NHS LRA - e.g. TemperatureObservation ELEMENT (mindmap)

NHS LRA - e.g. TemperatureObservation ELEMENT (mindmap)

Modelling Patterns Review & Suggestions Dr Linda Bird 16th August 2012 Modelling Layers CLUSTER ENTRY SECTION COMPOSITION Add Implementation Purpose Context Dispensed Medications GUI Neonatal Blood Pressure in EHR Current Medication List in EHR Discharge Summary Doc or Message

Add Care Setting Context G.P. Dispensed Medication Item Home Blood Pressure Outpatient Clinic Current Medication List Inpatient Discharge Summary Add Specialty Context Paediatric Medication Item Neonatal Blood Pressure Nephrologist Medication List Cardiology Discharge Summary

Add Use Case Context Dispensed Medication Item Standing Blood Pressure Current Medication List Medication Reconciliation Report Clinical Models Medication Item Blood Pressure Medication List Discharge Summary Modelling Patterns Schedule, Address, Material

Observation, Action Clinical List Event Summary, Assessment Reference Model Modelling Patterns Review openEHR NHS LRA SNOMED CT results4Care DCMs IMH CEMs MOHH LIM VAs Discernables EN13606 Association HL7 v3 RIM

Modelling Patterns Types 1. Clinical Statement Types 2. Isosemantic model structure key concept, qualifiers, modifiers 3. 4. 5. 6. 7. Clinical processes events links History of Events Order state machine and care flow mapping Composition/Document Clinical Model Patterns Reference Range Set, Schedule, Material (Device, Medication), Score/Assessment Scale NHS LRA Care Components Reference Model class extract package constrained classes EXTRACT_CRITERIA AUDIT_INFO RECORD_COMPONENT {leaf} -

{leaf} all_versions: BL [0..1] archetype_ids: II [0..*] max_sensitivi ty : CS [0..1] multi media_i ncluded : BL [0..1] other_constraints: ED [0..1] time_peri od : IVL [0..1] - constraints {all_versi onsDefault} {all_versi onsDefined} {other_constrai ntsDefined} -criteria committer: II.Uuid.Ref ehr_system: II previous_version: II [0..1] reason_for_revision: CD.CV [0..1] time_committed: TS version_set_i d: II [0..1] version_status: CS [0..1] -feeder_audit 0..1 0..1

constraints {version status LRA vocab} {reason for revi sion LRA vocab} 0..* -com mittal - LINK archetype_id: ST [0..1] meaning: CD.CV [0..1] name: ST ori g_parent_ref: II [0..1] policy_ids: II [0..*] rc_id: II.Uui d sensi ti vity: CS [0..1] synthesised: BL -li nks 0..* follow_l ink: BL nature: CS target: II.Uuid.Ref constraints {fol low_li nk default value false} {li nks all owed onl y one target i n LRA}

{target exi sts} {nature LRA vocab} constraints {synthesised defaults to fal se} {sensitivity LRA vocab} 1..1 0..1 EHR_EXTRACT {leaf} - -content COMPOSITION {l eaf} -all_compositions authorising_party: II [0..1] ehr_id: II ehr_system: II rm_id: ST subject_of_care: II ti me_created: T S - 0..*

constraints {rm_id is 13606} contributi on_id: II [0..1] session_ti me: IVL_TS territory: CS [0..1] 0..1 0..* ITEM - obs_time: IVL_TS [0..1] -members constraints {i tem category undefi ned in LRA} 0..* {emphasis undefined i n LRA} -parts 0..* constraints {name value} {composer is of type FUNCT IONAL_ROLE} {there exists one and only one other_participations instance representing the

record target (i.e. subject of care)} 0..1 -i tems CONTENT 0..* SECTION CLUSTER ELEMENT {leaf} demographics -demographic_extract 0..* -composer - -attestations {l eaf} attested_view: ED [0..1] proof: ED [0..1] reason_for_attestati on: CD.CV

