1 April 28, 2002International Affiliate Meeting1 HL7 Modeling Project for Perinatology Irma Jongeneel, Tom de Jong HL7 the Netherlands.

April 28, 2002 International Affiliate Meeting 1

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HL7 Modeling Project for Perinatology

Irma Jongeneel,Tom de Jong

HL7 the Netherlands


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Agenda

• Purpose and background of the Project

• Conceptual domain

• Implementation domain– Domain Message Information Model for Perinatology– From D-MIM to XML messages– Issues that came up.


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Purpose and background for project

NICTIZ : recently established national institute for ICT in healthcare develops the information structure to support safe exchange of health information

NICTIZ sponsors the HL7 project office to run a pilot project with HL7 for Perinatology domain • conceptual domain• implementation domain

Work list with products among both domains.


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What is the Perinatology domain?

Pregnancy until 28th day after childbirth

• 1st line healthcare obstetrics (GP, midwife)• 2nd en 3rd line healthcare obstetrics (gynecologist)• neonatology (neonatologist)


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Why perinatology?

Good opportunities

• Many providers (referrals) in the perinatology domain

Model for information exchange in other care chains• There is consensus about care chain in the perinatology• Standards for nomenclature available• Short defined 'episodes of care‘.


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Perinatology project

Goal:

• Improve information exchange– between healthcare providers (referrals)– with supporting departments (lab, radiology, pharmacy, …)

• by using Information Technology.


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Results end of 1st quarter 2002

• Domain Information Model in the conceptual domain– Version 1 based on 10 ‘pathways’ and national registration system– Based on HL7 V3 Reference Information Model (RIM)

• Domain Message Information Model in the implementation domain– Message specification for part of pathway for discussion with

vendors– Determine deliverables in the implementation domain

• Next four quarters– Finish D-MIM– Check for general applicability for COPD and general surgery.


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Midwifes, GP’s, gynecologists, neonatologists, nursing, supporting departments

Project organization

Vendors

Program Management

NICTIZ

Panel International

HL7 Netherlands (project office)

Project team NICTIZ-HL7

Irma JongeneelTom de JongWilliam GoossenJos BaptistSevkan Cevirgen

Marcel Jonker

Bert KabbesRobert Stegwee e.a.

translator communicatorHans vd SlikkePathway Pathway


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Why start with HL7?

• Advice of the panel International:– Start with HL7 version 3, focus on RIM– Parallel comparison with other international standards

• Large ‘installed base’ for version 2.x

• Supporting organization in the Netherlands available (project office HL7 Netherlands)

• Furthest specified, for now the most practical choice.


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Products Conceptual domain

• 10 representative Pathways

• Interaction tables

• Conceptual Domain Information Model


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Mapping of pathways to the HL7 V3 RIM

The future mother has been referred by the midwife or G.P to the clinician (gynecologist) because of severe growth disorder of the child. After examination by the gynecologist the child is diagnosed with breathing problems and the decision is made to do a intra-uterine transfer to a NICU (3rd line). The gynecology department in the regional institute is contacted.

Fragment of a ‘pathway’


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Mapping of pathways to the HL7 V3 RIM

Living Subject Act

HL7-RIM

The future mother has been referred by the midwife or G.P to the clinician (gynecologist) because of severe growth disorder of the child. After examination by the gynecologist the child is diagnosed with breathing problems and the decision is made to do a intra-uterine transfer to a NICU (3rd line). The gynecology department in the regional institute is contacted.

Observation


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Conceptual Domain Information Model perinatologyObservation class of 'Acts'

-value : ANY-derivation_exp : ST

-method_cd : SET <CV>-target_site_cd : SET <CD>

-Interpretation_cd : SET <CS>

Alle klassen op de niveaus 3 en 4 inde tekening zijn subklassen van'observation'. In alle gevallen moetende waarden nog worden vastgesteld.

