Implementing Detailed Clinical Models   HL7 UK Technical Committee Working Meeting             London, UK, 8-dec-2010     ...
Michael van der Zel●   Personality (MBTI) INFJ – Idealist, Perfectionist,    Chaotic    ●   “INFJs prefer the future and t...
Today in history            1931 Coaxial cable pattented1965 First Ph.D. awarded by Computer Science Dept,                ...
Subject●   “Michael will present were DCM fits in other    architecture frameworks. After that he will present    about th...
Place of DCM in                         What isWhat is DCM?                            Architecture                      A...
What is DCM?
???“Detailed Clinical Models are not the same as          Detailed Clinical Models.”“Detailed Clinical Models can be docum...
Use of DCM                    C            M           DBuilding BlockEHR / CR System                        RIMBAA
What is Architecture?
The ArchitectThe Project leader
Architecture
IT Architecture●   Architecture is about setting the boundaries,    creating overview, understanding and coherence of    s...
Place of DCM in Architecture
DCM in Architectural Viewpoints●   B. Blobel Generic    Component Model●   HL7 SAIF●   OMG MDA●   Common RM-ODP●   Many ot...
GCM & RM-ODP
RM-ODP & HL7 SAIF
Place of DCM in EHR-S FM
EHR-S FM                                                                                       Function                   ...
Model Driven Architecture
MDA                              ,                      L, open       r-neu tral, UM     odels, vendo            ndent m  ...
Gartner Hype Cycle
Were are we today?De Turk. Bron: http://en.wikipedia.org/wiki/The_Turk copyrights expired
MDA Viewpoints                          C   M  Conceptual                      D                          C   M     Logica...
Focus of different DCM Approaches●   logical & physical views    ●   Clinical Templates Scotland    ●   Korea CCM – Clinic...
DCM in the Netherlands                     National IT Institute                     for Healthcare in the                ...
Some Information Model Characteristics:   1. Requirements for Good Models     2. Information vs Terminology             3....
Requirements for Good Models1. Accurate – corresponds to the real world2. Unambiguous – only one meaning3. Understandable ...
Information vs Terminology●   Information Model vs Terminology Model●   Where to cut?                     Source: David Ma...
Source: David Markwell Masterclass CiC 2010-mrt-25
Where to Cut●   You should split all parts that are important in the    interpretation of the DCM       body part = “Left ...
3. Granularity
Granularity                                                                  Medical Condition                            ...
The Granularity Issue●   Information- vs Terminology Model●   Level of Detail    ●   direct care    ●   use for measures (...
Example Counts➔                          7 forms          personal➔   CCR / CCD              9 entries        summary➔    ...
Example Forms
Granularity Summary●   Information- vs Terminology Model●   Level of Detail●   Fit-for-Purpose … and stop there!
Propensity to Adverse Reaction    (PtAR) Example Case
Propensity to Adverse ReactionWhen I talk about PtAR             #2 Event / ReactionI talk about #1       #1 Statement    ...
Transforming
Transformation Tool Options●   Eclipse M2M as used by the HL7 SMD●   EA Model 2 Model Transformations●   Robert Worden Map...
Transformation Examples●   Document●   Information Model Narrative●   HL7 v3 CSP●   HL7 v3 CSP XML
1st Informative HL7 v3 Ballot sept 2010         (example Body Height)
Information Model NarrativePropensityToAdverseReaction has CausativeAgentPropensityToAdverseReaction has ReactionPropensit...
Mapping to HL7 v3                                                                                                         ...
<REPC_MT000100UV01.Organizer xmlns="urn:hl7-org:v3"            xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"      ...
PtAR Widget
DCM Tooling
DCM Tool Chain●   Tools for DCM can be considered a set of software    programs that facilitate one or more steps in the  ...
DCM Tool ChainConceptual                 Logical             Physical  Mindmap                                     + XSLTD...
DCM Model Creator
Why EA & UML●   Why EA?    ●   Not expensive, but not free    ●   Use existing tooling    ●   Widely used (e.g. HL7, CDISC...
Lessons Learned●   Conceptual, Logical, Physical separation is very    useful even if not doing full MDA●   Traceability v...
Lessons Learned●   There is no one answer to the question of    granularity. Maybe, 42?●   … Oh yes, and of course, use DCM!
Working on ...●   Patient History, Advance Directives, Trial, other    Patient Summary●   Patient – Provider Relationships...