target: II.Uuid.Ref [1..*] time: T S constraints {target must exist wi thi n extract} {attester is of type FUNCT IONAL_ROLE} {reason for attestation LRA vocab} 1..* healthcare_faci li ty: II.Uuid.Ref [0..1] mode: CS [0..1] -other_parti cipations performer: II.Uui d.Ref 0..* 1..1 -i nfo_provi der extended PARTICIPATION constraints {secti ons may only contai n (by value) other secti ons} - value: ANY

structure_type: CS constraints {name val ue} {cluster structure type LRA vocab} {meaning is undefined} ENTRY {l eaf} 0..1 -attester 0..1 - -other_parti cipations constraints {function i s undefined i n LRA} {mode LRA vocab} {service setting is undefi ned i n LRA} 0..* ATTESTATION_INFO - 0..1 0..1

FUNCTIONAL_ROLE IDENTIFIED_ENTITY {l eaf} 0..1 0..1 - act_i d: II [0..1] uncertai nty_expressed: BL.Null constraints {uncertainty expressed has null Flavor} {meani ng undefi ned} {entry i tems may only contain el ements} {subject_of_informati on_category undefined in LRA} {subject_of_informati on_category no default in LRA} {act_status is undefi ned i n LRA} {no relati onshi p type conflict i n LRA} {name value} {i nformation_provider is of type FUNCTIONAL_ROLE} RELATED_PARTY {l eaf} -subj ect_of_i nformation 0..1 -

party: II.Uuid.Ref [0..1] relationship: CD.CV.SCT constraints {rel ationshi p code type LRA vocab} NHS LRA ELEMENT patterns class extract package derived classes ITEM ELEMENT BOUND_DATA_ELEMENT constraints {meaning is coded data} {meaning is defined and is not null} OBSERVATION_ELEMENT - value: ANY ::ITEM - emphasis: CD.CV [0] - item_category: CS [0] - obs_time: IVL [0..1] ::RECORD_COMPONENT - name: SC - archetype_id: ST [0..1] - rc_id: II - meaning: CD.CV [0..1] - synthesised: BL

- policy_ids: SET [0..1] - sensitivity: INT [0..1] - orig_parent_ref: II [0..1] constraints ::ITEM { item category undefined in LRA } { emphasis undefined in LRA } ::RECORD_COMPONENT { synthesised defaults to false } MATERIAL_ENTITY_ELEMENT {leaf} constraints {meaning is a material} {name value} {value is type QTY} {obs_time is undefined in LRA} FINDING_OBSERVATION_ELEMENT {leaf} constraints {name value} {meaning is a finding} {value is null} PROPERTY_OBSERVATION_ELEMENT {leaf} constraints {name value} {meaning is observable} {value type not allowed to be time based}

{coded value is observation value} ACTIVITY_ELEMENT constraints {meaning is a procedure} {value is null} INVESTIGATION_ACTIVITY_ELEMENT {leaf} constraints {name value} {meaning is an investigation} UNBOUND_DATA_ELEMENT {leaf} constraints {name value} {meaning undefined} COMPONENT_RELATIONSHIP_ELEMENT {leaf} constraints {name value} {value defines dependency} {must have exactly 2 links} {value is coded data} {one link to subject} {one link to object} {coded meaning from LRA vocab} {meaning is defined}

RECORD_ARTEFACT_ELEMENT {leaf} constraints {name value} {meaning is a record artefact} {value must be null} MATERIAL_ACTIVITY_ELEMENT {leaf} constraints {name value} {meaning is a substance procedure} GENERAL_ACTIVITY_ELEMENT {leaf} constraints {name value} {meaning is a general activity procedure} NHS LRA ELEMENT Domain Models Finding Observations AllergyOrAdverseReactionEvent AllergyOrAdverseReactionPropensity DiagnosisName GenericFindingObservation GenericProblemAndIssue RisksExpectationsOrGoals Property Observations BloodPressureObservation BloodSugarObservation BodyHeightObservation