Verpleegkundige_Anamnese-Afdeling

-verpleegkundige-ouder_met_wie_gesproken

Crisis_verpleegkundige_anamnese-reden_sectio

-reden_opname_kind_op_NICU-duur_zwangerschap-duur_partus_sectio

-bereikbaarheid_vader-bereikbaarheid_moeder

-bereikbaarheid_contactpersoon-wens_borstvoeding-start_borstvoeding

Basis_Verpleegkundige_Anamnese-Wensen_ouders-beleving_ouders

-wensen_zorg_participatie

+Note dit kan verder worden ingevuld()


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Products implementation domain

• Transfer the conceptual model to the HL7 RIM and model the results in Domain Message Information Model (D-MIM) Perinatology

• Find the types of applications for Perinatology and transfer them to generic application roles

• Find interactions between application roles

Starting point: Conceptual Domain Information Model, as defined in the care domain


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• Model necessary data in interactions in Refined Message Information Model (R-MIM)

• Transfer R-MIM to hierarchical message description (HMD), with general constraints and defaults

• Transfer HMD to a XML message structure (ITS)

Starting point: Conceptual Domain Information Model, as defined in the care domain

Steps for the implementation domain


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Relationship between products from different steps

6. Domain Information model Perinatology (DIM)

HL7 Reference Information Model (RIM)

1. Storyboards (pathways

Perinatology)

9. Domain Message Information Model

Perinatologie (D-MIM)

10. Applications & Application roles

Perinatology

11. Interactions

12. Refined Message Information Model

Perinatologie (R-MIM)

13. Hierarchical Message Description Perinatology (HMD)

Implementation Domain


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Moeder

LVR1 3 administratienummerTFE gegevensZwangerschapGravida : ...xPara : ...xSpontane abortus : xAbortus provocatus : ...xEUG : ...xDatum eerste dag laatste menstruatieA terme datum ( = verwachte bevallingsdatum)Meerling ja/neeBloedgroep moederRhesusfactor moederZiektes moeder,medisch relevante gegevens moedermet name diabetes, hoge bloeddruk, medicatie gebruikIs er al / niet sprake van zwangerschapspathologie,

Patient

confidentiali ty_cd : CVvery_important_person_cd : CV

Hulpverlener

position_cd : CVprimary_care_ind : BL

Huisarts

Organization

standard_industry_class_cd : CEaddr : SET<AD>

Living_subject

birth_time : TSdeceased_time : TSdeceased_ind : BLadministrative_gender_cd : CEorgan_donor_ind : BLmultiple_birth_ind : BLbirth_order_nbr : INT

Person

disabi lity_cd : CEethnic_group_cd : SET<CV>race_cd : SET<CV>ambulatory_status_cd : CVeducation_level_cd : CVliving_arrangement_cd : CVmari tal_status_cd : CVrel igious_affi liation_cd : CVaddr : SET<AD>special_accommodation_cd : SET<CV>mothers_maiden_nm : ST

Huisartsen prakti jk

Entity

id : SET<II>class_cd : CSdeterminer_cd : CSimportance_status_txt : EDqty : SET<PQ>telecom : SET<TEL>desc : EDstatus_cd : CScd : CEnm : SET<EN>risk_cd : CEhandling_cd : CE

Role

class_cd : CSeffective_time : IVL<TS>id : SET<II>status_cd : CSposition_nbr : LIST<INT>qty : RTOcerti ficate_txt : EDaddr : SET<AD>telecom : SET<TEL>cd : CE

Verzekeringsmaatschappij

Example: Mother (pregnant woman)(Information from conceptual model)


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Mapping from DIM to HL7 RIMPeri DIM HL7 RIMClass Attribute Class Constraints Attribute Vocabulary

Moeder NAW Person Entity.class_cd = PSN Entity.nmPerson.addr

Geboortedatum Living_subject Living_subject.birth_timeLVR1 3 administratienummer Person Entity.class_cd = PSN Person.id assigningAuthorityName = 'LVR'TFE gegevens

Geslacht Living_subjectLiving_subject.administrative_gender_cd fixed 'F' ?

Verzekering => Verzekeringsmaatschappij, ziekenfonds/particulier, verzekeringsnummer Act

Act.class_cd = COV; mood_cd = EVN zie CMET COCT_RM01801

Naam Huisarts Role Role.class_cd = PROV zie CMET COCT_RM00911 Assigned_entity.primary_care_ind = YESEUG:...x Observation?

Datum eerste dag laatste menstruatie: Act

Act.class_cd = ACT; mood_cd = EVN Act.activity_time

kun je door deze class te clonen zorgen dat je geen specifieke waarde van Act.cd hoeft te bepalen?

Act_relationshipAct_relationship.type_cd = ???

