Typology of content types
The Question
This page addresses the question of whether there are substantively different categories of DCM, which would require different modelling 'styles' or strategies.
What's important are the abstract structures.
One thing that is useful to consider is to distinguish two kinds of 'context':
- situation context - who / where / when - information about situation, i.e. places, people, time
- specific context - information items that are not the key datum, but are typically required along with it, e.g.
- patient state - exertion, position, etc
- method/protocol - e.g. instrument, measurement protocol, device etc
In the table below, the conclusion is that the categories in the left hand column (at least, if not column 2) each correspond to a different modelling style, and are likely to be the basis for different RM classes and/or reference archetypes, that provide the basic 'shape' and semantics of the information type.
A partial classification
Abstract category | Concrete Category | Description | Proposed CIMI Modelling pattern |
---|---|---|---|
Lab result categories | Lab Analyte | Common features:
| while logically atomic, due to the need of specific context items, a container like a CLUSTER or higher is required; the key datum is an ELEMENT containing a DATA_VALUE. It may be possible to model every single Lab analyte using a single ELEMENT archetype with LOINC coding. |
Lab Panel | Common features:
| ENTRY with slot for Lab Analyte CLUSTERs. One Lab panel archetype should be usable for most lab panels. Possibly a couple of other variants for special structures. | |
Lab Report | Report containing one or more panel result(s); carries audit + attestation, and other specific context like order ids, lab comments etc | COMPOSITION containing one or more Lab Panels, plus top-level situation context | |
Questionnaires | Questionnaire item | Common features:
| CLUSTER containing ELEMENTs that model the natural language form of the question (via terms), the meaning of the question, and the possible result values. |
Questionnaire group / list | Set of Questionnaire items making up the logical questionnaire (equivalent to a 'panel' for questionnaires) | ENTRY containing one or more Questionnaire Item CLUSTERs | |
Questionnaire form | The full thing, filled out, attested, committed to EHR; carries audit + attestation | COMPOSITION containing (usually?) one Questionnaire group | |
General clinical information structures | Clinical entry structure | Common features:
| ENTRY containing free structure of CLUSTERs and ELEMENTs, making up the overall datum + specific context structure |
Clinical situation recording | committed report, document, or other artefact containing one or more Clinical entry structures, potentially with added heading structure; carries audit + attestation | COMPOSITION containing one or more ENTRYs | |
Orders | Order item | Common features:
| ENTRY |
Order set | A set of order items + other meta-data (TBC) | ||
Prescription | Arguably a special kind of grouping of order items | ||
Actions | TBC | ||
etc |
We don't treat computed / summed data items that appear in e.g. Apgar or BMI as special here, because I don't think they change the structure categories.
Lab results (i.e. in general the panel result, not a single lab analyte) and Questionnaires should be treated as special kinds of collections, whose members are logical atoms of a standard mould, whereas most other clinical data is not like this - each thing is its own structure. There are probably other special kinds of collections as well.
Readers might not agree exactly (or at all) with the above but I think we have to live with an ontological reality: not everything is the same, and we need to identify the structure of information in the real world in order to find appropriate modelling patterns.