The Clinical Information Modeling Initiative

Fall 2012
Volume 3
Edition 1

The Clinical Information Modeling Initiative (CIMI) is an international collaboration that is dedicated to providing a common format for detailed specifications for the representation of health information content so that semantically interoperable information may be created and shared in health records, messages and documents. CIMI members recognize a multipolar world of health informatics and are dedicated to a shared vision of universally implementable clinical information models.

In April 2011, the HL7 Board authorized a task force to focus on how interoperability could be more forcefully assured through evolving HL7 standards for representing clinical information. Stan Huff was named as the chairperson of this “Fresh Look” Task Force. Over the next few weeks, conversations among members of the task force led to the conclusion that many parties were interested in creating a shared open library of detailed clinical models. It was felt that this group needed to be independent of any existing standards group, at least initially, to insure that any models developed would be open and free for use.

Subsequent meetings were held in 2011 in McLean, Virginia (July), San Diego (September), Sydney (October), and London (December). These meetings, chaired by Stan Huff, were attended by representatives from twelve countries and from organizations that included standards bodies, national agencies, open source software developers and proprietary software vendors. The mission of the group is to improve the interoperability of healthcare information systems through shared implementable clinical information models. The organization adopted the name of the Clinical Information Modeling Initiative, agreed on its purpose, and began to publish formal summaries of meetings and proceedings in a wiki hosted by the Mayo Clinic (http://informatics.mayo.edu/CIMI).

Organizational members of CIMI

Voting Members (February 2012)
1.CDISC
2. Canada Health Infoway
3. EN13606 Association
4. GE Healthcare
5. HL7
6. Intermountain Health
7. Kaiser
8. Mayo Clinic
9. MOHHoldings Singapore
10. NEHTA (Australia)
11. NHS England
12. openEHR
13. Results4Care
14. SMART
15. South Korea
16. Tolven
17. US Departments and Agencies
Active participants who have declined to vote
1. CEN
2. IHTSDO

Rules for and listing of voting members can be found at http://informatics.mayo.edu/CIMI/index.php/CIMI_Voting_Member_Policies.

The guiding principles articulated at the London meeting included:

  1. CIMI specifications will be freely available to all. The initial use cases will focus on the requirements of organizations involved in providing, funding, monitoring or governing healthcare and to providers of healthcare IT and healthcare IT standards as well as to national eHealth programs, professional organizations, health providers and clinical system developers.
  2. CIMI is committed to making these specifications available in a number of formats, beginning with the Archetype Definition Language (ADL) from the openEHR Foundation (ISO 13606.2) and the Unified Modeling Language (UML) from the Object Management Group (OMG) with the intent that the users of these specifications can convert them into their local formats.
  3. CIMI is committed to transparency in its work product and process.

In 2012, meetings have been held in San Antonio (January) and Pleasanton, California (May). Various task forces and an interim governance group (the Interim Executive Committee or IEC) were launched in San Antonio. A key principle that was agreed upon in San Antonio is that CIMI models will utilize tight binding to terminology to provide required clinical meaning and richness. SNOMED CT was chosen as CIMI’s primary reference terminology with other terminologies such as LOINC to be used as needed for specific uses and/or geographies. The members also agreed that CIMI model should be valid regardless of programming language, serialization form, or target reference model.

The work of the task forces was reviewed in Pleasanton and, in particular, the work of the Reference Model Task Force was accepted and is being used to guide the work of the Modeling Task Force, members of which were named following the Pleasanton meeting. The Modeling Task Force recently asked the CIMI membership for:

1. Donation of clinical information models (in human-readable format and computable format, if available) for the following:

  1. Heart Rate
  2. Body Mass Index (including calculation)
  3. Apgar Score
  4. Glucose Tolerance Test Result
  5. Adverse Reaction
  6. Medication order
  7. Problem list
  8. Care Giver Reported Nausea
  9. Wound Culture Result (including sensitivities)

2. A set of reference patterns (in human-readable format and computable format, if available) upon which the above models are based – for example, observation, evaluation, instruction, action, activity, finding observation, property observation, procedure, list, schedule, address, name. For each of these reference patterns, the contributors were asked to include appropriate metadata for each model (as above), as well as details of the structure, definitions, constraints and value sets for each component of the model. The contribution of additional reference patterns would also be welcomed.

The contributions of existing clinical models and reference patterns will then be used by the CIMI Modeling Task Force to provide context for its work. Comparisons between different organizations’ approaches to these entities are expected to be instructive.

Other important agreements reached in the Pleasanton meeting were that:

  • In order to be sustained, CIMI should seek to ally itself with an appropriate parent organization that could provide administrative and logistical support
  • An RFI should be issued 1) to identify a parent organization and 2) to determine the scope of contributions that collaborating organizations are willing to freely donate to CIMI.

CIMI members will meet in Rockville, Maryland September 14-16. The work of the Modeling Task Force will be reviewed; responses to the RFI will be shared; and other business will be conducted as needed. Planning is underway for a follow up meeting in Europe later in the year and meetings in 2013.

New organizations are welcome to join the CIMI initiative. Any observer is welcome and contributing organizations may be admitted as voting members. The conversations at the CIMI meetings and in on line forums have been highly interactive, respectful, and frank. A great strength of CIMI, distinguishing it from other efforts, is the active participation of stakeholders representing all of the main points of view on clinical modeling. Willingness to leverage experience across many organizations to forge new ground has been heartening. We expect the coming year to be productive and stimulating.