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Mapping Challenges and Solutions in HL7 RIM for Diastolic Blood Pressure Assessments

This document addresses the complexities involved in mapping assessment properties related to diastolic blood pressure measurements within the HL7 Reference Information Model (RIM). It highlights issues such as the difficulty in creating meaningful semantic mappings due to the lack of context and clear definitions for properties like "Assessment." The document also explores specific examples of observations, such as oscillometric measurements and their associated entities, to provide clarity on the challenges faced in ensuring accurate health data representation.

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Mapping Challenges and Solutions in HL7 RIM for Diastolic Blood Pressure Assessments

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  1. 0..* 0..* 0..* 0..* 1 1 1 1 1 1 0..* 0..* HL7 RIM June 2010 Role Link Act Relationship type_cd : CS effective_time : IVL<TS> type_cd : CS Entity Role Participation Act class_cd : CS cd: CE determiner_cd : CS status_cd : CS id : II class_cd : CS cd: CE effective_time : IVL<TS> status_cd : CS id : II type_cd : CS time : IVL<TS> status_cd : CS class_cd : CS cd: CD mood_cd : CS status_cd : CS effective_time : GTS id : II 0..1 plays 0..* 0..1 scopes 0..*

  2. HL7 RIM: Sample Observation Organization classCode* <=ORG determinerCode* <= INSTANCE Id*: II[1..1] 1..1 providerOrganization ObservationEvent classCode* <=OBS moodCode* <= EVN Id*: II[1..1] code*: CV CNE[1..1] < ObservationType effective Time*: TS[1..1] Patient classCode* <=PAT Id*: II[1..1] subject typeCode* <=SBJ 0..1 patientPerson Person classCode* <=PSN determinerCode* <= INSTANCE name: PN[0..1] Agent classCode* <=AGNT Id*: II[1..1] author typeCode* <=AUT Time*: TS [1..1] component typeCode* <=COMP component typeCode* <=COMP ObservationEvent classCode* <=OBS moodCode* <= EVN Id*: SET II[1..1] code*: CV CNE[1..1] < CPT4 value*: ST[1..1] ObservationEvent classCode* <=OBS moodCode* <= EVN Id*: SET II[1..1] code*: CV CNE[1..1] < CPT4 value*: ST[1..1]

  3. HL7 RIM: Simple Observation Observation classCode* <=OBS moodCode* <= EVN Id*: II[1..1] code*: CV CNE[1..1] < ObservationType effective Time*: TS[1..1] Value*: Patient classCode* <=PAT Id*: II[1..1] subject typeCode* <=SBJ 0..1 patientPerson Person classCode* <=PSN determinerCode* <= INSTANCE

  4. Mapping 11179 CDE to RIM: Ex 1 8 Object Class Diastolic Blood Pressure: C25299 9 Data Element Concept 7 Diastolic Blood Pressure Property 10 Data Element Assessment: C25367 Diastolic Blood Pressure First Dinamap Oscillometric Measurement 6 Value Domain First Dinamap Oscillometric Measurement 1 2 3 4 5 Conceptual domain Representation class Data type (added) Unit of measure (added) Value meanings (added) ASSESS_RESULTS N/A Number mmHg C25509:C69319:C25209 Measurement: Oscillometric Blood Pressure Monitor : First

  5. Mapping to RIM

  6. Problems with Ex 1 • The property Assessment does not really have any useful semantics – dangling concept • No context information – cannot infer entity, role and participation • “Measurement: Oscillometric Blood Pressure Monitor : First” – has to be parsed • Not easy to convert into a terminology expression • Hard to derive from the concept derivation rule that oscillometric blood pressure monitor is the methodCode • Leveling and context of information changes from CDE to CDE

  7. Mapping 11179 CDE to RIM: Ex 2 8 Object Class Person Blood Pressure: C25190:C54706 9 Data Element Concept 7 Person Blood Pressure Property 10 Data Element Assessment: C25367 Person Blood Pressure ?? 6 Value Domain 1 2 3 4 5 Conceptual domain Representation class Data type (added) Unit of measure (added) Value meanings (added) AE_RESULTS N/A Number mmHg N/A

  8. Mapping to RIM

  9. Problems with Ex 2 • The property Assessment is hard to map • Assessment is used to reference blood pressure but the concept itself links to “assessment”  semantics of assessment seam irrelevant • Leveling and context of information changes from CDE to CDE

  10. Mapping 11179 CDE to RIM: Ex 3 8 ObservationEvent classCode* <=OBS moodCode* <= EVN Id*: II[1..1] code*: CV CNE[1..1] < ObservationType effective Time*: TS[1..1] methodCode*: Object Class Blood Pressure : C54706 ENT:LIV:POSN.ROL:PAT.DIR:SBJ.ACT:OBS: CODE 9 Data Element Concept 7 Blood Pressure Start Measurement Property 10 Data Element Begin Measurement : C25431:C25209 ENT:LIV:POSN.ROL:PAT.DIR:SBJ.ACT:OBS: EFFECTIVETIME Blood Pressure Start Measurement Hour Minute Time 6 Value Domain Hour Minute Time 1 2 3 4 5 Conceptual domain Representation class Data type (added) Unit of measure (added) Value meanings (added) ASSESS_RESULTS N/A Time N/A C25529:C48154:C25207

  11. Problems with Ex 3 • The property Assessment is hard to map • Assessment is used to reference blood pressure but the concept itself links to “assessment”  semantics of assessment seam irrelevant • Mapping Time interval is challenging • Leveling and context of information changes from CDE to CDE

  12. Mapping 11179 CDE to RIM: Ex 4 8 ObservationEvent classCode* <=OBS moodCode* <= EVN Id*: II[1..1] code*: CV CNE[1..1] < ObservationType effective Time*: TS[1..1] methodCode*: Object Class Dental Professional Practice: C41136:C52673 ENT:LIV:POSN.ROL:PAT.DIR 9 Data Element Concept 7 Dental Professional Practice Blood Pressure Assessment Property 10 Data Element Blood Pressure Assessment : C54706:C25217 ENT:LIV:POSN.ROL:PAT.DIR:SBJ.ACT:OBS: CODE Dental Professional Practice Blood Pressure Assessment Ind-2 6 Value Domain Assessments Ind-2 1 2 3 4 5 Conceptual domain Representation class Data type (added) Unit of measure (added) Value meanings (added) ASSESS_RESULTS C38147 CHARACTER N/A CL307587, CL30586

  13. Mapping Challenges and Risks • Every mapping is a custom problem • Inferencing using concepts doesn’t work as same concepts are used differently • Context has to be provided manually in many cases • Post migration verification will take a lot of time and effort - as losing information will not be acceptable • All the CDE administrative constructs for lifecycle management have to be migrated – no placeholder in RIM • Creating forward and reverse transforms is not feasible – as the view will change from element to element • Identifying simple, medium and hard CDEs will require manual work as tooling cannot infer from the information

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