The Clinical Element Model Browser displays Clinical Element Models (CEMs) developed by Intermountain Healthcare and GE Healthcare/Caradigm. CEMs are Intermountain’s strategy for representing detailed clinical models – granular, computable models defining the logical structure of data elements used in healthcare. Intermountain is currently representing CEMs using the Constraint Definition Language (CDL), a context-free grammar developed by GE Healthcare.

In 2006, Intermountain Healthcare and GE Healthcare entered into a partnership to develop a clinical information platform that implemented CEMs. CEMs developed by Intermountain during the partnership became GE copyright material, licensed to Intermountain under an open content license agreement. Under the terms of that license, Intermountain distributes the models and associated terminology to external parties who can use them without fee or royalty.

Recently, GE Healthcare and Microsoft formed a new company called Caradigm. The Intermountain partnership agreement has been transferred to this new company. During this transition period, the copyrights on the CEMs and the Open Content Agreement (see next section) still refer to “General Electric Company,” although the title of the site refers to “Caradigm.”

An Intermountain copyright notice on the main page refers to the site itself, not the models.

The intention is to present new releases of models on a monthly basis.

Accessing the Clinical Element Model Browser

Go to the Model Request site located at http://www.clinicalelement.com/. On a user’s first visit to the site, the Open Content License Agreement will appear.

NOTE: Always use the latest version of the internet browser being used to open the Clinical Element Model Browser.

This agreement describes the user’s responsibilities toward use of the CEMs and related terminology. The user is required to scroll to the end of the license and click the Accept button. Accepting the agreement remains valid for 14 days. After 14 days the license will need to be accepted again.

The license agreement is available for viewing at any time from the main page after the license has been accepted.

When the license has been accepted, the user is brought to the main page.

For the purposes of this site, a release is a collection of models distributed at a point in time as a snapshot of our repository. For each dated release there are three collections of models; Intermountain, SHARP, and Caradigm.

From the main page the most current release will automatically populate the browser. The user can also select a specific model release from the drop-down list under Releases. Once a release is selected, all models for that release will appear in a list in the left panel of the screen.

  • Intermountain contains models in use by Intermountain Healthcare.
  • SHARP contains models in use in the Strategic Health IT Advanced Research Project (SHARP) project. For these models, the Tree view also shows elements inherited from the SHARP reference classes, used for the SHARP implementation. A reference class contains metadata elements of use to an implementation. Patient identifier, database storage time, and source application identifier are examples of such elements. These inherited elements are shown in gray, as noted in the Legend.
  • Caradigm contains models in use by the Caradigm Qualibria implementation.

From the main page a user can select a specific model release from the drop-down list under Releases. Once a release is selected, all models for that release will appear in a list on the left of the screen.

Simple Search for a Specific Model

To search for a specific model, type the name of the model and the display will show those models containing the filtered criteria. The desired model can then be opened by selecting it from the filtered criteria in the left panel.

NOTE: Multiple-word models should be typed without spaces.

NOTE: Keyboard shortcuts can be used: pressing [Tab] will toggle through the buttons and CEMS listed in the left panel and [Enter] will select the CEM or button that is highlighted.

Advanced Search for a Specific Model

CEMs can also be filtered by more advanced criteria. To open the advanced criteria, click on Advanced. CEMs can be filtered by a combination of the following:

  • CEM Name
  • Parent Name
  • Reference Class (For example, Annotation, Modifier, Statement etc.)
  • Data Type (For example, Coded Data (CD), String Value (ST), Time Stamp (TS) etc.)
  • Collection (Caradigm, Intermountain, and SHARP)

Each CEM listed in the left panel will also include the collection in parentheses. The full name of the CEM and its collection can also be viewed by hovering the cursor over the CEM. A pop-up will appear and show the full name of the CEM and its collection.

The specific model information will appear to the right. The user can choose to view the model in Tree view, CDL or XSD by selecting the corresponding tabs along the top.

Clear All

To clear search criteria, click on the Clear All button.

Resize Options

The browser search section may be collapsed by clicking on the arrowhead near the filter options.

Collapse list

To expand the search section, click the arrowhead again.

Expand list

The browser search may be resized by clicking and dragging the border to the left or right.

Resize list

Opening More than One Model at a Time

There are two options to open more than one model at a time.

  1. Hover over a model from the list in the left panel, right click on the selected model then choose the Open link in new tab/Window option.
  2. Right click on a model that is open in the compiled tree view then choose the Open link in new tab/Window option.

To view specific details in the Tree view, select the Tree tab, and then click on the arrow head next to the desired topic. For example, click on the horizontal arrow head next to BodySide:

Once the arrow is clicked, the information is expanded.

