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The best current examples of what a "VMR" is is in the recently updated = GELLO R2 standard. In this it defines the EHR interface that GELLO talks to= , to query a patient's, or a population's Medical Records. The VMR is based= on the HL7 V3 model and datatypes.
It is a "Virtual" interface and is optimised for point in time clinical = decision support and while it could be used as the basis for an EHR design = it is intended to be simplified, to represent a snapshot and to omit import= ant concepts that should exist in a real EHR.
In particular concepts such as audit trail, result history and display f= orms are omitted and only data relevant to making decisions based on the cu= rrent patient state are represented. The hard bit is excluding as much comp= lexity as possible while ensuring that any decisions made are safe and base= d on adequate data.
It is intended that each EHR system would create an "Adaptor" or "Facade= " to present patient data in a consistent form so that the clinical decisio= n logic can be common across many systems. Obviously some systems will be m= issing data and it is likely that the data will not be in a HL7 V3 form and= this is where the word virtual comes in, there needs to be a translation l= ayer to transform data into a form that complies with the VMR. There are ma= ny potential ways to do this ranging from creating a CDA document, a HL7 V3= message, a SOAP service or even creating HL7 V2 message(s) that contain th= e required structured data to allow the creation of a VMR interface. A dire= ct database access layer is also possible. So documents, messages, services= , archetypes/templates, CCD, databases for example could all populate the v= MR.
The aim is to allow GELLO or another CDS language access to a standard m= odel to reliably access patient data about the current patient's "Observati= ons" (eg haemoglobin) or "Family History" or eg "Surgical History"/"Problem= List". This is the single patient "Context" but other contexts are relevan= t. Access to population based data is very important for public health moni= toring (perhaps context "Population"?) and in the case of templates access = to data during the editing process (context "Template").
The project is currently under active development and these ideas are no=
t fixed or standardized but give some idea as to our view of what a VMR sho=
uld be. In this area we intend to attempt to try and model the requirements=
using the HL7 "SAEAF" famework - the "Services Aware Enterprise Applicatio=
n Framework". We think this framework, when used in an agile manner shows g=
reat promise in structuring thoughts on the topic and allowing alignment wh=
en people come at the problems from different world views.
VMR modelled in SAEAF
Enterprise View | Information View | Computational View | Engineering View | Technology View | |
---|---|---|---|---|---|
Conceptual | Exampl= es | ||||
Platform Independent | UML M= odel | GELLO Class definition | |||
Platform Specific | LRA Models | CCD RMIM View |
Enterprise View - Concerned with the purpose, scop= e and policies governing the activities of the specified system within the = organisation of which it is part.
Information - concerned with the kinds of informat= ion handled by the system and constraints on the use and interpretation of = that information.
Computational - concerned with the functional deco= mposition of the system into a set of objects that interact at interfaces -= enabling system distribution.
Engineering - concerned with the infrastructure re= quired to, and distribution of, the computing resources defined in the Comp= utational View.
Technology - concerned with the choice of technolo= gy to support system distribution.
Noone has an exact implementation of the vMR. It will always need to be = mapped to local structures. It needs to handle missing data items, for exam= ple if the local structure doesn't have a smoking history for patient, the = vMR needs to know it doesn't have it - it is null. Another example would be= if the Allergies section of a populated instance of a patient's electronic= medical record is not filled in - is this 'No - there are no allergies' or= is this a null value? A test for the vMR is that is needs to be addressabl= e by GELLO. (The vMR is for clinical decision support). It exists for CDS, = then it is gone.
As an artefact of the HL7 standards community it might seem that this no= tion of a vMR is confused with that of an instance of the RIM such as a RMI= M. Remember it is a simpler, snapshot view and it's a slightly different vi= ew at that. So instead of top level Entities and Acts, we have explicit lin= ks, such as Patient (Entity) has Observation (Act). The vMR has a context w= hich would often be a patient context, but it could be a population one. Th= is context builds a specific patient class property rather than following t= he RIM links (ie Person playing the role patient..). So the link is clearer= (perhaps) and stuff at the RMIM level can be exposed as top level construc= ts.
Additional classes can be included such as ProblemList, FamilyHistory an= d Procedures. Our current approach to do this is to add some xmi export cap= ability from our gello tooling and then bring that into Enterprise Architec= t.
The vMR also includes support for Common Terminology Services. The vMR m= ight properly 'live' in the Guideline model part of Rector's Model of Model= s diagram.
So what's to be in and what's to be out? ideally we'd be in the Goldiloc= ks zone with a one pager that keeps most people happy. We should borrow the= SNOMED-CT editorial policy of 'URU' - understandable, reproducible and use= ful. Here is a list of some potential vMR class sources:
In addition we think the vMR should use the latest ISO datatype standard= .
We are active in the newly formed vMR project of the HL7 Decision Suppor= t Working group. The shape of the vMR is emerging.
To link to the HL7 vMR wiki, go to: