The following description of the project provides an overview of the work accomplished.
Several Federal partners whose missions include providing, funding, improving healthcare or protecting and advancing public health by regulating medicines and food, are actively building enterprise information models in order to foster interoperability, consistency, efficiency, data quality and transparency both within and across their jurisdictions. Federal partners are directed to produce a Data Reference Model (DRM) as part of an overall Federal Enterprise Architecture (FEA). Federal partners need an understanding and clear specification of the information / data required to run and manage their organizations, as well as communicating effectively with their partners. The need for such models is particularly important as government organizations embrace Service Oriented Architecture (SOA), which is an architecture pattern designed to significantly enhance business agility. It is well understood that SOA implementation is infeasible without a set of commonly understood and agreed-upon information models.
Because there are currently multiple information modeling efforts within the health “space” across the Federal partners and state agencies, the information modeling project of the FHIMS WG was established in order to minimize duplication of efforts, conserve scarce modeling talent, and foster quality and interoperability, in a single cross-cutting modeling effort. In this way, Federal partner modeling efforts can collaborate to refine their models individually, and to achieve consensus on a more universal information model.
One of the main benefits of information modeling is the promotion of semantic interoperability between agency systems. By providing a forum by which agencies can harmonize their information models across the “Health Segment,” interoperability between agencies becomes more achievable. This ability to communicate and semantically understand information being communicated is increasingly being asked and required of the Federal partners. Information modeling and their related terminology specification can provide the foundation for semantic interoperability.
A key factor is that many of the Federal partners need to interoperate with trading partners outside of the Federal government. For example, a large percentage of veterans simultaneously receive care at VA facilities and with private healthcare providers. DoD and Indian Health Service have similar scenarios. Therefore, it is important to not only build consensus among Federal partners but to also harmonize the Federal information model with those of major health industry standards setting bodies. Many of the Federal partners are active at Standards Development Organizations (SDOs) such as HL7 , or Standards Related Organizations (SROs) such as Integrating the Healthcare Enterprise (IHE) or Health Information Technology Standards Panel (HITSP).
The following domains are currently residing in the FHIM repository as UML class diagrams. They vary in size from very large, spanning many vertical business areas such as Labs and Pharmacy, to smaller domains such as Problem List that covers the patient problems in the EHR. The FHIM domains are groupings of related information that are modeled as a group. Each of these domains was evaluated by determining the scope of the domain and main classes involved.\n - Adverse Event Reporting – Regulatory reporting of Adverse Reactions to Drugs, Devices, etc.\n - Allergies - Intolerance Conditions to Drugs, Environmental, and Food\n - Audiology And Speech Pathology - ASP Visit, Location, Tests, etc\n - Behavioral Health - Behavioral Health Assessment and Problem Areas, including substance abuse\n - Blood Bank - Blood Bank Domain including facility and requests for blood.\n - Clinical Decision Support - Provide Clinical Decision Support functionality including alerts and alert tracking\n - Clinical Document - Specify and Manage Clinical Documents\n - Clinical Observations - Clinical Observation such as Vital Sign and Assessment Panel\n - Consultation - Consultation Requests - Referrals and consult results\n - Dental - Dental Domain\n - Dietetics – Dietetics, including nutrition and meal orders\n - Encounter - Information and data relationships that support the documentation of care for encounters and episodes of care\n - Enrollment Eligibility COB - Information about Enrollment and Eligibility and Coordination of Benefits\n - Event Capture - Captures information about Clinical Patient centric Events\n - Health Factors - Health care factors about a patient needed by the EHR System\n - Home Based Primary Care - Information concerning self-management of a condition between patient-provider encounters\n - Imaging - Imaging Event Management and Information associated with Images. The domain appears to be similar to Radiology, but broader.\n - Immunization and Skin Test - Immunization Management and Skin Test Information Model\n - Lab - Labs Information Model including chemistry, orders, and results\n - Mental Health - Mental Health Information Model\n - Oncology Registry - Cancer Events and Registry Information Model\n - Orders - Common Orders Domain - Common to each specialty domain such as Labs, Radiology, etc.\n - Patient Education - Patient Education Materials and Distribution Information Model\n - Person Demographics - Captures identifying and health care related demographic information about any person participating in the Health Care Enterprise\n - Person Eligibility - A Persons Eligibility in for Services, Insurance - seems to be similar to EECOB.\n - Pharmacy – Pharmacy domain, Drugs, Administration, Medication List, etc.\n - Problem List - Patient Problem List Data including source and history\n - Prosthetics - Prosthetics Domain\n - Radiology - Radiology and Imaging Domain, Radiologic Examination\n - Security And Privacy - Security and Privacy Domain associated with role based access, authentication.\n - Social Work – Focus on information in Social Work Domain\n - Spinal Cord – Focus on information regarding specifics of Spinal Cords\n - Surgery - Surgery Domain\n - Vital Signs – Vital Health Observation information.\n - Women’s Health – Information related to Women’s Health