Abstract
OBJECTIVE: To construct a large-scale clinical repository that accurately captures a detailed understanding of the data vital to the process of health care and that provides highly efficient access to patient information for the users of a clinical information system. DESIGN: Conventional approaches to data modeling encourage the development of a highly specific data schema in order to capture as much information as possible about a given domain. In contrast, current database technology functions most effectively for clinical databases when a generic data schema is used. The technique of "generic data modeling" is presented as a method of reconciling these opposing views of clinical data, using formal operations to transform a detailed schema into a generic one. RESULTS: A complex schema consisting of hundreds of entities and representing a rich set of constraints about the patient care domain is transformed into a generic schema consisting of roughly two dozen tables. The resulting database design is efficient for patient-oriented queries and is highly flexible in adapting to the changing information needs of a health care institution, particularly changes involving the collection of new data elements. CONCLUSION: Conventional approaches to data modeling can be used to develop rich, complex models of clinical data that are useful for understanding and managing the process of patient care. Generic data modeling techniques can successfully transform a detailed design into an efficient generic design that is flexible enough to meet the needs of an operational clinical information system.
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Selected References
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- Barrows R. C., Jr, Johnson S. B. A data model that captures clinical reasoning about patient problems. Proc Annu Symp Comput Appl Med Care. 1995:402–405. [PMC free article] [PubMed] [Google Scholar]
- Bell D. S., Pattison-Gordon E., Greenes R. A. Experiments in concept modeling for radiographic image reports. J Am Med Inform Assoc. 1994 May-Jun;1(3):249–262. doi: 10.1136/jamia.1994.95236156. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Campbell K. E., Das A. K., Musen M. A. A logical foundation for representation of clinical data. J Am Med Inform Assoc. 1994 May-Jun;1(3):218–232. doi: 10.1136/jamia.1994.95236154. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dolin R. H. A high-level object-oriented model for representing relationships in an electronic medical record. Proc Annu Symp Comput Appl Med Care. 1994:514–518. [PMC free article] [PubMed] [Google Scholar]
- Essin D. J., Lincoln T. L. An information model for medical events. Proc Annu Symp Comput Appl Med Care. 1994:509–513. [PMC free article] [PubMed] [Google Scholar]
- Essin D. J., Lincoln T. L. Implementing a low-cost computer-based patient record: a controlled vocabulary reduces data base design complexity. Proc Annu Symp Comput Appl Med Care. 1995:431–435. [PMC free article] [PubMed] [Google Scholar]
- Friedman C., Cimino J. J., Johnson S. B. A schema for representing medical language applied to clinical radiology. J Am Med Inform Assoc. 1994 May-Jun;1(3):233–248. doi: 10.1136/jamia.1994.95236155. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Johnson S. B., Hripcsak G., Chen J., Clayton P. Accessing the Columbia Clinical Repository. Proc Annu Symp Comput Appl Med Care. 1994:281–285. [PMC free article] [PubMed] [Google Scholar]
- Linnarsson R., Wigertz O. The data dictionary--a controlled vocabulary for integrating clinical databases and medical knowledge bases. Methods Inf Med. 1989 Apr;28(2):78–85. [PubMed] [Google Scholar]
- McDonald C. J., Blevins L., Tierney W. M., Martin D. K. The Regenstrief medical records. MD Comput. 1988 Sep-Oct;5(5):34–47. [PubMed] [Google Scholar]
- Stead W. W., Hammond W. E. Computer-based medical records: the centerpiece of TMR. MD Comput. 1988 Sep-Oct;5(5):48–62. [PubMed] [Google Scholar]
- Whiting-O'Keefe Q. E., Whiting A., Henke J. The STOR clinical information system. MD Comput. 1988 Sep-Oct;5(5):8–21. [PubMed] [Google Scholar]
- van Ginneken A. M., Stam H., Duisterhout J. S. A powerful macro-model for the computer patient record. Proc Annu Symp Comput Appl Med Care. 1994:496–500. [PMC free article] [PubMed] [Google Scholar]