Patent Publication Number: US-8996584-B2

Title: Systems and methods for healthcare service delivery location relationship management

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This patent claims priority to U.S. Provisional Application Ser. No. 61/444,994, entitled “Systems and Methods for Healthcare Service Delivery Location Relationship Management,” which was filed on Feb. 21, 2011 and is hereby incorporated herein by reference in its entirety. 
    
    
     FIELD OF THE DISCLOSURE 
     The present disclosure relates generally to healthcare information systems and, more particularly, to methods and apparatus for content-driven systems and methods. 
     BACKGROUND 
     Healthcare environments, such as hospitals and clinics, typically include information systems (e.g., electronic medical record (EMR) systems, lab information systems, outpatient and inpatient systems, hospital information systems (HIS), radiology information systems (RIS), storage systems, picture archiving and communication systems (PACS), etc.) to manage clinical information such as, for example, patient medical histories, imaging data, test results, diagnosis information, management information, financial information, and/or scheduling information. These healthcare information systems are used to implement different types of workflows in which clinical information is generated, updated, augmented, and/or otherwise processed for one or more purposes. 
     BRIEF DESCRIPTION 
     Certain examples provide systems, methods, and apparatus for content-based healthcare location management. 
     Certain examples provide a content-based healthcare location management system including a correlation services manager to receive a location correlation identifier and correlate the location correlation identifier with an associated location instance identifier based on an ontology. The location instance identifier is to identify an internal instance of the location correlation identifier to provide location information according to a location schema. The example system includes a location services manager to update a location map using the location instance identifier. The location services manager is to store the location instance identifier in a location relationship object based on at least one relationship associated with the location instance identifier. The example system includes a frame manager to utilize the location relationship object to configure one or more content items forming a clinical application based on the location and relationship identified in the location relationship object. 
     Certain examples provide a tangible computer-readable storage medium including computer program code to be executed by a processor, the computer program code, when executed, implementing a content-based healthcare location management system. The example system includes a correlation services manager to receive a location correlation identifier and correlate the location correlation identifier with an associated location instance identifier based on an ontology. The location instance identifier is to identify an internal instance of the location correlation identifier to provide location information according to a location schema. The example system includes a location services manager to update a location map using the location instance identifier. The location services manager is to store the location instance identifier in a location relationship object based on at least one relationship associated with the location instance identifier. The example system includes a frame manager to utilize the location relationship object to configure one or more content items forming a clinical application based on the location and relationship identified in the location relationship object. 
     Certain examples provide a method for content-driven healthcare location relationship management. The example method includes receiving one or more location identifiers for a content-based clinical application. The example method includes assigning one or more locations to a source role and a target role based on the one or more location identifiers and an ontology, the ontology including a plurality of relationship types. The example method includes identifying a relationship between the source role and the target role based on the one or more location identifiers and the ontology. The example method includes associating the source role and target role based on the identified relationship. The example method includes utilizing the source role, target role, and identified relationship to configure one or more content items forming the content-based clinical application. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a block diagram of an example healthcare environment in which the example methods, apparatus, systems, and/or articles of manufacture disclosed herein for clinical content-based healthcare may be implemented. 
         FIG. 2  illustrates an example clinical knowledge system providing an aggregation of data from multiple sources. 
         FIG. 3  illustrates an example interdependence of content types. 
         FIG. 4  illustrates an example hierarchy of content, associated data models, and terminology. 
         FIG. 5  shows an example root content item having one or more content variants, which may be associated with one or more context variants. 
         FIG. 6  provides an example multi-patient view (MPV) including a plurality of formlets and a frameset. 
         FIG. 7  illustrates an example content management process. 
         FIG. 8  shows a deployment example including a plurality of models in a content package deployed to create a content frame. 
         FIG. 9  provides an example of namespaces A, B, and C including various content items (CIs). 
         FIG. 10  depicts an example of a state versus a workflow. 
         FIG. 11  illustrates an example clinical information system including a reference platform and one or more content items that define clinical functionality. 
         FIG. 12  shows an example directed acyclic graph used to provide a location relationship ontology. 
         FIG. 13  depicts an example location correlation identification (CID) schema. 
         FIG. 14  depicts an example sequence diagram showing interaction between various components for location correlation. 
         FIG. 15  illustrates an example location service application programming interface (API). 
         FIG. 16  illustrates a flow diagram for an example method of location relationship management in a content-based clinical system. 
         FIG. 17  is a block diagram of an example processor system that may be used to implement the systems, apparatus and methods described herein. 
     
    
    
     The foregoing summary, as well as the following detailed description of certain implementations of the methods, apparatus, systems, and/or articles of manufacture described herein, will be better understood when read in conjunction with the appended drawings. It should be understood, however, that the methods, apparatus, systems, and/or articles of manufacture described herein are not limited to the arrangements and instrumentality shown in the attached drawings. 
     DETAILED DESCRIPTION 
     Although the following discloses example methods, apparatus, systems, and articles of manufacture including, among other components, firmware and/or software executed on hardware, it should be noted that such methods, apparatus, systems, and/or articles of manufacture are merely illustrative and should not be considered as limiting. For example, it is contemplated that any or all of these firmware, hardware, and/or software components could be embodied exclusively in hardware, exclusively in software, exclusively in firmware, or in any combination of hardware, software, and/or firmware. Accordingly, while the following describes example methods, apparatus, systems, and/or articles of manufacture, the examples provided are not the only way(s) to implement such methods, apparatus, systems, and/or articles of manufacture. 
     Locations are an integral part of a healthcare delivery management system. Location management has a profound impact on overall healthcare delivery management. Location not only has geographical annotations but also has usage context based annotations that relates to a role played by a location in an association with another location. Locations share relationship based upon the organizational needs of a healthcare delivery enterprise. A relation among various locations may be facilitated using a location type and a relationship among location type(s) and/or roles played by a location. Locations are used by their types as well as well as their relation among the location type. Using types and relations, a single location may play multiple roles and participate in multiple locations. A relationship among various types of locations is hierarchical in nature and may be represented as an ontology of location types. 
     Certain examples provide systems and methods to handle location relationship management for a clinical knowledge platform (e.g., GE&#39;s Qualibria®) and associated clinical information system(s) and method(s). Certain examples provide a source location, target location, location relationship, and rule/ontology definition. Locations and location relationships may be provided as clinical element instance objects, and an ontology definition may be provided as a terminology concept. Location and location relationship may be updated independently and a relationship between two locations may be created and updated independently in runtime, for example. 
     Certain examples leverage a Clinical Element Model (CEM), where location and location relationship are clinical elements and may be modeled by each healthcare delivery organization to suit their specific needs without requiring changes in software. Locations are loaded into the system as independent entities, and one or more location relations are created to connect locations in a desired relationship ontology. 
     In certain examples, a location plays a source role or target role and is stored in a location relationship object. Allowed relationships between source and target roles are determined by the terminology definition of the ontology. Location relationship management services validate conflict of roles between locations and/or by location, for example. 
     In certain examples, location relationships may be established as a healthcare delivery organization changes/grows/reorganizes without impacting existing software infrastructure of its location(s). These newly added relationships may be made part of the system just in time or to be specific in realtime subject to availability of the terminology, for example. 
     After patient and encounter information, location information is an important entity in a healthcare delivery management system. Location relationship is hierarchical in nature and ties locations with each other. However, healthcare organizations undergo frequent changes for care delivery management, financial management, research, teaching etc. This requires establishing a new relationship and changing the old relationship in realtime without stopping the working software of a Healthcare Delivery Management System, which would impact patient healthcare. 
     Certain examples provide an approach for location relationship management to solve a creation, update and modification of relationship problem and make it possible to do in real time (or at least substantially real time accounting for some system delay). Certain examples avoid tying location relationship information with location, which would make it difficult to change later in real time, for example. 
     Entities of healthcare enterprises operate according to a plurality of clinical workflows. Clinical workflows are typically defined to include one or more steps or actions to be taken in response to one or more events and/or according to a schedule. Events may include receiving a healthcare message associated with one or more aspects of a clinical record, opening a record(s) for new patient(s), receiving a transferred patient, and/or any other instance and/or situation that requires or dictates responsive action or processing. The actions or steps of a clinical workflow may include placing an order for one or more clinical tests, scheduling a procedure, requesting certain information to supplement a received healthcare record, retrieving additional information associated with a patient, providing instructions to a patient and/or a healthcare practitioner associated with the treatment of the patient, and/or any other action useful in processing healthcare information. The defined clinical workflows can include manual actions or steps to be taken by, for example, an administrator or practitioner, electronic actions or steps to be taken by a system or device, and/or a combination of manual and electronic action(s) or step(s). While one entity of a healthcare enterprise may define a clinical workflow for a certain event in a first manner, a second entity of the healthcare enterprise may define a clinical workflow of that event in a second, different manner. In other words, different healthcare entities may treat or respond to the same event or circumstance in different fashions. Differences in workflow approaches may arise from varying preferences, capabilities, requirements or obligations, standards, protocols, etc. among the different healthcare entities. 
     However, the entities of a healthcare enterprise and/or entities from separate healthcare enterprises sometimes operate within a broader, interdependent information system, which hinder the ability of entities to customize clinical workflows. For example, the information system to which a healthcare entity belongs may place restrictions on changes to workflow applications or programs. Moreover, because some healthcare entities operate using systems, programs, devices, etc. from varying manufacturers, software providers, etc., a lack of interoperability between the systems, programs, devices, etc. of each healthcare entity prohibits many customizations from realization. As a consequence of these example factors as well as additional or alternative factors, healthcare entities that desire customized clinical workflows are typically required to request such customizations from the manufacturers, software providers, etc. Furthermore, for such customizations to implemented or integrated into a healthcare information system, a wide range of system-interrupting updates or re-releases occur within the information systems. 
     Certain examples provide a clinical knowledge platform that enables healthcare institutions to improve performance, reduce cost, touch more people, and deliver better quality globally. In certain examples, the clinical knowledge platform enables healthcare delivery organizations to improve performance against their quality targets, resulting in better patient care at a low, appropriate cost. 
     Certain examples facilitate better control over data. For example, certain example systems and methods enable care providers to access real-time patient information from existing healthcare information technology (IT) systems together in one location and compare this information against evidence-based best practices. 
     Certain examples facilitate better control over process. For example, certain example systems and methods provide condition- and role-specific patient views enable a user to prioritize and coordinate care efforts with an institution&#39;s agreed upon practice standards and to more effectively apply resources. 
     Certain examples facilitate better control over outcomes. For example, certain example systems and methods provide patient dashboards that highlight variations from desired practice standards and enable care providers to identify most critical measures within the context of performance-based care. 
