Project Summary for Detailed Clinical Models Release 1
Visit Project Insight to see the full project details. *
Project Details
Number | 320 View Ballot Items List (with NIBs) |
---|---|
Name | Detailed Clinical Models Release 1 |
Sponsor(s) | Patient Care Work Group |
Co-Sponsor(s) | Clinical Decision Support Work Group, Clinical Interoperability Council Work Group, Clinical Statement Work Group, Structured Documents Work Group, Templates Work Group |
Steering Division | Clinical |
Description | The DCM series of projects are as such a follow up of the DCM meeting in Boca Raton, led by Craig Parker and the DCM Brisbane workshop in 2007 with CEN, ISO, HL7, OpenEHR and clinical involvement where the recommendations were to work on harmonization of granular and detailed clinical content and where four action areas included clinician involvement, quality of detailed clinical models, representation formalisms and establishing and maintaining repositories. This is because different communities where working in splendid isolation on the same specifications of blood pressure, pulse, breathing, Apgar score, Glasgow Coma Scale, Health and Physical, assessments and so on. The overall goals of the DCM initiative are: - to develop methods, tools for requirements gathering with clinicians, requirements for modelling tools, - to enforce quality control, authorisation and governance of DCM rules - to identify clinical items, binding of clinical content to terminology, - to model generically and make transforms to different formalisms, - and to maintain in a repository a set of DCM that are useable in different standards, formats and different technical implementations using the same generic model. The purpose is to enhance the semantic interoperability between different systems and developments. Based on discussions in ISO Joint Working Group 9, the JWG leadership requested two projects to be started: 1. A set of examples, useful in a standard 2. A set of criteria for good quality of DCM that are indeed clinically sound and implementable in different technical environments. We have created a Top 10 list of DCMs and discussed its use in HL7 project 320 on DCM, where this document is an update of. Establishing DCM criteria and methodologies is currently done under ISO NIWP 13972, which was approved on July 2009. In 2010 is was re-examined by the TSC and reapproved, reducing the scope to maximum of 5 DCM examples. This proposal includes the proper representation of assessment scales, indexes and scoring systems. It will use elements of other HL7 WGs or projects such as TermInfo, Structured Documents, Templates and Clinical Statement. A DCM includes the purpose of one or small set of clinical data elements, the evidence base, data element specification, proper procedure, interpretation of values, and literature references. A guideline for this has been created on behalf of Nictiz in the Netherlands. A DCM specification must be - usable within the HL7 Clinical Statement and HL7 template specification - meet HL7 TermInfo requirements - adjustable to the CEN/IOS 13606 and OpenEHR archetype environment, and the Clinical template specification, among others. Technical implementations that would be able to deploy DCM include GUI design, database design, HL7 message design, algorithm design, rule-based Decision Support System design, among others. In particular a DCM is to form a bridge between different technical representation formats, in particular HL7 v3 templates / clinical statements and OpenEHR archetypes. That is the harmonization aspect of DCM. In order to actually use a DCM, the transformation to HL7 must be made. This is done via mapping the DCM content to a Clinical Statement R-MIM, in any HL7 domain that uses Clinical Statement. The formalism to use a DCM in HL7 space would be that of an HL7 v3 template. |
Project Facilitator | Dr. William Goossen: |
Status | Archived |
SD Approval Date | Jan 18, 2010 |
TSC Approval Date | Dec 10, 2012 |
Type | Ballot - STU to Normative |
Objectives / Deliverables | Objective is to publish in NE 2014 and ballot materials 2014 Decision Making in HL7 organization - Target: February 2014 Handling the administration within HL7 - Target: February 2014 Publication - Target: February 2014 Project End Date - Target: February 2014 DCM Release 1 will support the following goals: - Develop methods and tools requirements for binding of clinical content to terminology, to generic models and to different technical implementations using the same generic model. The first ballot will include a guideline for DCM creation. - Identify a means to involve clinical groups to determine and specify relevant clinical content. This in line with the HL7 clinical interoperability council work and Domain Analysis Modelling (DAM), and HDF among others. - Set up a methodology for verification, validation and quality, control and review cycle of clinical materials and their representation in terminology and information models so clinicians can trust the EHR and the message content presented to them. This will become part of the ISO 13972. - Create a superset from which various applications, e.g. the CDA H&P, Detailed Clinical Models, DEEDS, etc. can draw data element identifiers in particular to provide a value set suitable for use in a clinical statement's Observation.code. - Generate clinical value sets in both SNOMED-CT and in LOINC, according to Terminfo guidelines. This includes appropriate use of principles how information model and terminology model interact properly. - Define and apply quality criteria for DCM clinical content, terminology, classification and unique coding, language