Clinical Information Model Initiative (CIMI) Reference Model Specification

Context indicating the known absence of a finding in the subject of information. If the finding is suspected to be absent, use the known or suspected present context instead.

Type supporting the capture of accreditation information.

The ActionContext class provides the context for the ProcedureTopic of a clinical statement. For instance, a statement about a procedure may specify that the procedure has been proposed, ordered, planned, performed or possibly not performed. This class aligns with the SNOMED Situations with Explicit Context.

Base class for addresses to be specialized based on regional and realm-specific needs.

A record about the admission of a patient to a facility generally for the provision of care.

An entry in the patient record documenting an untoward or unexpected finding observed during the course of an activity or an activity. Adverse events may capture either a workflow breach that may or may not result in harm but that must be documented for quality improvement purposes or an adverse finding whether or not it can be traceable to an actual workflow breach.

An entry in an adverse event report documenting an event that may result in harm to a subject and which must be documented.

An AdverseFinding is any unexpected clinical finding in a patient in the course of care or clinical investigation subject which does not necessarily have a causal relationship with a specific intervention.

Any unfavorable and unintended sign, symptom, disease or other medical occurrence with a possible causal association with the use of a medical product, procedure, or other therapy. Note that the manifestation of the adverse reaction is captured in FindingTopic.result attribute.

A finding related to an individual's risk of harm from exposure to a substance or class of substances.

A part of the body.

A note containing information relevant to an entry, also containing information about who commented and when.

Abstract supertype. Usually maps to a type like "Any" or "Object" in an object system. Defined here to provide the value and reference equality semantics.

Archetypes act as the configuration basis for the particular structures of instances defined by the reference model. To enable archetypes to be used to create valid data, key classes in the reference model act as root points for archetyping; accordingly, these classes have the archetype_details attribute set. An instance of the class ARCHETYPED contains the relevant archetype identification information, allowing generating archetypes to be matched up with data instances.

Statement context pertaining to clinical assertions.

An assertion is a finding that takes the form of a single coded concept, without an explicit measureable property. An assertion is used to express findings such as 'patient has diabetes' or 'patient has high blood pressure'. An assertion is not expressed as a {measureable property, measured value} pair; if the finding takes that form, EvaluationResult should be used. Note that EvaluationResults {eye color, blue} can sometimes be expressed as assertions and vice versa (blue eye color).

To be added later

Attribution provides a formal pattern and reusable structure for attributes of a record that describes an activity in a process involved in producing, delivering or otherwise influencing the entry in a record. Attribution provides a critical foundation for assessing authenticity, enabling trust, and allowing reproducibility. Provenance assertions are a form of contextual metadata and can themselves become important records with their own provenance. Provenance statement indicates clinical significance in terms of confidence in authenticity, reliability, and trustworthiness, integrity, and stage in lifecycle (e.g. Document Completion - has the artifact been legally authenticated), all of which may impact security, privacy, and trust policies. Attribution provides a common reference model pattern that may be included directly within a clinical statement (e.g., the metadata associated with the recording of a clinical statement in a system) or within the Provenance pattern when it is preferrable to have such information external to but referencing the clinical statement (see Provenance). Note that, when included directly within a clinical statement, updates made to attribution attribute values will result in a versioning change in the instance. When part of the Provenance class, updates to provenance do not result in an update of the clinical statement referenced by the Provenance class (see Provenance.target).

Type supporting the capture of birth-related information.

logical True/False values; usually physically represented as an integer, but need not be

The BradenScaleAssessmentResult class captures the results of evaluating a patient with the Braden Scale to assess an adult patient's susceptibility to skin breakdown. The summation of the scores ranges from 6-23. Note: this class does not represent the assessment instrument itself which is considered to be a knowledge artifact rather than an entry in a patient record.

a type whose value is an 8-bit value.

EXPERIMENTAL - A placeholder for a patient care plan.

The result of an assessment of causality typically done for pharmacovigilance - i.e., whether an adverse reaction was caused by exposure to the suspected entity.

To be added later

a type whose value is a member of an 8-bit character-set (ISO: "repertoire").

Type supporting the capture of citizenship information.