     Certain examples leverage existing IT investments to standardize and centralize data across an organization. In certain examples, this includes accessing multiple systems from a single location, while allowing greater data consistency across the systems and users. 
     In certain examples, an advanced Service-Oriented Architecture (SOA) with a modern technology stack helps provide robust interoperability, reliability, and performance. The example SOA includes a three-fold interoperability strategy including a central repository (e.g., a central repository built from Health Level Seven (HL7) transactions), services for working in federated environments, and visual integration with third-party applications. Certain examples provide portable content enabling plug &#39;n play content exchange among healthcare organizations. A standardized vocabulary using common standards (e.g., LOINC, SNOMED CT, RxNorm, FDB, ICD-9, ICD-10, etc.) is used for interoperability, for example. Certain examples provide an intuitive user interface to help minimize end-user training. Certain examples facilitate user-initiated launching of third-party applications directly from a desktop interface to help provide a seamless workflow by sharing user, patient, and/or other contexts. Certain examples provide real-time (or at least substantially real time assuming some system delay) patient data from one or more IT systems and facilitate comparison(s) against evidence-based best practices. Certain examples provide one or more dashboards for specific sets of patients. Dashboard(s) can be based on condition, role, and/or other criteria to indicate variation(s) from a desired practice, for example. 
     Generally, the example methods, apparatus, systems, and/or articles of manufacture disclosed herein enable healthcare entities of an enterprise clinical information system (ECIS) to dynamically customize one or more clinical workflows. Among other functions and/or benefits, the ECIS supports healthcare practitioners in decision making processes by aggregating healthcare information across disparate enterprises and/or entities thereof and referencing collection(s) of data (e.g., guidelines, recommendations related treatment and/or diagnosis, studies, histories, etc.) to automatically generate supportive information to be communicated to one or more healthcare practitioners related to the aggregated healthcare information. While each entity operates in connection with the ECIS that is administered by a provider thereof, the examples disclosed herein enable each entity of operating in connection with the ECIS to originate and/or modify one or more clinical workflows without relying on the provider of the ECIS to do so on behalf of the entity. In other words, although a healthcare entity is part of the ECIS and exchanges data with and via the ECIS, that entity can independently create and/or manage its clinical workflows using the examples disclosed herein. Furthermore, the examples disclosed herein enable entities of the ECIS to deploy or initiate the customized workflows without having to reboot or significantly interrupt the ECIS and/or the other components, workflows, etc., thereof. The example methods, apparatus, systems, and/or articles of manufacture disclosed herein and the advantages and/or benefits thereof are described in greater detail below in connection with the figures. 
       FIG. 1  is a block diagram of an example healthcare environment  100  in which the example methods, apparatus, systems, and/or articles of manufacture disclosed herein for clinical content-based healthcare may be implemented. The example healthcare environment  100  of  FIG. 1  includes a first hospital  102  having a plurality of entities operating within and/or in association with the first hospital  102 . In the illustrated example, the entities of the first hospital  102  include an oncology department  104 , a cardiology department  106 , an emergency room system  108 , a picture archiving and communication system (PACS)  110 , a radiology information system (RIS)  112 , and a laboratory information system (LIS)  114 . The oncology department  104  includes cancer-related healthcare practitioners, staff and the devices or systems that support oncology practices and treatments. Similarly, the cardiology department  106  includes cardiology-related healthcare practitioners, staff and the devices and/or systems that support cardiology practices and treatments. Notably, the example oncology department  104  of  FIG. 1  has specifically designed clinical workflows to be executed in response to certain events and/or according to a schedule. At the same time, the example cardiology department  106  of  FIG. 1  has specifically designed clinical workflows to be executed in response to certain events and/or according to a schedule that differ from the clinical workflows of the example oncology department  104  of  FIG. 1 . For example, the oncology department  104  may execute a first set of actions in response to receiving a Healthcare Level 7 (HL7) admission-discharge-transfer (ADT) message, while the cardiology department  106  executes a second set of actions different from the first set of actions in response to receiving a HL7 ADT message. Such differences may also exist between the emergency room  108 , the PACS  110 , the RIS  112  and/or the accounting services  114 . 
     Briefly, the emergency room system  108  manages information related to the emergency care of patients presenting at an emergency room of the hospital  102 , such as admission information, observations from emergency examinations of patients, treatments provided in the emergency room setting, etc. The PACS  110  stores medical images (e.g., x-rays, scans, three-dimensional renderings, etc.) as, for example, digital images in a database or registry. Images are stored in the PACS  110  by healthcare practitioners (e.g., imaging technicians, physicians, radiologists) after a medical imaging of a patient and/or are automatically transmitted from medical imaging devices to the PACS  110  for storage. The RIS  112  stores data related to radiology practices such as, for example, radiology reports, messages, warnings, alerts, patient scheduling information, patient demographic data, patient tracking information, and/or physician and patient status monitors, as well as enables exam order entry (e.g., ordering an x-ray of a patient) and image and film tracking (e.g., tracking identities of one or more people that have checked out a film). The lab information system  114  stores clinical information such as lab results, test scheduling information, corresponding practitioner(s), and/or other information related to the operation(s) of one or more labs at the corresponding healthcare facility. While example types of information are described above as being stored in certain elements of the hospital  102 , different types of healthcare data may be stored in one or more of the entities  104 - 114 , as the entities  104 - 114  and the information listed above is included herein as non-limiting examples. Further, the information stored in entities  104 - 114  may overlap and/or be combined into one or more of the entities  104 - 114 . Each of the example entities  104 - 114  of  FIG. 1  interacts with an electronic medical record (EMR) system  116 . Generally, the EMR  116  stores electronic copies of healthcare records associated with, for example, the hospital  102  and the entities  104 - 114  thereof. 
     The example healthcare environment  100  of  FIG. 1  also includes an outpatient clinic  118  as an example of another healthcare enterprise. The example outpatient clinic  118  of  FIG. 1  includes a lab information system  120  and a PACS  122  that operate similarly to the corresponding entities of the example hospital  102 . The lab information system  120  and the PACS  122  of the example outpatient clinic  118  operate according to specifically designed clinical workflows that differ between each other and the clinical workflows of the entities  104 - 114  of the hospital  102 . Thus, differences in clinical workflows can exist between the entities of a healthcare enterprise and between healthcare enterprises in general. 
     In the illustrated example of  FIG. 1 , the hospital  102  and the outpatient clinic  118  are in communication with an ECIS  124  via a network  126 , which may be implemented by, for example, a wireless or wired Wide Area Network (WAN) such as a private network or the Internet, an intranet, a virtual private network, a wired or wireless Local Area Network, etc. More generally, any of the coupling(s) described herein may be via a network. Additionally or alternatively, the example hospital  102  and/or the example outpatient clinic  118  are in communication with the example ECIS  124  via direct or dedicated transmission mediums  128  and  130 . 
     Generally, the ECIS  124  supports healthcare information processing implemented by systems, devices, applications, etc. of healthcare enterprises, such as the hospital  102  and the outpatient clinic  118 . The ECIS  124  is capable of processing healthcare messages from different entities of healthcare enterprises (e.g., the entities  104 - 114  of the hospital  102 ) that may generate, process and/or transmit the healthcare messages differently and/or using different formats, protocols, policies, terminology, etc. when generating, processing, and/or transmitting the healthcare messages. Moreover, the example ECIS  124  of  FIG. 1  supports healthcare practitioners in decision making processes by aggregating healthcare information across disparate enterprises and/or entities thereof and referencing collection(s) of data to automatically generate suggestive and/or definitive data for communication to one or more healthcare practitioners related to the aggregated healthcare information. 
     Certain examples provide a library of standardized clinical content and proven best practices. Over time, this “library” of content may expand as healthcare organizations add to their own content modules. Because the content is standardized it can be shared and leveraged among organizations using the library and associated clinical knowledge platform. The library and platform help enable organizations to share best practice content. Thus, certain examples provide a clinical knowledge platform that enables healthcare delivery organizations to improve performance against their quality targets. 
     In certain examples, a quality dashboard application enables creation of one or more dashboards based on the data/content most relevant to an organization at a given period of time. A clinical knowledge platform brings together real-time patient data from existing IT systems within an organization and allows for the comparison of this data against evidence-based best practices. The example quality dashboard application leverages the platform to enable personalized “Quality Dashboards” to be created for specific sets of patients, based on condition, role, and/or other criteria. Variations from desired practice will be highlighted on each dashboard, enabling care providers to ensure better clinical outcomes and enrich patient care. 
     In this example, the clinical knowledge platform aggregates data from an organization&#39;s existing IT solutions. These can be solutions from the same and/or different manufacturer and/or provider. For example, as long as there is an HL7 or Web Services feed, the clinical knowledge platform can utilize the data from an existing solution. The existing IT solution(s) will continue to operate as they always have, and an organization can continue to use these solutions separate from the clinical knowledge platform if they so desire. However, the clinical knowledge platform and associated application(s) and/or workflow(s) can help to put organizations in greater control of their data by aggregating as much data from disparate IT solutions as possible.  FIG. 2  illustrates an example clinical knowledge system  200  providing an aggregation  210  of data from multiple sources. Aggregated data may include, for example, medication orders, radiology reports, microbiology, admit/discharge/transfer (ADT) message, lab results, specific observations, electronic medical record (EMR) data, etc. 
     As the different data sources are pulled into a central data repository, content standardization occurs. It is this “standardization” that enables content from different IT sources to be used together. For example, as shown in  FIG. 2 , an interface  220  provides terminology mapping and standardization to the aggregated data. 
     After the content is standardized, clinical decision support mechanisms can be tied to the content (as illustrated, for example, by the clinical decision support  230  of the system  200  of  FIG. 2 ). The data and associated clinical decision support are then stored in a clinical data repository (CDR), such as CDR  240  of the example system  200 . By combining the aggregated and standardized data with clinical decision support rules and alerts, the clinical knowledge platform may provide end-users with an understanding of important elements to which they should pay attention (and take action on) within the larger set of data they are considering when caring for a patient. 
     Combined data and clinical decision support mechanisms create valuable content that, when arranged properly, may be used to improve the quality of care provided. Organizations can elect to use the application(s) that are provided as a part of the example clinical knowledge platform and/or may choose to build their own clinical application(s) on the platform. The open architecture nature of the platform empowers organizations to build their own vision, rather than base their vision on the static/hard coded nature of traditional IT solutions. 