BodySurfaceAreaObservation BodyWeightObservation DiastolicPressureObservation GenericPropertyObservation PulseRateObservation General Activities GenericAdmissionEvent GenericDischargeEvent GenericProcedure SpecimenCollection Material Activities GenericSpecimen MeasurementDevice ProductOrSubstance Investigation Activities BloodPressureMeasurement BodyHeightMeasurement TemperatureMeasurement Unbound Data AdviceForPatient CourseTiming FutureEventTime InterpretationRange NHS LRA ENTRY Domain Models

GenericClinicalNarrative GenericAdmissionEvent GenericFinding HealthcareActionPlan GenericProblemAndIssue GenericProcedure GenericProperty MedicationReviewPlan ProductOrSubstance ProductOrSubstanceRelatedActivity ProvisionOfInformationAndAdvice RecommendationActivity AllergyOrAdverseReactionEvent GenericAdmissionProspect AllergyOrAdverseReactionPropensity GenericDischargeEvent BloodPressure

BloodSugar GenericTransfer BodyHeight GenericTransferProspect BodySurfaceArea RisksExpectationsAndGoals BodyWeight ProvisionOfAdviceAndInformation Diagnosis FluidIntakeRate GenericAssessment SubjectOfCareObservations GenericInvestigation PulseRate

Temperature TreatmentDevice NHS LRA e.g. Temperature ENTRY omposite structure Temperature UNBOUND_DATA_ELEMENT Text FUNCTIONAL_ROLE_CHOICE InformationProviderChoice HasAnnotation OBJECT 0..* 0..* -items SUBJECT 0..1 PROPERTY_OBSERVATION_ELE... TemperatureObserv ation 0..1 IsResultantObservationOf -items

SUBJECT 1 ENTRY Temperature RELATED_PARTY_CHOICE SubjectOfInformationChoice 0..1 - name: SC {readOnly} rc_id: II synthesised: BL uncertainty_expressed: BL {readOnly} -items 0..1 0..1 INVESTIGATION_ACTIVITY_EL... TemperatureMeasurement OBJECT SUBJECT 0..1 HasClinicalContext

-items 0..* 0..* FINDING_OBSERVATION_ELEM... GenericFindingObserv ation OBJECT 0..* SUBJECT 0..* FUNCTIONAL_ROLE_CHOICE OtherParticipationsChoice 0..* -items 0..* OBJECT UNBOUND_DATA_ELEMENT UnboundGenericFinding 0..* OBJECT HasClinicalContext OBJECT

0..* 0..* NHS LRA e.g. Temperature ENTRY Subject of Information (Participation) Information Provider (Participation) OtherParticipation (Participation) TemperatureObservation (PropertyObservation) TemperatureMeasurement (InvestigationActivity) Text (UnboundDataElement) UnboundGenericFinding (UnboundDataElement) GenericFindingObservation (FindingObservation) NHS LRA e.g. TemperatureObservation ELEMENT composite structure TemperatureObserv ation INVEST IGATION_ACT IVIT Y_ELEME... TemperatureMeasurement

PROPERT Y_OBSERVAT ION_ELEMEN... TemperatureObserv ation - archetype_id: ST [0] meaning: CD.CV name: SC {readOnly} obs_time: IVL [0..1] orig_parent_ref: II [0] policy_ids: SET [0] rc_id: II sensitivity: INT [0] synthesised: BL value: PQ IsResultantObservationOf OBJECT 0..1 SUBJECT0..1 - archetype_id: ST [0] meaning: CD.CV.SCT name: SC {readOnly} obs_time: IVL_T S [0..1] orig_parent_ref: II [0] policy_ids: SET [0] rc_id: II.Uuid sensitivity: INT [0] synthesised: BL

value: ANY {readOnly} FINDING_OBSERVAT ION_ELEMENT GenericFindingObserv ation HasClinicalContext SUBJECT 0..* 0..* OBJECT 0..* SUBJECT 0..1 HasAnnotation - archetype_id: ST [0] meaning: CD.CV name: SC {readOnly} obs_time: IVL [0..1] orig_parent_ref: II [0] policy_ids: SET [0] rc_id: II sensitivity: INT [0] synthesised: BL value: ANY {readOnly} OBJECT