This resource identifies an instance or a type of a manufactured item that is used in the provision of healthcare without being substantially changed through that activity. The device may be a medical or non-medical device. Medical devices includes durable (reusable) medical equipment, implantable devices, as well as disposable equipment used for diagnostic, treatment, and research for healthcare and public health. Non-medical devices may include items such as a machine, cellphone, computer, application, etc.

A special type of information entry consisting of a topic and a context. The ClinicalStatement class provides the core pattern for more specific clinical statement archetypes, such as a statement that a finding has been found in a patient or that a procedure has been proposed by a clinical decision support system. The ClinicalStatement pattern defines the core attributes common to most clinical statements and specifies a composition pattern that encourage model component reuse and better alignment with the SNOMED CT Concept Model. A clinical statement is composed of the StatementTopic class (grouping of attributes for capturing information about a procedure or a clinical finding) and the StatementContext class (grouping of attributes providing the context for the statement topic such as whether a procedure was performed, requested, not performed or whether a finding is suspected present or absent in the patient). At the archetype level, the topic and context components are coordinated to form the clinical statement. For instance, the composition of the ProcedureTopic with the NotPerformed context indicates that the given procedure was not performed.

An AdverseFinding is any unexpected clinical finding in a patient documented as part of a clinical investigation which does not necessarily have a causal relationship with a specific study intervention. For instance, a study participant developing a fever during the course of the study.

A Text in a human language whose meaning is captured as concept in a formal terminology. Since CodedText is a subtype of Text, it can be used in place of it, effectively allowing the type Text to mean a text that may optionally be coded. A common use is to record the coded version of a verbatim text (a text originally selected or entered by a human).

The component abstract class is used to represent dependent observations, findings, or procedures associated with the parent clinical statement. A dependent component is a component that does not have an independent existence outside of its parent. For instance, the description of a wound bed must exist in the context of a wound assertion. However, a systolic blood pressure measurement can exist independently of a blood pressure panel. This distinction is important. Collections of independent statements should be represented using the composition structure offered by the CompoundClinicalStatement class. Collections of dependent structures should be modeled using the Component pattern.

A composition represents a document such as a patient record, a knowledge artifact, or a catalog definition.

A reference to a concept in a terminology or an ontology.

The condition that is the reason for this encounter.

An assertion that represents a health condition of a patient that runs a clinical course over a period of time, and may be tracked during that time period.

Abstract ancestor of all concrete content types. A unit of content that makes up a composition - e.g., a clinical statement in a patient record, a simple or composite action is a knowledge document, a catalog entry in a catalog.

Serves as a common ancestor of all CIMI types which represent the core granularity of the model.

Represents one day in time, as measured on the Gregorian calendar, used for recording time when the exact time is unknown or excessive precision is undesired, such as birth dates. Date uses the semantics defined by ISO 8601.

A date, date and time or partial date (e.g. just year or year + month) as used in human communication. If hours and minutes are specified, a time zone SHALL be populated. Seconds must be provided due to schema type constraints but may be zero-filled and may be ignored. Dates SHALL be valid dates. The time "24:00" is not allowed.

Information of about a death event.

Rational numbers that have a decimal representation. Decimals may not use exponents, and leading 0 digits are not allowed.

An interaction between a patient and a practitioner under the auspices of a given organization for the purpose of providing healthcare-related service(s). It is important to understand that if the there is a change in provider or organization, by definition a new encounter will be generated. For example, if a patient is moved from Surgery to Post-Op, a new encounter is generated. Similarly, if a patient receives care from 2 nurses while in Post-Op, there will be 2 encounters.

Refinement of the Person class with additional attributes.

This resource identifies an instance or a type of a manufactured item that is used in the provision of healthcare without being substantially changed through that activity. The device may be a medical or non-medical device. Medical devices includes durable (reusable) medical equipment, implantable devices, as well as disposable equipment used for diagnostic, treatment, and research for healthcare and public health. Non-medical devices may include items such as a machine, cellphone, computer, application, etc.

Characterizations of the physical size of an anatomical feature.

A record pertaining to the discharge of a patient from an institution.

A timing expression expressed as a point on a timeline, e.g., a date, time, or timestamp.

Base class for dispense contexts.

Record of the dispensing event.

Medication dispensing instructions provided by the prescriber.

Base class for medication dosage instruction and dosage event.

A dosage of medication as it actually occurred, as opposed to a dosage that was planned.