     In certain examples, “Quality Dashboards” created via an example application display data via columns and rows in addition to individual patient “inspector” views. For example, the system  200  shown in  FIG. 2  provides one or quality dashboards  250  to be created and personalized by an end user. The flexible nature of this dashboard application empowers organizations to create dashboards of the aggregated data based on their needs at a given period of time. The organization may determine what data elements they would like to include on each dashboard and, without significant IT resources, create a dashboard that reflects their vision. In addition, organizations can determine where on the dashboard they would like the information to be displayed and further adjust the view of the content via features such as “bolding” font, etc. When data is added to each dashboard, clinical decision support mechanisms attached to this data are displayed on the dashboard as well. For example, content related to treating a patient based on a particular use case may be included on a quality dashboard, along with alerts and notifications to indicate to end-users when desired outcomes are varying from defined clinical standards. Thus, organizations can create dashboards based on their own idea of “best practice” care for a given disease state. 
     In certain examples, since combined content and best practices have been standardized, content from one organization using the clinical knowledge platform may be easily shared with other organizations utilizing the platform. In addition, because the content within platform-related applications is standardized in the same manner, upgrades to the example platform can occur efficiently across organizations. That represents a dramatic change from prior IT solutions which require unique IT upgrades because they are usually uniquely customized to each organization in which they are installed. 
     Generally, content is information and experience that may provide value for an audience. Any medium, such as the Internet, television, and audio CDs, may deliver content as value-adding components. Content represents the deliverable, such as a DVD movie, as opposed to the delivery mechanism, a DVD player. As long as content conforms to the media standard, any compatible device can play it. 
     Content, as used herein, is the externalization or parameterization of “the instructions” that tell applications how to work. For example, content is a collection of externalized information that tells software, in conjunction with data, how to behave. In certain examples, a clinical knowledge platform takes in and executes content against data to render applications visually and behaviorally. 
     Content includes data read and interpreted by a program to define or modify presentation, behavior, and/or semantics of the program and/or of application data consumed by the program, for example. Content includes documents presented to a client by a program without modification, for example. Content may be created, stored, deployed, and/or retrieved independently of the creation and deployment of the program(s) consuming the data, for example. Content may be versionable to capture desired variation in program behavior and/or semantics, for example. 
     Classes of content may include configuration content, preferences content, reference content, application content, etc. Content types may combine behaviors of two or more classes, for example. 
     Software vendors take many different approaches to customization. At one extreme, some vendors write different software for each customer or allow customers to write software. At the other extreme, a vendor has the same software for each customer, and all customization occurs through creating or modifying content. In certain examples, the same software may be used for each customer, and customization is handled through content. 
     In healthcare, new laboratory tests, medications, and even diseases are constantly being discovered and introduced. Structuring this as content, where underlying software does not need to change, helps accommodate and use updated information. 
     In certain examples, many different content types, such as form definitions, data models, database schema, etc., are accommodated. In certain examples, each content type may be used differently and involve a distinct authoring tool. Thus, in certain examples, content may refer to “a collection of the content instances for all content types,” also called a content repository, knowledge repository, or knowledge assets. For example, a content instance is a specific member of a content type, such as a heart rate data model. 
     In certain examples, each content type is associated with a generic, extensible structure that content instances of the content type follows. An example clinical information system can specify content in an abstract way that does not presuppose a particular software implementation, for example. That is, another system, such as GE&#39;s Centricity Enterprise, may consume content from a knowledge repository, apply a different set of software, and achieve the same behaviors. Additionally, an abstract content definition can more easily transition to a new system. If one can extract content from a legacy system, a knowledge repository may be able to import and reuse it. Such a capability helps reduce a large barrier to change for potential customers. 
     Content can change with time. In an example, a current knowledge repository can handle any “old” data entered into a system under the auspices of an older knowledge repository. Occasionally, a question may arise where someone could ask, “What did Dr. Smith see at some past time?” Under these circumstances, a current definition of a particular display may not correctly reflect the situation at the time. An example CIS, unlike other systems, can bring back the old form for visualizing the data since all knowledge assets are versioned and retained. 
     Content may need to vary for different circumstances. For example, an MPV may differ between emergency department (ED) and labor and delivery settings. Each MPV has rows and columns of data specific to its setting. Context refers to being aware of and reacting distinctively to a location and other situational differences. For example, interpretation of a patient&#39;s low temperature can vary based on location. If it occurs in the recovery room after cardiopulmonary bypass with deliberate patient cooling, it means one thing. If the patient is in the ED after breaking through ice into a lake, it means something completely different. Context may vary based on user location, patient location, user role, and/or various other factors. In certain examples, content may be applied based on context. 
     Globalization is a process of adapting software so that it has no language references, before embedding capabilities to make it suitable for particular languages, regions, or countries. Having globalized it, a CIS may then translate it to other languages and cultures, called localization. Globalizing a software product involves creating content separate from the software. For example, embedded text (e.g., user messages), sort orders, radix characters, units of measure, data formats, currency, etc., may be removed and parameterized. References to languages, character sets, and fonts may also be removed, for example. In certain examples, while display representations may be local, terminology concepts are applied universally, making a rule, calculation, or other content based on one or more terminology concepts useable worldwide without modification. 
     For example,  FIG. 3  illustrates an example interdependence of content types. As shown in the example of  FIG. 3 , content is a set of interdependent building blocks. Content may be thought of as a hierarchy, with terminology  310  (e.g., names of lab tests) as a lowest level. Terminology  310  may be common and coded across a customer base. Clinical element models (CEMs)  320  govern structure and content of objects stored in a database and used by applications. A formlet  330  provides a way to display a particular content item (e.g., a way to display a particular lab result). A form definition  340  provides an application or view (e.g., a dashboard) of a collection of formlets (e.g., a multi-patient view (MPV) showing one or more lab results and/or other information). For example, if a particular MPV definition is moved from one customer to another, the MPV definition along with other content items on which the form definition depends are imported into the new customer&#39;s knowledge repository. Content items may include appropriate formlets, CEMs, and terminology, for example. 
     In certain examples, a detailed clinical model defines, at a granular level, the structure and content of a data element. For example, the detailed Clinical Model for “Heart Rate Measurement” dictates the data type of a heart rate measurement, and the valid physiologic range of a heart rate. It says that a “body location” is valid qualifying information about a heart rate measurement, but a “color” is not. It further decrees that the valid values for “body location” are terminology codes found in the “heart rate body location” value set. Moreover, it prescribes that a “resting heart rate” is an instance of “Heart Rate Measurement” where the value of “temporal context” is “resting”, where “resting” is also a coded value. A detailed clinical model pulls the information together into a single, explicit, and computable form. The detailed clinical models or clinical element models (CEMs) govern the content and structure of all data objects stored in an example clinical database and used by applications, for example. In addition, CEMs are extensible, such that content authors may add new CEMs or attributes to existing CEMs without requiring major changes to database structures or software, for example. 
     In certain examples, shared or portable content is, in effect, “plug &#39;n play”. System administrators can add it (e.g., plug it into) to a system without any software changes, and the content behaves in the intended way and does not cause errors. The size or scope of shared content can range from a single term to an entire knowledge repository, for example. Shared content fundamentally changes an implementation paradigm and reduces a total system cost of ownership, for example. 
     Customers can change shared content. Customers can improve it or make it more suitable for their institutions. When customers do this, they leave the original definition intact, but clone it and keep their changed version in their “local” space, for example. 
     As described above, classes of content may include configuration content, preferences content, reference content, application content, etc. Configuration content is content that is modified infrequently and is concerned primarily with system behavior, for example. Examples of configuration content may include internet protocol (IP) address and port of clinical knowledge database, identifiers of terminals in systems, security access privileges, configuration files, etc. Configuration content may affect program semantics, for example. Configuration content is generally modified by system administrators and is often stored in the file system, for example. 
     Preference content is modified frequently and is concerned primarily with variation between users. Examples of preference content include display colors and fonts, default search parameters, screen layout, etc. Preference content rarely affects program semantics and is most commonly modified by individual users. While modified by users, the system generally distributes initial or default preference content. 
     In certain examples, distributed or default preference content behaves very similar to application content before modification by a user. Preference content may be context sensitive, transformed at deployment, etc. Preference content may include vocabulary concepts and pick-lists that are resolved when loading and retrieving just like other content types. 
     Reference content is documents that are presented without modification as part of the application. Reference content is often stored in formats that are opaque to a program (e.g., as a PDF, a Microsoft Word™ document, etc.). Reference content is generally not specific to or customized for a specific patient (e.g., instruction sheets, information sheets, policies and procedures, etc.). Reference content may be independent of program semantics and behavior. Reference content may be authored independently of a program. While not an element of a content drive system per se, reference content is often managed as content by a clinical knowledge system. Once reference content is modified for presentation to a specific user, the content starts behaving much more like patient data/documents. Reference content with the structure to enable modification starts behaving much more like application content. 
     Application content may be modified frequently or infrequently depending on use. Application content may be concerned primarily with application behavior and semantics. Applicant content may be generally specific to an application domain. Examples may include a flow sheet template, clinical element models, terminology, document templates that are modified and stored as patient data (e.g., hot text), etc. Terminology is application content but has behaviors distinct from other application content types and is managed (largely) independently of other application content, for example. Application data often affects program semantics and behavior. Application content may be authored at multiple levels in an organization or external to the organization, for example. 
     Application content may be implemented as a custom markup language, for example. Application content may be implemented as a domain specific language (DSL), for example. For example, data queries may be implemented using a frame definition language (FDL). Clinical element models may be implemented using a constraint definition language (CDL). Application content may be directly authored or imported as data into a content store (e.g., concepts in a vocabulary server), for example. 
     In certain examples, while patient data is transactional and often includes discrete data elements, application content is often structured, complex objects and often has associated metadata. In certain examples, metadata is data used to manage content, such as content identifier, version, name of author, access privilege, encryption certificate, etc. Metadata is not treated as content, for example. While patient data is owned by a patient and is part of a legal record, application content is not owned by a patient and is not part of a legal record. Application content may be published (e.g., is not transactional) and managed using a lifecycle. 
     Certain examples provide content-driven systems and processes that rely primarily on content to determine application behavior. An example system includes a reference platform that consumes, interprets, and/or executes content while remaining application neutral. An example system uses content that remains independent of an implementation of the reference platform to allow independent evolution of the platform and the application. 
       FIG. 4  illustrates an example hierarchy  400  of content, associated data models, and terminology. In certain examples, once one chooses content based data models, content-based queries and data management are also selected. Content based applications are also chosen. An integral terminology basis includes semantics of data defined in terminology content, for example. As shown in the example of  FIG. 4 , application definition content  410  (e.g., MPV templates, form(let) definitions, interface mappings, and/or document templates, etc.) relies on data management content (e.g., frames)  420  (e.g., data query definitions, data update definitions, and/or data transformations, etc.). The data management content  420  leverages data models (e.g., CEMs)  430 , such as clinical data organization (e.g., structure) and/or coded clinical data, etc. The data models  430  are constructed based on a terminology  440  including clinical concepts and relationships between concepts, for example. 
