MDC UML framework - Overview

1. MDC UML framework- Overview MDC_ArchFrmwk_UMLmodeling-Ovw-Dsize_jw3 17Jun11 - UML Modeling Framework - Overview

2. Informatics-DCM4MD-Vent-OntologicalReln Ontological framework –Model of models • The ontological framework comprises an ordered set of sub-models. • A Ventilator modality is characterized by several OO/relational metrical sets, (as follows, from left to right of diagram): • Respiratory Mechanics • Mode & Breath) Type (MTBT) & related Settings and provision types (i.e. FSM) • Observations • Ventilatory/Respiratory (Phasic; Direct and Derived) • Metrological; Annotational • Temporal (Intervals, Rates) • Analogical ({P, Q, V [tidal, minute]}- • Respiratory Dynamics [typ. calculations] • Other Modalities , e.g. • Vital • Capnog. • Ancillary • [Clinical] Control Variables Supervisory Control - UML Modeling Framework - Overview 2

3. Informatics= UML-DCM4MD-Topology Ontological framework –UML Reference Model The UML Reference Model comprises a set of sub-models treated as “Packages”. Package content is generally a set of related metrics, typically numeric but also enumerational. For example, the Mode:Breath relation is a matrix comprising an ordered set of phasic, modal breath provision functional enumerations, tuned according to a set of [typ.] numerical control variable Settings (a set, or “vector” per mode:breath type variation), while the Resp/Vent Dynamics Package comprises an ordered set of numerical calculations, based on machine and patient breath contributions in terms of [airway] pressure, flow, and volume over time. The overall set of metrical objects comprise a relational “namespace”, as depicted by the spreadsheet-oriented background grid. See UML Overview Package CDS Ctls WoB Mode & Breath Ctls Therapy Mgmt Sup’yCtl Order Mode : Breath Provision Function [Matrix] BT:MT Settings Property Sheets Feed back Auto Ctl Ventilator Resp /Vent Dynamics Flow sheet FSM Observ’ns Multi-Br Br2Br Annot’ns Semi- Auto Ctl RT Breath Frame Annot’ns Apnea Vent’n ATC AEV Nebuliz’n Humidif’n Ventilator Infrastructure Gas Analyzer Ancillary Instrumentation Cardiac Analyzer … - UML Modeling Framework - Overview 3

4. Informatics= UML-DCM4MD-Package Appendix A UML Domain Model - Overview The UML Domain Model Overview Package (see following diagram) is a graphic showing the Package composition in abstract, relational form. Each of the symbols correlates with a particular Package. Subsequent slides show Package detail, using hyperlinks to emulate the navigational nature of the UML tool. See Package topology See UML Packages diagram See detail. - UML Modeling Framework - Overview 4

5. Informatics= UML-DCM4MD-Vent-Topology Appendix A UML Reference Model – Package topology The Domain Model has two top-level Packages, a “StdsObject” Package, which includes standards-based [OO] abstractions, and a “DCM4MD” Package, which comprises the sub-models previously characterized. As noted, the Overview Package depicts the Package topology. See detail. See detail. See detail. See detail. See detail. - UML Modeling Framework - Overview 5

6. Informatics= UML-DCM4MD-Vent-ModalTypology Appendix B-1.1 UML Reference Model - DCM4MD Packages – Mode:Breath Typology Mode:Breath typology is shown below in both relational (lower) and OO (upper-right) forms. The OO progression (left to right) corresponds with the relational row progression (Mode Classes i-iii, top to bottom, which generally provide decreasing “assurance” of Ventilator contribution ). In general, each modality (row of the matrix) is a phasic progression, spanning inspiration (initiation, delivery, and termination) and expiration, with Variations providing high-order refinement of breath delivery patterns. Parent node OO Class Inheritance Rationale Modal Patttern Archetypes - UML Modeling Framework - Overview 6

7. Informatics-UML-DCM4MD-Vent-OO Appendix B-1.2 UML Reference Model - DCM4MD Packages – OO Class Inheritance Rationale Specialization is used to characterize variations in phases of breath provision. In the Inspiration initiation phase (columns at left), the progression ranges from timed- to physiological-initiation, primarily by means of a “synchronization” feature (as characteristic of “SIMV”). In the Inspiration delivery phase (middle columns), the progression ranges from Ventilator- to Patient-driven. The composite result is a range of breath delivery patterns, ranging from higher- to lower-levels of Ventilator “Work of Breathing” (WoB). Parent node - UML Modeling Framework - Overview 7

8. Informatics-UML-DCM4MD-Vent-BTMTmatrix Appendix B-1.3 UML Reference Model - DCM4MD Packages – Breath Pattern Archetypes The diagram at right shows the Ventilator- (reddish-colored) and Patient-(light blue-colored) provided contributions to breathing as “archetypal” form.; that is, the ongoing breath pattern comprises a series of recurring archetypes. The diagram at left is the Mode:Breath matrix, this time showing the general increase (blue shading) in breath delivery contribution by the Patient. Parent node See Timelines. - UML Modeling Framework - Overview 8

