Fact relationships: Searching for an extensible approach

[rtmill (Robert Miller)]

@Andy_Kanter

It is a shame if this conversation has happened before (perhaps several times over the history of the CDM)

To me that speaks to the community need of such a mechanism!

@Andy_Kanter

However, I don’t think we need to make the perfect the enemy of the good, and perhaps there is a maturity model approach here that allows for standards to evolve in a controlled manner.

Agreed. It’s worth at least acknowledging that there is a dichotomy of implementers in the CDM - those with only claims data and those with other sources. Finding a balance between creating solutions to enable use cases only relevant to subsets of implementers of the CDM while still preserving the ability to query them together when the data overlaps seems key.

@Chris_Knoll

These relationships preserve context in a very source-specific way that will not be standardized across the CDMs in a network, making it difficult or impossible to standardize the analytics applied to them. You probably have a series of ideas that would connect records from different domain tables in creative ways. I think if you asked 10 people, they’d give you 10 unique ideas about relating records together. How can we standardize that?

Standardization is exactly what I’m after here. A discrete (albeit likely evolving over time) set of concepts, let’s call it the ‘fact relationship vocabulary’ for discussion purposes, that defines the scope of relationships in which are considered valid. Anything placed in the modified FACT_RELATIONSHIP table that does leverage these concepts in an appropriate manner should be considered invalid and not included in any analysis. Additionally, if we require all of those relational concepts to include indications as to what are the appropriate “to” and “from” domains of that relationship, it opens up opportunities for validation/DQ checks.

@Chris_Knoll

the CDM model has those 5 or 6 domains of information to capture about the patient, but in a EAV model, there’s really no limit to the number of attributes you can put to an entity (like a visit or a person), and likewise with FACT_RELATIONSHIP, there’s really no limit to the number of ways you can relate records to each other (only limited to the relationship_concept_ids)

A fair point, but I’d argue the source data would limit the amount of relations that could be possible between valid entities in the standard CDM. From my perspective, we would only be enabling relationships that are explicitly given to us in the data, and we just need to find a way to preserve that relationship.

The content of the current “Relationship” vocabulary may be causing confusion here and perhaps should be thought of as separate as it solely contains very specific relationship types (~200) listing out every iteration of how a person can be related to another person. What I’m referring to are much more high level concepts that do not contain that level of granularity. “Procedure given to treat condition”, “Observation from imaging procedure”, “drug as part of regimen”, etc. Point being, a much smaller list than folks might be thinking… at least to start.

@Chris_Knoll

Need to see it in action!

If clarity on the proposal would still be helpful, I can try to mock something up this weekend. A few mock examples with standard concepts, relationships between them, and perhaps how it could be integrated with the tooling?