The Health Innovation Exchange

The World has voted for a single clinical content modelling formalism - and the result is...

One big challenge in health informatics is to obtain structured and coded data in clinical practice and then being able to make different systems understand their meaning - aka the 'semantic interoperability'. Biomedical terminology, like SNOMED, is important; however having common 'content models' (such as how to represent blood pressure measurement or APGAR score) is essential. These are, in engineering terms, are computable information models. It is really these clinically meaningful 'units of clinical discourse' as you like that clinicians exchange in real world when dealing with patient information or other stuff like population health and research and not individual terms and codes. Unfortunately there has been no agreed way of expressing clinical models and this has been recognised as a critical problem by experts. So I'm talking about UML, HL7 v3, CDA, CCD, CCR, openEHR, ISO 13606 and even ontologies and web standards like OWL.

I'd like to inform that the Clinical Information Modelling Initiative (CIMI) formed by some 'high caliber' organisations has voted for a single formalism and here's the media release. I'm happy to tell that our newly baked Reference Architecture for Interoperability, soon to be HISO standards, in underpinned by these principles and formalisms.

[press release from the CIMI group]

The Clinical Information Modeling Initiative is an international collaboration that is dedicated to providing a common format for detailed specifications for the representation of health information content so that semantically interoperable information may be created and shared in health records, messages and documents. CIMI has been holding meetings in various locations around the world since July, 2011. All funding and resources for these meetings have been provided by the participants. At its most recent meeting in London, 29 November - 1 December 2011, the group agreed on the following principles and approach.

Principles

1. CIMI specifications will be freely available to all. The initial use cases will focus on the requirements of organisations involved in providing, funding, monitoring or governing healthcare and to providers of healthcare IT and healthcare IT standards as well as to national eHealth programs, professional organisations, health providers and clinical system developers.

2. CIMI is committed to making these specifications available in a number of formats, beginning with the Archetype Definition Language (ADL) from the openEHR Foundation (ISO 13606.2) and the Unified Modeling Language (UML) from the Object Management Group (OMG) with the intent that the users of these specifications can convert them into their local formats.

3. CIMI is committed to transparency in its work product and process.

Approach

ADL 1.5 will be the initial formalism for representing clinical models in the repository.
- CIMI will use the openEHR constraint model (Archetype Object Model:AOM).
- Modifications will be required and will be delivered by CIMI members on a frequent basis.
A set of UML stereotypes, XMI specifications and transformations will be concurrently developed using UML 2.0 and OCL as the constraint language.
A Work Plan for how the AOM and target reference models will be maintained and updated will be developed and approved by the end of January 2012.
- Lessons learned from the development and implementation of the HL7 Clinical Statement Pattern and HL7 RIM as well as from the Entry models of 13606, openEHR and the SMART (Substitutable Medical Apps, Reusable Technologies) initiative will inform baseline inputs into this process.
A plan for establishing a repository to maintain these models will continue to be developed by the group at its meeting in January.

Representatives from the following organizations participated in the construction of this statement of principles and plan