Hospital IT Europe Magazine
Thank you for your attention.    m.van.der.zel AT ict.umcg.nl© 2010-sep-17 Michael van der Zel @ Bioparco di Roma
Results 4 Care B.V.        T: +31 6 54 614 458De Stinse 15               F: +31 33 25 70 1693823 VM Amersfoort         E: ...
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2010-dec-08 HL7 Detailed Clinical Modelling and Architecture

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HL7 UK Results4Care
about DCM information modelling, terminology binding, architecture, tooling, MDA

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2010-dec-08 HL7 Detailed Clinical Modelling and Architecture

  1. 1. Implementing Detailed Clinical Models HL7 UK Technical Committee Working Meeting London, UK, 8-dec-2010 Michael van der Zel
  2. 2. Michael van der Zel● Personality (MBTI) INFJ – Idealist, Perfectionist, Chaotic ● “INFJs prefer the future and the pathway along which they aspire for profundity.”● University Medical Center Groningen, Netherlands ● HIT Architect, Information Systems (EHR-S)● Results 4 Care, Netherlands ● Detailed Clinical Models (ISO), HL7 v3● HL7 WGs: RIMBAA, EHR, ArB, Patient Care
  3. 3. Today in history 1931 Coaxial cable pattented1965 First Ph.D. awarded by Computer Science Dept, Univ. of Penna
  4. 4. Subject● “Michael will present were DCM fits in other architecture frameworks. After that he will present about the specifics of the information model of a DCM and a toolset for creating, validating, exporting and transforming the DCM.”
  5. 5. Place of DCM in What isWhat is DCM? Architecture Architecture? Models Place of DCM in EHR-S FM Gartner on MDA Some aspects 1. Guidelines of Information 2. Info vs Terminology Modelling 3. Granularity MDA views 1. DCM PtaR Case 2. Transformations 3. Use in Widget DCM & MDA Views 1. DCM Content Creator DCM Tooling 2. DCM Model Creator 1. ISO DCM and others 3. Validation 2. NL DCM UML
  6. 6. What is DCM?
  7. 7. ???“Detailed Clinical Models are not the same as Detailed Clinical Models.”“Detailed Clinical Models can be documented using the ISO Detailed Clinical Model formalism.”
  8. 8. Use of DCM C M DBuilding BlockEHR / CR System RIMBAA
  9. 9. What is Architecture?
  10. 10. The ArchitectThe Project leader
  11. 11. Architecture
  12. 12. IT Architecture● Architecture is about setting the boundaries, creating overview, understanding and coherence of systems● Different sets of views exist● Each view has different focus● The most common views are business, information, application, technology● Most also add implicit or explicit a level of detail for each view
  13. 13. Place of DCM in Architecture
  14. 14. DCM in Architectural Viewpoints● B. Blobel Generic Component Model● HL7 SAIF● OMG MDA● Common RM-ODP● Many others e.g. TOGAF … not now
  15. 15. GCM & RM-ODP
  16. 16. RM-ODP & HL7 SAIF
  17. 17. Place of DCM in EHR-S FM
  18. 18. EHR-S FM Function «rootconcept» DC.1.4.1 PropensityToAdv erseReaction CD «data,enum eration» Certainty 1..* EHR-FM CD «data,enum era ti... Reaction trig gers (Functions) Causativ eAgent Criteria #1 CD «data,enum er... FM Info Reqs CD Sev erity « data ,enu m eration» ReactionType Computational Criteria #4 Independent Model Criteria #3HL7 Archetype ... DCM?
