Modeling [Patient] INT

[pedropaulofb]

Concept Consolidation Task — Patient

Goal

Align and consolidate domain concepts across FHIR, OMOP, openEHR, and CARE-SM for a conceptual model of real-world phenomena, minimizing data-like artifacts and scope creep.

Provenance (inputs)

• FHIR: FHIR v5.0.0 (Release 5, R5 - STU) — Accessed on 2026-03-02
• OMOP: OMOP CDM v5.4.2 — Accessed on 2026-03-02
• openEHR: openEHR RM Component Release-1.1.0 — Accessed on 2026-03-02
• CARE-SM: CARE-SM 1.0.0 — Accessed on 2026-03-02

Checklist (modeling progress)

MUST

• Patient
• Person

SHOULD

• Birthdate
• Clinical entry
• Death
• Diagnosis
• EHR
• First confirmed visit
• Longitudinal record
• Participation status
• Party identity
• ResearchSubject
• Role
• Sex
• Visit occurrence

COULD

• Address
• Biobank
• Birthplace
• Birthyear
• Care site
• Clinical trial
• Cohort
• Consent
• Contact
• Disability
• Examination
• Genetic
• Group
• Hospitalization
• Laboratory
• Location
• Medication
• Note
• Organisation
• Participation
• Party relationship
• Patient animal
• Patient communication
• Payer plan period
• Phenotype
• Provider
• Questionnaire
• RelatedPerson
• Symptoms onset
• Surgical intervention
• Visit detail

SHOULD NOT

• CARE-SM CSV template columns
• CARE-SM Toolkit
• CDM source
• Cohort definition
• Cohort definition syntax
• Concept
• EHR access
• EHR status
• event node
• event_id
• Fact relationship
• Hier object id
• ISO 8601 formatted date
• Linkage
• model
• named graphs
• Observation period
• Observation period id
• Party identified
• Party proxy
• Party related
• Party self
• Patient active
• Patient contact
• Patient generalPractitioner
• Patient identifier
• Patient link
• Patient managingOrganization
• pid
• Person id
• Person source value
• RDF-Quads
• RDF-Triples
• ResearchSubject identifier
• ResearchSubject subject
• SPARQL query patterns
• value_datatype
• Versioned EHR status
• Versioned party
• Visit occurrence id
• YARRRML templates

Consolidated tables

MUST

Concept name	Very short description	Why in this table	Where (standards)
Patient	Role of receiving healthcare services.	Core subject-of-care role (distinct from Person and records).	FHIR; CARE-SM
Person	Human individual independent of care/research roles.	Needed to separate identity from patient/participant roles (aliases: PERSON).	FHIR; OMOP; openEHR

SHOULD

Concept name	Very short description	Why in this table	Where (standards)
Birthdate	Date of birth.	Foundational demographic quality in CARE-SM; keep as patient characteristic.	CARE-SM
Clinical entry	Single clinical/registry record about a patient.	Core record content artifact in CARE-SM; supports patient-record sense.	CARE-SM
Death	Death event or death date/time.	Merges FHIR deceased[x], OMOP DEATH, CARE-SM Deathdate.	FHIR; OMOP; CARE-SM
Diagnosis	Clinically established condition affecting the patient.	Core patient characterization in CARE-SM; keep but avoid making it mandatory.	CARE-SM
EHR	Electronic health record for a subject of care.	Patient-record artifact distinct from Person/Patient role; demoted from openEHR MUST.	openEHR
First confirmed visit	First verified care interaction or enrollment date.	Temporal anchor for patient timeline; demoted from CARE-SM MUST.	CARE-SM
Longitudinal record	Timeline linking a patient’s records.	Record-level longitudinal framing; core in CARE-SM but not universal.	CARE-SM
Participation status	Engagement state in program, study, or registry.	Separates care-delivery patient from registry/study participation state.	CARE-SM
Party identity	Registration identity information for a party.	Supports patient identity/registration distinct from clinical content.	openEHR
ResearchSubject	Research participation context for a study subject.	Separates research participant from care-delivery patient; demoted from FHIR MUST.	FHIR
Role	Role performed by a party.	Supports explicit role modeling (patient/participant) without conflating with Person.	openEHR
Sex	Biological sex.	Foundational demographic quality in CARE-SM; keep as patient characteristic.	CARE-SM
Visit occurrence	Episode of receiving healthcare services.	Care-interaction event (alias: VISIT_OCCURRENCE); keep optional to avoid encounter dependency.	OMOP

