More Related Content More from Michael van der Zel (13) CAZ20111. De gereedschapskist van
de Zorg Informatie Architect
Congres 'Architectuur in de Zorg‘
23-jun-2011
Michael van der Zel
HIT Architect
University Medical Center Groningen #CAZ2011
© 2011 M.van.der.Zel AT umcg.nl
2. De gereedschapskist van de Zorg Informatie Architect
Congres 'Architectuur in de Zorg', 23-jun-2011
University Medical Center Groningen, Netherlands
Michael van der Zel
HIT-Architect
#CAZ2011
© 2011 M.van.der.Zel AT umcg.nl
3. 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
● Healthcare Information Systems Architect
● Results 4 Care, Netherlands
● Detailed Clinical Models (ISO), HL7 v3
● HL7 WG's: RIMBAA, EHR, ArB, Patient Care
© 2011 M.van.der.Zel AT umcg.nl
5. )
No w :-
The baseline Infostructure in 2010. Will it fly? How long? With how much effort?
© 2011 M.van.der.Zel AT umcg.nl
7. Informatie Architect Tools
● Methoden & Technieken & Standaarden
● Bibliotheken
● Patterns (e.g. SCT Content Models)
● Referentie Modellen
● Producten, Software
© 2011 M.van.der.Zel AT umcg.nl
8. De IJsberg
Functioneel
Gebruikers
Wens
DAM
EHR-S FM
DCM
SNOMED CT
G-Standaard
IHE
UML
Traceability
HDF
HL7 v3
Archetypes
HL7 v2
Techologie
MLLP
XML
© 2011 M.van.der.Zel AT umcg.nl
11. Referentie Modellen
● iZiekenhuis Ref Model
● EHR-System Functional Model
– ISO 18308.2 Requirements for
an EHR Architecture
18308: Definieerd
conceptueel eisen aan
informatie modellen
iZkh: Definiteerd
conceptueel informatie
modellen
© 2011 M.van.der.Zel AT umcg.nl
13. “Stairway to Heaven”
● Techniek: letters; chinees, arabisch
你好 أهل وسهل
Structuur, Syntax: zin samenstelling, leesrichting
Bron: Bernd Blobel, University of Regensburg
●
Doorgaans is dit niet de belangrijkste om een
boodschap over te krijgen.
● Semantic: woordbetekenis
Als je de woorden eenmaal kan lezen moet je de
betekenis kennen.
● Acties: afspraken over uitvoeren
© 2011 M.van.der.Zel AT umcg.nl
14. Requirements for “Good” Models
● Accurate – corresponds to the real world
Bron: Stanley M. Huff, MD
● Unambiguous – only one meaning
CMIO
● Understandable
● People recognize the real world referent(s)
● Reproducible
● Different modelers would model in the same way
● Parsimonious and harmonious use of terminology
● Semantics of the model and terminology match
● Flexible
● Evolve gracefully over time
● Consistent across domains – Specimen Collection and I&O Charting
● Practical – implementable in real systems
● Minimally complex – cover only what is needed
● Common queries are easy
● Fits with available technology (OO languages)
© 2011 M.van.der.Zel AT umcg.nl
15. Model Abstractie Lagen
C M
Conceptueel
D
C M
Logisch
+ referentie model D
Fysiek /
Implementeerbaar
beton of plastic
© 2011 M.van.der.Zel AT umcg.nl
18. DAM Voorbeeld LifeLines
Study #10 View: Study #9
“QT-IGC GWAS Phase” SBP, DBP “ICBP GWAS PP & MAP”
ECG Params Race SBP, DBP, MAP, PP Blood
pressure
Gedetaileerde specificatie
+ SNOMED CT codes
+ eenheden, max/min, etc.
