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2009-apr-07 UMCG RIMBAA and DCM HL7 UK
1. RIMBAA Experiences
HL7 UK AGM and TC WGM, April 7th 2009
University Medical Center Groningen, Netherlands
Michael van der Zel
HIT-Architect
2. Who Am I?
Michael van der Zel
●
michael.vanderzel@skype @linkedin @facebook @gmail
●
m.van.der.zel AT ict.umcg.nl
●
36 yrs – 2 kids (aged 7 and 4)
●
Personality (MBTI) – INFJ
●
Idealist, Perfectionist, Chaotic
●
“INFJs prefer the future and the pathway along which
●
they aspire for profundity.”
Michael van der Zel april 7th, 2009
3. What Did I Do?
University Hospital Amsterdam
●
BSc Final Project: virtual EHR (Poliplus) 1997
–
0 ~1998 Dipak Kalra
–
Lead Developer & Architect
–
University Hospital Groningen
●
Architect; Healthcare Service Bus
–
Ernst de Bel (Nijmegen); got me hooked on HL7 v3
–
String-of-Pearls Dutch Biobank – Information Arch 2008
–
Co-Chair RIMBAA-NL since 2007
–
Member of RIMBAA Int'l
–
CDA Certified Specialist
–
Michael van der Zel april 7th, 2009
6. Inside the Office
Clinical
Statement SQL
Clinical
Document CMET
Clinical
Statement CMET
Michael van der Zel april 7th, 2009
7. UMCG – Some Numbers
1 of 8 UMC’s, 1 of 120 hospitals in the Netherlands
900 trauma helicopter flights
9.756 employees
1.339 beds (including cradles)
11.823 day care treatments psychiatry (2006)
20.758 day care treatments (excl. Psychiatry)
32.831 admissions
326.400 nursing days
460.297 visits to outpatient clinics
Source: annual report 31-12-2007
Michael van der Zel april 7th, 2009
8. Agenda
1 2
3 4
Michael van der Zel april 7th, 2009
9. “ Everything should be made as simple as
”
possible, but not simpler.
–– Albert Einstein
“ ”
Technology is something that doesnot yet work.
–– Douglas Adams
“ ”
I've seen things you people will not believe...
–– BladeRunner
Michael van der Zel april 7th, 2009
10. “ If language is not correct,
then what is said is not what is meant.
If what is said is not what is meant,
”
then what ought to be done remains undone.
–– Confucius
Michael van der Zel april 7th, 2009
12. Duplicate Functionality
3 HISses, custom build, etc.
●
3 archives; DOCMA &
●
Multiple registration of for the same patient
but different specialty.
E.g. allergies or patient history.
Michael van der Zel april 7th, 2009
13. Piles of Paper Forms
“Newest
form!”
Michael van der Zel april 7th, 2009
15. !
Why?
?
Data Data
Michael van der Zel april 7th, 2009
16. What?
+ +
Reference Clinical
Terminology
Information Models
Model
= Computable
Semantic
Interoperability
Michael van der Zel april 7th, 2009
17. !
Result
!
Clinical
Clinical
Info
Info
Michael van der Zel april 7th, 2009
18. How?
+ + HL7 v3 Templates,
SNOMED CT,
HL7 v3 RIM, Detailed Clinical
ISO Datatypes LOINC Models, CCD
=
Computable
Semantic
Interoperability
Michael van der Zel april 7th, 2009
19. CSI
HL7 SAEAF – Computable
●
Semantic Interoperability
●
Report jan 2009
– Semantic InterOperability (SIOp)
Semantic SOA
●
Michael van der Zel april 7th, 2009
21. Gartner CPR Generations
D:My documentsInternationaal, Nationaal, RegioGartner2007 CPR Generation Criteria Update - Clinical Display.pdf
Michael van der Zel april 7th, 2009
22. UMCG vEHR Roadmap
5. Desicion Support
4. Regional
(RHIO)
3. Process Driven
Functionality
2. Semantic SOA
1. Operational Chaos
2008 2009 2012 2015
2010
Availability
Michael van der Zel april 7th, 2009
23. Semantic SOA
Classical Model
Tomorrows Model
Source: http://www.openhealthtools.org/Reports/Apr08/OHTStandardsVisionV2.pdf
Michael van der Zel april 7th, 2009
24. Ideal Model
Tomorrows Model
&
RIMBAA T
DC
SNOME
Ideal Model inside
Service Provider Service Provider
Message
End-To-End HL7 v3, SNOMED CT, RIMBAA, From UI to DB
Michael van der Zel april 7th, 2009
25. Architecture Overview v0.8 | mrt 2009 | Michael van der Zel
created: dec 2006
(Clinical) Portal
> Clinical Documents (CDA)
Portlet eForm > HL7 v3 Templates
> Detailed Clinical Models
> Widgets
DigiD
UZI
BSN ...
