HL7 Domain Analysis Model: THEMES (Terminology Harmonization in Exercise Medicine and Exercise Science) Framework, Release 1

DESCRIPTION

The THEMES (Terminology Harmonization in Exercise Medicine and Exercise Science) project will develop a Domain Analysis Model that will address major concept, data elements, and data interoperability barriers that have impeded the use of physical activity and exercise outcomes in translational research and in clinical applications. Data elements will be identified from several sources: 
- Current terminologies used in clinical Cardiopulmonary Exercise Testing (CPET) derived from major texts and published guidelines used nationally and internationally 
- Exercise and physical activity terms used by national societies such as the American Thoracic Society, American College of Sports Medicine, and the American Heart Association, Cystic Fibrosis Foundation, etc. 
- Exercise and physical activity variables used in large data sets associated with clinical trials (e.g., NHANES, CARDIA, Project Healthy) 

Data elements will be synthesized (sematic equivalents identified and semantic similarities disambiguated), defined and reviewed by a 10-11 member Clinical and Research Champions (CRC) group. Resulting data elements will be represented in a UML Class diagram and accompanied by clinical scenarios, a use case diagram, and an activity diagram. The resulting model will go through a balloting process at the informative level.describes the function, organization, structure and major workflows for exercise medicine and science. The goal of the THEMES DAM is to update the current normative CDA implementation guide supporting submissions to the American College of Surgeons’ (ACS) National Trauma Data Bank (NTDB) to comply with the 2017 release of the NTDB, including performance measures.

 

ALTERNATIVE NAMES

HL7 Domain Analysis Model: THEMES (Terminology Harmonization in Exercise Medicine and Exercise Science) Framework, Release 1 may also go by the following names or acronyms:

TARGETS

• Quality Reporting Agencies
• Standards Development Organizations (SDOs) 
• Pharmaceutical Vendors
• EHR, PHR Vendors
• Healthcare Institutions (hospitals, long term care, home care, mental health)

BENEFITS

• Enables standardized data elements in order to remove the interoperability barriers that have impeded the use of physical activity and exercise outcomes in translational research

DEVELOPMENT BACKGROUND

Physical fitness and exercise biomarkers are promising research and clinical tools for a remarkably wide variety of health conditions, ranging from osteoporosis in the elderly to asthma in children. Exercise testing provides insight into integrated physiological responses that are hidden when the subject is at rest. Despite this promise, exercise- related outcome variables are used far more commonly in the research laboratory than in clinical trials or clinical practice due to gross variability in terminology in the field of exercise medicine. Poor fitness and low physical activity are major causes of heart disease, stroke, type 2 diabetes, chronic respiratory diseases, and some malignancies, but the use of exercise biomarkers in clinical trials is still largely untapped. Consequently, the potential tangible clinical benefits of exercise as a diagnostic and therapeutic tool have failed to fully materialize. This project will attempt to standardize data elements in order to remove the interoperability barriers that have impeded the use of physical activity and exercise outcomes in translational research. 

Recently, Young and coworkers reviewed the role of cardiopulmonary exercise testing (CPET) in vascular surgery. They noted that the Consensus American and European guidelines for pre-operative practice emphasize the need for assessment of a patient's fitness or functional capacity. However, when they systematically examined more than 1,300 records using PRISMA standards, they found that heterogeneity in methodology and outcome variables prevented the translation of best practices from the exercise research laboratory to clinical use, in no small measure due to inadequate standards and procedures related to CPET. This and similar examples illustrate the urgent need for harmonization and standards in the field of exercise medicine biomarkers.  The THEMES DAM was developed under the auspices of the Health Level Seven International (HL7) Clinical Interoperability Council (CIC) work group, organized as the THEMES (Terminology Harmonization in Exercise Medicine and Exercise Science) project. The THEMES team included providers Healthcare Institutions (hospitals, long term care, home care, mental health), Quality Reporting Agencies, Standards Development Organizations (SDOs) and Pharmaceutical vendors. The content of the DAM draws heavily upon the guidance and collective wisdom and experience of the THEMES project team, and contributions by third party reviewers. The team has a Canadian representative and will reach out to other interested parties on the international level.

 

RELATED DOCUMENTS

HL7 Domain Analysis Model: THEMES (Terminology Harmonization in Exercise Medicine and Exercise Science) Framework, Release 1

(Download) (2.80 MB)

BALLOT TYPE

• Informative

STATUS DATE

2018-04-11

RESPONSIBLE WORK GROUP

PRODUCT TYPE

• Domain Analysis Model

STAKEHOLDERS

• EHR, PHR Vendors
• Healthcare Institutions
• Pharmaceutical Vendors
• Quality Reporting Agencies
• Standards Development Organizations (SDOs)

FAMILY

• Cross-paradigm

CURRENT STATE

• Stable

REALM

• Universal