COULD

Concept name	Very short description	Why in this table	Where (standards)
Address	Postal or electronic address for contact.	Optional contactability detail; used in registration/communication.	openEHR
Biobank	Donation and storage of biological samples.	Research-oriented participation artifact; registry-dependent.	CARE-SM
Birthplace	Country of birth.	Optional demographic attribute; registry-dependent.	CARE-SM
Birthyear	Year of birth.	Alternative when full birthdate is unavailable.	CARE-SM
Care site	Facility/unit where care is delivered.	Adds institutional context for patient-in-care interactions.	OMOP
Clinical trial	Participation in a clinical trial.	Specific research participation framing; optional module.	CARE-SM
Cohort	Time-bounded cohort membership.	Research-participant membership interval (alias: COHORT).	OMOP; CARE-SM
Consent	Informed consent process and resulting permissions.	Participation governance artifact; registry/study-dependent.	CARE-SM
Contact	Purpose grouping for one or more addresses.	Optional structuring of contact details (home/work, etc.).	openEHR
Disability	Impairment extent on scales/scores.	Optional patient state/outcome; condition-dependent.	CARE-SM
Examination	Findings from exams, measurements, or imaging.	Optional clinical findings; registry-dependent.	CARE-SM
Genetic	Genomic analysis results.	Specialized patient findings; cohort/pathway-dependent.	CARE-SM
Group	Group actor created for a shared purpose.	Optional for modeling patient-associated groups beyond cohorts.	openEHR
Hospitalization	Inpatient stay with admission/discharge.	Optional care event; only when inpatient tracking exists.	CARE-SM
Laboratory	Laboratory test results.	Common measurement type; optional for this patient-focused scope.	CARE-SM
Location	Physical location/address information.	Optional location concept (alias: LOCATION); keep separate from Address.	OMOP
Medication	Drug therapy and administration details.	Common intervention; optional scope extension beyond patient identity.	CARE-SM
Note	Unstructured clinical narrative text.	Patient record artifact (free text); optional narrative context.	OMOP
Organisation	Organisation actor, e.g., provider or sponsor.	Optional institutional actor related to care/research.	openEHR
Participation	Participation of a party in an activity.	Optional relation for involvement in care/research activities.	openEHR
Party relationship	Relationship between parties with validity interval.	Optional modeling of guardian/next-of-kin and similar relations.	openEHR
Patient animal	Patient is a non-human animal.	Optional when non-human patient needs explicit modeling.	FHIR
Patient communication	Preferred language for health communication.	Optional communication preference; jurisdiction/profile-dependent.	FHIR
Payer plan period	Continuous insurance enrollment under a plan.	Optional coverage context (alias: PAYER_PLAN_PERIOD).	OMOP
Phenotype	Observable signs, traits, or characteristics.	Optional clinical characterization; common in registries.	CARE-SM
Provider	Individual healthcare provider delivering care.	Optional actor role; avoid forcing practitioner dependency.	OMOP
Questionnaire	Structured patient-reported responses.	Optional PRO capture; instrument-dependent.	CARE-SM
RelatedPerson	Person involved in patient’s care, not care target.	Optional related-person modeling distinct from Patient/Person.	FHIR
Symptoms onset	Date symptoms first noticed/reported.	Optional temporal anchor for condition course.	CARE-SM
Surgical intervention	Surgical procedure with date and site.	Optional care event; condition-dependent.	CARE-SM
Visit detail	Sub-visit segments such as unit transfers.	Optional finer-grained care movements within a visit.	OMOP