Pattern for the dosing of a medication. Describes how medication is to be administered or how it should be taken.

To be added later

Contains properties common to multiple kinds of Encounters which last more than a few hours. Such encounters typically include an admission and discharge process.

Represents a length of time, independent of any specific point time. Duration is expressed in customary format, i.e. days, hours, minutes, etc. Note that durations cannot be used to represent points or intervals in time.

Data structure representing an electronic contact such as an email address or a phone number.

Abstract parent class for all types of encapsulated data, such as media files.

Emergency is an encounter without a scheduled appointment and urgent clinical services are required.

An abstract class that represents an encounter class.

A diagnosis, which is a disease or injury determined to be present through evaluation of patient history, examination, and/or review of laboratory data.

Root class for entities such as people, organizations, and devices that have a separately identifiable existence.

An association to an entity.

To be added later

A party may be either an entity such as a specific person or organization or a role played by an entity such as patient or care provider.

An ENTRY is the minimal unit of logical information or knowledge documented within a composition such as a clinical statement in a patient record, a knowledge entry in a knowledge artifact, a product in a product catalog, etc...

Represents a heading in a heading structure, or section tree . Can also be used to represent a collection of entries without metadata.

TO BE DOCUMENTED

The outcome of an evaluation of a characteristic. This model holds a "question" in the key and holds a value in the result. This value is further qualified through the model's properties.

Context associated with non-clinical events such as floods, accidents, and tornadoes.

An non-clinical event such as a natural disaster. Topic allows the capture of information related to such events when they pertain to the clinical context associated with a given patient.

A role played in the subject's family, such as parent or sibling. Family members do not have to be related by blood, and can include social connections subjectively recognized by the subject as "family".

The FindingContext class provides the context for the EvaluationResult and Assertion topics of a clinical statement. For instance, a statement about findings may state that the finding was observed present or absent. This class aligns with the SNOMED Situation with Explicit Context.

An assertion about a clinical condition, problem, diagnosis, or other event, situation, issue, or clinical concept located on a specific body location that has risen to a level of concern.

The base topic class for assertions and evaluation results that result from medical investigations or diagnostics, independent of the context of the result being present, absent, or hypothetical (as in the case of a goal).

A timing expression expressed as a frequency.

A generic and not fully structured address expressed using postal conventions (as opposed to GPS or other location definition formats).

Type for representing identifiers of real-world entities. Typical identifiers include drivers licence number, social security number, veterans affairs number, prescription id, order id, and so on.

A position, site, point in space, or polygon, designated either by altitude, latitude, and longitude or a postal address, and may be navigated to via directions.

Clinical statement context for a goal.

A location on the surface of the Earth, described by a latitude and longitude (and optional altitude).

Role assumed by an entity acting as a health care consumer.

A location in a health care facility.

An organization involved in the provision of health related services.

A healthcare provider role associated with a person.

A non-person health care entity such as a medical group or other organization.

Role associated with the delivery of health care as opposed to a consumer of health care.

A role associated with the delivery or consumption of health care services.

Base class representing an identifier scheme.

Experimental class for an imaging procedure. Note that this class is still incomplete at this time.

Archetypable type that has an independent existence meaning that its existence is not dependent on the containing type.

An entry in a patient record or in a report, generally used for the documentation of clinical information about a subject of information such as a patient or a relative of the patient, asserted by a particular source, recorded, and potentially verified.

Association class used to represent the relationship between a class and one or more clinical statements where the relationship is qualified by one or more attributes.

A material component in a substance, represented by a code, substance, or medication.

An instant in time - known at least to the second and always includes a time zone. Note: This is intended for precisely observed times (typically system logs etc.), and not human-reported times - for them, use date and dateTime. instant is a more constrained dateTime

An integer type

A countable quantity, used for values such as number of pregnancies or number of cigarettes smoked in a day. Not to be used for amounts that have units.

A generic class defining an interval (i.e. range) of any ordered value type. The type T must be a descendant of the type OrderedValue.

A repeat timing expression that is bounded by a number of iterations. For instance, a timing expression to give a medication every 15 minutes not to exceed 10 administrations.

Specialization of Procedure with the intent of measuring specific characteristics of in vitro specimens.

Context for a laboratory test result that includes the time a specimen was collected.

