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Enhancements in vMR Phase 1: Expanded Data Types and Proposal Attributes

The Phase 1 update to the vMR introduces significant changes aimed at enriching data documentation. New ISO datatypes, such as Encapsulated Data and Extended vMR Datatypes like CodedIdentifier and CodedNameValuePair, facilitate complex comment structures. Enhanced proposal attributes for Procedure and Substance Administration proposals support a broader range of orderable items, with features including timing, frequency, and various comment types. Updated models allow for improved data relationships, while essential fixes ensure accuracy in dosing representation and clinical statements.

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Enhancements in vMR Phase 1: Expanded Data Types and Proposal Attributes

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  1. vMR Update – Phase 1Changes“So many changes, so little time” 03/12/2013

  2. New ISO Datatype • ED – EncapsulatedData • Allows for support of richer documentation than just free text • Used in Documentation type to support various types of proposal comments (see upcoming slide on proposal changes)

  3. New Extended vMRDatatypes • CodedIdentifier • Associate an II with a relevant concept from a terminology • CodedNameValuePair • Any coded name-attribute pair • Used to support attribute extension • Documentation • Currently used in ‘comment’ attribute to support various comment types. • Dose • Encapsulation of administeredDose and doseType to support multiple cardinality • DietQualifier • Generic way to add diet components to post-coordinated diets such as levels of fat, carbohydrates, fluids, fibers, nutrients, etc…

  4. ProcedureProposal Enhanced with New Attributes • Needed to support more kinds of orderables • originationMode • frequency • timing • prnReason • comment (0-*) • Can support any number of comments • Comments are typed – e.g., ‘Consult Note’, ‘Provider Instructions’, ‘PRN Instruction’, other… • Supports both free text and structured text

  5. SubstanceAdministrationProposal Enhanced with New Attributes • Needed to support more kinds of orderables • originationMode • comment • prnReason • infuseOver • timing • Note – no ‘frequency’ as this is already captured by dosingPeriod and dosingPeriodIntervalIsImportant

  6. SubstanceAdministrationBase Generalized • More than one dose can now be defined • E.g., starting dose, maintenance dose

  7. New Procedure Proposals • LaboratoryProposal • ImagingProposal • RespiratoryCareProposal • DietProposal • PatientCareProposal? Will probably be dropped as it is now covered by ProcedureProposal. May be revived in Phase 2.

  8. New SubstanceAdministrationProposals • ComplexIVProposal • PCAProposal

  9. New Attributes to Support InfoButton • CdsContext has the following new fields • cdsSubTopic • cdsEncounterType

  10. Important Model Enhancements • New extensible mechanism for class attributes • Entity, ClinicalStatement, and CdsContextnow include a new ‘attribute’ field of cardinality 0-* • Attribute is a CodedNameValuePair consisting of: • name – CD (1-1) • value – ANY (1-1) • In schema, each have an ‘extension’ container section • RTO type fixed to support ratios of QTY rather than PQ • Needed to support more types of ratios such as ratios of integers found in titers. • Fixed in XSD to support ratios of PQs. Only ‘decimal’ supported in v1. • RTO_PQ and RTO_INT added to XSD

  11. Important Model Enhancements • IVL_PQ now support optional lower and upper bounds in XSD • Allows the expression of unbounded upper and lower ranges • Probably an oversight in current version of vMR • AdministrableSubstance.strength • No longer a ratio of decimals • Now supports ratios of PQs • Probably an oversight in current version of vMR

  12. Changes to ClinicalStatement • ClinicalStatement.templateId now a CodedIdentifier • Allows code to be associated with II • II now supports ‘identifierName’ – string (0-1) • Templates can have a name just like we people do • ClinicalStatement.evaluatedPersonId • Bidirectional association between a CS and its owner. • Same change made to Entity class • Supports flattening of data • ClinicalStatement.id now optional • Need to add documentation to IG to specify that it is required

  13. Important Model Enhancements • GoalBase.targetGoalValue, ObservationResult.observationValue are now of type ANY • Supports polymorphism • BodySite.bodySiteCode changed to optional • Needed to support term precoordination use case where laterality only is post-coordinated

  14. Considered for Phase 1 but Deferred for Phase 2 • ImagingEvent • RadiationDose • RadiationDuration • Frequency • Need consistency between SubstanceAdministration and ProcedureProposals • Need optional coded field such as ‘TID’, ‘qac’ • Immunization enhancements • isValid • validAdministrationTimeInterval • Class extension mechanism • Should ClinicalStatement be concrete rather than abstract? Other mechanism? Finer grained model? • Bidirectional association between source and targets of relationships • “I am the object of which relationship?”

  15. Considered for Phase 1 but Deferred for Phase 2 • Chemotherapy • Intervention/Patient Education • Tube Feeding • Other proposal types? Need a round 2 potentially.

  16. Questions for Phase 2 • Fleshing out ‘Events’ for QDM. What do we need to support eMeasures • How much can we assume about terminologies? CD is nice but has limits if no value sets exist. • Can we enhance the vMR’sinferencing capabilities • Rethinking the hierarchies • Bridging by composition • Equivalence relationships • To OWL or not to OWL • More pilot feedback • Did we hit the 80%? • Keeping vMR agile and backward compatibility • And last but not least … • Templates and profiles

  17. For More Information… • Please see our change log at: • https://docs.google.com/spreadsheet/ccc?key=0AkVg6OcD6S5NdHkxaVZUSDJzVTZuQUZkM3NmdUlkM3c#gid=0

  18. Thank you!

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