Bloedgroep Observation zie Laboratorium


Rhesusfactor Observation zie Laboratorium



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Part of D-MIM: Pregnant woman


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Part of D-MIM: Referral


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Part of D-MIM: Pregnancy


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HL7 version 3 in perinatology

from D-MIM to XML messages:applied tools & methods

andintermediate results


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UML to describe conceptual DIM(visual representation)

VISIO 2000 to describe D-MIM and R-MIM’s(visual representation with HL7 stencils)RoseTree to specify R-MIM’s and HMD’s

(MS Access database with HL7 repository)

Applied tools & methods


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Modelling

Visio 2000

Conceptualization

Rational Rose

R-MIM

Referral

HMD

Rose Tree

XML Schema

Referral

Referral

MS Access database, with HL7 repository (RIM etc.) and representation of R-MIM’s & HMD’s


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Relationships between products6. Conceptual

Domain Information Model

(C-DIM perinatolgy)

HL7 Reference Information Model (RIM)

1. Storyboards (perinatoloy pathways)

9. HL7 Domain Message Information Model

(D-MIM perinatology)

10. Application roles

11. Interactions

12. Refined Message Information Model

(R-MIM pregnancy referral)

13. Hierarchical Message Description

(HMD pregnancy referral)


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Application roles – interactions - messages

• Application roles:

– Sender: ‘pregnancy referral placer’,

e.g. a primary care information system– Receiver: ‘pregnancy referral filler’,

e.g. a gynecology information system

• Message:

– Pregnancy referral message


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Diagram: perinatology pathway application roles – interactions – messages• Pilot specification for interaction referral of pregnant

woman from primary care to gynecologist from one of the perinatology pathways described (pathway 2).

Format Sender Receiver Healthcare trigger

Healthcare action

Information content Current Proposed

Reaction

Primary care obstetrics

Gynecologist in hospital

Growth disorder of unborn child

Consultation of gynecologist in 2nd line

Referral information

Letter of referral (in writing)

Pregnancy refdrral message (electronic)

Consultation advice from gynecogolist

Sender and receiver perform their

application roles Healthcare process describes

interaction

Information dictates content of

message


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What are the project deliverables?

• Domain Message Information Model (D-MIM) for the perinatology domain

• Specifications for information interchange– Application roles (well-defined responsibilities)

– Message specifications in the form of: • R-MIM’s• HMD’s• XML schema’s.


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Architecture of multi-tier systems

DATABASE (DBMS)(PHYSICAL STRUCTURE)

(E.G. ORACLE, MS SQL SERVER)

DATA-OBJECTS(CONCEPTUAL STRUCTURE)

USER INTERFACE(E.G. RICH CLIENT, WEB BASED)

PROCEDURALLOGICS

TRIGGEREVENTS

HL7 messages (XML format)


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Issues that came up… (I)

HL7 domain

Practice & Operations

Laboratory

HL7 domain


Pharmacy

HL7 domain


Referral

HL7 domain

Practice

Patient Adminstration

Healthcare domain Perinatology

How to balance ‘horizontal’ vs.‘vertical’ standard specifications and implementation guidelines?


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Issues that came up… (II)

• What type of deliverables should standardization organisations (like HL7 Netherlands) provide to the marketplace?

– Fully specified interactions and XML Schemas for message content

– Just D-MIM or R-MIM’s, from which vendors can create messages

– No specifications at all, the market will build from the RIM and the process described by the V3 backbone (a.k.a the MDF)

• What are the effects of decision on ‘time to market’ for V3 and the level of ‘plug-and-play’ achieved within the marketplace?


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Issues that came up… (III)• The good news: the HL7 RIM seems fully sufficient to create the

D-MIM for perinatology (classes and attributes). • The bad news:

– Current V3 products are not yet sufficient for the required messages.– Vocabulary domains are sometimes very hard to apply in practice.

• HL7 Netherlands is extending the current V3 products to a set of interactions and messages for a specific healthcare domain:

– This process is therefore ahead of the current content of V3 itself.– Is this potentially conflicting with the main standardization process?– How are results from such a project fed back into the main standard?


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Questions?

1 April 28, 2002International Affiliate Meeting1 HL7 Modeling Project for Perinatology Irma Jongeneel, Tom de Jong HL7 the Netherlands.

Documents

perinatology domain

hl7 rim

conceptual domain version

hl7 project office

netherlands slide

conceptual model

hl7 version

observation slide