     In certain examples, context refers to metadata attributes and/or labels that differentiate variations of a content item. For example, each variant of content item may be referred to as a context variant. Each variation of a content item has a specific set of context attributes (e.g., language, location, role, etc.). An algorithm or heuristic may select a desired variant when retrieving based on a current user&#39;s “context.” This process may be referred to as context resolution. 
     Searching refers to examining the content item and/or associated metadata for matches independent of context. Searching can include context attributes to filter for specific context variants in the search. The difference is that a specific variant is not selected algorithmically or heuristically by the content system when searching. Using the “user” as a context attribute is one way to associate a content item with a specific user; similarly provider as a context variable could be used to associate an item with a group of users. Resolving context generally requires some heuristic to resolve ambiguity or conflicts among context variants (e.g., weighting or priority schemes, default rules, etc.). This leads to some ambiguity since changing/adding a context variant or changing the weights of context attribute may change the context resolution on another item in not always obvious ways (at least to a user). 
     In certain examples, a content item includes: 
     1. A root content item represented by a universally unique identifier (UUID). The root content item includes metadata only; no actual content is stored. 
     2. One or more context variants that represent variations of an implementation of the content item in different client contexts occur as children of the root content item. 
     3. Context variants may form trees of increasing context specialization (e.g., a context variant may have child variants). 
     4. Each context variant has a unique UUID as well as a relation to the root content item. 
     5. Each context variant maintains versions of that variant as changes are applied to the variant. 
     As shown in the example of  FIG. 5 , a root content item  510  has one or more content variants  520 - 522 . Each content variant  520 - 522  may be associated with one or more context variants  530 - 531 . 
       FIG. 6  provides an example multi-patient view (MPV)  600  made up of a plurality of formlets  610 - 614  and a frameset  640 . Each formlet  610 - 614  corresponds to a concept  620 - 624  and a model  630 - 634 . The frameset  640  is also associated with each model  630 - 634 , and each model  630 - 634  is associated with a concept  650 - 654 , for example. 
     In certain examples, content may be stored in multiple content stores. For example, content may be stored in an ECIS database, an XDS repository, a third-party system, etc. Content documents in storage may be identified by a URI that specifies the content store and the key of that item in that content store. A content directory including the content metadata may be searched to obtain the URI for retrieval of the content item. A content type manager may specialize the search, storage, and/or retrieval of items of that content type, for example. 
     A content item in the content directory is keyed via a UUID for the item. That UUID is not necessarily part of the uniform resource indicator (URI) that defines the storage location. 
     In certain examples, content items may be organized as a content type. A content type is a set of content items that are defined and managed using common definitions and methodologies (e.g., terminology, clinical element models, frameset definitions, etc.). Content types may have different behaviors, states, lifecycles, etc. Each content type may be managed by a specific content type manager, which is treated as a plug-in to a clinical knowledge platform and/or associated clinical information system, for example. Content types may be added by creating a new content type manager, for example. 
     Content type managers may interact with a content management framework by implementing a set of event handlers (e.g., package, deploy, retrieve, etc.). “Generic” content types (e.g., content types with no special behavior) may use a default content type manager. An owner of a content type is responsible for implementing an associated content type manager, for example. 
     In certain examples, during authoring (that is, before deployment), dependencies exist between content items. At runtime (that is, after deployment), dependencies exist between deployed forms of context variants. Dependents that exist during authoring may or may not continue after deployment. For example, terminology description and pick-list resolution are translations during loading and retrieving, not dependencies per se. 
     In certain examples, at runtime, dependencies are between deployed forms of context variants, not the context variants themselves. The deployed form of a context variant is a “content frame”. At deployment time, it may be necessary to guarantee that the packages (e.g., terminology) that a package depends on are also deployed. Terminology dependencies may be inferred from terminology relationships and mappings and do not need to be explicitly tracked. 
     In certain examples, a content based system provides a capability to distribute content and content updates to external instances (e.g., test systems, quality assurance systems, customer installations, content patches (SPRS), etc.). An example distribution system provides a capability to distribute content items and associated dependent content items and/or insure that those content items already exist in the target system. For example, an FDL content item must have access to the clinical element types it references in order to process a frame query. The example distribution system may also facilitate an undo or reversal of installed content items that generate issues. Content may be distributed as large sets of items (e.g., during installation) and/or as individual items (e.g., bug fixes), for example. 
       FIG. 7  illustrates an example content management process  700 . The example process  700  includes authoring  710 , packaging  720 , exporting  730 , importing  740 , deploying  750 , loading  760 , and retrieving  770 . 
     Authoring  710  includes a process of creating and/or modifying a content item. Authoring may be done by an author composing content directly using an editor (e.g., CDL, FLD, etc.), for example. Authoring may be done using tools (e.g., editor(s), etc.) that are specific to a content-type (e.g., terminology), for example. Authoring may be done by tools within the application(s) consuming a content type (e.g., MPV, forms, etc.), for example. Authoring may be done by applications generating a content item (e.g., MPV generating FDL), for example. In certain examples, there is no single authoring environment for content; rather, there is a family of authoring tools that is often content type specific. 
     Packaging  720  includes combining all content items and (applicable) context variants within a transitive closure of dependency graphs of one or more content items into a package, for example. Packages may include multiple independent top level content items, for example. Packages may have dependency(-ies) on other package(s). For example, a package containing a frameset content item may dependent on a separate terminology package as a prerequisite to deployment. 
     Packages may very frequently contain multiple independent, top level items each with its associated dependency graph. A package may not include all context variants of an item. For example, packaging may filter based on context to form a package. Packaging events may include an event to allow a content type manager to specify dependencies of an item being packaged. 
     Packages may have dependencies on content types other than content packages. For example, a terminology package is a different content type than a content package. Content items within a package may not have explicit dependencies on terminology concepts. Rather, the package has dependencies on the appropriate terminology packages. 
     In certain examples, packages are used as a distribution mechanism. Packages may be deployed before items in the package are available to a runtime system, for example. Packages themselves may be treated as content items. Thus, packages can themselves be packaged (e.g., packages of packages), and packages may be dependent on other packages. In certain examples, packages may belong a namespace or domain. For example, packages may only include items from a single namespace. Packages may have dependencies on packages in another namespace, for example. 
     Package(s) may be exported  730  from one system and imported  740  into another. Exported packages may be used to distribute content, for example. System management tool(s) may be provided to create, export, import, and deploy content packages, for example. 
     Deploying  750  includes making content items included within a package available to a running system. A content item may be transforming during deployment, for example. For example, constraint definition language (CDL) models may be compiled and may create multiple type objects each with an associated schema. As shown in the deployment example of  FIG. 8 , a plurality of models  810  in a content package  815  are deployed  820  to create a content frame  830  including plurality of type objects  835  with associated XML schema. 
     In certain examples, each top level content item in a package being deployed is deployed independently. A deployed content item is logically (and often physically) a different object than the content item being deployed. For example, a deployed content item has independent state and lifecycle. Multiple content items may be created during deployment, for example. For example, deploying a CDL model may generate a CE type object and an XML schema. In certain examples, a source content item may not exist in the runtime system. For example, the source CDL models are not employed, and the generated CE type object is deployed. Deployment of a package may be done manually and/or implicitly by an authoring tool, for example. For example, system administrators may wish to explicitly control deployment of data models but MPVs authored by a user may be implicitly and immediately deployed. 
     In certain examples, each deployed content item is bundled with all of the content items that are used to execute and/or consume the item. The bundle is referred to as a content frame  830 . A content frame  830  is analogous to an archive file manifest. It may not (necessarily) contain the actual content items. The content frame  830  may not include all of the items generated during deployment. For example, the CDL schemas may not be part of the frame. 
     A content frame  830  is also analogous to a context variant. The frame has its own unique identifier but may be retrieved using the identifier of the root content item the frame is based upon in the same way that context variants are retrieved. Deployment events may include an event to allow the content type manager to specify dependencies of the deployed item(s) within the content frame, for example. 
     In certain examples, context resolution refers to conditioning selection, composition, and/or behavior of a content item based on a context of a user. Context resolution may occur at one or more levels. For example, context resolution may occur on selection of the content item(s) that a content item being deployed is dependent upon based on context. Such resolution occurs during deployment, and content frames are context specific with dependencies resolved. Context resolution may occur on selection of a content frame based on context when the content frame is retrieved by an application, for example. Context resolution may occur on translation of a content item based on context when loading and/or retrieving a content frame, for example. For example, context resolution may occur upon retrieval of terminology concept designations and/or retrieval and population of pick-lists. 
     Translation may be performed by the content type manager during loading and/or retrieval, for example. A template tool such as Apache Velocity may be used to implement the translation. The sensitivity of a content item to changes in the terminology server is a function of when the translation is applied e.g., during deployment, loading, or retrieval), for example. During deployment, context may be used algorithmically/heuristically to select dependent items and/or the deployment tool may specify the required dependent items. In general, context resolution is done heuristically (e.g., scoring and weighting schemes) because of the difficulty in determining an unambiguous algorithm to resolve conflicts. The content type manager may provide its own mechanism for context resolution, for example. 
     In deployment  750 , a content item may be a part of multiple content frames. For example, multiple copies of a content item may be loaded by an application if it loads multiple content frames containing the item. Applications may search for and retrieve content frames. For example, content management may load and cache content frames. In certain examples, authoring tools may retrieve content items directly. Running applications may retrieve content frames during execution, for example. 
     Context may be resolved while constructing a content frame. That is, selection of context variants on which the deployed content item is dependent is done during deployment, for example. Content frames may thus be context specific. During load and retrieve, context may be used to select a content frame, not content items contained in the frame, for example. 
     A content frame may itself be considered a content item. Thus, the content frame may be versioned, have associated metadata, etc. Since a content frame is a content item, packages of frames may be constructed and distributed content frames without the associated source content items, for example. In certain examples, content frames may contain content frames, allowing courser grained deploy and undeploy operations. In certain examples, optimizations to frame loading (e.g., loading a single copy of a common content item) may be done, if desired, using techniques such as reference counting, etc. 
     In certain examples, content frames are related to a deployed root content item in a fashion analogous to the relationship between context variants and the content item. For example, a content frame is identified by the same UUID as the root content item in the frame and shares the same directory metadata. Each content frame may have its own unique identifier that may be used as a reference. Each content frame may be context specific and may have multiple versions. In certain examples, only deployed content items have associated content frames. Because of this relationship, content frames may be treated in a directory as properties of a content item along with context variants, for example. 