> XDS
> RFD
> RID
AORTA & Common Information
1 2 3
Parelsnoer Model
& RHIO SSZOG
Wrap
Care Doc
ETS
Plan Repos
(CTS) (XDS)
Application
Packaged
HL7 v3
Terminology
XML XML
CDR
SNOMED CT
HL7 v3 MPI
Michael van der Zel april 7th, 2009
26. Healthcare Software Toolkit!
Current apps are developed with 1960 technology
●
Develop your own (parts)
●
We need: Healthcare Software Toolkit
●
Small ISV can start fast, developing Healthcare IT instead
●
of putting IT in Healthcare.
Common User Interface, Models, Standard Components
●
Master Patient Index
–
Clinical Data Repository
–
Template Repository
–
Michael van der Zel april 7th, 2009
27. RIMBAA
Experiences
Michael van der Zel april 7th, 2009
28. UMCG RIMBAA
Technology Matrix (1/2)
Persistent Object Serialized
Representation Representation Representation
(generic)
Model
RIM
Constrained
Information
SQL JAXB &
Clinical
Model
JPA Web
Server JAX-WS
Statement
RIM
Services
2005 WCF
Mapper
Application
specific
Model
Legacy
non HL7v3
XJC
HL7 XSDs
Michael van der Zel april 7th, 2009
29. UMCG RIMBAA
Technology Matrix (2/2)
Processing Object User
Logic Representation Interface
XPath
Binding
InfoPath (MOSS),
Java
ASP.NET (Ajax)
.Net C#
NHS CUI
Delphi, Java
(Applet)
(at a 90 ̊ angle to the matrix on the previous slide)
Michael van der Zel april 7th, 2009
30. Interoperability Paradigms
Services
●
More real-time
●
Level
of
Current HL7 v3 are messages wrapped Shared
●
Context
double Sending Identity (WS-Security)
–
double Operation (e.g. Schedule Appointment)
–
Documents
●
Messages (between systems and institutions)
●
Mainframe
●
Michael van der Zel april 7th, 2009
31. Code Model Generation
NE2008 XSD's; Clinical Document, Clinical
●
Statement, Patient, Assigned Entity
Java 6 XJC
●
Java 6 WebService Glassfish
●
WSDL > .Net WSDL.exe
●
Convert Arrays to Collections script
●
ObjectFactory and converters, e.g. DateTime > TS
●
Some minor simplifications (see Limitations)
●
Michael van der Zel april 7th, 2009
32. CDR Persistance
ORM JPA Toplink / MS-SQL & Derby
●
Datatypes R1, Clinical Statement, Patient,
●
Assigned Entity, Clinical Document
SQL generated from Java (with annotations)
●
Table per concrete base class (Act/Role)
–
Side table for datatypes (Patient_II)
–
Simplified BL (bit) and ST (varchar)
–
Table per Hierarchy for CD, CE, CV, CS
–
ANY as multiple; e.g. CD, ST, PQ
–
TS-like-types as serialized XML
–
Michael van der Zel april 7th, 2009
33. JPA Query Example
<named-query name=quot;findOrganizersByTemplateAndPatientIdquot;>
<query>
SELECT o
FROM A_Organizer o
JOIN o.templateId1 tid
JOIN o.recordTarget recordTarget
JOIN recordTarget.patient patient
JOIN patient.id id
WHERE tid.root = :templateRoot
AND tid.extension = :templateExtension
AND id.root = :patientRoot
AND id.extension = :patientExtension
</query>
</named-query>
ISO Datatypes as User Defined Types!
