ToC+Clinical+Model+Reference+Material

include component="page" wikiName="siframework" page="TOC Header" The reference material link provides examples of Clinical Information Models that can be potentially leveraged and re-used as applicable for the Transition of Care Initiative.

A Clinical Information Model is a conceptual definition of the discrete structured clinical information that is used in a clinical context. The model defines the data elements, attributes, possible values and types of attributes that are needed to convery the clinical reality in a fashion that is understandable to both clinical domain experts and modelers. These models have the potential for being used as part of electronic health information exchange including EMR's, EHR's, Telehealth applications, medical devices, analytics, decision support among others.
 * Definition of a Clinical Information Model: (Leveraged from Wikipedia)**

There has been significant work done by various organizations and individuals on Clinical Information Models. The links below provide an easy mechanism for the community to access and familiarize themselves with some of these models, in preparation for discussions among the working group.

The National E-Health Transition Authority Limited (known as NEHTA []) was established by the Australian, State and Territory governments to develop better ways of electronically collecting and securely exchanging health information. NEHTA is actively engaging with the healthcare community to develop computable clinical content definitions known as Detailed Clinical Models (DCMs). Each Detailed Clinical Model is inclusive of all data attributes and potentially terminology bindings that are useful to describe a single, discrete clinical concept for use in a broad range of clinical scenarios. Examples of DCMs include: Problem/Diagnosis, Adverse Reaction, Medication order, Blood Pressure measurement, and a symptom. The following link will allow the community to browse the Clinical Knowledge Manager [] to look at the various existing content that has been developed and could potentially be used for the ToC Initiative.
 * 1. National E-Health Transition Authority (nehta) :**

2. **Federal Health Information Models (FHIM):** The FHIM working group (consists of many of the Federal Agencies) has one main goal of achieving whole health interoperability. In order to achieve this goal the working group is developing information models, terminology models, security and privacy frameworks, information exchange frameworks along with other aspects required. The information models that have been developed can be accessed at : [|**https://www.projects.openhealthtools.org/sf/projects/fhims/**]

The Clinical Element Models have been developed by GE and Intermountain Healthcare to help move the industry towards computable models. Dr Stan Huff has been one of the primary contributors to these models. These can be browsed at [] after agreeing to the license agreement. The manuals attached below called as CEDatatypes and CEReference serve as background information to understand these models.
 * 3. Clinical Element Models:**

The HL7 RIM is a critical component of the HL7 V3 development process. It is the root of all information models and structures developed as part of the V3 development process.
 * 4. HL7 V3 Reference Information Model**

The HL7 V3 standard development process is a model-driven methodology in which a network of inter-related models are developed that depict the static and behavioral aspects of the requirements and design of HL7 standards, as well as the underlying semantics and business rules that govern them. The RIM provides a static view of the information needs of HL7 V3 standards. It includes class and state-machine diagrams and is accompanied by story boards, interaction models, data type models, terminology models, and other types of models to provide a complete view of the requirements and design of HL7 standards. The classes, attributes, state-machines, and relationships in the RIM are used to derive domain-specific information models that are then transformed through a series of constraining refinement processes to eventually yield a model of the information content of an HL7 standard. The HL7 V3 standard development process defines the rules governing the derivation of domain information models from the RIM and the refinement of those models into HL7 standard specifications. The rules require that all information structures in derived models be traceable back to the RIM and that their semantic and related business rules not conflict with those specified in the RIM. The RIM therefore is the ultimate source for all information content in HL7 V3 standards. The RIM is primarily for use by HL7 and its international affiliates. However, others outside of HL7 have also found the RIM useful. Although HL7 maintains a copyright on the expression of this standard, HL7 does not seek to license or otherwise control the use of information structures or programs that implement this specification. Currently available to the S&I project from HL7: [] HL7 V3 Standard > Foundation > Reference Information Model. Direct link: []

Examples of domain specific information models (also see the CDA model (CDA RMIM) below:
 * [|Clinical Statement]
 * [|Medication Common Message Element Type]

5. **HL7 Domain Analysis Models and Detailed Clinical Models** A Detailed Clinical Model specifies clinical knowledge about small items of information, usually single observations or actions, or small clusters of observations that belong together. Further in the DCM the data elements are specified, coded and relationships identified. This conceptual model of clinical information is depicted in a UML model. In itself a DCM is not implementable, it does need a transformation into a logical model, and implementation specifications, for instance a HL7 template format in XML against the clinical statement pattern, or a ISO/CEN 13606 archetype, or other format. In the context of HL7 International the implementation transformation will be into a HL7 template. It is intended to be so in order to keep the clinical content consistent independent of the actual technology used. A DCM is underspecified in such way that it does not include relationships with patients or providers (entity roles are not included), and it further does not include other more technical items such as the time stamp, storage specification and so on. Currently available to the S&I project from HL7: [] HL7 V3 Standard > Domain Analysis Models > Detailed Clinical Models. Example: [|Cardiology - Acute Coronary Syndrom]


 * 6. HL7 CDA Refined Message Information Model (RMIM)**

HL7 specifications derived from the HL7 RIM use a process known as "cloning" to refine domain specific models from the base HL7 RIM. When a refined model makes use of a specialization of an HL7 RIM class, the new class in the refined model is known as a clone of the HL7 RIM class. These specializations may further constrain the base class, for example, by specifying more restrictive attribute cardinality or by further constraints on the allowed vocabulary values. Multiple clones of a particular HL7 RIM class may appear in a refined model, each representing a different specialization. The CDA R-MIM is a graphical representation of the CDA specification. It is presented using diagramming conventions and notations that were developed by HL7 to represent the specific semantic constructs contained in the critical, "back-bone" classes of the RIM. Although it could be represented in UML notation, as the RIM is, the HL7 notation provides more details about the specific constraints and class clones being represented. The HL7 diagramming convention abbreviates some relationship conventions, enabling diagrams to be smaller and more concise and to convey more information visually. The CDA R-MIM is a graphical aid to understanding the specification. Because the CDA Hierarchical Description, and subsequently the CDA Schema, are derived from the R-MIM, the R-MIM serves as a good basis for describing the standard. The narrative description of the specific clones used by CDA is organized to correspond with the R-MIM. Currently available to the S&I project from HL7: []

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