9. Informatics-UML-DCM4MD-Vent-BreathTimelines Appendix B-1.4 UML Reference Model - DCM4MD Packages – Breath Pattern Timelines The diagram below shows higher-assurance modalities in terms of hierachically structured “timelines”. In general, the highest-level of breath provision assurance is used in cases (i.e. from left, e.g. OR), when a/the Patient is anesthetized, while reduced assurance is provided as the Patient recovers (to right of diagram); additional cases in the progression lead to “weaning” the Patient from a/the Ventilator, typically from wholly Patient-driven contribution, or “Pressure Support (PS)” mode (iii). As [Patient-] “spontaneous” breathing increases, determinism decreases, thus leading to the need for annotations concerning spontaneous events and metrics, particularly “breath rate” (BR), denoting Ventilator-provided contributions vs. “respiration rate (RR)”, denoting Patient-provided contributions. Parent node - UML Modeling Framework - Overview 9

10. Informatics-UML-DCM4MD-Vent-Settings Appendix B-2 UML Reference Model - DCM4MD Packages – Modality Settings Property Sheet(s) Each modality (/modal variation) requires a number of related “control variables”, typically denoted as “Settings”. The set for any given modality is modeled as a Settings “property sheet”, the set of sheets comprising an array. Various implementations may be used to realize the representative set and/or access/management of individual Settings, in particular any given Setting type that is used in multiple modalities, i.e. is reusable, in which case various indexing methods may be appropriate, based on implementation. Parent node - UML Modeling Framework - Overview 10

11. Informatics-UML-DCM4MD-Vent-FSM Appendix B-3 UML Reference Model - DCM4MD Packages – Finite State Models (FSM) Multi-modal finite state models (FSM) are used to characterize phasic breath provision on the part of the Ventilator. The breath initiation FSM (lower diagram) basically parses the operating context to manage breath-to-breath phasing, as an introductory subset of the general breath provision FSM (upper right diagram). Parent node - UML Modeling Framework - Overview 11

12. Informatics-UML-DCM4MD-Vent-RTepochs Appendix B-4 UML Reference Model - DCM4MD Packages – RealTime (RT) Epochs Temporal sub-models are organized according to general RT “epochs”, ranging from per breath[-to-breath, “Br[2Br]” (at left) to multi-breath to trend, or trajectory (as in “weaning” (at right). RT epochal timeline[s] RT epoch C Trend  Trajectory Parent node RT epoch A Br[2Br] RT epoch B Waves/Annot’ns - UML Modeling Framework - Overview 12

13. Informatics-UML-DCM4MD-Vent-RTepochs Appendix B-4A UML Reference Model - DCM4MD Packages – RT epoch A – Breath[2Br] Frame In the highest-precision view, a single breath or breath-to-breath (“Br2Br”) progression is shown, typically correlating [Airway] Pressure and Flow with [Ventilator- and Patient-]provided contributions. The following diagram shows an “Airway Pressure Release Ventilation (APRV)” mode breath type pressure waveform archetype. In this mode, the Patient may breathe during intervals of high-level pressure provision by the Ventilator, which releases pressure to a low[er]-level to allow air exchange, particularly to evacuate CO2 from the lungs. APRV is a form of “inverse-I:E (Inspiration:Expiration) Ratio” ventilaiton, so-called due to the fact that the expiration phase is generally longer than the inspiration phase in spontaneous breathing. Parent node RT epoch B BT Variations- Examples “Auto-PEEP” Flow deceleration progression PAV Flow-Vol diagram - UML Modeling Framework - Overview 13

14. Informatics-UML-DCM4MD-Vent-RTepochs Appendix B-4B UML Reference Model - DCM4MD Packages – RT Epoch B – Waves/Annotations A multi-breath pattern, or “snapshort” is typically needed for representing archetypes. Areas of Interest (AoI) may be “annotated” on or along with a waveform stream for analytic purposes. AoI may be “coarse-” or “fine-”grained; for example, the archetype at top shows only major phasic events, while the annotation stream at bottom show numerous high-precision events. Parent node See detail. RT epoch C - UML Modeling Framework - Overview 14

15. Informatics-UML-DCM4MD-Vent-RTepochs Appendix B-4C UML Reference Model - DCM4MD Packages – RT Epoch C – Vent/Resp Dynamics / Flowsheet Longer time periods are needed to assess some respiratory behavior patterns, such as dyspnea or cardiac-related variations. In general, key variables are trended and then reused in a layered way rather than on the basis of each derivative calculation or per mode, as in the case of Settings; however, during ventilation “optimization”, Settings trends may be useful in determining optimal settings, such as oxygenation level (e.g. FIO2). Parent node - UML Modeling Framework - Overview 15

16. Informatics-UML-DCM4MD-StdObjects Appendix C UML Reference Model – StdObjects Packages The “standard objects (StdObjects)” Package comprises a set of OO constructs, chiefly Class and Common data type constructs. Specifically, the IEEE 11073-10201 DIM (Domain Information Model) is defined in terms of Packages. See detail. Parent node See AARC Glossary of Terms. See MDC Wiki - Nomenclature MDC Wiki - Nomenclature See Relational Map - UML Modeling Framework - Overview 16

17. Informatics-UML-DCM4MD-Vent-Nomen-RelnMap Appendix C-1 UML Reference Model – StdObjects Packages – Nomenclature – Relational Map The relational map w.r.t. Packages is shown in the following diagram, which is a snapshot of the ontology in relational form for the purpose of mapping nomenclatures and related [sub-]partitions. Parent node - UML Modeling Framework - Overview 17