Hi Verbjorn,
I am going back through various recent posts on the lists, and suggest
that you might be interested to repost this one on the Discourse server
clinical list <https://discourse.openehr.org/c/clinical>.
- thomas
On 10/10/2019 10:29, Vebjørn Arntzen via openEHR-clinical wrote:
Hi
From a recently published document from the Norwegian directorate for
e-Health, I've stumbled upon a description of how terminologies can be
used in information models. See text below, mostly Google translated –
sorry! I've got a feeling of "Well, yeah, it's fairy right but not
quite". To me it seems to mix the physical data model for storing (and
also messaging and user interface) with information models.
If anyone feels like commenting the correctness (or incorrectness) of
the description, please do.
Kind regards
*Vebjørn Arntzen*
Special Adviser, RN
ICT-dept, Oslo universitetssykehus HF and
Coordinator, National governance of archetypes in Norway, Nasjonal IKT HF
Chapter 2.4 Terminologies in Information models
Information models specify the type of information to be used and how
information elements are sorted and stored in relation to each other,
internally in a system or when exchanging between systems. For
example, this may mean that the end user's screen displays a field
with the patient's name, a predefined list of current diagnoses, or a
field containing the physician's free text description. Much of what
is described below in this chapter will be handled in the systems and
won't be anything the end user needs to relate to.
One way to define what should be included in the various information
elements is to bind their definition or content to a terminology or
coding system, as illustrated in Figure 4 below, where both
designation of the value list is linked to a terminology (parent
reference) while the content of the value list is linked to other
terms in the ontology (binding to the value list). For example, by
binding, you can specify that diagnosis should use code and text from
a terminology with an underlying ontology. The information models also
operate with their own value lists for certain elements. Common
standardized terminology can be mapped to these value lists, if it is
appropriate for a comprehensive exchange of information.
Established relations between termsInformation recorded dynamically in
the context where it is used Terms in relation to each other
Information elements in relation to each other Binding to value
setReference to parent
Many information models that are used in Norway today are defined as
national e-health standards, this applies to both reporting standards
and reporting to registers. The standards are set out in the Reference
Catalog for e-Health, based on the Regulation on ICT standards in the
health and care sector. These are mandatory or recommended. Although
measures have been taken to implement international standards such as
the FHIR, for many years there will be a need to adhere to these
national information models. There is a trend towards increased
international standardization of information models and the use of
terminologies as information carriers. Important examples of
frameworks that can be used in Norway include Digital Imaging and
Communication in Medicine (DICOM) (21), Cross Enterprise Document
Sharing (XDS) developed by Integrating the Healthcare Enterprise
(IHE), Fast Healthcare Interoperability Resources (FHIR) developed by
the organization Health Level Seven (HL7) and archetypes developed by
OpenEHR. The frameworks have different methods for terminology
binding, but what they have in common is that they look at the use of
standardized terminologies and the utilization of mutual experiences
where appropriate. This is a natural development of an ecosystem of
information exchange within health, driven by an international
environment. A whole that contains both coding systems, terminologies
and information models is an international trend. For example, IHE
will use information models from HL7. HL7 uses, among other things,
SNOMED CT as proposed coding in its FHIR information models and DICOM
uses SNOMED CT directly which encodes several places in its
frameworks. Common to the organizations that drive the development
going forward is broad international participation, anchoring in
academia and with suppliers and / or authorities. There is an issue
related to the use of SNOMED CT as a bound terminology as it is
licensed, and use will therefore be tied to membership or require
payment. SNOMED International has previously allowed DICOM to use
terms as part of a published standard. In 2019, a larger amount of
terms were released for use in the International Patient Summary
(discussed later). This is done to make it easier to use SNOMED CT,
even where there is a need for restrictive binding to terminology in
an information model.
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--
Thomas Beale
Principal, Ars Semantica <http://www.arssemantica.com>
Consultant, ABD Project, Intermountain Healthcare
<https://intermountainhealthcare.org/>
Management Board, Specifications Program Lead, openEHR Foundation
<http://www.openehr.org>
Health IT blog <http://wolandscat.net/> | Culture blog
<http://wolandsothercat.net/> | The Objective Stance
<https://theobjectivestance.net/>
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