NOTE: When the information node is expanded, a formatted and detailed summary of the information node will be displayed.

To hide the details, select the down-arrow head and the node will collapse again.

NOTE: Definitions for the models can be viewed in the CDL View.

Tree View Tools

The entire tree can be expanded or collapsed by clicking either the Expand All or the Collapse All buttons.

NOTE: The Expand All button may take a few seconds to load the expanded tree view.

Valuesets and terminologies associated with individual SHARP models will be displayed in a popup window. To open the popup, click on the valueset. To close the popup, click outside of the popup window.

Value Sets

When the Legend button is clicked, a screen elements legend appears at the right of the screen. To close the legend pop up, click the Legend button again.

Legend
Model Icon Model
Purple “A” Attribution
Green “D” Data
Blue “I” Item
Red “M” Modifier
Yellow “Q” Qualifier
Key Icon Key
Chain Icon Constraint
Question Mark Information
Brown Text Inherited from Parent This element was inherited from a model that the current model extends or restricts
Grey Text Inherited from Reference Class This element came from a reference class*
Italic Text Restricts Parent This element restricts the parent class

*A reference class contains implementation-specific metadata such as instance ID, patient ID, etc. When a CEM is used in an implementation (e.g., SHARP or Caradigm), the CEM inherits these reference class elements.

NOTE: If there is a list of data types separated by commas, the user can choose from any of the listed data types.

When the Data Types button is clicked, a data type console will appear at the bottom of the screen. This console contains information that describes data types in more detail.

Data Types

Concept Descriptor (CD): A reference to a concept defined in our default code system.
codeA code for a concept defined in the primary code system.
codingRationaleCodingRationale provides a reason why a particular CD has been provided, either as the root concept or as one of the translations.
originalTextThe text seen and/or selected by the user who entered the data.
translationA set of other CDs that each represent a translation of this CD into equivalent codes within the same code system or into corresponding concepts from other code systems.
Coded Ordinal (CO): Coded data that defines an order on the codes in our default code system, for example, the codes for "1+", "2+", etc.
codeA code for a concept defined in the primary code system. Code is required.
codingRationaleCodingRationale provides a reason why a particular CO has been provided, either as the root concept or as one of the translations.
originalTextThe text seen and/or selected by the user who entered the data.
translationA set of other COs that each represent a translation of this CO into equivalent codes within the same code system or into corresponding concepts from other code systems.
valueA numeric representation of the code's meaning.
Integer Value (INT): Integer numbers (-1,0,1,2, 100, 999999, etc.) are precise numbers that are results of counting and enumerating.
operator=, >, <, >= or <=. Absence means exact ("=").
valueThe integer value.
Real Number (REAL): Real numbers (1.5, 2.3 etc). The typical representation is decimal, where the number of significant decimal digits is known as the precision. There is no unit of measure for REAL data type.
operator=, >, <, >= or <=. Absence means exact ("=").
storagePrecisionThe number of significant floating point digits of the stored real number.
valueThe value of this real number.
Physical Quantity (PQ): A dimensioned quantity expressing the result of measuring. It will have unit of measure information.
codingRationaleCodingRationale provides a reason why a particular PQ has been provided, either as the root value or as one of the translations.
operator=, >, <, >= or <=. Absence means exact ("=").
originalTextThe text seen and/or selected by the user who entered the data.
storagePrecisionThe number of significant floating point digits of the stored double number.
translationAn alternative representation of the same physical quantity expressed in a different unit, of a different unit code system and possibly with a different value.
unitA code for a unit of measure concept defined in the primary code system.
unitOriginalTextThe unit seen and/or selected by the user who entered the data.
valueThe magnitude of the quantity measured in terms of the unit.
Interval of Physical Quantity (IVLPQ): A set of consecutive values of physical quantities, for example, [1, 10].
codingRationaleCodingRationale provides a reason why a particular RTOPQ has been provided, either as the root concept or as one of the translations.
highThe high end of the interval.
lowThe low end of the interval.
originalTextThe value seen and/or selected by the user who entered the data.
translationAn alternative representation of the same physical quantity expressed in a different unit, of a different unit code system and possibly with a different value.
unitA code for a unit of measure concept defined in the primary code system.
unitOriginalTextThe unit seen and/or selected by the user who entered the data.
Ratio (RTO): A quantity constructed as the quotient of a numerator quantity divided by a denominator quantity. The RTO data type supports titers (e.g., "1:128") and other quantities produced by laboratories that truly represent ratios.
codingRationaleCodingRationale provides a reason why a particular RTOPQ has been provided, either as the root concept or as one of the translations.
denominatorThe denominator of the ratio.
numeratorThe numerator of the ratio.
originalTextThe text seen and/or selected by the user who entered the data.
subtypeThe type of this RTOPQ, for example, a TITER.
translationAn alternative representation of the same physical quantity expressed in a different unit, of a different unit code system and possibly with a different value.
Instance Identifier (II): An identifier that uniquely identifies a thing or object. Examples are medical record number, order id, Social Security Number (SSN), Vehicle Identification Number (VIN), etc.
correlationIdAn identifier that references the set of values required to interpret the value in root (for example, namespace, assigning, authority, etc.). It is assumed that this information is maintained in a separate store and that this identifier serves as a key to access that information.
extensionA unique identifier within the scope of the identifier root.
typeThe type of the identifier.
String (ST): Text data.
languageFor character based information the language property specifies the human language of the text.
translationAlternate renditions of the same content translated into a different language. The translation property is a set of STNT that each translate the first rendition into a different language.
valueThe sequence of characters that make up the content of the string.
Time Stamp (TS): A quantity specifying a point on the axis of natural time. A point in time is most often represented as a calendar expression.
operator=, >, <, >= or <=. Absence means exact ("=").
originalTextThe text representation from which the time was encoded, if such a representation is the source of the time.
storagePrecisionThe number of significant digits of the calendar expression representation.
timezoneTime zone of the point in time.
valueUTC representation of the point in time.

