RIMBAA Experiences
             HL7 UK AGM and TC WGM, April 7th 2009
University Medical Center Groningen, Netherlands



...
Who Am I?
             Michael van der Zel
        ●


                    michael.vanderzel@skype @linkedin @facebook @gm...
What Did I Do?
             University Hospital Amsterdam
        ●


                           BSc Final Project: virtua...
I Work Here




Michael van der Zel april 7th, 2009
My Office




Michael van der Zel april 7th, 2009
Inside the Office
                    Clinical
              Statement SQL




                                           ...
UMCG – Some Numbers
      1 of 8 UMC’s, 1 of 120 hospitals in the Netherlands
               900                    trauma...
Agenda



                                      1            2
                                      3            4
Michae...
“       Everything should be made as simple as

                                            ”
                  possible, ...
“       If language is not correct,
                   then what is said is not what is meant.
                   If what ...
Chaos
Michael van der Zel april 7th, 2009
Duplicate Functionality
             3 HISses, custom build, etc.
        ●




             3 archives; DOCMA &
        ●...
Piles of Paper Forms
                        “Newest
                         form!”




Michael van der Zel april 7th, 20...
Vision
Michael van der Zel april 7th, 2009
!
                                      Why?

                                                    ?
                      ...
What?



                                      +                 +
                      Reference                        ...
!
                                       Result

                                                           !
            ...
How?



                                      +                + HL7 v3 Templates,
                                       ...
CSI
             HL7 SAEAF – Computable
        ●


             Semantic Interoperability
        ●



             Repor...
Michael van der Zel april 7th, 2009
Gartner CPR Generations




      D:My documentsInternationaal, Nationaal, RegioGartner2007 CPR Generation Criteria Update...
UMCG vEHR Roadmap

                                                                                    5. Desicion Support...
Semantic SOA
  Classical Model




                                                                           Tomorrows Mo...
Ideal Model
  Tomorrows Model




                                                                                        ...
Architecture Overview                                                     v0.8 | mrt 2009 | Michael van der Zel
          ...
Healthcare Software Toolkit!
             Current apps are developed with 1960 technology
        ●



             Develo...
RIMBAA
                    Experiences
Michael van der Zel april 7th, 2009
UMCG RIMBAA
                                      Technology Matrix (1/2)
                                              Pe...
UMCG RIMBAA
                                      Technology Matrix (2/2)
                                         Process...
Interoperability Paradigms
             Services
        ●


                    More real-time
               ●
         ...
Code Model Generation
             NE2008 XSD's; Clinical Document, Clinical
        ●


             Statement, Patient, ...
CDR Persistance
             ORM JPA Toplink / MS-SQL & Derby
        ●



             Datatypes R1, Clinical Statement, ...
JPA Query Example

         <named-query name=quot;findOrganizersByTemplateAndPatientIdquot;>
           <query>
         ...
Query CDR by Example
                 <organizer>
                   <templateId assigningAuthorityName=quot;UMCGquot;
   ...
Current Limitations
             Clinical Document CS != Care Provision CS
        ●



             XSD Enumerations for ...
Results
             Cookbooks & Guidances (NL Realm)
        ●



             HL7 v3 Templates
        ●



            ...
Patient History Widget
                                                                                         HL7 v3
   ...
ENT (KNO) Patient History Widget


                                             CUI
                                      ...
Diagnosis HL7 v3 Template
                       class PatientHistory.Diagnoses


                                        ...
Sample Output
<organizer classCode=quot;ORGANIZERquot; xmlns=quot;urn:hl7-org:v3quot;>
    <templateId root=quot;2.16.840....
Procedure HL7 v3 Template

                          class PatientHistory.Procedures


                                   ...
Rudimentary Templates Viewer




                                      http://digizorgo1.umcg.nl/Templates.WebApplication/...
OID Registry




                                      https://www.surfgroepen.nl/personal/michael_vanderzel/Lists/OID%20R...
Document Services
             UMCG CDA Implementation Guide
        ●



