CIMI: Thoughts about Modifiers and semantics between and of nodes

[Gerard Freriks]

Dear colleagues,

Some thoughts about modifiers.

CIMI is about creating Clinical Statements of the form:

1- An inference was made about the patient and documented as A is B. e.g. 'Diagnosis' is 'Diabetes'

2- An observation was made about an aspect of the patient and documented as: X has a value, or Y was observed ,or an aspect of Y was observed to be Y(z)

3- Other statements that are documented are about: Assessments of processes, Plans, Orders and Execution of processes. Some are clinical in nature, others are administrative.

These Statements are extended with contextual data about the Localisations, Reasons, Participations, Methods and Confounding factors.

Modifiers can change the meaning of these statements completely.

Modifiers can be used at any level of the structure/archetype.

The complete statement or any part of it can have a Modifier operating on that part.

Modifers that I have found until now are:

- Status: not final, final (e.g. a lab result in a report)

- Certainty: uncertain, certain (as subjective assessment)

- Presence: not present, present (e.g. no rash observed, no diagnosis hypertension inferred, a diagnosis is inferred but it was not diabetes)

Placing Modifiers in the structure of an archetype create the problem that we need to decide what that operator (the modifier) is operating on,

My rule is that it operates on the parent node.

All child nodes in my SIAMM are related to the parent node as: ‘has’. 

e.g. Node N ‘has’ a subject S and Node N ‘has’ a result R, and Node N ‘has’ modifier M.

In this way I do not need an ‘attribute’ that indicates that something is the Focus. In my 'fixed’ SIAMM pattern the focus is always clear.

Gerard Freriks

g.fr...@me.com