MOHH – Models
Submission
Dr Linda Bird
9th August 2012
Singapore’s Future Healthcare Landscape
Strategic vision of patients moving seamlessly across the
healthcare system, receiving coordinated patient-centric care
at the most appropriate settings.
Enabled by the National
Electronic Health Record
CH
NH
Polyclinics
Screening &
Prevention
(EHR)
Palliative
Care
RH
Home
Care
FPs
Rehab &
support
services
CH
NH
Polyclinics
Screening &
Prevention
CH
Screening &
Prevention
Palliative
Care
RH
Home
Care
FPs
CH
NH
Polyclinics
Home
Care
FPs
Rehab &
support
services
Screening &
Prevention
Palliative
Care
RH
Home
Care
FPs
Rehab &
support
services
Home
Care
Rehab &
support
services
NH
Polyclinics
Screening &
Prevention
Palliative
Care
RH
Home
Care
FPs
Rehab &
support
services
Palliative
Care
RH
CH
CH
NH
Screening &
Prevention
FPs
Rehab &
support
services
Polyclinics
NH
Polyclinics
Palliative
Care
RH
Standards Products
• Diagnosis - SNOMED CT and
Singapore Extension (SE)
• Drugs - Singapore Drug Dictionary
(SDD)
• Allergic Reactions– SNOMED CT +
SE
• Allergens - SNOMED CT + SDD
• Laboratory Results – LOINC
• Data Dictionary – MOHH Data
Dictionary
• Procedures - TBD
• Reason for visit - SNOMED CT
• Symptoms and Problems - SNOMED
CT and Singapore Extension
• Laboratory Reports – Smart SNOMED
CT
• Laboratory Orders – SNOMED CT
• Radiology Orders - SNOMED CT
LIM Development Process
Clinical Modelling Framework
Requirements
Generate
Terminology
Ontology
Computable
Implementation
Specification
References
Logical Reference Model
(ISO13606+21090)
Singapore
Logical
Information
Model
References
Clinician
Input
Instance of
Graphical
Representations
Lim
Repository
Bind values
Clinician
Verification
Clinical Modelling
Language
(LOM)
Store
Terminology Server
Clinician Validation of the LIM
LIM
ID
LIM Name
LIM
Cardin
ality
LIM Definition
Laboratory
Test Item
1
A class describing the laboratory test that was
performed.
Test Name
LIM Example (for
Exchange)
LIM Example (for
Display)
1
The name of the laboratory test within a panel of
tests.
("xxx", "LDH
measurement")
("xxx", "Blood sodium
measurement")
"LDH
measurement"
"Blood sodium
measurement"
Sequence
Number
0..1
A number that identifies and sequences this
laboratory test item within a given panel.
"1"
"2"
"1"
"2"
Additional
Description
0..1
A descriptor used in combination with the Test
Name to fully define the description of the
laboratory test.
POCT
Indicator
0..1
The POCT (Point-of-care Testing) indicator at the
laboratory test item level.
("xx, "Point of Care
Test")
"Point of Care
Test"
Type
0..1
The type of the test.
WYSIWYG
NDDS snippet
NXDS LXML XSD
NXDS LXML Instance
IsoSemantic Models – Example of Problem
e.g. “Suspected Lung Cancer”
IsoSemantic Models – Example Instances
e.g. “Suspected Lung Cancer”
IsoSemantic Models – Compositional Grammar
Problem Diagnosis = $ProblemDiagnosisName:
246090004|associated_finding|=
(404684003|clinical_finding|:
63698007|finding_site|=($BodySite:
272741003|laterality|=$Laterality),
246112005|severity|=$Severity),
408729009|finding_context|=$FindingContext
IsoSemantic Models – Equivalence Testing
Problem Diagnosis = $ProblemDiagnosisName:
246090004 |associated finding| = (404684003|Clinical Finding|:
363698007 | finding site | = ($BodySite:
272741003|laterality| = $Laterality),
246112005 | severity| = $Severity),
408729009 | finding context | = $FindingContext
GP Problem Diagnosis = 86049000|Cancer| :
246090004 |associated finding| = (404684003|Clinical Finding| :
363698007 | finding site | = 39607008|Lung|),
408729009 | finding context | = 415684004|Suspected|
Polyclinic Problem Diagnosis = 162572001 |Suspected cancer|:
246090004 |associated finding| = (404684003|Clinical Finding|:
363698007 | finding site | = 39607008|Lung|)
RH Problem Diagnosis = 86049000|Suspected lung cancer|
Bi-directional Semantic
Interoperability
Source Data
Prob/Dx :”Osteoarthritis”
Severity : “Severe”
Location : “Knee Joint”
Side : “Left”
NEHR
Design Patterns Diagnosis
DP-based GP - Source
Data
GP - Source
Data
Prob/Dx :”Osteoarthritis”
National Term
Severe osteoarthritis
of the left knee
Severity : “Severe”
Location : “Knee Joint”
Side : “Left”
Transformed GP - Source Data in RH
format
Diagnosis : ”Osteoarthritis
Problem/Diagnosis : “Severe
of the left knee”
osteoarthitis of the left knee”
Degree : “Severe”
Transformed GP - Source Data in Polyclinic
format
Research
Semantics
Submission Overview
• ENTRY
– Observation Entry (Observable Name/Value)
• Heart Rate/ Blood Pressure / Blood Glucose
– Clinical Finding
• Problem Diagnosis Entry
• Adverse Reaction Entry
• Alert Entry
– Activity
• Pharmacy Activity Entry
– Pharmacy Order Entry
– Pharmacy Dispense Entry
– Pharmacy Administration Entry
• Investigation Activity Entry
– Investigation Order Entry
– Investigation Result Entry
• Procedure Entry (Reference Pattern)
• CLUSTER
– Pharmacy Item / Investigation Test Item
Thank You
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