UNBOUND_DAT A_ELEMENT UnboundGenericFinding 0..* OBJECT UNBOUND_DATA_ELEMENT Text - archetype_id: ST [0] name: SC {readOnly} obs_time: IVL [0] orig_parent_ref: II [0] policy_ids: SET [0] rc_id: II.Uuid sensitivity: INT [0] synthesised: BL value: ED.T ext - archetype_id: ST [0] name: SC {readOnly} obs_time: IVL [0..1] orig_parent_ref: II [0] policy_ids: SET [0] rc_id: II sensitivity: INT [0] synthesised: BL value: ANY

SUBJECT 0..* OBJECT HasClinicalContext 0..* 0..* OBJECT NHS LRA e.g. TemperatureObservation ELEMENT (mindmap) openEHR ENTRY patterns SNOMED CT OBSERVABLE ENTITY CLINICAL FINDING Finding method: PROCEDURE Interprets: PROCEDURE Interprets: OBSERVABLE ENTITY PROCEDURE Has focus: CLINICAL FINDING SNOMED CT Observable (draft) SNOMED CT Observable

(draft) results4Care DCMs Root concept Data Qualifier State IMH CEMs Observed, StandardLabObs, Procedure, Order, Intolerance, Allergy, Adverse Reaction Summary, Admit/AdminDiagnosis Key, Item, Qualifier, Modifier, Attribution MOHH LIM ENTRY Observation Entry (Observable Name/Value) Heart Rate/ Blood Pressure / Blood Glucose Clinical Finding Problem Diagnosis Entry Adverse Reaction Entry Alert Entry

Activity Pharmacy Activity Entry Pharmacy Order Entry Pharmacy Dispense Entry Pharmacy Administration Entry Investigation Activity Entry Investigation Order Entry Investigation Result Entry Procedure Entry (Reference Pattern) CLUSTER Pharmacy Item / Investigation Test Item IsoSemantic Models Example Instances e.g. Suspected Lung Cancer IsoSemantic Models Compositional Grammar Problem Diagnosis = $ProblemDiagnosisName: 246090004|associated_finding|= (404684003|clinical_finding|: 63698007|finding_site|=($BodySite: 272741003|laterality|=$Laterality), 246112005|severity|=$Severity), 408729009|finding_context|=$FindingContext

EN13606 Association HL7 v3 RIM Modelling Patterns Types 1. Clinical Statement Types 2. Isosemantic model structure key concept, qualifiers, modifiers 3. 4. 5. 6. 7. Clinical processes events links History of Events Order state machine and care flow mapping Composition/Document Clinical Model Patterns Reference Range Set, Schedule, Material (Device, Medication), Score/Assessment Scale Clinical Statement Types Reviewed openEHR Observation, Evaluation, Instruction, Action, Admin Entry

MOHH Observation, Finding, Activity (Medication, Laboratory), Administration NHS LRA ELEMENTs: Property Observation, Finding Observation, Activity (Investigation, Material, General), Material Entity ENTRYs: GenericFinding, GenericProcedure, GenericProblemAndIssue, .... Intermountain/GE Observed, StandardLabObs, Procedure, Order, Intolerance, Allergy, Adverse Reaction Summary, Admit/AdminDiagnosis, ... SNOMED CT Observable Entity, Clinical Finding, Procedure, ... HL7 v3 Act (Observation, Procedure, Exposure, Patient Encounter, Financial Contract, Financial Transaction, Account, Invoice Element, Context Structure, Device, Task, Supply) Clinical Statement Types (Observation)

openEHR Observation, Evaluation, Instruction, Action, Admin Entry MOHH Observation, Finding, Activity (Medication, Laboratory), Administration NHS LRA ELEMENTs: Property Observation, Finding Observation, Activity (Investigation, Material, General), Material Entity ENTRYs: GenericFinding, GenericProcedure, GenericProblemAndIssue, .... Intermountain/GE Observed, StandardLabObs, Procedure, Order, Intolerance, Allergy, Adverse Reaction Summary, Admit/AdminDiagnosis, ... SNOMED CT Observable Entity, Clinical Finding, Procedure, ... HL7 v3

Act (Observation, Procedure, Exposure, Patient Encounter, Financial Contract, Financial Transaction, Account, Invoice Element, Context Structure, Device, Task, Supply) Clinical Statement Types (Finding) openEHR Observation, Evaluation, Instruction, Action, Admin Entry MOHH Observation, Finding, Activity (Medication, Laboratory), Administration NHS LRA ELEMENTs: Property Observation, Finding Observation, Activity (Investigation, Material, General), Material Entity ENTRYs: GenericFinding, GenericProcedure, GenericProblemAndIssue, .... Intermountain/GE Observed, StandardLabObs, Procedure, Order, Intolerance, Allergy, Adverse Reaction Summary, Admit/AdminDiagnosis, ... SNOMED CT

Observable Entity, Clinical Finding, Procedure, ... HL7 v3 Act (Observation, Procedure, Exposure, Patient Encounter, Financial Contract, Financial Transaction, Account, Invoice Element, Context Structure, Device, Task, Supply) Clinical Statement Types (Activity) openEHR Observation, Evaluation, Instruction, Action, Admin Entry MOHH Observation, Finding, Activity (Medication, Laboratory), Administration NHS LRA ELEMENTs: Property Observation, Finding Observation, Activity (Investigation, Material, General), Material Entity ENTRYs: GenericFinding, GenericProcedure, GenericProblemAndIssue, .... Intermountain/GE Observed, StandardLabObs, Procedure, Order, Intolerance, Allergy, Adverse Reaction

Summary, Admit/AdminDiagnosis, ... SNOMED CT Observable Entity, Clinical Finding, Procedure, ... HL7 v3 Act (Observation, Procedure, Exposure, Patient Encounter, Financial Contract, Financial Transaction, Account, Invoice Element, Context Structure, Device, Task, Supply) Clinical Statement Types (Administration) openEHR Observation, Evaluation, Instruction, Action, Admin Entry MOHH Observation, Finding, Activity (Medication, Laboratory), Administration NHS LRA ELEMENTs: Property Observation, Finding Observation, Activity (Investigation, Material, General), Material Entity ENTRYs: GenericFinding, GenericProcedure, GenericProblemAndIssue, ....

Intermountain/GE Observed, StandardLabObs, Procedure, Order, Intolerance, Allergy, Adverse Reaction Summary, Admit/AdminDiagnosis, ... SNOMED CT Observable Entity, Clinical Finding, Procedure, ... HL7 v3 Act (Observation, Procedure, Exposure, Patient Encounter, Financial Contract, Financial Transaction, Account, Invoice Element, Context Structure, Device, Task, Supply) CIMI ENTRY Pattern Suggestions Property Observation (property-value pair) Clinical Finding (name) Activity (orders, procedures, etc) Administration (X ?) Property Observation (Existing Definitions)

openEHR Observation: the observation of any phenomenon or state of interest to do with the patient (eg diagnosis, goal, adverse reaction). NHS LRA Property Observation: Used to represent the results of investigations undertaken to find out more information about a patient's state of health or wellbeing and device or procedure related parameter settings. (Meaningvalue pairs) SNOMED CT Observable Entity: represents a question or procedure which can produce an answer or a result. Used to code elements on a checklist or any element where a value EN13606 Association Observation/Inspection: Used to define all that can be documented about a specific state of a process in the Patient System at a point in time using the faculties of seeing, hearing, tasting, touching, smelling, or directly via a medical device or service. Property Observation (Suggested CIMI Definition) Used to represent the results of observations or investigations undertaken to find out more information about a patients state of health or wellbeing, and device or procedure related settings. Comments:

E.g. Heart rate, Blood glucose, Glasgow Coma Scale Represents the common name-value or question-answer pattern Supports isosemantic representation of Observation Names that may include method, patient_state, device, location and other related information in pre or post-coordinated form. Clinical Finding (Existing Definitions) openEHR Evaluation: the Opinion category , including problem/diagnosis, risk assessment, scenario, goal and recommendation NHS LRA Finding Observation: used to represent both normal and abnormal clinical states found on examination or deduced from clinical reasoning (e.g. 'clear sputum', 'diabetes mellitus') and events to which the patient or service user may have been to subject (e.g. 'physical abuse', 'exposure to mercury'). SNOMED CT Clinical Finding: represent the result of a clinical observation, assessment or judgement, and include both normal and abnormal clinical states EN13606 Association Evaluation/Consideration: Used for the documentation about an inferred process in the patient system using observations, expertise and knowledge, or about plans with, or risk assessments about, the Patient system

Clinical Finding (Suggested CIMI Definition) Used to represent clinical states found on examination or deduced from clinical reasoning (e.g. diabetes mellitus, clear sputum), and events to which the patient may have been subject (e.g. physical abuse, exposure to mercury). Comments: E.g. Diagnosis, Adverse Reaction, Alert Supports isosemantic representation of Clinical Finding Names that may include body location, laterality, causative agent and other related information in pre or post-coordinated form. Activity (Existing Definitions) openEHR Action: Information recorded due to the execution of an instruction by some agent Instruction: Actions to be performed in the future. NHS LRA Activity: Used to record treatment procedures, investigation procedures, administrative procedures and the provision of advice and information to patients and carers SNOMED CT Procedure: Activities performed in the provision of health care

EN13606 Association Instruction/Order: used to define all that can be documented about the intended actions with the aim to change the state or process in the Patient System Action/Intervention: is used to define all that can be documented about events that changed (or could change) states or processes in the Patient System Activity (Suggested CIMI Definition) Used to record activities that have been, are being, or are to be performed, including treatments, investigations, administrative procedures and the provision of advice or information. Comments: E.g. Medication Activity (Requested, Dispensed, Administered), Investigation Activity (Requested, Performed) Supports isosemantic representation of Activity Names, which may include body location, priority, context and other related information in pre or post-coordinated form. CIMI Modelling Patterns (Suggested Definitions) Property Observation (property-value): Used to represent the results of observations or investigations undertaken to find out more information about a patients state of health or wellbeing, and device or procedure related settings. E.g. Heart rate, Blood glucose, Glasgow Coma Scale

Clinical Finding (name): Used to represent clinical states found on examination or deduced from clinical reasoning (e.g. diabetes mellitus, clear sputum), and events to which the patient may have been subject (e.g. physical abuse, exposure to mercury). E.g. Diagnosis, Adverse Reaction, Alert Activity: Used to record activities that have been, are being, or are to be performed, including treatments, investigations, administrative procedures and the provision of advice or information. E.g. Medication Activity (Requested, Dispensed, Administered), Investigation Activity (Requested, Performed) CIMI Call For Clinical Models Heart Rate - Property Observation Body Mass Index Property Observation Apgar Score Property Observation Glucose Tolerance Test Result Property Observation Adverse Reaction Clinical Finding Medication order - Activity Problem list List (Section) of Clinical Finding (+ ?)

Care Giver Reported Nausea Clinical Finding Wound Culture Result Activity + Property Observation? LINKS between Models (Suggestions) Property Observation to: Finding: has interpretation Activity: results in Activity to: Activity: has instruction, depends on, must occur before, etc Clinical Finding: has focus, results in Property Observation: results in Clinical Finding to: Property Observation: reason for Activity: finding method, is indication for Where to from here? Review of Existing Approaches (e.g. NHS, ISO, SNOMED) Proposal for CIMI NHS LRA Component Relationship Vocabulary (draft) EN13606:3 Link Nature