  19. 19. Model Driven Architecture
  20. 20. MDA , L, open r-neu tral, UM odels, vendo ndent m -indepe sinessplatform arate bu sep hnology from tec
  21. 21. Gartner Hype Cycle
  22. 22. Were are we today?De Turk. Bron: http://en.wikipedia.org/wiki/The_Turk copyrights expired
  23. 23. MDA Viewpoints C M Conceptual D C M Logical+ reference model D Physicalconcrete or plastic
  24. 24. Focus of different DCM Approaches● logical & physical views ● Clinical Templates Scotland ● Korea CCM – Clinical Content Models ● Archetypes ● HL7v3 Domain Models ● Intermountain Health Clinical Elements● conceptual & logical views ● Care Information Models (Dutch ZIMs)● conceptual view ● ISO DCM 13792
  25. 25. DCM in the Netherlands National IT Institute for Healthcare in the Netherlands
  26. 26. Some Information Model Characteristics: 1. Requirements for Good Models 2. Information vs Terminology 3. Granularity
  27. 27. Requirements for Good Models1. Accurate – corresponds to the real world2. Unambiguous – only one meaning3. Understandable – People recognize the real world referent(s)4. Reproducible – Different modellers would model in the same way5. Parsimonious and harmonious use of terminology – Semantics of the model and terminology match6. Flexible – Evolve gracefully over time7. Consistent across domains – Specimen Collection and I&O Charting8. Practical – implementable in real systems9. Minimally complex – cover only what is needed10.Common queries are easy11.Fits with available technology (OO languages) Source: 2010 Stan Huff, Intermountain Health
  28. 28. Information vs Terminology● Information Model vs Terminology Model● Where to cut? Source: David Markwell Masterclass CiC 2010-mrt-25
  29. 29. Source: David Markwell Masterclass CiC 2010-mrt-25
  30. 30. Where to Cut● You should split all parts that are important in the interpretation of the DCM body part = “Left Ear” body part = “Ear” 1 Data laterality = “Right”? Element 2 Data Elements
  31. 31. 3. Granularity
  32. 32. Granularity Medical Condition (e.g. Diabetes Record) Questionnaire Apgar Score Full BP Propensity to Adverse ReactionSystolic Bp “I can not tell you how big a clinical model must be, only guidelines.”Number of Data Elements → “There are Clinical Models from small to big, just because they are.”
  33. 33. The Granularity Issue● Information- vs Terminology Model● Level of Detail ● direct care ● use for measures (KPI) ● highly detailed for research● Level of Detail <> Number of Data Elements● Temporal aspect ● e.g. Apgar Score is measured a number of times, the IM has a data element for the number
  34. 34. Example Counts➔ 7 forms personal➔ CCR / CCD 9 entries summary➔ 15 DCMs summary➔ String-of-Pearls 75 DCMs research➔ 89 types / things personal➔ LRA (R3) 37 entry models summary 241 elements➔ HCLS 322 DCMs research
  35. 35. Example Forms
  36. 36. Granularity Summary● Information- vs Terminology Model● Level of Detail● Fit-for-Purpose … and stop there!
  37. 37. Propensity to Adverse Reaction (PtAR) Example Case
  38. 38. Propensity to Adverse ReactionWhen I talk about PtAR #2 Event / ReactionI talk about #1 #1 Statement #3 Test
  39. 39. Transforming
  40. 40. Transformation Tool Options● Eclipse M2M as used by the HL7 SMD● EA Model 2 Model Transformations● Robert Worden Mapping Tool● Advanced MDA Tooling● For now: ● XSLT ● Plain Old Programming ● EA RTF Export
  41. 41. Transformation Examples● Document● Information Model Narrative● HL7 v3 CSP● HL7 v3 CSP XML
  42. 42. 1st Informative HL7 v3 Ballot sept 2010 (example Body Height)
  43. 43. Information Model NarrativePropensityToAdverseReaction has CausativeAgentPropensityToAdverseReaction has ReactionPropensityToAdverseReaction has Certainty «roo tcon cept» PropensityToAdv erseReactionCausativeAgent triggers Reaction CD «da ta,en um erati on »Reaction has Severity Certainty 1..* CD Reaction « data,enum era ti ... tri gg ersReaction has ReactionType Causativ eAgentSeverity is a coded description DCM IM (Conceptual) CD «da ta,en um er... Sev erity CDCertainty is a coded description «d ata,e num e ra tio n» ReactionTypeCausativeAgent is a coded descriptionReactionType is a coded description
