Explore the Clinical Data Model

Learning Objectives

After completing this unit, you’ll be able to:

  • Explain the benefits of the clinical data model.
  • Describe how records relate to objects in the clinical data model.

The Clinical Data Model

In the Spring ’21 release, Health Cloud upgraded to the latest FHIR standard, FHIR R4, putting clinical data in the limelight. With FHIR resources now mapped to Salesforce standard objects, care providers and insurance payers can seamlessly connect HL7v2 and FHIR R4 data to Salesforce entities and fields. The result? A broad range of data, from administrative to clinical, all in a single system, all on Health Cloud.

Before we look at the data model, let’s review how the clinical data model differs from the packaged EHR data model supported by Health Cloud. These are the key differences.

The Packaged EHR Data Model The Clinical Data Model

Built on a managed package

Built on Salesforce core, with no reference to package entities

Based on the FHIR R1 standard

Based on the FHIR R4 standard

Entities have a lookup to Accounts and need new permissions to access EHR entities 

Master-detail relationships enable multiple sharing settings without needing new permissions

Captures data in text fields and doesn't use code sets to upsert patient data

A new code set entity aligns with the FHIR R4 standard to store all kinds of codes

Highly denormalized data model, with data duplicated and stored in multiple entities

Makes extensive use of references so that there’s less data overlap

The clinical data model is a FHIR R4-aligned data model. Although the Health Cloud data model is inspired by FHIR R4, it differs from FHIR R4 in these ways.

  • The clinical data model supports only the attributes that Health Cloud users need, not all attributes in every FHIR R4 resource.
  • Some entities, such as Code Set and Identifier, have more attributes in the Health Cloud clinical data model than they have in their corresponding FHIR R4 resources. The additional attributes allow reuse of those entities beyond Health Cloud across the Salesforce platform.
  • FHIR R4 defines four cardinalities (minimum and maximum numbers of attribute values):
    • Zero-to-one: Attribute can have no value or one value.
    • One-to-one: Attribute must have only one value.
    • Zero-to-many: Attribute can have no value, one value, or many values.
    • One-to-many: Attribute must have one or more values.

Cardinality in Salesforce

Fields in Salesforce don’t support zero-to-many and one-to-many references (except in multi-select picklists), so Health Cloud has reference fields from the logical target to the logical source.

For instance, the Procedure field has a cardinality of zero-to-many. Following FHIR R4, the Procedure field in the Charles Green Account object would refer to three identifier records in the Identifier object.

Zero-to-many diagram corresponding to the preceding description.

Health Cloud’s clinical data model uses a reference field (Parent Record) in place of the zero-to-many reference in FHIR R4. Each identifier record in the Identifier object has a reference field that connects to the Procedure field in the Charles Green Account object.
Diagram corresponding to the preceding description.

Now let’s look at the clinical data model.

Follow the Patient’s Journey

The clinical data model is the framework that supports integration of health data from external source systems such as EHRs. Health Cloud maps fields and entities in the clinical data model to their counterparts in HL7v2 and FHIR R4. Currently supporting 26 FHIR R4 resources, administration, clinical, medication, diagnostics, and workflow, Health Cloud plans to expand the data model further. 

Here’s a glimpse of what that looks like.

Charles Green suffers from severe headaches. His doctor asks him to take medicine and gives him a prescription for it. In the data model, Charles Green is represented using a Person Account. His prescription is represented by a MedicationRequest object. And his medicine, a painkiller, is represented by a Medication object. Charles (Person Account) is linked to his medicine (Medication) through his prescription (MedicationRequest).

Diagram corresponding to the preceding description.

The FHIR-aligned clinical data model allows a lot more. It supports sophisticated mappings that detail Charles’s physician, the physician’s specialty, procedure details, medication ID, Charles’s allergies, and so on. Let’s take a peek at what the clinical data model can do for Charles’s complex case.

Charles Green (Person Account), who is suffering from severe headaches, has to visit the hospital (ClinicalEncounter). Carol Peterson (Healthcare Provider), the doctor for this encounter (ClinicalEncounterProvider), reviews Charles’s medical history (MedicationStatement) and runs a few tests (CareObservation). Charles Green receives his report (DiagnosticSummary). The encounter diagnosis (ClinicalEncounterDiagnosis) indicates that Charles is suffering from a sinus infection (HealthCondition). The doctor prescribes new medicine (MedicationRequest) for him and specifies which medicine to take (Medication) and the amount of medication to take (PatientMedicationDosage).
Diagram of Charles Green’s hospital visit corresponding to the following table.

Records and Objects in the Clinical Data Model
Type of Health Record
Object Relationships
Hospital Visit (ClinicalEncounter)
Charles Green (Person Account object)
Doctor-Encounter Connection (ClinicalEncounterProvider)

Hospital Visit (ClinicalEncounter object) and 

Carol Peterson (HealthcareProvider object)

Prescription (MedicationRequest)

Charles Green (Person Account object),

Hospital Visit (ClinicalEncounter object),

Carol Peterson (HealthcareProvider object),

Sinus Infection (HealthCondition object), and

Sinus Medicine (Medication)

Medicine Instructions (PatientMedicationDosage)

Prescription (MedicationRequest object)

Report (DiagnosticSummary)

Charles Green (Person Account object) and

Hospital Visit (ClinicalEncounter object)

Medical Tests (CareObservation)

Charles Green (Person Account object) and

Hospital Visit (ClinicalEncounter object)

Medical History (MedicationStatement)
Charles Green (Person Account object)

Encounter Diagnosis (ClinicalEncounterDiagnosis)

Hospital Visit (ClinicalEncounter object) and

Sinus Infection (HealthCondition object)

Sinus Infection (HealthCondition)
Charles Green (Person Account object)

The clinical data model helps you create a connected healthcare experience. With field mappings, a robust data model, and added functionalities from Salesforce partners, you are well-supported to drive interoperability for all the stakeholders of a patient’s care.

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