SHOULD NOT

Concept name	Very short description	Why in this table	Where (standards)
CARE-SM CSV template columns	Ingestion column set for registry data.	Implementation structure for CSV loading; not domain meaning.	CARE-SM
CARE-SM Toolkit	Software for curation/transformation workflows.	Tool/process artifact outside patient domain modeling.	CARE-SM
CDM source	Dataset and ETL provenance metadata.	Dataset-level provenance, not patient-world phenomenon.	OMOP
Cohort definition	Artifact describing cohort derivation rules.	Derivation/provenance artifact; not patient reality.	OMOP
Cohort definition syntax	Executable cohort logic text.	Operational code artifact; representation-level.	OMOP
Concept	Terminology concept dictionary entry.	Vocabulary infrastructure, not patient real-world phenomenon.	OMOP
EHR access	Access-control and policy settings for EHR.	Authorization/governance artifact, not patient meaning.	openEHR
EHR status	Administrative status and subject reference wrapper.	Record-administration construct; model record–subject relation directly.	openEHR
event node	Record-grouping node for longitudinal design.	Grouping mechanism; representation convenience, not an event itself.	CARE-SM
event_id	Identifier column for event grouping.	Identifier artifact; not the visit/event/grouping itself.	CARE-SM
Fact relationship	Generic linkage storage between records.	Generic relationship table; prefer explicit domain relations.	OMOP
Hier object id	Hierarchical object identifier datatype.	Identifier datatype; representation-level only.	openEHR
ISO 8601 formatted date	Date string formatting constraint.	Encoding constraint, not real-world time concept.	CARE-SM
Linkage	Resource for linking duplicate records.	Record-linking/deduplication artifact; representation-level.	FHIR
model	Workflow tag for module generation.	Processing tag; not a domain concept.	CARE-SM
named graphs	Graph containers for record separation.	RDF implementation mechanism; not domain meaning.	CARE-SM
Observation period	Recorded-data coverage interval for a person.	Data-availability construct; fails Real-World Test for patient domain.	OMOP
Observation period id	Surrogate key for observation period row.	Database key; representation-only.	OMOP
Party identified	Identifier-centric proxy for a party.	Proxy wrapper; model the party/identity directly.	openEHR
Party proxy	Proxy reference wrapper to a party.	Reference wrapper; not a real-world entity or role.	openEHR
Party related	Proxy plus relation to EHR subject.	EHR-internal convenience; prefer explicit relationships.	openEHR
Party self	Proxy representing EHR subject (“self”).	EHR-internal proxy; represent subject as Person/Patient/Role.	openEHR
Patient active	Patient record lifecycle flag.	Record status, not a property of the person/role.	FHIR
Patient contact	Contact-party element on patient resource.	Representation-level element; model persons/relationships instead.	FHIR
Patient generalPractitioner	Primary care provider link element.	Representation-level link; treat provider relation as optional domain relation.	FHIR
Patient identifier	Identifiers assigned to a patient record.	Identifiers are representation keys; identity exists independently.	FHIR
Patient link	Assertion that two records refer to one person.	Record-linking/deduplication construct; representation-level.	FHIR
Patient managingOrganization	Patient record custodian organization.	Record custodianship, not the patient’s real-world role.	FHIR
pid	Patient identifier column value.	Identifier/record-linking artifact; representation-focused.	CARE-SM
Person id	Surrogate identifier for person row.	Database key; representation-only.	OMOP
Person source value	Source-system person identifier string.	ETL traceability identifier; representation-only.	OMOP
RDF-Quads	RDF serialization enabling named graphs.	Serialization detail; not domain meaning.	CARE-SM
RDF-Triples	RDF serialization form for graph data.	Serialization detail; not domain meaning.	CARE-SM
ResearchSubject identifier	Study-assigned identifier for participation.	Identifier; representation key, not domain phenomenon.	FHIR
ResearchSubject subject	Element path pointing to study subject record.	Representation-level path; subject modeled via Person/Patient.	FHIR
SPARQL query patterns	Query mechanics over graphs.	Retrieval technique; not domain meaning.	CARE-SM
value_datatype	XSD datatype metadata for values.	Representation metadata, not domain meaning.	CARE-SM
Versioned EHR status	Versioning container for EHR status.	Change-control wrapper; not patient domain phenomenon.	openEHR
Versioned party	Versioning container for party data.	Change-control wrapper; not patient domain phenomenon.	openEHR
Visit occurrence id	Surrogate key for visit occurrence row.	Database key; representation-only.	OMOP
YARRRML templates	Mapping templates used to generate RDF.	Transformation artifact; not domain meaning.	CARE-SM

Notes

• Merge decisions (old names → normalized name):
  • PERSON; Person → Person
  • patient → Patient
  • Patient.deceased[x]; DEATH; Deathdate → Death
• Kept-separate near-duplicates and why:
  • Address (contact address) vs Location (general physical location) are not the same meaning.
• Category conflicts (what differed and how resolved):
  • Concepts marked MUST in only one input were generally demoted one level to limit scope creep (e.g., EHR, Visit occurrence, CARE-SM demographics/clinical entries).
  • EHR status was demoted to SHOULD NOT as record-administration wrapper, not patient-world meaning.