Neuere Entwicklungen in HL7 Version 3 – Ist HL7 ein ...

Neuere Entwicklungen in HL7 Version 3 – Ist HL7 ein Kommunikations- oder ein Architekturstandard?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?
Leiter der Projektgruppe Gesundheitstelematik Leiter 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-Proof EHR 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
Model-driven approach
• 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
Business Concepts
Relations Network
</xxxx> <xxx xxx xx>
specific Meta-metamodel
Entity1 Entity2
Entity1 Entity2Act
Entity1 S. Role1 F. Role1 Act
Entity
Role
Participation
Act
Class_CD : CS CD : CD Mood_CD : CS Status_CD : CS Activity_Time : GTS
1
Entity Class Code
Role Class Code
1
0..*
plays
validates
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
Name • TEL Telecom
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
• 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 Modeling Language (UML) der Object Management Group (OMG)
-visibility uml:ModelElement
hl7ModelElement
uml:Namespace
uml:Feature
uml:behaviorFeature
uml:TemplateArgument
-externalId hl7Namespace
-kind -defaultValue
-minimumSupportedLength Hl7UsedDatatypeHow to handle
codes w ith no minLength?
HL7 vs. UML Architectural Components
Mapping of the MDF to UML MDF Metamodel Package UML Metamodel Package
Model Identification and Scope Model Management
Use Case Model Use Cases
Information Model Core
J. Suico
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
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
Department • Respiratory Therapy • Document sections • Standard survey
instruments • Ophthalmology
• EKG (ECG) • Cardiac Ultrasound • Obstetrical Ultrasound • Discharge Summary • History & Physical • Pathology Findings • Colonoscopy/Endosc
opy • Radiology reports • Clinical Documents • Tumor Registry
NewNew !!
New!New!
New!New!
New!New!
NewNew !!
• In 1995 LOINC 1.0 contained 4000 Clinical/26000 Lab LOINC codes
• In 2001 LOINC contained 30,400 entries • LOINC list servers at www.hl7.org • Download files and tools from Regenstrief
Web Site – www.regenstrief.org/loinc
0 Numeric code 3257-3 1 Component
Component identifier GLUCOSE Strain test information (amount, 2H POST 100G GLUCOSE PO Application form, time) Additional adjustments/conditions PH ADJUSTED TO 7.4 Special 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 concentration period
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)
PT 1H 24H …
QN ORD ORDQN NOM NAR
AGGL CF IB IF RIA …
SODIUM GLUCOSE^2 H POST 100 G GLUCOSE PO GENTAMYCIN^TROUGH ABO GROUP MICROORGANISM IDENTIFIED
MCNC SCNC VOL MCRTO NCNC …
Example of a LOINC DB Record
Measurement
Numeric Code
Knowledge Representation
Constraint Languages
• OWL (Web Ontology Language) • OCL (Object Constraint Language) • XML/XML Schema • KIF (Knowledge Interchange Format) • GELLO • ADL
Arden Syntax
• Standard specification for defining and sharing modular health knowledge bases – Arden Syntax for Medical Logic Modules
(ASTM Standard) – Specification covers the sharing of
computerised health knowledge bases among personnel, information systems, and institutions
– Applicable to knowledge bases that can be represented as a set of discrete modules
Medical Logic Modules
• A MLM consists of three categories (maintenance, library, and knowledge)
• Each category consists of slots
Medical Logic Modules
… library:
Library Category • purpose: Screen for newborns who are at risk for
developing hepatitis B;; • explanation: This woman has a positive hepatitis B
surface antigen titer within the past year. Therefore her newborn is at risk for developing hepatitis B.;;
• Keywords: hepatitis B; pregnancy;; • Citations: 1. Steiner RW. Interpreting the fractional
excretion of sodium. Am J Med 1984;77:699-702. ;;
• links:
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
… ENDIF;;
• action: (write, return, if-then, call statement) • urgency: 50;;
Parts of EN 13606 Part 1: Reference Model
– comprehensive, generic EHR model drawing on 12 years of R&D and 2 previous CEN standards
– mapped to HL7 RIM and CDA
Part 2: Archetype Interchange Specification – adopting the openEHR archetype approach – compatible with HL7 Template specification
Part 3: Reference Archetypes and Term Lists – initial archetypes for Europe, and repository specification – micro-vocabularies for the Part 1 model
Part 4: Security – measures to support access control, consent and auditability of EHR
communications
Part 5: Exchange Models – messages and service interfaces to enable EHR and archetype communication
Questions?
Future-Proof Architecture for Health Information Systems and Health Networks
Architecture Definition
Available Models:HL7 Development Framework
HL7 Version 3 Components
Categories of Data Types
HL7 DEVELOPMENT FRAMEWORK (HDF)
LOINC Objectives
Clinical LOINC Subject Areas (after C. McDonald)
Important facts (after C. McDonald)
Formal LOINC Components
Knowledge Representation
Constraint Languages
Arden Syntax