neuere entwicklungen in hl7 version 3 – ist hl7 ein
TRANSCRIPT
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
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
Business Concepts
Relations Network
Basic Services/Functions
Basic Concepts
Ent
erpr
ise
Vie
w
Info
rmat
ion
Vie
w
Com
puta
tiona
l Vie
w
Eng
inee
ring
Vie
w
Tech
nolo
gy V
iewComponent
View
ComponentDecomposition(Granularity)
PIM PSMxxxxx
xxxxxx
xxx
ReferenceModel
DomainModels
<schema targetnamespabc.xyz.org>
<xxx xxx xx>ssss sssssss
</xxxx><xxx xxx xx>
ssss sssssss</xxxx>
</schema>
DB
cons
train
ts
expo
rts
transfers transferstransfers
transfers
imports
transferstransfers
Servlet
InstanceAppletGUI
Model RepositoryMDA
Expression means:Metamodel Metamodel profile Platform
specificMeta-metamodel
Entity1 Entity2
Entity1 Entity2Act
Entity1 Entity2ActF. Role1 F. Role2
Entity1 S. Role1 F. Role1 Act
Entity
Class_CD : CSCD : CVDeterminer_CD : CSStatus_CD : CS
Role
Class_CD : CSCD : CVEffective_TMR : IVL<TS>
Participation
Type_CD : CSTMR : IVL<TS>Status_CD : CS
Act
Class_CD : CSCD : CDMood_CD : CSStatus_CD : CSActivity_Time : GTS
1
0..* 1
0..*
1
0..*
RIM Core Attribute Value Sets (nach Woody Beeler)
EntityClass Code
•• Living SubjectLiving Subject•• PersonPerson•• OrganizationOrganization•• MaterialMaterial•• PlacePlace•• ......
RoleClass Code
•• PatientPatient•• ProviderProvider•• EmployeeEmployee•• SpecimenSpecimen•• PractitionerPractitioner•• ......
ParticipationType Code
•• PerformerPerformer•• AuthorAuthor•• WitnessWitness•• SubjectSubject•• DestinationDestination•• ......
ActClassCode
•• ObservationObservation•• ProcedureProcedure•• SupplySupply•• MedicationMedication•• FinancialFinancial•• ......
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
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 (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)
-visibilityuml:ModelElement
-historyItem-annotations-formalName-sortKey-businessName
hl7ModelElement
uml:Namespace
uml:Packageuml:Classifier
-headerhl7Package
artifactPackage
document
domainPackage
staticModel
ballotPackageprofilePackage
Hl7DatatypeDefinition
-abstractuml:GeneralizableElement
datatypeModel
uml:Relationship
uml:Dependency
-reasonderivedFrom
Split into separate stereotypes for each 'type'
uml:Feature
uml:behaviorFeature
uml:TemplateArgument
-propertyKinddatatypeProperty
id is not inherited by property
-externalIdhl7Namespace
-kind-defaultValue
uml:parameter
vocabularyModel
vocabularyDomain
-isMandatory-conformance
hl7Feature
-codingStrengthhl7CodedDatatype
Attribute
Associations to'vocabularyDomain'and 'vocabularyCode'
-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
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)
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
instruments• Ophthalmology
measurements
Clinical LOINC Subject Areas (after C. McDonald)
• 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!!
Important facts (after C. McDonald)
• 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
• RELMA – a tool for mapping local codes to LOINC
Formal LOINC Components# Content/Sub-identifier Examples
0 Numeric code 3257-31 Component
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
MCNCSCNCVOLMCRTONCNC…
Example of a LOINC DB Record
Measurement
Component Time Scale type
13942-8 SPERMATOZOA.MOTILE : ACNC : PT : SMN : ORD : MICROSCOPY.LIGHT
NumericCode
MethodSystem/Investigationmaterial
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
• General layout
maintenance:slotname: slotbody;;slotname: slotbody;;
…library:
slotname: slotbody;;…knowledge:
slotname: slotbody;;…end:
Maintenance Category• title: Hepatits B Surface Antigen in Pregnant Woman;;• filename: hepatitis_B_in_pregnancy;;• version: 1.00;;• institution: Columbia Univerity;;• author: John M. Smith, Jr., M.D. ([email protected]);;• specialist:• date: 1989-01-01;;• validation: testing;;
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:
Knowledge Category• type: data-driven;;• data: penicillin_storage:=event(store penicillin order);
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 13606Part 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?
Contact details:
Bernd Blobel Ph.D.Associate ProfessorHead of the Health Telematics GroupFraunhofer Institut Integrierte SchaltungenAm Wolfsmantel 3391058 ErlangenEmail: [email protected].: +49-9131-776-5830Fax (Department Office): +49-9131-776-588