translations, generic information modelling independent of a particular standard, transformations via tooling from generic models to standards specific modelling, - Give guidelines for the linkage from a Domain Analyses Model to a HL7 D-MIM / R-MIM / template and/or archetype - Develop transformation of generic model into HL7 v3 RIM / R-MIM / Clinical statement modelling and message development - Develop transformation of generic model into CEN/ISO / OpenEHR archetypes - Develop methods and tools to combine DCM into larger clinical templates - Develop tools to combine archetypes / R-MIMs / DCM into different technologies - Support actual use of DCM as clinical statements in messages (v2 and v3) and CDA (HL7 Patient Care / SD (CDA) / Clinical statement / O&O). - Provide a forum to develop and maintain actual instances and artefacts for clinical content. - Apply relevant metadata such as in the HL7 templates specification and ISO metadata ISO 11179. - Set requirements, organise and develop a repository for DCM, serving the different clinical and standards organisations. - Facilitate the re-use of materials and resources and prevent unnecessary duplication of efforts. - The goal will be to ballot the DCM set Release 1 for normative status in first half of 2011 followed closely by implementation guide(s) that help promote interoperability across vendor implementations and across standards. - At the end of this project, the DCM collection will be enhanced to better support the long-term goal of an automated standards-based information technology (IT) environment for the exchange of information supporting the process for clinical data collection and exchange to support continuity of care, aggregation of data and lifetime storage and retrieval, more or less independent of the actual technical implementations. - Work products intended to produce a standard should be in terms of HL7 V3 deliverables, including but not limited to the following: - Make an inventory of examples already in the current HL7 v3 ballot domains - Clinical data specification guidelines and criteria - Methods how to apply - Storyboard, storyboard examples - State Transition Diagrams, trigger events where appropriate - Interaction Diagram, interactions - Message Information Models, Refined Message Information Models consistent with Clinical Statement and its derivates such as Care Statement - Hierarchical Message Definitions and XML examples that can be used as plug in for CDA and Care Provision Record message. - Implementation Guide for DCM within different standards and technical contexts - Tool criteria and tools for conversions - Repository of DCM, joint with CEN / ISO and OpenEHR including requirements from TermInfo, template, 13606 and OpenEHR deliverables if applicable - Feasibility studies for using DCM in the different technologies. Work plan 2008 and status: 1. Analyse and model Glasgow Coma Scale for DSTU: sept 08 ready, For informative ballot May 2010. 2. Revise Barthel index in PC DSTU and ISO 13606-3 (june 08). For informative ballot May 2010. 3. Translate Dutch example scales into English (Dec 08). For informative ballot May 2010. 4. Identify use cases for larger scales and make new R-MIM for nested scales based on PC DSTU and Oemig's set of scores and model and Coonans clinical examples. (Dec 08 for May 09 ballot). Last revisions underway before filing DSTU status. 5. Proof of concept with Top 10 of items with CIC (clinical), TermInfo (apply Snomed CT and or LOINC), Templates (authorization and registry) for 10 items (now 9). Simultaneous work. Send out the material now and ask for review feedback. (Sept 08 - May 09). Has been done, general feedback: yes must go on. 6. Flesh out the different features that come out of different models and decide on what needs to be mandatory and what can be optional. And then outline into a methodology for making DCM, checking for vocabulary requirements and template requirements, and transform to R-MIM, archetypes and EHR profiles. (June 08 - Jan 09.) => some progress made, lot of confusion on this part in particular. See work items for 2009-2010 below. 6. Set up HL7 repository for collection of existing R-MIMs for small observations and scales that are DCM. => Work by Jane Curry, |
Next Milestone Date | 2014 May WGM |
Project End Date | 2014 May WGM |
Project Intent | Create New Standard, Supplement to a Current Standard |
Project Need | The DCM series of projects are a follow up of the DCM meeting in Boca Raton in 2006, led by Craig Parker and the DCM Brisbane workshop in 2007 with CEN, ISO, HL7, OpenEHR and clinical involvement. The rationale for DCM is that different communities are working in splendid isolation on the same specifications of blood pressure, pulse, breathing, Apgar score, Glasgow Coma Scale, Health and Physical, assessments and so on. Based on discussions in ISO Joint Working Group 9, the JWG leadership requested two projects to be started: 1. A set of examples, useful in a standard. 2. A set of criteria for good quality of DCM. The outcome of these discussions were HL7 project 320 which lead to balloting 5 DCM examples, and their reconciliation. Of this original set of five length and weight have been published as informative in the HL7 NE 2013. The work in ISO did take longer than expected. This in particular for the issues of clinicians engagement, patient safety and repository. However the requirements for the DCM themselves have not been changed over the years and the HL7 examples are 100% consistent with the ISO format. The ISO TS 13972 on DCM is currently in preparation for publication. During May 2012 the discussion with TSC led to the following position: PC will publish the 2 that are ready after ballot reconciliation (done in NE 2013). But the other 3 DCM will need a new PSS and its subsequent approval in order to keep the development and balloting of DCMs manageable. Hence, this new PSS for DCM heart rate. |