     In certain examples, content may be undeployed. An undeploy is a process of a making a (deployed) content frame unavailable to a running instance, for example. However, data instances stored in a CDR may be dependent on the content frames used to create the data instances (e.g., clinical element (CE) types). As a result, a content frame, once deployed, may not be physically deleted from the clinical content system without compromising referential integrity, for example. Undeploy, then, may make a content frame invisible to subsequent searches and context selection. Through undeploy, a previous version of a content frame may then be once again visible to search and context selection, for example. In certain examples, an undeployed content item may still be directly retrieved using the UUID for the content frame. 
     In certain examples, content item translation refers to modifying a content item during loading and/or retrieval to make the content item responsive to changes in content items on which it is dependent without redeploying the content item. For example, terminology designations and pick-lists may change independently of the deployment of the content item. Content item translation may be a responsibility of a content type manager responsible for a content item. For example, translations that make sense for one content type may not make sense for another content type. Content item translation may be context specific, for example. Content item translations may be performed by inserting custom macros in a content item (e.g., at authoring time) and applying a template tool to execute the macro and perform the translation with the item is retrieved. 
     Content item translations may be fine-grained. For example, they do not change the structure of the content item but replace elements (e.g., labels, lists of labels, etc.) within the item. Course grained modification of content frames (such as re-resolving content items that the content item being retrieved is dependent upon at retrieval time) may be undesirable because they can lead to unpredictable changes to application appearance or behavior. Hence, these kinds of modification are restricted to occurring at deployment time. In certain examples, common tools may be used to perform translation of content items represented in XML or HTML. Apache&#39;s Velocity is used here as an example only. Dependencies for items that depend on translations may be managed by maintaining a content frame dependency on a content frame containing the items to be translated (e.g., a terminology content frame) rather than by maintaining specific dependencies, for example. 
     Loading  760  is a process of retrieving a content frame containing deployed content item(s) from storage and making the frame available for use by running application(s). Content items in a content frame may be translated during loading. For example, terminology designations may be resolved and/or pick-lists retrieved. A content frame may be cached after loading. Content items contained within a content frame may be loaded as a single operation, for example. 
     In certain examples, the choice of doing translation at retrieval time or load time is up to the content type manager. Translating at load time means that the cost of translation is amortized over multiple uses of the item; translating at retrieve time means that the item is more sensitive to context variation and changes in resolved content. A selection of translation time may be content type specific, for example. 
     Retrieving  770  includes fetching a loaded content frame by a consuming application. Content items within the content package may be translated during retrieval (e.g., resolving terminology designations, retrieving pick-lists, etc.). A loaded content package may be retrieved multiple times by different clients, for example. An application may choose to reuse (e.g., cache) a retrieved content package at its discretion. Content items within a content frame may be loaded as a single operation, for example. In certain examples, since a content item may be present in different content packages, different instances of an item may be translated using different context. For example, an application may show a content item in two different languages concurrently for comparison. 
     A choice of doing translation at retrieval time or load time may be made by the content type manager. Translating at load time means that the cost of translation is amortized over multiple uses of the item. Translating at retrieve time means that the item is more sensitive to context variation and changes in resolved content. A selection of translation time may be content type specific, for example. 
     In certain examples, content may be divided based on namespace. A namespace is a partition of content items in a system where each partition is owned and managed independently of other partitions.  FIG. 9  provides an example of namespaces A, B, and C including various content items (CIs). 
     Namespaces may be motivated by various factors. For example, content items in one namespace may be protected from modification by another party (for example, a customer modifying GE distributed and owned content). Applying maintenance (e.g., updates, bug fixes, etc.) becomes difficult, if not impossible, if a customer can modify GE distributed content (e.g., customer modified content may potentially be broken when replaced with an update). Alternatively or additionally, for example, customers may be allowed to add and extend distributed content in safe ways while enforcing governance restrictions on such modification (e.g., models may not be modified or extended, but MPVs may). 
     While some of these restrictions may be enforced by a security system, customers often set security policy, so another mechanism may be used to enforce such restrictions. Additionally, some rules such as inheritance restrictions may not be adequately managed via security policy. 
     In certain examples, a simplified namespace model provides that each content item in a system may be searched for using a single namespace precedence order. It is possible that different content types may involve different search precedence (e.g., a search path to resolve data models may not be the same as a search path to resolve forms or reference content). Extensions to the model can be made based on circumstances, for example. 
     In certain examples, namespaces may be “owned” by a provider, a customer institution, a department, etc. Such ownership separates provider content from customer content, for example. Multi-tenancy and digital rights management may be facilitated through the use of namespaces, for example. In certain examples, only the owner of a namespace may create or modify content items within the namespace. An owner may own multiple namespaces, for example. A clinical knowledge platform and/or associated enterprise clinical information system may serve as an owner of a “root” namespace (and possible others), for example. Each customer installation may be an owner of at least one namespace for that customer, for example. 
     In certain examples, an “owner property” on a content item used as a context attribute is also presented in some contexts as equivalent to a namespace. However, in context resolution, using an owner property there may be no inherent precedence. For example, given a concept with designations potentially owned by A, B, and C, an application asks for the designation owned by A but that designation does not exist. Does the system return designation B or designation C? In general, property precedence in context resolution involves a heuristic to resolve (e.g., weighting and scoring schemes). 
     Additionally, there may be necessary relationships between content items in namespaces. For example, specialization via inheritance, overriding content items in one namespace with the same item in another, copying an item from one namespace to another (e.g., is it legal to do the copy?), etc. These behaviors may or may not be able to be implemented using an owner property (alone) in the general case. 
     Additionally, “owner” may be used in at least two different senses: first, as an intellectual property/digital rights management (IP/DRM) concept where it designates actual ownership (e.g., a package by “owner” is a practical application of this concept—package everything that is owned by an owner); second, as an attribute used to select a desired/appropriate context variant when retrieving a content item. This second usage is more directly analogous to namespaces with the caveats above. 
     In certain examples, a difference between an owner context attribute and a namespace is that namespaces are known to and defined by a system rather than defined independently for each content item in content (e.g., owners are generally terminology content). The system can establish precedence, maintain persistent/immutable relationships between items in different namespaces without expectation that the relationships will change, for example. That is, “namespaces” may be part of a reference implementation; owners are content defined and hence may be interpreted by the reference implementation, for example. 
     In certain examples, namespaces have “precedence” when searching retrieving, etc. For example, as shown in  FIG. 9 , a highest precedence namespace C is first searched for a content item, then a second highest (e.g., namespace B), etc. Precedence may be established when configuring the system or defining the name spaces, for example. Precedence may be overridden when deploying a package. 
     In certain examples, relationships may exist between content items in one namespace and content items in a lower precedence namespace. In certain examples, changing namespace precedence may change the nature of a relationship. 
     In certain examples, a new content item may be created in a higher precedence namespace by copying an item in a lower precedence namespace. For example, an MPV may be copied from base content, modified, and saved as a user-owned MPV. A content item may be created in a higher precedence namespace that hides or replaces the same content item in a lower precedence namespace, for example. For example, a new version of a formlet that hides the same formlet in base GE Qualibria® content to customize display of that formlet. Creating a new content item that specializes (e.g., inherits from) an existing content item may hide or replace a base content item in a lower precedence namespace. For example, a new attribute may be added to a patient clinical element model provided by Qualibria by specializing the Qualibria patient model. 
     In certain examples, namespace relationships are managed by a content management system. If a base content item is modified, a specialized content item may need to be redeployed. In certain examples, specialization of a content item in a namespace may be allowed in another namespace but copying the content item may not be allowed. State changes in a base content item may involve state changes in a specialized content item (e.g., if the base item is deprecated, the specialized item may also require deprecation), for example. In certain examples, digital rights management may prevent a copy of a content item from being created. In certain examples, if a content item that was copied to a new namespace is modified, an owner of the target namespace may need to be notified of the change so the copy can be reviewed for changes. 
     In certain examples, an owner attribute on a content item may be insufficient to manage namespace relationships. Clinical element models (CEMs) are an example of a relationship restriction: copying and hiding a CEM can lead to data inconsistencies while specialization through restriction or extension can be safely done. Hiding an MPV on the other hand, is generally a safe operation, for example. In certain examples, relationship management/enforcement is a responsibility of a content type manager (CTM), or at least the CTM should be able to specialize system relationship management. 
     Namespaces may be used in a variety of stages of a process. For example, namespaces may be used during authoring. For example, namespaces may be used when resolving context variants, establishing relationships such as copy, copy and hide, etc. Namespaces may be used during packaging, for example. A package may include content items from a single namespace, for example. Context variants, relationships, etc., in other namespaces involve dependencies on packages in those namespaces, for example. Namespaces may be used during deployment (e.g., when resolving context variants, when establishing relationships such as inheritance relationships, etc.), for example. In certain examples, namespaces are not used during load and retrieve at runtime. 
     In certain examples, each context variant of a content item has a current “state”. For example, a state may include deployable, deployed, loaded, deprecated, etc. Each content type has a set of allowable states and a set of allowable state transitions represented as a state machine. Content types may have different state machines in an authoring environment than in a runtime environment, for example. State machines may be owned by a content type manager since the manager defines a meaning of each state for a content type. 
     In certain examples, a state in a runtime system is actually the state of the content frame. However, for simplicity, a state of the content frame is assumed to be (and managed as) the state of the root content item. A state of content items included via dependency resolution may be irrelevant to the runtime system (e.g., it may be required that the root content item of the content frame be redeployed to bubble up state changes in that item). 
     In certain examples, lifecycle management refers to a set of workflows that manage transition of a content item from one state to another. Each state in a content type state machine is associated with a distinct workflow that manages the content item when in that state, for example. In certain examples, workflows are content items to allow variation across implementations. 
       FIG. 10  depicts an example of a state versus a workflow. As shown in the example of  FIG. 10 , each state in a content item state machine  1010  has an associated workflow  1020  that controls transition(s) to the next state(s). 
     In certain examples, governance refers to a set of policies that manage lifecycles of each content type. Governance policies are implemented in state machines and associated workflows of a content type, for example. Governance may be an operational function, for example. 
     Certain examples provide a content-based clinical information system including a stable reference platform that defines and executes the core capabilities of the system and a set (e.g., one to many) of content classes (e.g., content based languages) that are implemented upon the reference platform and that independently define clinical information functions. The content classes are specialized to allow implementation of narrowly defined clinical functions, for example, Defined clinical functions can include data definition, data query, data transformation, data display, data entry, decision support rules, etc., for example. 
     In certain examples, clinical applications are created by composing one or more content items (e.g., instances of a content class) from one or more content classes. Each content item is authored or created independent from the creation of the reference platform. Content items and the reference platform can have independent life-cycles and evolve independently over time, for example. Since content classes are independent, support for additional content classes can be added as an update to the reference platform to extend core system capabilities, for example. 