             Modelled after IHE XDS
        ●


...
Used Standards
      EHR-S-FM
      PKI




Michael van der Zel april 7th, 2009
http://www.zurich.ibm.com/news/07/asme.html
Michael van der Zel april 7th, 2009
Conclusions 1/2
             Querytool Essential
        ●



             Paradigm Shift (Monilite > SOA > Semantic SOA C...
Conclusions 2/2
             Tooling constrains developers
        ●


                    When .Net or Java would provide...
http://softwareindustrialization.com/content/binary/design.jpg
Michael van der Zel april 7th, 2009
DCM's
Michael van der Zel april 7th, 2009
Content Modeling
             HL7 v3 Templates
        ●



             Detailed Clinical Models (ISO)
        ●



     ...
Building Block
                                                       M
                                          C


    ...
William Goossen DCM sum up
      20 februari 2009
      “DCM = clinical concepts (blood pressure, Apgar score,
      Glasg...
DCM Content Modeling
                                               DCM is the “glue” between UML and e.g HL7 v3

   Physi...
DCM's under Development
             Evolution of “Zorginformatiemodellen”
        ●



             NICTIZ – Results4Care...
DCM
             Patterns, Score, Scale, Finding, Conclusion
        ●



             extends mechanism; KNO Oncology Dia...
Together with William / ISO
             XMI Export
        ●


                    > RTF Document
                    > S...
RIM everywhere!




                                                          Photos © Frank Ploeg
                    Tha...
More Info
             Email
        ●

                    m.van.der.zel AT ict.umcg.nl
               ●



             ...
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2009-apr-07 UMCG RIMBAA and DCM HL7 UK

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2009-apr-07 UMCG RIMBAA and DCM HL7 UK

