Progress on Virtual Medical Record

©2001 Sowerby Centre for Health Informatics at Newcastle

Progress on Virtual Medical Record

HL7 Salt Lake City


Requirements

• Medical record communication• From existing EHR to DSS• From DSS to EHR

• E.g. decisions, goals, inferred observations

• Computer understandable record• Semantic interoperability

• Same problems as EHR system to EHR system communication


EHR DSS communication

• Guideline system EHR : queries• Guideline system EHR : query results• Guideline system Clinical system : act

requests• Guideline system EHR : data recording• Guideline system EHR : decision recording• Guideline system EHR : assessment

recording• Guideline system EHR : goal recording


virtual Medical Record (vMR)

• Required to represent standardised view of EHR for • a – standard names in expressions, result

sets• b – writing new records to the EHR

EHR Guideline Interpreter

User Interface

1a

1b


What is it?

• Simplification of medical record• only has distinctions important to DSS

• Aim is to find the minimal set of record types & attributes required to achieve semantic interoperability

• Expression language has to be able to write criteria using these


Five Basic Classes

• Observation• Intervention• Goal• Plan• Commitment

• + Patient, Guideline, Agent (Care Provider, DSS)


Attributes: All Classes

• Patient (instance of Patient)• Care providers• Coded concept• Recording agent• Recording time• Where• (n.b. no encounter class)


Observation kinds

• Quantitative Observation • e.g. Height 1.56m

• Qualitative Observation• e.g. ‘nocturnal cough’

• Assessment• e.g. ‘diagnosis Gestational Diabetes’

• Extra attributes• Duration of observation


Qualitative Observation

• Subjective • ‘Primary’ observations, not inferred• e.g. symptoms, signs


Quantitative Observations

• Objective measurements• Additional attribute ‘observed

quantity’• Has quantity and units of measure

• e.g. height, weight, hemoglobin


Observation questions

• Inferred flag• e.g. BMI calculated from weight and height• Use instead of Assessment? e.g. a diagnosis is an

observation inferred by clinician

• ‘Consequence of’ relationship• To tie observations to the intervention which

generated them. Is this necessary for DSS?• e.g. potassium level as result of Chem 7• !!! Implies Causality – should we represent this?

• Do we need observation subtypes?


• Uncertain list of types• Extra attributes

• ???Reason – obs that cause this intervention• Valid time

• These are ‘done’ interventions• Medication Authorisation

• Dose/admin/quantity & ingred/product/pack CMETS

• Investigation |• Procedure | • Education• … Schedule appointment + others

Intervention

is this a useful distinction?


Goal, Plan, Commitment

• Important for guideline execution and history of guideline use

• Extra attribute: context• Context = the guideline they came

from• Expression language has to be

able to write criteria using these.


Goal

• A (future) observation you wish to achieve, maintain, avoid.• e.g. ‘keep blood pressure < 130/85’

• Need to be able to cope with these:• e.g. ‘miminise side effects’

• Extra • Observation ‘BP 130/85’ or set{side effects}• Type symbols ‘maintain, less than’ , ‘avoid,

any of’


Plan

• Planned Intervention set• Planned intervention will be

converted into Act with mood code


Commitment

• Decisions made • Choice between alternatives • e.g. ‘start beta blocker’


EHR SIG

• Initial proposed R-MIM provides most of these classes

• Commitment?• EHR SIG have VMR as their second

use case• Widen their current R-MIM to do

VMR


Questions

• Workflow – any extensions?• Profiles/templates

• Deliberately avoided

• Events from EHR• Can these be standardised?

• Need to name them in expressions

• e.g.• Patient has encounter with care provider• Add/delete/change to record – subtypes?


Next steps

• Clarify any extensions/changes• Clarify medication info CMETS• Work with HER SIG to extend R-

MIM• Aim for candidate R-MIM January

2002

Documents

Progress on Virtual Medical Record