> Demo SQL Server UDT II
Michael van der Zel april 7th, 2009
34. Query CDR by Example
<organizer>
<templateId assigningAuthorityName=quot;UMCGquot;
extension=quot;5ae9e3b0-7295-4798-a34a-26229f3e8075quot;
root=quot;2.16.840.1.113883.2.4.3.8.1000.9quot; />
<recordTarget typeCode=quot;RCTquot;>
<patient classCode=quot;PATquot;>
<id assigningAuthorityName=quot;UMCGquot;
extension=quot;1010101quot;
root=quot;2.16.840.1.113883.2.4.3.8.12quot; />
</patient>
</recordTarget>
</organizer>
Michael van der Zel april 7th, 2009
35. Current Limitations
Clinical Document CS != Care Provision CS
●
XSD Enumerations for ValueSets > want CTS use
●
fixed / default values
●
XML Validation (Schematron)
●
Current HL7 doesnot have inheretance
●
PatientNL extends PatientLite extends PatientIdentified
ISO Datatypes not native, result is complex coding
●
required (in C#, Java and SQL)
Reuse types e.g. with VSTS Add Web/Service
●
Reference
Michael van der Zel april 7th, 2009
36. Results
Cookbooks & Guidances (NL Realm)
●
HL7 v3 Templates
●
Mapper Services
●
Widgets
●
Terminology Services (CTS)
●
Clinical Statement CDR (Templates & Instances)
●
HL7 v3 .Net Framework
●
Excel Template Editor, OID Registry
●
Michael van der Zel april 7th, 2009
37. Patient History Widget
HL7 v3
End
Modeller
Users
Other Apps (RO) Template Editor
CUI Widgets
Template Browser
(RW)
HL7 v3
Templates
OID Registry
MOSS List
Clinical Statement
OID
HIS LOB Repository
Master
Michael van der Zel april 7th, 2009
38. ENT (KNO) Patient History Widget
CUI
DateInputBox
Relevant?
CUI
DateLabel
http://digizorgo1.umcg.nl/PatientHistory/
Michael van der Zel april 7th, 2009
39. Diagnosis HL7 v3 Template
class PatientHistory.Diagnoses
«Pa rticipa tion» «Ro le»
«Act»
:RecordTarget :PatientIdentified CMET
Diagnoses :Organize r
code = RJM
«Participati on» «Role »
« Act» :DataEntere r :AssignedEntityIdentified CMET
Diagnosis :Observ ation id = Zorgve rlenerId
text = Glob ale beschrijvin g van d e diag nose
c od e = DX
«Role »
effe ctiveT im e = di agnose datum «Pa rticipati on»
:AssignedEntityIdentified CMET
valu e < KNO Diag nose :Author
0..*
id = Specia lism eCode of Zorgverlener
HL7 v3 ClinicalStatement Observation value ContentObject / ZIS
{text OR value}
dbc.reg.getAlleZorgtrajectenV
anPatient
id<II>.root “2.16.840.1.113883.2.4.3.8.1000.31”
id<II>.assigningAuthorityName “UMCG”
id<II>.extension 6. zorgtrajectid^INTEGER
moodCode “EVN”
HL
7v
Zo
value<CD>.code “DX”
u
3C
value<CD>.codeSystem “2.16.840.1.113883.1.11.16228”
ga
lin
(
value<CD>.codeSystemName “ObservationDiagnosisTypes”
LO
i ca
B
code<CD>.code
l
Ad
St
code<CD>.originalText 3. diagnose
at
ap
em
te
code<CD>.codeSystem
r)
en
code<CD>.codeSystemName “KNO Diagnosen”
t
effectiveTime<IVL_TS>.min.value 0. begindatum^DATE
effectiveTime<IVL_TS>.max.value 5. einddatum^DATE
author.assignedEntity.id<II>.root “2.16.840.1.113883.2.4.3.8.1000.8”
author.assignedEntity.id<II>.extension 1. specialisme
author.assignedEntity.id<II>.assigningAuthorityName “UMCG”
Michael van der Zel april 7th, 2009
41. Procedure HL7 v3 Template
class PatientHistory.Procedures
« Participation » «Role»
