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QIDAM

QIDAM. Issues and proposals for a logical model For discussion during HL7 WG Meeting in Jan 2014 Thursday Q3. Background. Need to harmonize the “clinical data model” for Clinical Decision Support Clinical Quality Information

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QIDAM

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  1. QIDAM Issues and proposals for a logical model For discussion during HL7 WG Meeting in Jan 2014 Thursday Q3

  2. Background • Need to harmonize the “clinical data model” for • Clinical Decision Support • Clinical Quality Information • Currently, there are multiple specifications that address these domains • Virtual Medical Record • Quality Data Model • Health Quality Measures Framework (Data request in r2) • Clinical Statements and associated templates in HQMF, QRDA, CCDA

  3. Quality Improvement DAM • Conceptual model that aims to harmonize the domains • Represented as a UML class diagram • Concepts modeled mostly by drawing from vMR, FHIR, QDM • QIDAM was submitted for ballot for the Jan 2014 cycle • The scope was incomplete – not all clinical concepts were modeled • Will add significantly to the scope for the May cycle

  4. Next steps • How do we get to a logical model? • What is the foundation of the logical model? • V3 • FHIR • VMR • Other? • Integration of the logical model into the existing specifications

  5. Two aspects of CQI Applying the knowledge to a patient Patient data interoperability and exchange Examples Quality reports: QRDA Transitions of care: CDA CDS: VMR, CDA Data models Used in instances of patient data Clinical statement and CCDA/QRDA templates VMR and templates Specifying the knowledge and using it in reasoning • Knowledge specifications and interoperability • Examples • Measure specs: HQMF • CDS artifacts: Knowledge Artifacts (Health eDecisions), Arden Syntax MLMs • Data models • Used in expressions about patient data QDM VMR Data exchange model Reasoning model

  6. Reasoning model versus data exchange model • Reasoning model requirements/desiderata may be different than for data exchange model • Important example: a reasoning model must be compact so that expressions in these approaches can be easy to read, write, and implement • Many data exchange models already • V2 • V3 • QRDA, CCDA • VMR • FHIR

  7. Expressions in reasoning model and in data exchange model • In QDM: • Diagnosis, Active • using “Asthma Value Set” • In Clinical Statement pattern: • Act [classCode=“ACT” and moodCode=“EVN”] • code = (“LOINC Code for Problem”) and • sourceOf[typeCode=“COMP”] • observation[classCode=“OBS” and moodCode=“EVN”] • code=“SNOMED-CT Code for Problem” • value = “Asthma Value Set” • sourceOf[typeCode=“REFR”] • observation[classCode=“OBS” and moodCode=“EVN”] • code=“LOINC Code for Status” • value=“SNOMED-CT code for Active”

  8. SAIF Model QIDAM QI Logical Model Clinical Statement VMR Logical Model VMR ITS, CCDA, QRDA, HQMF

  9. Proposal • Focus on a reasoning model • Where there is a need, created mappings between the relevant data exchange model and the reasoning model • E.g., We must map from QRDA to reasoning model used in HQMF • Advantages • Addresses the immediate issue in harmonization of HQMF and HeD Knowledge artifacts • Does not create yet another data exchange model

  10. Issues in creating the reasoning model • What form should the reasoning model take? • Quality Improvement Virtual Record (QIVR) • UML model that is a refinement of QIDAM • Possibly replaces or refines the vMR • FHIR profile • Can this meet the needs of a reasoning model? • A RIM refinement • Others? • What is the role of templates?

  11. Recommended approach • Create a FHIR profile from QIDAM • Create a hierarchical logical model equivalent to the FHIR profile • Used in expressions • Advantages • Reuse of models/profiles/resources created by other WGs • E.g., medication-related resource created by Pharmacy • Avoids creating another model • Tooling of FHIR • Mappings of FHIR to CDA family • RDF mapping – enables CDS

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