Representing Multiple Standards in a Single DAM: Use of Atomic Classes

Transcription

1 Representing Multiple Standards in a Single DAM: Use of Atomic Classes Salvatore Mungal 1 ; Mead Walker 2 ; David F Kong 3 ; Rebecca Wilgus 3 ; Dana Pinchotti 4 ; James E Tcheng 3 ; William Barry 1 ; Brian McCourt 3 1 Duke Cancer Institute, Durham, NC, 2 Mead Walker Consulting, Downingtown, PA, 3 Duke Clinical Research Institute, Durham, NC, 4 American College of Cardiology Foundation, Washington, DC

2 Agenda Aim: To create a Cardiology DAM Background Movement towards Interoperability The issues Atomic class resolution Results Conclusion

3 Background The National Cardiovascular Research Infrastructure team and many stakeholders created a consensusbased, authoritative and harmonized set of clinical data standards to meet the diverse requirements necessary to streamline collection and secondary reporting of health care data. Data element (DE) components included names, definitions, permissible value names and definitions, data types, citations, links to the source vocabulary and inter-de relationships and represented the smallest meaningful unit of instantiated data. DAM creation From these DEs, a multi-disciplinary team created a UML-based representation following NCI s modeling guidelines to facilitate ISO compliant metadata publication.

4 Background Overcoming methodological and tooling challenges, we formulated a UML-based metadata model allowing multiple representations (such as HL7 RIM and the CDISC Study Data Tabulation Model (STDM)) within in a single Domain Analysis Model (DAM) and subsequent dissemination via an ISO compliant metadata repository.

5 Interoperability Overlapping perspectives on nomenclature and formalisms toward interoperability in healthcare. Use of ISO metadata standard via NCI s cadsr (ontologies and terminologies) with the addition of CDISC and HL-7 standards lay the foundation for interoperability in healthcare.

6 Issues The typical ad hoc mapping of disparate document-based standards and controlled terminology are insufficient for representing the complex relationships such that barriers to reuse are greatly reduced. The dynamic, multidimensional and interrelated nature of information consumed and generated during the patient care process dictates that data elements must be able to be used, unconstrained, in each scenario. Initial attempts to represent a data element in a common model of aggregated contexts were informative; however, modeling every instantiation or permutation led to a very high level of complexity and redundancy. We observed a large number of attributes (DEs) were duplicated - as many as 19 times with over 1800 CDEs created. Maintenance of the UML DAM was intractable. Many other approaches such as the abstraction, inheritance and instance classifiers failed to satisfy functional requirements of the model.

7 Issues Illustration of the CABGIndications and CABGComplications classes associated to the CABG class showing the acutemi attributes before use of Atomic classes.

8 Atomic Class Resolution Conversion to the Acute Myocardial Infarction atomic class. Note the Indication and Complication associations to the CABG class.

9 Results The CV DAM R2 yielded approximately 349 CDEs. The DEs are organized into approximately 165 atomic classes within 18 parent classes and 4 sub-domains of cardiology. By leveraging atomic classes, our data model with 349 unique DEs was dispersed and replicated to over 1800 attributes in the original model but condenses to a more parsimonious and generalizable model with only 815 elements (from the replicated 349 CDEs).

10 Conclusion Modeling different representations of harmonized vocabulary-based DEs in a single DAM serving disparate groups became intractable, but the use of atomic classes in a CDELibrary curtails this. The use of atomic classes reduces maintenance efforts because updates to any DEs are cascaded to all uses in the model. Using the atomic classes in the CDELibrary, it is relatively easy to formulate a different representation through standard modeling methods. This, plus the publication in a public metadata repository, offers a readily consumable, common source for data specifications serving diverse stakeholders. This DAM with use of atomic classes in a CDELibrary will facilitate future semantic and syntactic interoperability across healthcare and secondary reporting initiatives.

11 Thank you!