     Certain examples provide content and data, along with executable software or code. In certain example, content includes data and expressions/instructions concerning data. However, neither data nor content is “software” as the term software is traditionally defined. In certain examples, content is stored in a content database and is independent of hard-coded libraries. Thus, clinicians do not need a new installation of software to change an application, such as a multi-patient view (MPV) dashboard. Other dashboard views can include a rapid recovery dashboard, a hospital-acquired infections dashboard, etc. Content can be configured by a clinician, technician, and/or other user at a location without the platform provider&#39;s intervention. Clinicians can author new MPVs on the fly, for example. In certain examples, content can be used to facilitate a query for data by a user and/or application. 
       FIG. 11  illustrates an example clinical information system  1100  including a reference platform  1110  and one or more content items  1120  that define clinical functionality (e.g., content-based applications). The example content-based clinical information system  100  of  FIG. 11  includes a reference platform  1110  having three major layers  1112 ,  1114 ,  1116 . 
     In the example system  1100  of  FIG. 11 , Reference Platform Services  1112  provide foundation services to implement content class managers and interpreters. The reference platform services  1112  are constructed using standard software development techniques and can be modified independent of content items implementing application functionality to enhance available system functionality without impacting the application functionality, for example. 
     In the example system  1100  of  FIG. 11 , a Content Class Managers layer  1114  implements management services for one or more content classes. A content class includes defined (e.g., a narrowly defined) domain specific language that allows clinical personnel to define custom programmatic elements (e.g., content items) that will be used when composing a clinical application (for example, clinical vocabulary concepts, clinical data models, data queries, data transformations, display forms, etc.). An example Content Class Manager provides capability(-ies) to author content items of that content class. The example content class manager provides capability(-ies) to package those content items for distribution, export and import the content items from and to installations of the clinical information system, and deploy the content items to a running clinical information system (e.g., compile, translate, etc., the content item into an executable form). The example content class manager provides capability (-ies) to load the content items into memory while performing context-based translation of the content item (e.g., resolve terminology designations, pick-lists, etc.), and to retrieve the content items for execution in an associated content class interpreter. While a running clinical application can include content items of different content classes, each content item is independently managed by the content class manager associated with the content item. 
     In the example system  1100  of  FIG. 11 , a Content Class Interpreter layer  1116  defines one or more interpreters (e.g., programs that consume a content item and execute the instructions defined in the content item) for content items of each content class. Since an application is a composition of content items, multiple content class interpreters can participate in the execution of the composed application(s). Content class interpreters consume a deployed (e.g., executable) form of the content item(s). Optimizations and/or other improvements to performance of a content item interpreter can be implemented in conjunction with a content class manager, for example. 
     Content Based Applications are composed of one or more content items that are managed by content class managers and executed by content class interpreters. A set of content items of which an application is composed are stored in a content repository and managed as a set of interdependent items. Content based applications are independent of the reference platform; that is content based applications can be changed without changes to the reference platform, and the reference platform may be changed without changes to the content based applications (though content based applications may be changed to take advantage of new capabilities in the reference platform), for example. 
     Since medical practices vary widely between different institutions (and even within institutions or between patients) and change rapidly as medical practices evolve, prior clinical information systems require extensive customization to be deployed widely. Very frequently, this degree of customization can render ongoing maintenance (e.g., new releases, error fixes, etc.) difficult or even impossible. Additionally, responsiveness to requests for customizations may be unacceptable to the institutions because of the difficulty in creating, testing, distributing, and managing the customizations. 
     Two common approaches to these issues may be found in existing products. First, the producer of the system tightly controls the software system and controls/restricts the changes that can be made to the system, thereby severely restricting the ability of the software to be customized to specific customer needs. Second, the producer of the system may allow extensive customization of the software wherein each implementation becomes essentially a custom system which limits the maintainability of the system. 
     Certain examples address these problems by separating the application, where customization generally occurs, from the system itself, where maintenance generally occurs. An example clinical information system application is implemented in content, that is, as a set of content items that are created and maintained independently of the system, often by the customers of the system themselves. The reference platform (e.g., the system) is maintained, enhanced, tested, and deployed by a vendor. Since the application (in content) is independent of the reference platform, the two can evolve largely independent of each other. Independent evolution allows a much greater degree of possible customization without reducing the maintainability of the system, for example. 
     Rather than basing content on a single general-purpose interpreted language, certain examples implement a content based system as a set of content languages. In certain examples, each content language is narrowly focused and specialized to allow independent evolution, optimization, etc. 
     In certain examples, by separating applications from a reference implementation, independent evolution of the application and the system can be supported. In certain examples, application(s) can be authored by domain specialists rather than by engineering. For example, terminology and data can be modeled by informaticists; clinical forms can be designed by clinical teams; etc. In certain examples, functionality can be added to the system incrementally by adding new content classes to the system. Since content classes are narrowly focused for specific tasks, a risk of over-generalization is reduced or avoided, for example. Content classes can be independently evolved and improved/optimized, for example. 
     In certain examples, clinical content includes structured knowledge components such as decision support rules, protocols, reports, user preferences (e.g., triage form layout, patient and/or department worklist format, etc.), and unstructured knowledge components such as discharge instructions, guidelines, etc. Clinical information systems (CIS) that are content-driven provide functionality that improves clinical outcomes by enhancing compliance with institutionally/nationally recognized standards of care and reduce practice variation. In certain examples, a new process has been defined to streamline clinical content management from its inception to its consumption by the CIS. 
     The example process allows for building of an infrastructure for managing clinical content in a more efficient and more optimal manner. Using this clinical content management process, clinical content management is scalable and expressive, for example. When a CIS is introduced into a new environment, lack of a standard process interferes with resource planning, effort planning and estimating timelines, for example. An example clinical content management infrastructure built around this process can help with the implementation effort by identifying appropriate dependencies, breakdown tasks along with their associated resources, and help align priorities. 
     In an example, a small client is interested in going live with a couple of clinical modules (e.g., a discharge module and a billing module). As part of these modules, using the example content-driven process, structured and unstructured clinical content can be authored, versioned, packaged, and tracked to ensure compatibility with future updates. Building on the example use case, if the client wants to add its own local content, plug-n-play packagers and deployers are provided that are applicable only to these two modules. If the client is happy with the two example modules and wants to go live with additional modules, the infrastructure built around the process can scale up to identify potential clinical content interdependencies, help eliminate redundancies, and bridge clinical application versions and clinical content versions, for example. 
     In certain examples, the clinical content management infrastructure can be integrated into a software lifecycle to eliminate separate iterations and planning exercises. Integration can produce significant savings in planning, effort, and execution time, for example. 
     In certain examples, during the content authoring and packaging processes, the infrastructure verifies and validates dependencies and helps ensure content integrity, for example. The infrastructure eases the process of versioning at the content and package level. 
     In certain examples, future updates can be automatically packaged as patches that can be released internally and/or externally to clients on a pre-determined schedule. Patch releases can still maintain content integrity that can be described through a conformance statement, for example. 
     Thus, certain examples provide a clinical content management process that is scalable, expressive, and semantically interoperable. For example, the process is scalable in that it can support core content as determined by an application&#39;s needs in addition to customer/competitor specific content. For example, the process allows end users to consume content to support individual preferences at an enterprise level. For example, the process provides an infrastructure for clinical entities to create semantically interoperable systems to derive clinical, research and business benefits thereof. 
     From a business standpoint, the example process enables modular content packages and pluggable deployment. This flexibility allows tailorable content to support different types of clients to augment a “surround and supplement” strategy, where-in a small client with limited budget can go live with only couple of modules/content-deployers, whereas a large enterprise customer might want a whole suite of content management infrastructure. 
     Certain examples define processes apriori to help ensure that structured and unstructured clinical content development and management is more predictable, measurable, efficient, and integrated into application lifecycle management. Current systems and/or processes for managing clinical content in content-driven systems are fraught with uncertainties such as in version compatibility, quality control, timely packaging and delivery of content, updating knowledge bases, and smart deployment. 
     Building a clinical application on an infrastructure as described herein provides significant benefits to a content management process such as making it scalable, expressive, supportive of standard(s), semantically interoperable, and flexible. 
     In certain examples, content and infrastructure can be used to map or resolve concept identifiers into human-readable designations using a terminology. 
     One example of how a clinical information system might be configured is a patient admission screen. The software for the clinical information system includes an admission screen for new patients. The admission screen includes a form associated with a workflow directing which information to collect and when to collect it. The admission screen may also display other information about the patient or hospital to assist the care provider during the admission process. While the system includes an admission screen that works well for many hospitals, it will not have everything needed for every situation. 
     Different hospital networks may want to change the admission process to be different from the one that is included by default with the software. In those cases, they will want to modify the admission process to fit the needs of their network. Within the hospital network, there may be a region that needs to modify their admission process. Within that region, there may be a hospital that needs to add a step in the admission process specific to that hospital. There may even be a care provider who wishes to modify the way the admission form is laid out to fit a user specific need. 
     These modifications are based on a context. The region, hospital, language, and user all help to define the context for the particular admission process. The context is based on a hierarchy where the hospital depends on what regions it is in, and the user depends on what hospital it is in. For example, a user might customize their layout of the admission form one way when they are working at one hospital. It might need to be customized another way at a different hospital. 
     Traditionally, preferences are stored in a separate data store or stored locally on a client workstation. The system retrieves the content and preferences separately, and then the system alters the content based on the preference. This requires the consumer of the content to be aware of the preference system and also requires the consumer to alter the content. 
     An example of a traditional preference application is an admissions screen for collecting new patient information. The system may want to allow users to choose if the form was displayed vertically or horizontally. The form itself could be saved as content in a content repository. The system could save the preference, vertical or horizontal, in the preference storage. The application would need to retrieve the form, and then it would need to read the preference for the user and modify the form to appear the way the preference indicated. This requires the application to be programmed in a way that it knows what all the possible preference are, and it would have to know how to modify the form to fit those preferences at runtime. 
     In certain examples, a clinical information system provides functionality for users to define what the preferences are based on each hierarchical context as needed or desired. The CIS should then provide a correct admission process for the context that exists at admission time. Certain examples provide an intelligent, preference-based content system capable of storing hierarchical-based preferences. 
     Certain examples store content for each preference separately. A consumer passes in a context when requesting content, and the content for those preference(s) is returned. There is no need for the consumer to analyze the preferences or alter the content. In the patient admission example, an admission form is stored as content to be used by default in the application. If a care provider prefers to change the admission form, the user specifies the desired change, and the system stores that form as content in the content system. The new content is stored with context information that includes the specific user. When the system retrieves the admission form, the system identifies that the context includes the specific user, and the content for that user is used. The content storage is aware of the context, but the consumer did not need to know what the preference was and did not need to alter the content. 