:RecordTarget :PatientIdentified CMET
«Role»
« Participation »
:AssignedEntityIdentified CMET
:DataEntere r
{text OR code}
«Act»
«A ct» :Procedure
Procedures :Organize r
e ffectiveT ime = jaa rtal
code = COT G code
text = operatie
i d = Id
0..*
«Role»
« Participation »
:AssignedEntityIdentified CMET
:Performe r
id = S pecialism eCode of Zorgverlener
Michael van der Zel april 7th, 2009
42. Rudimentary Templates Viewer
http://digizorgo1.umcg.nl/Templates.WebApplication/
Michael van der Zel april 7th, 2009
43. OID Registry
https://www.surfgroepen.nl/personal/michael_vanderzel/Lists/OID%20Registry/AllItems.aspx
Michael van der Zel april 7th, 2009
44. Document Services
UMCG CDA Implementation Guide
●
Modelled after IHE XDS
●
Virtual to make our archives
●
standards compliant
Move to full IHE XDS
●
compliance
Michael van der Zel april 7th, 2009
45. Used Standards
EHR-S-FM
PKI
Michael van der Zel april 7th, 2009
47. Conclusions 1/2
Querytool Essential
●
Paradigm Shift (Monilite > SOA > Semantic SOA CSI)
●
We need: “Let's make this work!”
●
instead of “Is this the way to go?”
Use standards as jump starts
●
Michael van der Zel april 7th, 2009
48. Conclusions 2/2
Tooling constrains developers
●
When .Net or Java would provide a HL7 framework &
guidance they will use it.
Standards give jump start to design and
●
implementation, but current design/developers
don't know how to integrate this into their process.
They want to start from scratch.
Michael van der Zel april 7th, 2009
51. Content Modeling
HL7 v3 Templates
●
Detailed Clinical Models (ISO)
●
Archetypes
●
HealthVault Things
●
Google Health
●
Michael van der Zel april 7th, 2009
52. Building Block
M
C
D
Electronic Health Records
RIMBAA
Michael van der Zel april 7th, 2009
53. William Goossen DCM sum up
20 februari 2009
“DCM = clinical concepts (blood pressure, Apgar score,
Glasgow Coma scale and a milion others)
with a slot binding to terminology for code
with a UML representation similar to DAM but
detailed level
with a HL7 v3 (XML) representation to fit the clinical
statement and its use in CDA and Message
with a OpenEHR/ 13606 archetype
with a screen design
with a database table suggestion
with XYZ upon request.”
Michael van der Zel april 7th, 2009
55. DCM's under Development
Evolution of “Zorginformatiemodellen”
●
NICTIZ – Results4Care / Patient Care
●
BMI, Weight, Length
●
Body Temperature
●
Vital Signs
●
Scores and Scales
●
Allergies
●
UMCG Patient History, TNM
●
String-of-Pearls Dutch Biobank
●
Michael van der Zel april 7th, 2009
56. DCM
Patterns, Score, Scale, Finding, Conclusion
●
extends mechanism; KNO Oncology Diagnosis
●
extends Generic Diagnosis
Tool Chain
●
CIM
●
Examples
●
Implicit Rules for transformations
●
Michael van der Zel april 7th, 2009
57. Together with William / ISO
XMI Export
●
> RTF Document
> Spreadsheet Mapping Table
> HL7 v3 Template XML
Michael van der Zel april 7th, 2009
59. More Info
Email
●
m.van.der.zel AT ict.umcg.nl
●
Wiki
●
RIMBAA-NL http://hl7book.net
●
RIMBAA http://wiki.hl7.org/index.php?title=RIMBAA
●
Blog
●
My Healthcare SOA http://hl42.blogspot.com
●
Michael van der Zel april 7th, 2009