Definitions for the models can be viewed in the CDL view. To view the CDL source of the current model, select the CDL tab.

NOTE: This tab only shows the CDL for the currently selected model. It does not show the CDL for any models referenced by the currently selected model, for example, qualifiers, modifiers, items, or attributions. To view the CDL for those models, select those models individually.

CDL Tools

Comments can be viewed or hidden by clicking the Hide Comments/Show Comments button.

Model information can be downloaded by clicking the Download File button.

To view an XSD generated from the selected model, select the Compiled XSD tab.

The text in the XSD view is color coded as follows:

Blue: Elements
Purple: Attributes
Green: Attribute data
Red: Comments

NOTE: The XSD is an implementation of the CDL model specific to Caradigm and SHARP projects (i.e., it is a structure that may be used for capturing a data instance conforming to the logical CDL model). It contains the structure not only of the selected model, but of any and all models referenced (i.e., as by the selected model, for example, qualifiers, modifiers, items, and attributions). This tab will not be available for projects that do not have an implementation.

XML Tools

The XML Schema can be downloaded by clicking the Download File button.

NOTE: If the XSD download is not successful, right click on Download File button and select the Save As option.

Some clinical element models have the option to view a mind map associated with the model. If the model has a mind map, the CDL Mind tab will appear. Click on the tab to see the mind map.

An annotation is indicated by a yellow box, such as the one seen to the left of StandardLabObs above. The mind map may be expanded further by clicking on the name, or a small circle next to the name if applicable, such as the one seen to the left of StandardLabObs. Click on the circle or name again to collapse the expanded view. The mind map may be moved around on the screen by clicking any part of the model and then dragging it as desired. For more information about the program used to create these mind maps, see the FreeMind website.

Mind Map Tools

The mind map can be downloaded by clicking on the Download File button.

New Features and Functionalities for version 1.7

  • Detailed and formatted information nodes
  • Data type console
  • Valuesets pop up feature associated with SHARP models
  • CDL Mind Maps over 1004 nodes now load in the Browser
  • Clear all button in advanced search section
  • Resize and collapse feature

New Features and Functionalities for version 1.6

  • New folder structure that includes:
    • Release Date
      • Collections
        • Tree
        • XSD (if applicable)
        • CDL
        • Mind Maps (if applicable)
  • New tree view icons
  • Active and Proposed folders removed
  • Search features and functionality
    • By parent-child relationship
    • By reference class (For example, statement, panel, component)
    • By data type (For example, Coded Data, Coded Ordinal, Physical Quantity)
    • By collection (For example, Intermountain, SHARP)
  • Modified sort order with latest release at the top
  • Consistent order in tree view (For example, key, data, qualifiers, mods, attributions)
  • Ability to expand CEMs by clicking on a model
  • Multiple views of individual CEMs
    • Mind map View (Graphical)
    • Split View (in a new tab or window)
    • View two models side by side in CDL, graphical or XSD using browser tabs
  • Ability to download documents associated with CEMs

In the future, we plan to address the following:

  • Show version history for the models
  • Show model statuses
  • Integrate terminology
    • Terminology-supported search for models