     Language provides another example of how a preference can be stored as content. A patient discharge form can be stored by default in English. In a bilingual hospital, care providers may speak two languages, but a patient may only speak one language or the other. A second discharge form can be stored as content with a context indicating that it is in a second language different from a first language (e.g., a discharge form in Spanish and a discharge form in English). The patient&#39;s language is included as part of the context when retrieving the discharge form from the intelligent, preference-based content system. The application then displays the correct discharge form. 
     In certain examples, by storing preferences as content, preferences do not need a separate data store. Preferences can be assigned that are user and/or patient specific. Preferences are stored as content, so a consumer of the content does not need to have a knowledge of the preference system. Preferences can follow a user across workstations and/or be centrally managed, for example. 
     In certain examples, the system and associated software is flexible and configurable by end users. The flexibility and configurability should improve adoption by and usefulness for clinicians, for example. Context-based preference configuration and storage can be provided as part of an enterprise clinical information system, such as GE&#39;s Qualibria® system, for example. 
     Certain examples resolve multiple variants of a content item based on who, what, and/or where the content consumer is. This allows consumers to create, specialize, and/or customize their own content on top of vendor-released content (e.g., shareable and interoperable content). This allows for a single content type to vary by properties associated with the content consumer without the need to customize every application that consumes that content to be aware of the rules necessary to vary the display of the content. 
     In clinical applications, there are often times that information and data are to be displayed in different ways based on a context of application use. A role of a clinician may impact what clinical information he or she wants and/or needs to see and how he/she wants or needs to see it. A location of a user may also impact a type of information that is desired to be displayed based on clinical need, preference, etc. Clinical information may also be displayed in one or more languages, especially for patients. 
     Resolution of context by an application allows appropriate information to be displayed based on who, what, and/or where the user of the application is. This ability enables streamlined workflows and targeted documentation for clinical use. This also gives flexibility to customize content for specific use(s). 
     In certain examples, a content management system implements workflow actions to perform location management for a location model. The system may implement workflow actions to perform a bulk import and export of locations for a selected location ontology, for example. The system may implement workflow actions to perform a bulk update of locations for a selected location ontology, for example. The system may implement workflow actions to perform a CRUD (Create, Read, Update and Delete) operation for a location relationship between locations, for example. The system may implement workflow actions to perform a CRUD operation for a location relationship for a location and location ontology, for example. The system may implement workflow actions perform a CRUD operation for an association of a location to a patient, for example. 
     In certain examples, a model with a type of location defines a single independent instance of data (e.g., a data object with an identity) describing a specific location (e.g., a facility, department, room, bed, etc.), and including information used to establish an identity of the location. Additional, non-identifying information about the location (e.g., information such as certifications, etc.) may be stored as instance(s) of a data statement reference class, for example. Specifying a reference class of location indicates that the model is a specialization (e.g., extension) of a location reference class. 
     A location reference class may include data constraints and component reference-class constraints (e.g., component, qualifier, modifier, and attribution), for example. In certain examples, a location reference class may not include instance derived reference-class constraints (e.g., statements, associations, etc.). Data constraints appearing in a location derived model result in the generation of an anonymous data component to contain the actual data constraint, for example. 
     A model with a type of location relationship defines an association that is not owned by a patient, where associated instances are assumed to be locations with a typed relationship between them. To define this relationship, a location relationship instance contains one or more references to independent instances of reference class location. Constraints for the reference class location instance references may include a role constraint to specify the role each location instance plays in the relationship, for example. Specifying a reference class of location relationship indicates that the model is a specialization (e.g., extension) of the location relationship reference class, for example. 
     A status constraint is used in a model derived from the location relationship reference class. The status constraint may contain a default processing instruction to allow the constraint to be transparent to a derived model. 
     Element constraints contained within a location relationship derived reference class that specify a reference-class constraint derived from the instance reference class may optionally include the role constraint, for example. The role constraint may contain a default processing instruction to allow the constraint to be transparent to a derived model. If not specified, role may defaults to unspecified-role in the association-role domain, for example. 
     A location relationship type model may include data constraints and component reference-class constraints (e.g., component, qualifier, modifier, and attribution). In certain examples, the model includes only location derived reference-class constraints. Data constraints appearing in a location relationship derived model may result in the generation of an anonymous data component to contain the actual data constraint, for example. 
     An ontology may be defined as an organization of a knowledge domain that is usually hierarchical and contains relevant entities (e.g., concepts) and their relationships. Concepts in controlled medical vocabularies (CMVs) may be organized into one or more ontologies, for example. 
     In the context of location management, a location ontology indicates a hierarchical organization of relation between various location types. Application of a particular ontology to a set of locations involves defining the locations as instances of various location types and creating the relationship among them thereon, for example. In certain examples, an ontology is a collection of tuples with members including source role, target role, and relationship type. An ontology uses one relationship type, for example. 
     As shown in the example of  FIG. 12 , a directed acyclic graph  1200  may be used in an ontology. In certain examples, location management actions may restrict this using terminology services. A location relationship validation service may validate that a location is not participating in a relationship where it has conflicting roles from one ontology to another ontology, for example. 
     Location correlation is a quick way to find the locations for incoming messages from another sending application, such as HL7 message systems. This system sends various patient information along with healthcare delivery location(s) information. In order to identify a location based on the relationship with other healthcare delivery locations, a relationship ontology, role(s) played, and location attributes of the required location should be supplied. 
     As shown in  FIG. 12 , a location  1210  relates to one or more ontologies  1220 ,  1230  through the directed graph  1200 . Location  1210  includes a plurality of variants  1211 - 1217 . Each location  1211 - 1217  relates to a particular ontology  1220 ,  1230  which defines a role. 
     As depicted in the example of  FIG. 12 , nursing unit role  1233 , critical care unit role  1235 , teaching unit role  1237  are different variants of a unit role  1231 , as defined by an ontology  1230 . For a given location  1212 ,  1213 , a role is directed according to one or more relationships  1232 ,  1234 ,  1236  in the unit role ontology  1230  (e.g., a location “is a” unit). 
     An additional hierarchy of roles  1221 ,  1223 ,  1225 ,  1227  in an “is part of” role ontology  1220  is illustrated by relationships  1222 ,  1224 ,  1226 . Thus, as shown in the example of  FIG. 12 , a bed  1227  is part of  1226  a room  1225 , which is part of  1224  a unit  1223 , which is part of  1222  a facility  1221 . Each location  1211 - 1217  is associated with a particular part of a facility  1221  as defined by the graph  1200 . 
     The graph  1200  provides location relationship validation logic to help ensure that appropriate constraint(s) are applied on each location relationship. Using the directed graph  1200  for a given ontology  1220 ,  1230 , cyclic relationships can be prohibited. For example, Ontology (isPartOf)  1220  cannot have (Facility→Unit) as well as (Unit→Facility) as valid relations. Once a location plays a role in a given ontology, it cannot play any other role from the same ontology. An ontology can be checked for a valid relation for a given source and target role, for example. A Location Relationship can be identified where the location plays a Role in this Ontology. Using the graph  1200 , the location can be examined to determine whether it plays a different role in the location relationship from the ontology. If yes, then the new location relationship may not be created. A clinical data repository, for example, can be accessed to retrieve ancestor and child for participating location(s) for the given ontology. For each location, the location is checked to determine whether the location played any other role for that ontology either as source or target. If yes, an exception may be thrown. In certain examples, self-relationship can be ignored for validation. If locations are already connected to each other, an exception can be thrown, for example. 
       FIG. 13  depicts an example location correlation identification (CID) schema  1300 . The location CID schema  1300  facilitates expression and organization of patient location data (e.g., assigned patient location or APL data is mapped to a location CID). The schema  1300  provides an identifier (CID) type, location, related location, and ontology for an assigned or other initial patient location, for example. These parameters can have associated attributes, for example. As illustrated in the example schema  1300 , a location and/or related location can be associated with a name, a role numerated correlation identifier (ECID), etc. An ontology can be associated with an ontology ECID, a relationship type ECID, etc. Information organized according to the location schema  1300  is passed by a location correlator to a location service to retrieve a location instance identifier (IID). Thus, the location CID is an object carrying information of external and associated internal identifiers. The location IID is an object including information regarding an internal identifier. 
     In certain examples, as locations are part of the system and are created upfront before the relationships being created, location correlation happens on demand from interface engine. Each time a location is correlated, it is cached with a location correlator and provided on demand, for example. On a cache miss, a CDR and/or other data store may be queried to retrieve the relevant location via a frame manager. The example sequence diagram  1400  of  FIG. 14  depicts interaction between various components for location correlation. 
     As shown in  FIG. 14 , interoperability services  1405  is used to create a location CID  1410 , which is passed to correlation services  1415  to correlate the CID with an IID  1420 . The correlation services  1415  passes the CID-IID correlation  1430  to a location correlation plugin  1425 , which finds the location IID using the CID  1440 . A find location message  1450  is passed to a location service  1445 , and an internal IID is resolved  1460  using a correlation store  1435  (e.g., a CDR). A location map can be updated  1470 . The location service  1445  generates a location query  1480  and gets location  1490  from a frame manager  1455 . 
     A location manager tool is an editor to import, export, and edit locations into a clinical knowledge platform. In certain examples, the tool makes use of location management services for get and set location, location relationship, and ontology definition, for example. The tool provides an ability to search and view locations currently stored based on location attribute(s), role(s) played by the location, and ontology, for example. The tool provides an ability to retrieve decedents and ancestors for a selected location and ontology, for example. The tool provides an ability to edit (e.g., create, read, update, and/or delete) a location, for example. The tool provides an ability to edit (e.g., create, read, update, and/or delete) a location relationship, for example. The tool provides an ability to generate a location import template (e.g., in Microsoft Excel®) format for location and location relationship using ontology definition(s), for example. The tool provides an ability to import locations, location relationship(s), etc., using ontology definition(s) from a location import template based file, for example. 
       FIG. 15  illustrates an example location service application programming interface (API)  1500 . External applications  1510  can communicate with client applications  1530  and a client library  1540 , which work in conjunction with a content server  1570  to provide content arranged as clinical application functionality and data according to one or more detailed clinical models and customized based on location. 