Code Meaning LINK-A0 is related to LINK-B0 is confirmed by LINK-C0 is related to the same problem or health issue LINK-D0 is related to the same plan of care, act or episode LINK-E0 is a related documentation EN13606:3 Link Role Code LINK-A1 LINK-A2 LINK-A2i LINK-A3 LINK-B1 LINK-B2 LINK-B3 LINK-B3i LINK-B4 LINK-B5 LINK-B6 LINK-B6i LINK-C1 LINK-C1i LINK-C2

LINK-C3 LINK-C3i LINK-C4 LINK-C4i LINK-C5 LINK-C5i LINK-C6 LINK-C6i Meaning unspecified link suggests (tentatively related to) is suggested by re-occurrence or repeat of endorses (agrees with, confirms, verifies) disagrees with (e.g. another opinion) permits (sanctions, authorises) permitted by assumes responsibility for declines (refuses, cancels) consents to consented by cause (interpretation) caused by revised interpretation evidence for justified by evidence against countered by indicated by indication for

contra-indicated by contra-indication for Code Meaning LINK-C7 trigger for LINK-C7i triggered by LINK-C8 manifestation of LINK-C8i manifested by LINK-C9 sequel (consequence, progression) LINK-C10 intended (aim, goal, target, hoped for, desired) LINK-C11 anticipated (predicted) LINK-C12 to be avoided (at risk of, fear of, prophylaxis) LINK-D1 outcome LINK-D2 has pre-condition LINK-D3 evaluation (assessment, milestone) LINK-D4 contributes to or fulfils goal, plan or act LINK-D5 revised state of the same act LINK-D6 sub-task of

LINK-E1 documented by (is documented within) LINK-E1i documents (describes, reports) LINK-E2 summarises LINK-E3 supplements LINK-E4 excerpts LINK-E5 derived from LINK-E6 has reference ranges LINK-E7 identified within (study product) SNOMED CT OBSERVABLE ENTITY CLINICAL FINDING Finding method: PROCEDURE Interprets: PROCEDURE Interprets: OBSERVABLE ENTITY PROCEDURE Has focus: CLINICAL FINDING ... And many other Linkage concepts SNOMED CT Concept Model Clinical Finding

Finding site <<442083009|Anatomical or acquired body structure| Associated morphology << 4975500|Morphologically abnormal structure| Associated with <<404684003|Clinical Finding|, 71388002|Procedure|, 272379006|Event|, 410607006| Organism|, 105590001|Substance|, 260787004|Physical object|, 78621006|Physical force|, 373873005 | Pharmaceutical / biologic product| Severity <= 272141005 |Severities| Clinical course <= 288524001|Courses| Episodicity <= 288526004|Episodicities| Interprets << 363787002|Observable entity|, 108252007|Laboratory procedure|, 386053000|Evaluation procedure| Has interpretation << 260245000|Findings values| Pathological process == 263680009|Autoimmune|, <<441862004|Infectious process| Has definitional manifestation << 404684003|Clinical finding| Occurrence < 282032007|Periods of life| Finding method <= 71388002|Procedure| Finding informer <<420158005|Performer of method|, 419358007|Subject of record or other provider of history| SNOMED CT Concept Model Procedure Procedure site << 442083009|Anatomical or acquired body structure| Procedure morphology <<49755003|Morphologically abnormal structure| Method <<129264002|Action| Procedure device <<49062001|Device| Access <=309795001|Surgical access values| Direct Substance <<105590001|Substance|, 37387305|Pharmaceutical / biologic product| Priority <=272125009|Priorities| Has focus <<404684003|Clinical finding|, 71388002|Procedure| Has intent <=363675004|Intents (nature of procedure values)|

Recipient category <<125676002|Person|, 35359004|Family|, 133928008|Community|, 105455006|Donor for medical or surgical procedure|, 389109008|Group| Revision status <<261424001|Primary operation|, 255231005|Revision - value|, 257958009|Part of multistage procedure| Route of administration <<284009009|Route of administration value| Surgical approach <=103379005|Procedural approach| Using energy <<78621006|Physical force| Using substance <<105590001|Substance| LINKS between Models (Suggestions) Property Observation to: Finding: has interpretation Activity: results in Activity to: Activity: has instruction, depends on, must occur before, etc Clinical Finding: has focus, results in Property Observation: results in Clinical Finding to: Property Observation: reason for Activity: finding method, is indication for Where to from here?