Measurement resulted from a laboratory.

Type representing proficiency in a language.

An ordered collection of items with non-unique membership.

Most classes in the CIMI reference model inherit from the Locatable class, which defines the idea of 'locatability in an archetyped structure'. Locatable defines a runtime name and an archetype_node_id. The archetype_node_id is the standardised semantic code for a node and comes from the corresponding node in the archetype used to create the data. The only exception is at archetype root points in data, where archetype_node_id carries the archetype identifier in string form rather than an interior node id from an archetype. Locatable also provides the attribute archetype_details, which is non-Void for archetype root points in data, and carries meta-data relevant to root points. The name attribute carries a name created at runtime. The 'meaning' of any node is derived formally from the archetype by obtaining the text value for the archetype_node_id code from the archetype ontology section, in the language required.

A description of a location in terms of who to contact at the location, and activities that may take place at the location. The subclasses of Location, GeographicalLocation and HealthCareFacilityLocation, define the actual location of the Location.

A class representing a medication, either a prescription drug or over-the-counter drug (potentially including vitamins, herbal remedies, and dietary supplements) that is used to prevent, treat, or relieve symptoms of a disease or abnormal condition. It covers the ingredients and the packaging for a medication.

Context pertaining to the recording of a medication administration that has been performed.

Context for the documentation of a medication dispense event.

Context for a medication order.

The topic for clinical statements concerned with prescribing, administering, or dispensing a medication.

Action intended to modify an existing action such as a request to discontinue the administration of a medication or a proposal to cancel an existing order. Experimental

A representation of media files, such as audio, visual, biosignal, and similar types.

Abstract supertype for the name of an entity.

A record that a clinical act was initiated by not completed.

An informal and non-credentialed care giver such as a family member with skills relevant to the provision of patient care.

Archetypable type that has a non-independent existence - that is, whose existence is determined by its containing type.

A record that a clinical act was not performed and/or never initiated. Do not use this context if the act was initiated or started but aborted or cancelled. Use the NotPerformed context instead.

Abstract class defining quantified amounts.

Describes the kind of job a person has held.

An instruction by a healthcare provider to another healthcare provider to perform some act.

Abstract class defining a value on a number line or time line, whose location (magnitude) may be given precisely, or bounded by another value.

Represents rankings and scores, e.g. pain, Apgar values, etc, where there is a) an implied ordering, b) no implication that the distance between each value is constant, and c) the total number of values is finite. This class can be used for recording symbolic values, e.g., the results on a urinalysis strip {neg, trace, moderate, ...} or numbers like Agar values {0, 1, 2, 3, ...}. Note that although the term "ordinal" in mathematics means natural numbers only, here any integer is allowed, since negative and zero values are often used by medical professionals for values around a neutral point, for example {-3, -2, -1, 0, 1, 2, 3} for reflex response values.

A description of a social or legal structure formed by human beings.

A direct contact between a patient and a practitioner, to order or furnish hospital services for diagnosis or treatment of the patient, not resulting in formal hospitalization (an overnight stay as an admitted patient).

TO DO

Encapsulated data expressed as a parsable text. The internal syntax of the data item is not described, but must follow the given formalism.

Association between a party (entity or a role) in an activity.

A directed association to a party (i.e., a role or an entity). The PartyAssociation pattern can be used to represent a participation in an activity or a relationship that exists between two parties.

The Care Team includes all the roles and entities performing these roles who plan to participate in the coordination and delivery of care for a patient.

Context associated with the performance of an educational intervention.

Class representing a patient record.

This class captures information about counselling or education provided to (or an attempt to provide to) the Patient or to the Patient's representative and provides a means to note how well the Patient understood the information provided. Patient Education may be in the form of written instructions - either pre-defined materials, or personalized instructions - as well as oral counseling.

A context indicating the actual performance or execution of a healthcare-related action, e.g., administration of the third dose of Hepatitis B vaccine on Dec 4th 2012, or an appendectomy performed today.

Base person class.

Common human name format.

This class represents a MedicationOrder from the perspective of the filling system (i.e., the pharmacy). This class is a subtype of Healthcare Promise, which describes all types or Orders from the filling system perspective, but adds those properties which are specific to medication orders. Although there are many properties shared with MedicationOrder; the pharmacy may change the order within prescribed limits, for example, substituting a generic drug for a branded drug.

