysis Composition – Decomposition mappings Isosemantic models

13. Decomposition Mapping Precoordinated Model (User Interface Model) SystolicBPRightArmSitting SystolicBPRightArmSittingObs 138 mmHg data Post coordinated Model (Storage Model) SystolicBP SystolicBPObs 138 mmHg data quals BodyLocation BodyLocation Right Arm data PatientPosition PatientPosition Sitting data