Review of Existing Approaches (e.g. NHS, ISO, SNOMED) Proposal for CIMI CIMI Modelling Pattern Attributes (Suggestion) All Participations: subject, information provider Elements: Timing Elements: Clinical Status Property Observation Participations: observer Cluster (Isosemantic ): Property (name, descriptors) Cluster: Result (name, value, details, interpretation, reference range) Links: observing activity, interpretation, is indication of, other Finding Participations: finder Cluster (Isosemantic ): Finding Item (name, descriptors) Cluster: Finding Details (details)

Links: finding method, finding procedure, is indication of Activity Participations: performer Cluster (Isosemantic): Activity Item (name, descriptors) Element: Activity Identifier(s) Cluster: Activity Details (details) Links: has instruction, depends on, must occur before Property Observation Heart Rate Example Clinical Finding Activity Thank You This material contains information that is confidential to MOH Holdings Pte Ltd (MOHH) and should not be circulated beyond MOHH without permission. All Rights Reserved

Recently Viewed Presentations

  • Motor Control Using 555 Timer - Electronics Simplified!!

    Motor Control Using 555 Timer - Electronics Simplified!!

    WATER LEVEL CONTROLLER USING 555 TIMER By, Department of TCE/ECE JNNCE , Shimoga OBJECTIVE: Automatic Control of AC Motor Thus Preventing overflow from Over Head Tank.
  • 幻灯片 1

    幻灯片 1

    The strength increased with the increase of MgO percentage. When MgO is maintained at 90℃, the strength increased with the increase of the MgO percentage. The maintenance period is prolonged for 24 h, and the strength increases, on average, by...
  • Chapter 3 Injury Emergencies Bleeding Control  Avoid contact

    Chapter 3 Injury Emergencies Bleeding Control Avoid contact

    For a short object, place a donut-shaped pad around the eye, and wrap a bandage around the head to hold it in place. Cover both eyes. Keep the person flat on his or her back. Call 9-1-1 as soon as...
  • Byzantine Empire &amp; The Crusades

    Byzantine Empire & The Crusades

    Pope Benedict presents a book at the Greek Orthodox Patriarchate, 15 May 2009. Crusades. Byzantine Emperor calls on the Pope for help defending Muslims from the Holy Lands (Jerusalem). Pope Urban II encourages Christians & knights to fight in a...
  • Literary Terms Teaching Powerpoint - WordPress.com

    Literary Terms Teaching Powerpoint - WordPress.com

    Mood: The feeling created in the reader by a literary work or passage. The mood may be suggested by the writer's choice of words, by events in the work, or by the physical setting. Motif: A recurrent image, word, phrase,...
  • Interventions to Increase Pro-social Behaviors (Effective Discipline, Consequences,

    Interventions to Increase Pro-social Behaviors (Effective Discipline, Consequences,

    In addition to general lack of academic success, students' gradual estrangement from high school is hastened by school misbehavior. ... Build supportive partnerships with parents. Provide culturally diverse students with equal opportunities to participate.
  • Kingdom Animalia - Phylum Mullusca

    Kingdom Animalia - Phylum Mullusca

    Kingdom Animalia - Phylum Mullusca Phylum Mullusca - snails, slugs, clams, oysters, squids, octopus, etc. (> 50,000 species - maybe up to 100,000??) General characteristics: Bilaterally symmetrical (or secondarily asymmetrical), coelomate Well developed organ systems Have mantle with shell glands...
  • FGDC Thoroughfare, Landmark, and Postal Address Data Standard ...

    FGDC Thoroughfare, Landmark, and Postal Address Data Standard ...

    FGDC Address Data Standard. Scope, Status, and Structure. United States Street, Landmark, and Postal Address Data Standard" Scope: Street, landmark, and postal addresses in the United States