Information Models & FHIR It’s all about content!

Koray Atalag MD, PhD, FACHI k.atalag@auckland.ac.nz

Vice Chair HL7 New Zealand

Chair openEHR New Zealand

openEHR Localisation Program Leader

Member HISO

Programmes of research in

• Health informatics & technology

• Clinical trials

• Cardiovascular disease

• Addictions

• Nutrition & physical activity

Research services

Teaching

• PG Diploma in Health Informatics

• MSc & PhD

(Clinical) Information Models Myths and Facts

• They are NOT reference information models; – as in HL7 v3 RIM, openEHR/ISO13606 or FHIR resource ontology!

• They are pure representations of health information

• They may employ a number of formats and methods; inc. – Mindmaps, pdf, UML, XML/XSD, Archetypes, FHIR resources and even

OO language implementations

• For max semantic interoperability & computability: formal reference information model – but can be very generic!

• Latest buzzword: Detailed Clinical Models (DCM)

What’s in the name?

Terminology: Labels/codes attached to atomic concepts (mostly without explicit context)

– Diabetes Mellitus, ear ache, left hip, CT scan etc.

Some have hierarchy (ICD) & relationships (SNOMED)

Boundary Problem Terminology binding

Information Model: structure and semantics of concrete clinical concepts w/ context

– Blood pressure measurement, lab test result, discharge summary, adverse reaction, prescription etc.

The Hard Way:

Coronary

arteriosclerosis

Structural

disorder of heart

Heart disease

Cardiac finding

Cardiovascular

finding

Finding by site

Clinical finding

SNOMED CT

Concept

Mediastinal

finding

Finding of region

of thorax

Finding of trunk

structure

Finding of body

region

Viscus structure

finding

Disorder of

mediastinum

Disorder of

thorax

Disorder of trunk

Disorder by

body site

Disease

Disorder of body

system

Disorder of body

cavity

Disorder of

cardiovascular

system

Disorder of

coronary artery

Coronary artery

finding

Arterial finding

Blood vessel

finding

General finding

of soft tissue

Disorder of soft

tissue of thoracic

cavity

Disorder of soft

tissue of body

cavity

Disorder of soft

tissue

Disorder of

artery

Vascular

disorder

Arteriosclerotic

vascular disease

Soft tissue

lesion

Degenerative

disorder

Structure with terminology: SNOMED Inconsistencies due to different post-coordination of concepts

In a vasculitis physical examination: “Vascular exams: Carotid Right/Tender”

247348008 | tenderness (finding) | : 363698007 | finding site | = 69105007 | Carotid artery structure (body structure) | : 24028007 | Right (qualifier value) |

_____________________________________________________________________________

301390006 | tenderness of cardiovascular structure | :

363698007 | finding site | = 69105007 | Carotid artery structure (body structure) |:

272741003 | laterality | = 24028007 | Right (qualifier value) |

_______________________________________________________________________________

309655006 | On examination-artery (finding) | :

69105007 | Carotid artery structure (body structure) | :

24028007 | Right (qualifier) |:

247348008 | tenderness |

_______________________________________________________________________________

401050002 | Carotid artery finding (finding) | :

363698007 | finding site | = 69105007 | Carotid artery structure (body structure) | :

272741003 | laterality | = 24028007 | Right (qualifier value) | :

247348008 | tenderness |

Problem/Diagnosis Archetype (Nehta)

Archetype terminology binding

Open specs, tools and content for representing health information & building EHR – Based on 18+ years of international implementation experience

including Good European Health Record Project

– Origin of ISO/CEN 13606 EHR standard

Not-for-profit organisation - established in 2001 www.openEHR.org

“Inside Systems” vs HIE

Separation of clinical and technical worlds

• Big international community

& Archetypes

• FHIR resources and Archetypes are closely related – should avoid reinvention at all costs!

• Archetype FHIR resource conversion is expected to be seamless – Archetypes are maximal datasets; as opposed to

– FHIR resources include most commonly used items (e.g. 80%) with an option to extend as needed (e.g. 20%)

• An opportunity exists for FHIR to leverage openEHR content, tooling and expertise

FHIR: Adverse Reaction Resource

ADR Archetype (from CKM tool)

Getting closer…

HISO 10040 Interoperability Reference Architecture

10040.1 R-CDRs

XDS

10040.2 CCR

SNOMED CT openEHR

10040.3 CDA

Acknowledge Alastair Kenworthy

What is a Content Model?

• IT IS A REFERENCE LIBRARY – of validated information models for health information exchange (and more!)

• Consists of maximal datasets (as opposed to minimal) – normalised using a standard EHR record organisation (openEHR) – Expressed as reusable and computable models – Archetypes

• Top level organisation follows CCR

• Only relevant items bound to SNOMED, ICD, LOINC etc.

• Further detail provided by: – Existing relevant sources (CCDA, Nehta, epSoS, HL7 FHIR etc.) – Extensions (of above) and new Archetypes (NZ specific)

• Each HIE content (CDA/FHIR/v2) will include one or more models and formally conform

Usage of the Content Model

Exploiting Content Model for Secondary Use

Single Content Model

CDA

FHIR

HL7 v2/3

EHR Extract

UML

XSD/XMI

PDF

Mindmap

PAYLOAD

System A

Data Source A

Map

To

Content

Model

System B

Data Source B

Native openEHR Repository

Secondary Use

Map

To

Content

Model

Automated Transforms

No Mapping

Questions? k.atalag@auckland.ac.nz