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vMR Update – Phase 1 Changes “ So many changes, so little time”

vMR Update – Phase 1 Changes “ So many changes, so little time”. 03/12/2013. New ISO Datatype. ED – EncapsulatedData Allows for support of richer documentation than just free text

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vMR Update – Phase 1 Changes “ So many changes, so little time”

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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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