Implementers | 1) NICTIZ, the Netherlands, Jos Baptist 2) NHS, UK |
Security Risks | |
External Drivers | |
Common Names / Keywords/ Aliases | |
Lineage | |
Dependancies | This is the final stage of this project component and is not depending on any other work that decision making to publish and publication. See the attached materials on heart rate and the publication request. - Semantic interoperability within relevant HL7 domains and with ISO and CEN standards, in particular the CEN/ISO 13606 series, archetypes, Open EHR and clinical templates. - Support for work by ISO, CEN, OpenEHR within the ISO/CEN/HL7/ CDISC / IHTSDO Joint Initiative. - The project is quite ambitious, and will only succeed if small parts are taken up as work items and lead to success. So one dependency is the ability of HL7 TC and other groups to derive concrete work plans from this overall project. - Synchronize with intern HL7 work on registry of templates and apply authorization rules developed. - Use HL7 wiki and set up a page for this. - Synchronize with TermInfo rules in DSTU. - Involvement of clinical organisations or bodies that guarantee the quality of clinical content: setting up a review cycle. - MnM create a 'hot topic' for how DCMs fit into the methodology |
Project Document Repository | http://wiki.hl7.org/index.php?title=Detailed_Clinical_Models |
Backwards Compatibility | No |
External Vocabularies | |
Products | Electronic Health Record; Functional Profile; V2 Messages-Clinical; V3 Documents-Clinical (e.g. CDA); V3 Documents-Knowledge; V3 Foundation-Vocab Domains & Value Sets; V3 Messages-Clinical; V3 Rules-GELLO; V3 Services-Java Services (ITS SIG); V3 Services- |
Joint Copyright? | |
External Pjt Collaborators | The DCMs are part of collaboration at JIC. The ISO work provided the guidelines for a proper DCM. |
Realm | Universal |
HL7 Affiliate | |
Stakeholders | Clinical and Public Health Laboratories, Quality Reporting Agencies |
Vendors | EHR, PHR; Clinical Decision Support Systems |
Providers | Clinical and Public Health Laboratories; Healthcare Institutions (hospitals, long term care, home care, mental health) |
Ballot Cycle Info | 2010 Sept Ballot Cycle Info: INFORMATIVE Ballot results: Did not meet basic vote requirements for approval Document Name: HL7 Version 3 Detailed Clinical Models, Release 1 Last Ballot Code: V3_DCMODELS_R1_TBD NIB Submitted By: William Goossen 2010 Jan Ballot Cycle Info: INFORMATIVE Ballot results: Document Name: HL7 Version 3 Detailed Clinical Models, Release 1 Ballot Code: V3_DCMODELS_R1_I1_2010JAN NIB Submitted By: William Goossen 2009 Sept Ballot Cycle Info: DSTU Document Name: HL7 Version 3 Standard: Care Provision; Assessment Scales, Release 2 Ballot Code: V3_PC_AS_R2_D1_2009JAN NIB Submitted By: William Goossen |
Misc Notes | 2021 November: JLyle: PC WG wants to retire the project. PMO archived project. Jan 2014: PC WG submitted a modified PSS for Publication of the third Detailed Clinical Model about heart rate as informative document in the NE 2014 and ballot materials of HL7. Jan 2013: PC WG: 2012 decided to not move the remaining 3 DCM examples further. PC will create new PSS for methodology and design patterns Jan 2013 H. Grain: this project is now largely managed through the CIMI process and need not be on the vocab list of projects. PMO removed Vocab as CoSponsor. Dec 2012: TSC approved the following publication: HL7 Version 3 Detailed Clinical Models, Release 1 (body weight and body height). Patient Care requests informative publication of two of the five Detailed Clinical Models, and also requests registration as an ANSI report. PSS Update 2012: Due to the many discussions around DCM, it became very hard for the PC WG to achieve the goals for this project. In fact only some examples where balloted (5) and its updating following ballot comments takes a lot more than initially anticipated. Hence PC requested to publish only 2 or 3 that are ready. Discussion with the TSC in May 2012 about publication of a part of the DCMs lead to a discussion on not able to control all this models ballots and management. During 2012 the discussion led to the following position: PC will publish the 2 or 3 that are ready after ballot reconciliation. But the others will need a new PSS and its subsequent approval in order to keep the development and balloting of DCMs manageable. During 2011 / 2012 two (length and weight) where completed after ballot reconciliation: and submitted for publication. Due to CIMI work end 2012, also heart rate / pulse was completed. These that are ready after informative ballot, ballot reconciliation and the actual changes carried out will be published. Braden and GCS will not be published, due of potential copyright issues. New DCMs from 2013 onward will require new project scope statements and a less ambit... |
U.S. Govt Interest? | Yes |
USRSC Approval | |
FMG Approval | |
ARB Approval | |
Start Date | May 20, 2008 |
* A Project Insight User ID and password is required to access Project Insight. Contact the HL7 PMO at for more information.
Visit the Projects, Ballots and Standards Metrics Excel Report to view projects that are behind 120+ days along with other ballots and standards requiring a Work Group's attention.
Visit the Projects, Ballots and Standards Metrics Excel Report to view projects that are behind 120+ days along with other ballots and standards requiring a Work Group's attention.