Practical Modeling Issues: Representing Coded and Structured Patient Data in EHR Systems

Stanley M. Huff, MD

Intermountain Healthcare, Department of Biomedical Informatics, University of Utah

Salt Lake City, UT

 

Abstract

This tutorial will describe the need for formal data models (detailed clinical models) for the EHR and how standard terminologies are used in the models. Starting with use cases encountered while developing EHR systems at Intermountain Healthcare, the instructor will discuss the basic name-value pair paradigm for flexible representation of patient data; the proper roles for standard terminologies like LOINC, SNOMED CT, First Data Bank, and RxNORM; approaches to handling pertinent negative findings and negation; support for precoordinated data entry while storing the data in a post coordinated database; and storage of data that belongs to another patient (baby or donor) in the patient record.

 

Outline

  • What are detailed clinical models?

  • Why are detailed clinical models important?

  • What are the requirements for defining and using detailed clinical models?

  • Name-value pair (NVP) and entity-attribute-value (EAV) strategies for representing clinical data

  • What are the proper roles for use of LOINC, SNOMED CT, drug codes (First Data Bank, RxNorm) and classifications in the models

  • The necessity of supporting both pre and post coordinated models in a clinical system

  • Approaches to the representation of negation and pertinent negative findings

  • Storing data that belongs to another person (relative, family member, donor) in the patient record

  • Specific alternatives for modeling including observations, diagnoses, and problems

  • Open candid discussion of ideas that the participants have about ways that the modeling issues can be addressed

  • Importance of supporting open consensus standards for EHR systems that are purchased or developed

  • Brief discussion of various national and international activities related to formal clinical data models

 

Learning objectives

  1. The assumptions and motivation for formal definitions of detailed clinical models

  2. How standard coded terminologies are referenced by detailed clinical models, and the different roles that SNOMED CT and LOINC play in the models

  3. The various alternative logical models for implementing clinical models related to diagnoses, problems, measurements and observations.

  4. The importance of adhering to terminology and modeling standards in developing or purchasing interoperable EHR systems

  5. National and international activities for sharing models that enable interoperability of EHR systems

 

Target audience

Anyone interested in the principles and practice of clinical data models and the practical use of standard coded terminologies should attend. This would include physicians, nurses, developers of clinical software, and clinical systems architects and designers. Individuals who want to better understand: the importance of adhering to terminology and modeling standards in developing or purchasing interoperable EHR systems; how standard coded terminologies are referenced by detailed clinical models, and the different roles that SNOMED CT and LOINC play in the models; the various alternative logical models for implementing clinical models; measurements and observations; and national and international activities for sharing models that enable interoperability of EHR systems.

 

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