     As shown in  FIG. 15 , external applications  1510 , such as a location management application  1511 , clinical content gateway (CCG)  1512 , etc., access client applications  1530  via one or more service endpoints  1521 ,  1522  implemented in a microkernel  1520 . Client applications  1530  can include one or more server co-located applications  1531 , such as interoperability  1532 , business services  1533 , etc. The applications  1532 ,  1533  access the client library  1540 , which includes a frames manager  1541 , a content proxy  1542 , a terminology proxy  1543 , a correlation client  1544 , a security client  1545 , etc. The client library  1540  communicates with the content server  1570  via a pair of transport managers  1550 ,  1560 . Thus, the library  1540  can store/update information at a clinical data repository  1571 , terminology  1572 , content services  1573 , security  1574 , etc. 
     Thus, using the services API, location information and other connected device information  1511 ,  1512  can be provided to one or more client applications  1530  and can update a client library  1540  and content server  1570 . The content server  1570  can use location relationship information to update a data repository  1571 , terminology  1572 , content services  1573 , security  1574 , etc. Content and terminology forming a frame can be correlated based on location relationship information to provide an application to a user, for example. 
     Certain examples allow a user/system to get a location instance and/or list of location instance based upon location attributes and role or roles played by the location. Certain examples allow a user/system to get a location relationship and/or list of location relationship instance(s) for a specified location. Certain examples allow a user/system to get a location instance&#39;s decedent(s) and ancestor(s) based upon one and/or more specified ontology. Certain examples allow a user/system to get locations instance(s) stored in the system irrespective of location relation information. Certain examples allow a user/system to get a device associated with a location. Certain examples allow a user/system to get a location associated with a device. Certain examples allow a user/system to get a location instance type. Certain examples allow a user/system to get a location relationship instance type. Certain examples allow a user/system to get location ontologies published by a controlled medical vocabulary services. 
     Certain examples allow a user/system to create, update, delete, and/or persist a location instance. Certain examples allow a user/system to create, update, delete, and/or persist a set of location instances in a batch process with a capability to specify a restart, resume, and/or continue mode of batch process. Certain examples allow a user/system to create, update, delete, and/or persist a location relationship instance for a specified tuple (e.g., source location instance, target location instance, location relationship instance, relationship ontology, etc.). This may be considered an atomic operation, for example. Certain examples allow a user/system to create, update, delete, and/or persist a set of location relationship instances in a batch process with capability to specify a restart, resume, and/or continue mode of batch process, where each location relationship is specified by a tuple (e.g., source location instance, target location instance, location relationship instance, relationship ontology). Certain examples allow a user/system to validate a location relationship for a specified tuple (e.g., source location instance, target location instance, location relationship instance, relationship ontology). 
       FIG. 16  illustrates a flow diagram for an example method  1600  of location relationship management in a content-based clinical system. In certain examples, a source location, a target location, a location relationship and a rule (e.g., an ontology definition) are provided. Location and location relationship can be updated independently and a relationship between two locations can be created and updated independently in runtime, for example. Clinical element models can be leveraged and customized by each of a plurality of healthcare delivery organizations to suit their specific needs without requiring changes in software. 
     At block  1610 , one or more locations are loaded in a content-based clinical information system as independent entities. For example, one or more hospitals, clinics, departments in a hospital enterprise, etc., are loaded to configure/customize a content-based clinical application (e.g., a dashboard, etc.). 
     At block  1620 , one or more location relations are created to connect locations in a desired relationship ontology. At block  1630 , one location is assigned a source role and another location is assigned a target role. At block  1640 , a relationship between the source and target locations is identified. Allowed relationships between source and target roles are determined by a terminology definition of an ontology. Location relationship management services can validate conflicts of roles between locations or by location, for example. At block  1650 , the source and target are stored in a location relationship object. At block  1660 , the location relationship object can be used to customize and/or otherwise configure one or more content items to provide clinical functionality and/or data to a user. For example, a multi-patient view of clinical information, made up of a plurality of content items organized according to a plurality of detailed clinical models, can be configured for a particular location based on one or more location relationship objects associated with the models. 
     Thus, location relationships can be established as a healthcare delivery organization changes/grows/reorganizes without impacting an existing software infrastructure of locations. Newly added relationships can be made part of the system just in time or to be specific in real-time subject to availability of terminology, for example. 
     While an example manner of implementing systems and methods have been illustrated in the figures, one or more of the elements, processes and/or devices illustrated in the figures may be combined, divided, re-arranged, omitted, eliminated and/or implemented in any other way. Further, one or more components and/or systems may be implemented by hardware, software, firmware and/or any combination of hardware, software and/or firmware. Thus, for example, any of the example components and/or systems may be implemented by one or more circuit(s), programmable processor(s), application specific integrated circuit(s) (ASIC(s)), programmable logic device(s) (PLD(s)) and/or field programmable logic device(s) (FPLD(s)), etc. When any of the appended claims are read to cover a purely software and/or firmware implementation, at least one of the example components and/or systems are hereby expressly defined to include a tangible medium such as a memory, DVD, Blu-ray, CD, etc., storing the software and/or firmware. Further still, any of the example systems may include one or more elements, processes and/or devices in addition to, or instead of, those illustrated in the figures, and/or may include more than one of any or all of the illustrated elements, processes and devices. 
     The flow diagrams depicted in the figures are representative of machine readable instructions that can be executed to implement example processes and/or systems described herein. The example processes may be performed using a processor, a controller and/or any other suitable processing device. For example, the example processes may be implemented in coded instructions stored on a tangible medium such as a flash memory, a read-only memory (ROM) and/or random-access memory (RAM) associated with a processor (e.g., the example processor  1712  discussed below in connection with  FIG. 17 ). Alternatively, some or all of the example processes may be implemented using any combination(s) of application specific integrated circuit(s) (ASIC(s)), programmable logic device(s) (PLD(s)), field programmable logic device(s) (FPLD(s)), discrete logic, hardware, firmware, etc. Also, some or all of the example processes may be implemented manually or as any combination(s) of any of the foregoing techniques, for example, any combination of firmware, software, discrete logic and/or hardware. Further, although the example processes are described with reference to the figures, other methods of implementing the processes of may be employed. For example, the order of execution of the blocks may be changed, and/or some of the blocks described may be changed, eliminated, sub-divided, or combined. Additionally, any or all of the example processes of may be performed sequentially and/or in parallel by, for example, separate processing threads, processors, devices, discrete logic, circuits, etc. 
       FIG. 17  is a block diagram of an example processor system  1710  that may be used to implement the systems, apparatus and methods described herein. As shown in  FIG. 17 , the processor system  1710  includes a processor  1712  that is coupled to an interconnection bus  1714 . The processor  1712  may be any suitable processor, processing unit or microprocessor. Although not shown in  FIG. 17 , the system  1710  may be a multi-processor system and, thus, may include one or more additional processors that are identical or similar to the processor  1712  and that are communicatively coupled to the interconnection bus  1714 . 
     The processor  1712  of  FIG. 17  is coupled to a chipset  1718 , which includes a memory controller  1720  and an input/output (I/O) controller  1722 . As is well known, a chipset typically provides I/O and memory management functions as well as a plurality of general purpose and/or special purpose registers, timers, etc. that are accessible or used by one or more processors coupled to the chipset  1718 . The memory controller  1720  performs functions that enable the processor  1712  (or processors if there are multiple processors) to access a system memory  1724  and a mass storage memory  1725 . 
     The system memory  1724  may include any desired type of volatile and/or non-volatile memory such as, for example, static random access memory (SRAM), dynamic random access memory (DRAM), flash memory, read-only memory (ROM), etc. The mass storage memory  1725  may include any desired type of mass storage device including hard disk drives, optical drives, tape storage devices, etc. 
     The I/O controller  1722  performs functions that enable the processor  1712  to communicate with peripheral input/output (I/O) devices  1726  and  1728  and a network interface  1730  via an I/O bus  1732 . The I/O devices  1726  and  1728  may be any desired type of I/O device such as, for example, a keyboard, a video display or monitor, a mouse, etc. The network interface  1730  may be, for example, an Ethernet device, an asynchronous transfer mode (ATM) device, an 802.11 device, a DSL modem, a cable modem, a cellular modem, etc. that enables the processor system  1710  to communicate with another processor system. 
     While the memory controller  1720  and the I/O controller  1722  are depicted in  FIG. 17  as separate blocks within the chipset  1718 , the functions performed by these blocks may be integrated within a single semiconductor circuit or may be implemented using two or more separate integrated circuits. 
     Certain embodiments contemplate methods, systems and computer program products on any machine-readable media to implement functionality described above. Certain embodiments may be implemented using an existing computer processor, or by a special purpose computer processor incorporated for this or another purpose or by a hardwired and/or firmware system, for example. 
     Certain embodiments include computer-readable media for carrying or having computer-executable instructions or data structures stored thereon. Such computer-readable media may be any available media that may be accessed by a general purpose or special purpose computer or other machine with a processor. By way of example, such computer-readable media may comprise RAM, ROM, PROM, EPROM, EEPROM, Flash, CD-ROM or other optical disk storage, magnetic disk storage or other magnetic storage devices, or any other medium which can be used to carry or store desired program code in the form of computer-executable instructions or data structures and which can be accessed by a general purpose or special purpose computer or other machine with a processor. Combinations of the above are also included within the scope of computer-readable media. Computer-executable instructions comprise, for example, instructions and data which cause a general purpose computer, special purpose computer, or special purpose processing machines to perform a certain function or group of functions. 
     Generally, computer-executable instructions include routines, programs, objects, components, data structures, etc., that perform particular tasks or implement particular abstract data types. Computer-executable instructions, associated data structures, and program modules represent examples of program code for executing steps of certain methods and systems disclosed herein. The particular sequence of such executable instructions or associated data structures represent examples of corresponding acts for implementing the functions described in such steps. 
     Embodiments of the present invention may be practiced in a networked environment using logical connections to one or more remote computers having processors. Logical connections may include a local area network (LAN) and a wide area network (WAN) that are presented here by way of example and not limitation. Such networking environments are commonplace in office-wide or enterprise-wide computer networks, intranets and the Internet and may use a wide variety of different communication protocols. Those skilled in the art will appreciate that such network computing environments will typically encompass many types of computer system configurations, including personal computers, hand-held devices, multi-processor systems, microprocessor-based or programmable consumer electronics, network PCs, minicomputers, mainframe computers, and the like. Embodiments of the invention may also be practiced in distributed computing environments where tasks are performed by local and remote processing devices that are linked (either by hardwired links, wireless links, or by a combination of hardwired or wireless links) through a communications network. In a distributed computing environment, program modules may be located in both local and remote memory storage devices. 
     Although certain methods, apparatus, and articles of manufacture have been described herein, the scope of coverage of this patent is not limited thereto. To the contrary, this patent covers all methods, apparatus, and articles of manufacture fairly falling within the scope of the appended claims either literally or under the doctrine of equivalents.