Measurement resulting from a physical assessment procedure.

A physical evaluation assessment performed on a patient such as review of systems, or taking vital signs at the doctor's office.

A text with optional human language. While the attributes of PlainText and Text are the same, the PlainText class should be used when the text will not be coded (since CodedText is a child of Text but not PlainText).

A record indicating an action in the planning phase. Typically, this would include a time at which the action is scheduled to be performed.

An integer whose value is greater than zero.

Class representing a patient or provider preference such as a diet preference, best time to contact, preferred communication method, etc ...

Base class for contexts asserting presence or absence of a finding.

A context indicating that a finding is known or suspected to be present in the subject of information.

The procedure that is the reason for the encounter.

Description of a healthcare action, independent of action context.

An order from the perspective of a fulfillment system.

Concept represents a recommendation from a clinical decision support system or advice from a consultation to not perform an act.

An offer or a suggestion to perform a healthcare act. A recommendation to a provider is an example of proposal made by a CDS system. A proposal must be accepted by an entity in order for it to be performed.

The Provenance pattern supports the attachment of attribution information to one or more clinical statements and is not part of the clinical statements themselves. The attachment of provenance information to a clinical statement in this manner does not impact the versioning of the clinical statement target since attribution information is external to the statement.

Education, training or special skills.

A qualitative reference range specified by a code - e.g., abnormal, severely abnormal.

A reference range specified by a quantitative interval.

Quantified type representing scientific quantities, i.e. quantities expressed as a magnitude and units of measure. Quantities can also be used for time durations, where it is more convenient to treat these as simply a number of seconds rather than days, months, years.

A parameterizable ratio, where the numerator and denominator should not be reduced to a decimal, such as 3 tablets/day.

32-bit real numbers in any interoperable representation, including single-width IEEE floating point

Statement context pertaining to evaluation results.

A reference range for the specific instance after lookup from, say, a reference range table given specific criteria. Note that this reference range is not definitional in nature but rather refers to the reference range considered for the given observation for a subject.

The Referral class is used to record and send details about a request for service or transfer of a patient to the care of another provider or provider organization.

When a repeated event is to occur.

A timing expression that is not expressed as calendar time. RepeatTiming expressions tend to be relative timing expressions or frequency-based timing expressions.

A reported activity associated with though not necessarily causal to an adverse event.

A request by a healthcare provider or system to another healthcare provider or system to perform some action.

A process where a researcher or organization plans and then executes a series of steps intended to increase the field of healthcare-related knowledge. This includes studies of safety, efficacy, comparative effectiveness and other information about medications, devices, therapies and other interventional and investigative techniques. A ResearchStudy involves the gathering of information about human or animal subjects.

Arm refers to a pre-specified group or subgroup of participants in a clinical trial assigned to receive specific interventions (or no intervention) according to a protocol. The protocol describes an expected sequence of events for one of the participants of a study, e.g. Exposure to drug A, wash-out, exposure to drug B, wash-out, follow-up.

Type supporting the capture of residency information.

Capacity in which an actor is involved in an activity. For instance, 'attending physician'. Note that attributes of the actor (an entity) that remain constant regardless of the role the actor plays should be part of the entity and not the role. For instance, a person may be a practitioner and a patient. In both cases their date of birth will be the same and thus such information should not be part of the role.

A team or grouping of roles assembled for a specific purpose such as a provider group or a care team.

A digital signature along with supporting context. The signature may be electronic/cryptographic in nature, or a graphical image representing a hand-written signature, or a signature process. Different Signature approaches have different utilities.

A specimen is a substance, physical object, or collection of objects, that the laboratory considers a single discrete, uniquely identified unit that is the subject of one or more steps in the laboratory workflow. A specimen may include multiple physical pieces as long as they are considered a single unit within the laboratory workflow. A specimen results from one to many specimen collection procedures, and may be contained in multiple specimen containers. Specimen may have one or more processing activities.

The specific instance of the procedure in which the specimen was obtained.

Physical object that touches and holds specimen. EXAMPLES: slide, tube, box, jar

Processing step performed on a specimen.

