Detailed Clinical Models: A Review

Abstract

ObjectivesDue to the increasing use of electronic patient records and other health care information technology, we see an increase in requests to utilize these data. A highly level of standardization is required during the gathering of these data in the clinical context in order to use it for analyses. Detailed Clinical Models (DCM) have been created toward this purpose and several initiatives have been implemented in various parts of the world to create standardized models. This paper presents a review of DCM.MethodsTwo types of analyses are presented; one comparing DCM against health care information architectures and a second bottom up approach from concept analysis to representation. In addition core parts of the draft ISO standard 13972 on DCM are used such as clinician involvement, data element specification, modeling, meta information, and repository and governance.ResultsSix initiatives were selected: Intermountain Healthcare, 13606/OpenEHR Archetypes, Clinical Templates, Clinical Contents Models, Health Level 7 templates, and Dutch Detailed Clinical Models. Each model selected was reviewed for their overall development, involvement of clinicians, use of data types, code bindings, expressing semantics, modeling, meta information, use of repository and governance.ConclusionsUsing both a top down and bottom up approach to comparison reveals many commonalties and differences between initiatives. Important differences include the use of or lack of a reference model and expressiveness of models. Applying clinical data element standards facilitates the use of conceptual DCM models in different technical representations.

Status and Direction of Healthcare Data in Korea for Artificial Intelligence

“…There are diverse approaches including the clinical contents model (CCM) [15], International Organization for Standardization (ISO) 13606 [16,17], detailed clinical model (DCM) [18], and Clinical Information Modeling Initiative (CIMI) [19]. By the implementation of the structured template, clinical data in EMR can be standardized to resolve ambiguity, provide semantic interoperability, and prevent data entry errors.…”

Requirements for clinical information modelling tools

“…This study applies the concept clinical information model (CIM) as a generic term that includes all the above specifications when applied to the structure of EHR related clinical information. CIMs can be used to organise (define) the structure of clinical information for multiple tasks such as exchanging clinical content, querying and analytics over clinical content, decision support over clinical content, entering clinical content, storing clinical content in EHR systems and displaying clinical content [10]. Based on this concept, this study aims to identify the most important requirements that should be met through the tools that are used to define them.…”

Clustering clinical models from local electronic health records based on semantic similarity

“…They are aimed at developing, refining, implementing, and evaluating information models to ensure clinical involvement as well as semantically-interoperable systems [1,2,[6][7][8][9][10]. Recently, an analysis criticized that many existing clinical modeling approaches violate good modeling practice since they fail to model the requirements of the health care domain using a consistent healthcarespecific ontology [11].…”

“…However, going from local customizability to global standardization is a challenge, especially in terms of modeling and managing clinical models (CMs) because this is the place where local clinical requirements are expressed in computerized form. CM is a relatively new construct resulting from the fact that modern EHR architectures separate reference information models from clinical models, these are called two-level modeling approaches [1,2]. CMs define documentation structures used in clinical situations such as physical examination, nutrition screening or vital signs measurement, and for each clinical situation CMs can be bound to relevant terminology [3].…”