  44. 44. Mapping to HL7 v3 «rootconcept» PropensityToAdv erseReaction● Bind DCM to CD «data,enu m e rati on» Certainty HL7 v3 Reference Model 1..* CD Reaction «d ata ,en um erati ... tri gge rs Causativ eAgent Care Statement DCM IM (Conceptual) CD «data,enu m e r... Severity● Add Common Elements «data,enu m e rati on» ReactionType CD «HL 7Role»Superv isor :AssignedEntity CMET «Pa rticipation» id = zo rgverle nerid v erifier :Verifier « Act» PropensityToAdv erseReaction :Organizer effectiveT im e = geld ighe idsp eriode overg evoelig heid cod e = S CT :42 0134 006 P rop ensity to a dverse reacti ons (clinical findin g) « HL 7Ro le» «P articipatio n» statusCode = < StatusCo de Auteur :AssignedEntity dataEnterer :DataEnterer ava ilabili tyT im e = - CMET id = - id = zo rgverle nerid tim e = registratie datu m te m pla teId = - « HL7 Role» «P articip ation » Patiënt :AssignedEntity recordTarget :RecordTarget CMET id = patientnum m er Care Statement (Logical) «Act» Reaction :Organizer «Act» Certainty :Observ ation cod e = SCT :2 4610 3008 ce rtain ty val ue < Cau sali ty «Act» Causativ eAgent :Observ ation code = SCT :246 0750 03 causative agen t value < CausativeAgent «A ct» «Act» ReactionType :Observ ation Sev erity :Observ ation code = SCT :2638 51003 rea ction cod e = S CT :2 46112 005 severi ty value < Reaction T ype val ue < S everity
  45. 45. <REPC_MT000100UV01.Organizer xmlns="urn:hl7-org:v3" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="urn:hl7-org:v3 multicacheschemas/REPC_RM000100UV.xsd" xsi:type="REPC_MT000100UV01.Organizer" classCode="CATEGORY" moodCode="EVN"> <templateId root="2.16.840.1.113883.2.4.3.8.1000.9" extension="TODO" /> <id root="2.16.840.1.113883.2.4.3.8.1000.10" extension="ac13267b-a0a7-4741-9363-2230c3f1da03" /> <code displayName="Propensity to adverse reactions (clinical finding)" code="420134006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" /> <statusCode code="active" /> <effectiveTime><low value="20090309" /></effectiveTime> <recordTarget typeCode="RCT"> <patient classCode="PAT"> <id root="2.16.840.1.113883.2.4.3.8.12" extension="6022832"/> <statusCode code="active"/> <patientPerson classCode="PSN" determinerCode="INSTANCE"/> </patient> </recordTarget> <dataEnterer typeCode="ENT"> <assignedEntity classCode="ASSIGNED"> Care Record XML (Physical) <id root="2.16.840.1.113883.2.4.3.8.1000.2" extension="10006773"/> </assignedEntity> </dataEnterer> <component typeCode="COMP"> <observation classCode="OBS" moodCode="EVN"> <code displayName="causative agent" code="246075003" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"/> <value displayName="Non-steroidal anti-inflammatory agent (product)" code="16403005" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" xsi:type="CD" /> </observation> </component> <component typeCode="COMP"> <observation classCode="OBS" moodCode="EVN"> <code displayName="certainty" code="246103008" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" /> <value displayName="possible diagnosis" code="60022001" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" xsi:type="CD" /> </observation> </component>
  46. 46. PtAR Widget
  47. 47. DCM Tooling
  48. 48. DCM Tool Chain● Tools for DCM can be considered a set of software programs that facilitate one or more steps in the DCM development or use.● Tools should work together, or allow moving smoothly from one step to the other, ending with testing of working systems
  49. 49. DCM Tool ChainConceptual Logical Physical Mindmap + XSLTDCM Content DCM Model SMD !? Creator Creatorhealthcare professionals healthcare systems developers software developers
  50. 50. DCM Model Creator
  51. 51. Why EA & UML● Why EA? ● Not expensive, but not free ● Use existing tooling ● Widely used (e.g. HL7, CDISC) ● Feature rich, extendible● Why UML? ● Use existing modelling language ● Dont reinvent the wheel ● Knowledge wide spread, easy to get
  52. 52. Lessons Learned● Conceptual, Logical, Physical separation is very useful even if not doing full MDA● Traceability very important and useful● Use a Generic Pattern and validation to get consistent Models● XMI is not so standard, XSLT tedious● Start by using standards as checklists and answers to questions, and then standards will be embrased, slowely
  53. 53. Lessons Learned● There is no one answer to the question of granularity. Maybe, 42?● … Oh yes, and of course, use DCM!
  54. 54. Working on ...● Patient History, Advance Directives, Trial, other Patient Summary● Patient – Provider Relationships (= Common Elements, not DCM)● EHR-S FM Tooling (in EA)● Integration with CliniClue SNOMED CT (in EA)● Connect to HL7 Static Model Designer?
  55. 55. Hospital IT Europe Magazine
  56. 56. Thank you for your attention. m.van.der.zel AT ict.umcg.nl© 2010-sep-17 Michael van der Zel @ Bioparco di Roma
  57. 57. Results 4 Care B.V. T: +31 6 54 614 458De Stinse 15 F: +31 33 25 70 1693823 VM Amersfoort E: info@results4care.nlThe Netherlands www.results4care.nl

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