  1. 1. RIMBAA Experiences HL7 UK AGM and TC WGM, April 7th 2009 University Medical Center Groningen, Netherlands Michael van der Zel HIT-Architect
  2. 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. 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
  4. 4. I Work Here Michael van der Zel april 7th, 2009
  5. 5. My Office Michael van der Zel april 7th, 2009
  6. 6. Inside the Office Clinical Statement SQL Clinical Document CMET Clinical Statement CMET Michael van der Zel april 7th, 2009
  7. 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. 8. Agenda 1 2 3 4 Michael van der Zel april 7th, 2009
  9. 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. 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
  11. 11. Chaos Michael van der Zel april 7th, 2009
  12. 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. 13. Piles of Paper Forms “Newest form!” Michael van der Zel april 7th, 2009
  14. 14. Vision Michael van der Zel april 7th, 2009
  15. 15. ! Why? ? Data Data Michael van der Zel april 7th, 2009
  16. 16. What? + + Reference Clinical Terminology Information Models Model  = Computable Semantic Interoperability Michael van der Zel april 7th, 2009
  17. 17. ! Result ! Clinical Clinical Info Info Michael van der Zel april 7th, 2009
  18. 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. 19. CSI HL7 SAEAF – Computable ● Semantic Interoperability ● Report jan 2009 – Semantic InterOperability (SIOp) Semantic SOA ● Michael van der Zel april 7th, 2009
  20. 20. Michael van der Zel april 7th, 2009
  21. 21. Gartner CPR Generations D:My documentsInternationaal, Nationaal, RegioGartner2007 CPR Generation Criteria Update - Clinical Display.pdf Michael van der Zel april 7th, 2009
  22. 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. 23. Semantic SOA Classical Model Tomorrows Model Source: http://www.openhealthtools.org/Reports/Apr08/OHTStandardsVisionV2.pdf Michael van der Zel april 7th, 2009
  24. 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. 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. 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. 27. RIMBAA Experiences Michael van der Zel april 7th, 2009
  28. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 38. ENT (KNO) Patient History Widget CUI DateInputBox Relevant? CUI DateLabel http://digizorgo1.umcg.nl/PatientHistory/ Michael van der Zel april 7th, 2009
  39. 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
  40. 40. Sample Output <organizer classCode=quot;ORGANIZERquot; xmlns=quot;urn:hl7-org:v3quot;> <templateId root=quot;2.16.840.1.113883.2.4.3.8.1000.9quot; extension=quot;660d999b-0157-41c2-8f2b-762d101aa279quot; assigningAuthorityName=quot;UMCGquot;/> <code code=quot;RJM2009021801quot; codeSystem=quot;2.16.840.1.113883.2.4.3.8.1000.21quot; codeSystemName=quot;UMCG Tijdelijkquot;> <originalText>Diagnosis</originalText> </code> <recordTarget typeCode=quot;RCTquot;> <patient classCode=quot;PATquot;> <id root=quot;2.16.840.1.113883.2.4.3.8.12quot; extension=quot;2761703quot; assigningAuthorityName=quot;UMCGquot;/> </patient> </recordTarget> <component typeCode=quot;COMPquot;> <observation classCode=quot;OBSquot; moodCode=quot;EVNquot;> <id root=quot;2.16.840.1.113883.2.4.3.8.1000.31quot; extension=quot;491216quot;/> <code code=quot;DXquot; codeSystem=quot;2.16.840.1.113883.1.11.16228quot; codeSystemName=quot;ObservationDiagnosisTypesquot;/> <text/> <effectiveTime value=quot;20060329quot;/> <value xsi:type=quot;CDquot; code=quot;474.10quot; codeSystem=quot;2.16.840.1.113883.6.103quot; codeSystemName=quot;ICD-9-CMquot;> <originalText>Otitis media / niet gespecificeerd</originalText> </value> <author typeCode=quot;AUTquot;> <assignedEntity classCode=quot;ASSIGNEDquot;> <id root=quot;2.16.840.1.113883.2.4.3.8.1000.8quot; extension=quot;KNOquot;/> </assignedEntity> </author> </observation> </component> <component typeCode=quot;COMPquot;> <observation classCode=quot;OBSquot; moodCode=quot;EVNquot;> <id root=quot;2.16.840.1.113883.2.4.3.8.1000.31quot; extension=quot;469403quot;/> <code code=quot;DXquot; codeSystem=quot;2.16.840.1.113883.1.11.16228quot; codeSystemName=quot;ObservationDiagnosisTypesquot;/> <text/> <effectiveTime value=quot;20060217quot;/> <value xsi:type=quot;CDquot; code=quot;784.69quot; codeSystem=quot;2.16.840.1.113883.6.103quot; Michael van der Zel april 7th, 2009 codeSystemName=quot;ICD-9-CMquot;>
  41. 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. 42. Rudimentary Templates Viewer http://digizorgo1.umcg.nl/Templates.WebApplication/ Michael van der Zel april 7th, 2009
  43. 43. OID Registry https://www.surfgroepen.nl/personal/michael_vanderzel/Lists/OID%20Registry/AllItems.aspx Michael van der Zel april 7th, 2009
  44. 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. 45. Used Standards EHR-S-FM PKI Michael van der Zel april 7th, 2009
  46. 46. http://www.zurich.ibm.com/news/07/asme.html Michael van der Zel april 7th, 2009
  47. 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. 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
  49. 49. http://softwareindustrialization.com/content/binary/design.jpg Michael van der Zel april 7th, 2009
  50. 50. DCM's Michael van der Zel april 7th, 2009
  51. 51. Content Modeling HL7 v3 Templates ● Detailed Clinical Models (ISO) ● Archetypes ● HealthVault Things ● Google Health ● Michael van der Zel april 7th, 2009
  52. 52. Building Block M C D Electronic Health Records RIMBAA Michael van der Zel april 7th, 2009
  53. 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
  54. 54. DCM Content Modeling DCM is the “glue” between UML and e.g HL7 v3 Physician, Info Analist Info Analist, Physician, Coder V3 Modeller, Developer Collect Group Model Add HL7 v3 Develop Information Information (UML) Terminology Template WebService/ Widget © William Goossen Clinical Specification Agnostic Different Technical / Information Model Standards Implementations Michael van der Zel april 7th, 2009
  55. 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. 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. 57. Together with William / ISO XMI Export ● > RTF Document > Spreadsheet Mapping Table > HL7 v3 Template XML Michael van der Zel april 7th, 2009
  58. 58. RIM everywhere! Photos © Frank Ploeg Thanks for all the fish ;-) Michael van der Zel april 7th, 2009
  59. 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

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