Workshop 4: Telematik-Plattform für eine verzahnte Versorgung auf der Basis von Interoperabilitätsstandards – Ist das bIT4health-Projekt state-of-the-art? Neuere Entwicklungen in HL7 Version 3 – Ist HL7 ein Kommunikations- oder ein Architekturstandard? Bernd Blobel Fraunhofer-Institut für Integrierte Schaltungen, Erlangen Leiter der Projektgruppe Gesundheitstelematik Leiter der GMDS AG “Standards für Kommunikation und Interoperabilität” Vorsitzender der HL7-Benutzergruppe in Deutschland
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Workshop 4: Telematik-Plattform für eine verzahnte Versorgung auf derBasis von Interoperabilitätsstandards – Ist das bIT4health-Projekt state-of-the-art?
Neuere Entwicklungen in HL7 Version 3 – Ist HL7 ein
Kommunikations- oder ein Architekturstandard?
Bernd BlobelFraunhofer-Institut für Integrierte Schaltungen, Erlangen
Leiter der Projektgruppe GesundheitstelematikLeiter der GMDS AG “Standards für Kommunikation und
Interoperabilität”Vorsitzender der HL7-Benutzergruppe in Deutschland
Future-Proof Architecture for Health Information Systems and
Health Networks
Architecture Definition
• An architecture of a system describes its components, their functions and relationships.
Challenges for Future-ProofEHR Systems
• Enabled to specify, present, and manage knowledge• Enabled to specify, offer, and manage services• Enabled to compose and to reuse components
according to the actual needs• Follow the shared care paradigm in the sense of
specialisation and distribution, communication and co-operation
• Systems have to be process controlled, component-based and semantically interoperable
System Requirements
• Openness• Scalability• Portability• Distribution at Internet level• Based on standards• Service-oriented interoperability• Appropriate security and privacy services
Model-driven approach
Architectural Paradigms forFuture-Proof Health Information Systems
• Distribution• Component-orientation (flexibility, scalability)• Separation of platform-independent and platform-specific
modelling • Separation of logical and technological views (portability)• Specification of reference and domain models at meta-level• Interoperability at service level (concepts, contexts,
knowledge)• Enterprise view driven design (user acceptance)• Multi-tier architecture (user acceptance, performance, etc.)• Appropriate multi-media GUI (illiteracy)• Common terminology and ontology (semantic interoperability)• Appropriate security and privacy services
HL7 Version 3 Components• MDF → HDF• RIM• Data Types• Publication DB• Vocabulary• Clinical Templates
• Story Boards• DIMs• RMIMs (walking
through the graph)• CMETs• HMDs• Application Roles• Conformance
Statements
Categories of Data Types
HL7 version 3 data types• Null• ANY all • BL Boolean• ST Character String• INT Integer Number• REAL Real Number• QTY Quantity• PQ Physical Quantity• II Instance Identifier• ED Encapsulated
Data
• CS Code Value• CE Coded Equivalent• CD Concept
Descriptor• EN Entity Name• PN Person Name• ONOrganization
Name• TEL Telecom
Address• AD Postal Address• TS Point in Time
HL7 version 3 data types• “compositions” of
data types– IVL interval– SET set– BAG bag– RTO ratio
• Denoted as– IVL<type>– Example
• Other examples– Interval TS
IVL<TS>– Interval PQ
IVL<PQ>– Ratio QTY
RTO<QTY,QTY>
Very special:• General Timing
Specification GTS
IVL<TS> Interval TS
HL7 Development Framework
HL7 DEVELOPMENT FRAMEWORK (HDF)
• Chapter 1: Project Initiation and Management • Chapter 2: Requirements Gathering and
Analysis• Chapter 3: Requirements Normalization and
Harmonization• Chapter 4: Specification Design and Packaging• Chapter 5: Specification Publication and
Balloting• Chapter 6: Specification Refinement and
Localization• Chapter 7: Specification Implementation and
Validation
HDF Objectives• Installation of an unified process for developing
specifications and their implementation für die Entwicklung von Spezifikationen und deren Implementierungen nach den HL7-Paradigma
• Harmonisierung mit globalen Standards und PAS, die einem analogen Ansatz folgen
• Harmonisierung mit der Unified ModelingLanguage (UML) der Object Management Group (OMG)
-minimumSupportedLengthHl7UsedDatatypeHow to handle
codes w ith nominLength?
HL7 vs. UML Architectural Components
Mapping of the MDF to UMLMDF Metamodel Package UML Metamodel Package
Model Identification and Scope Model Management
Use Case Model Use Cases
Information Model Core
Vocabulary Domain Model Datatype
Datatype Model Datatype
Design Information Model Core
Hierarchal Message Description Core
Application Roles Collaborations
Interactions Collaborations
LOINCLogical Observation Identifier
Names and Codes
after C. McDonaldG. Schadow
J. Suico
LOINC Objectives• To provide a universal identifier for
observations, so information about observations from different sources can be combined in one electronic medical record systems or research/ management database.
• To provide a universal ID for HL7 OBX field #3 (Observation ID)
Areas of Development
• Laboratory• Clinical• HIPAA Attachment
Clinical LOINC Objective (after C. McDonald)
Create universal observation identifiers (test codes) for use in data exchange standards that follow a name-value pair strategy (HL7, DICOM, ASTM, CEN, etc.).
Of course, if you want to use them as observation identifiers in your EMR, that is fine too!
• Vital Signs• Hemodynamic
measures• Fluid Intake/Output• Body Measurements• Emergency
Department• Respiratory Therapy• Document sections• Standard survey
Component identifier GLUCOSEStrain test information (amount, 2H POST 100G GLUCOSE POApplication form, time)Additional adjustments/conditions PH ADJUSTED TO 7.4Special information to distinct between PAT (patient), DON (donator),specimen and patient FET (foetus), CONT (control)
2 Measurement, type of measured/ MCNC (mass concentration)observed characteristic SCNC (substance concentrationperiod
3 Time information about measured/ PT (point in time), 1H, 24H (hours)observed characteristic / observation 3D (days)period
4 System / investigation material SER (serum), PLAS (plasma)5 Scale type of measured/observed QN (quantitative), SQ (semi-quantitative)
characteristic QL (qualitative)6 Method used to achieve measured/ AGGL (agglutination), US (ultrasound)
observed characteristic EIA (enzyme-immuno-assay)
Numeric CodeScale
Method
Measurement
Compo
nent
System
LOINC Axes
Time
…SERPLASURSMNPATGENV…
PT1H24H…
QNORDORDQNNOMNAR
AGGLCFIBIFRIA…
SODIUMGLUCOSE^2 H POST 100 G GLUCOSE POGENTAMYCIN^TROUGHABO GROUPMICROORGANISM IDENTIFIED
penicillin_dose:=read last (dose of stored penicillin order);cephalosporin_storage:=event(store cephalosporin order);cephalosporin_dose:=read last(dose of stored cephalosporin order);;;
• priority: 50;;• evoke: (penicillin_storage WHERE penicillin_dose>500 OR
(cephalosporin_storage WHERE cephalosporin_dose>500);;• logic: IF penicillin_dose>500 OR cephalosporin_dose>500 THEN