Compositional and reusable grouping of clinical statement attributes that provides the context for the topic of a clinical statement. The StatementContext class aligns with the SNOMED CT Situations with Explicit Context. The StatementContext provides the expressivity required to specify that an act was performed or not performed or that a finding was asserted to be present or absent for the given subject of information. It also often holds provenance information relevant to the context of the clinical statement. It is important to note that by default the context applies to the conjunction of the attribute specified in the statement. For instance, if a clinical statement has a topic describing a rash on left arm and a context of 'absent', then the statement states that the subject of interest did not have a rash on the left arm but might have had one on the right arm.

Compositional and reusable grouping of clinical statement attributes that make up the clinical focus of the statement. StatementTopic class attributes are aligned with SNOMED CT Concept Model attributes when such an overlap exists. Note that this class does not include contextual attributes such as the nature of the action (ordered, proposed, planned, etc...), the nature of the patient state being described (e.g., present, suspected present, absent), and the attribution of this information (the who, when, where, how, why of the information recorded).

represents unicode-enabled strings

An association between an entry and the party this entry is about.

A homogeneous material with a definite composition.

Base class for prospective and retrospective medication substitution information.

Information about a substitution that was performed.

Substitution instructions for prospective dispense clinical statements.

Procedure performed on a device such as the insertion or removal of an implant or the cleaning or repair of an implemented device.

The topic for surgical procedures, independent of whether the surgery was proposed, ordered, performed, not performed, etc.

To be added later

To be added later

To be added later

An abstract class representing a point in time to some accuracy, following the semantics of ISO 8601.

The representation of a conceptual idea represented by an ontology or controlled vocabulary.

Represents an alternative ("mapped") Concept associated with a source concept (i.e., CodedText.concept or the textual value of the CodedText when no equivalent concept has been defined), and the relative match of the mapped Concept with respect to the source Concept. Mappings may be used to add classification terms (e.g. adding ICD classifiers to SNOMED descriptive terms), for computational convenience, or to provide equivalents in other terminologies (e.g. across nursing vocabularies).

Abstract parent for plain textual and coded text items, which may contain any amount of legal characters arranged as e.g. words, sentences etc (i.e. one Text may be more than one word). Visual formatting and hyperlinks may be included.

Represents a point in time from an origin usually interpreted as meaning the start of the current day. Used for recording a time of (any) day, not an absolute point in time. Typically used for times of events such as substance administrations.

A repeat timing expression that is bounded within a temporal interval.

A timing expression such as points in time when an activity was performed, a frequency of occurrence, or a relative timing expression relative to some event.

Documents the transfer of a patient from one location or responsible organization to another. Note that a transfer from one organization to another will, by definition, trigger a new encounter. A transfer from one location to another may trigger a new encounter depending on whether the responsible organization has changed. A movement from one bed within the same ward to another probably will not, but a movement from one ward to another probably would.

EXPERIMENTAL - A treatment protocol definitional class which may be adhered by a care team. Currently used as a placeholder only.

Dependent statement indicating the presence or absence of tunneling.

A description of wound tunneling, a track that extends from the surface of an organ to an underlying area or abscess cavity.

Dependent statement indicating the presence or absence of undermining.

Assessment of deep tissue (subcutaneous fat and muscle) damage around the wound margin.

Unique device identifier (UDI) assigned to device label or package.

An integer whose value is greater or equal to zero.

A URI

A reference to an object which conforms to the Universal Resource Identifier (URI) standard. See "Universal Resource Identifiers in WWW" by Tim Berners-Lee at http://www.ietf.org/rfc/rfc3986.txt.

Structure capturing usage preferences for, say, a name, an address, or contact information.

An undesired activity or breach of protocol, regardless of whether it resulted in harm to the subject, which must be documented.

A determination that a wound exists at a particular body site, as well as the properties or condition of that wound.

Characteristics of the wound's base.

The area of identified wound bed appearance (necrotic, sloughing, etc.; see LOINC 72371-8) compared to the total area of the wound bed. For example, 40% of the wound bed is necrotic. Results can either be subjective or measured.

The area of identified wound bed color (red, pink, black, white) compared to the total area of the wound bed. For example, 40% of the wound bed is black. Results can either be subjective or measured.

Characteristics of the wound's edge.

Dependent statement indicating whether the wound has exudate and the nature of that exudate.

Assertion about the exudate associated with a wound.