© 2011 M.van.der.Zel AT umcg.nl
19. Bloeddruk DCM
class Information Model (+DefinitionCode)
Nam e: In form a tion M ode l (+Defin itionCod e) CD CD
A uthor: Abe l Enthove n, M ich ae l van de r Ze l « qua lifie r,e num eratio n» «q ua lifie r,e num eratio n»
V ersio n: 0 .98 Manchet Meetlocatie
Created : 2 1-6-20 11 23:08:12
Upd ate d: 2 1-6-20 11 23:09:43 + G root + Lin ke rbo vena rm
+ K le in + Lin ke rdi j
+ Neo na taa l + Lin ke ren ke l
+ S ta nda ard + Lin ke rpo ls
CD
+ V oo rDijb een + Rechterb oven arm
« qua lifi er,e num e rati on» + V oo rJongK in d + Rechterd ij
Meetmethode + V oo rKind ere n + Rechtere nkel
+ Rechterp ols
+ Inva si ef + V inger
tags
+ Niet-invasie f DCM ::Defi niti onCo de = S NOM ED-CT : 7 066 50 02 blo od pre ssure cuff
tags
tags DCM ::De fin itionCode = SNOM ED-CT : 39 798 700 2 m easu rem en t site
DCM ::De fini tion Code = SNOM E D-CT : 84 203 001 has m e tho d
«ro otco ncep t»
Bloeddruk
«q ual ifie r,en um era tion »
CD constraints Korotkov Geluid
« qua lifi er,e nu m e ratio n» {M a nche t a llee n b ij m eti ng m e t m anch et}
Meetapparaat {M e etlo cati e a llee n b ij m eti ng m e t m anch et} + Fa seIV
{Ko rotko v-geluid al lee n bi j ni et-i nvasie ve m eti ng} + Fa seV
+ A nde rs
+ A nero ide tags tags
+ Hybrid e DCM .id = DCM R4C2 DCM ::De fini tion Code = SNOM E D-CT : 855 49 003 koro tko ff sou nd s
+ K wi k DCM ::Defi niti onCo de = SNOM ED-CT : 7 536 70 02 blo od p ressure
tags
DCM ::Defini tion Code = SNOM ED-CT : 363 69 900 4 d ire ct de vice
B lo edd rukmeetw a ard e
B lo eddru kme etw aarde «d ata ,de rivation »
GemiddeldeArterieleDruk
«data»
Onderdruk
constraints
{waa rde ge lijk a an onderd ruk pl us 1/3 polsdru k}
tags
DCM ::DefinitionCo de = S NO M ED-CT : 2 71650 006 di astoli c blo od pre ssure tags
DCM ::De fin itio nCod e = SNO M E D-CT : 25 107 40 06 non -inva si ve m ea n a rterial pre ssure
Bl oed dru kmeetw aa rde
B loed dru kme etw aarde « data,d eriva tio n»
Polsdruk
« da ta»
Bov endruk
constraints
{wa ard e g elij k a an bo vend ruk m inu s ond erd ruk}
tags
DCM ::Defini tion Code = SNOM ED-CT : 271 64 900 6 systoli c blo od pre ssure tags
DCM ::Defi nitio nCod e = S NOM E D-CT : 8 717 900 4 a rte rial pu lse pressu re
© 2011 M.van.der.Zel AT umcg.nl
21. Assessment Scale Pattern
● 1 of meer som variabelen met losse scores
● e.g. Barthel Index
of Glasgow Coma Scale
? «rootconcept»
{AssessmentScaleOrScoreName}
● Ook Requirements &
Terminology «container»
Indiv idualScores
?
«data,derivati on»
INT val ue
inv: self.val ue >= {m in-
val ue} and self.val ue <=
{TotalScore}
{m ax-value}
● Resultaat: {value}
constraints
form ula
{form ula} inv: self.val ue = sum
(Indi vidualScores)
consistente(re) modellen
? CO ? CO ? CO
«data,enum eration» «data,enum eration» «data,enum eration»
{Variable#1} {Variable#2} {Variable#3}
© 2011 M.van.der.Zel AT umcg.nl
22. SNAQ en GCS Voorbeelden
? «rootconcept»
SNAQscore
? INT
« ro otco n ce p t»
«data,derivatio...
«container» GlasgowComaScale
TotalScore
Indiv idualScores
constraints
{value}
{form ula}
0 ..1
INT
« co n tai n e r»
« da ta ,de ri va tio ...
Items
CO TotalScore
CO
«data,enum eration»
WeightLoss «data,enum erat... constraints
Appetite {valu e }
+ >3KgLastM onth = 2 {fo rm u la }
+ >6Kg6M onths = 3 + No = 0
+ No = 0 + Yes = 1
CO CO CO
« d a ta,e n u m e ra ti on » « d a ta ,e n um e ra tio n » « da ta ,e nu m e ra tio n »
E=Eye opening M=Best motor response V=Verbal reaction
« e n um » « en u m » « e nu m »
+ S po n ta n eo u s: CO = 4 + T o ve rb al co m m a n d : ob e ys: CO = 6 + Orie nte d a nd co n ve rse s: CO = 5
+ T o sp ee ch : CO = 3 + T o p a in fu l sti m ul u s: l o ca l ize s p a in: CO = 5 + Diso rie n te d a n d co nve rses: CO = 4
+ T o p a i n : CO = 2 + Flexio n -with d ra wal : CO = 4 + In a pp ro p ri a te wo rd s: CO = 3
+ No re spo n se : CO = 1 + Flexio n -a bn o rm al: CO = 3 + In co m p re h en si ble so u n d s: CO = 2
+ Not p o ssi b le to de te rm in e (C): CO = 0 + Exte n sio n : CO = 2 + No re sp o n se : CO = 1
+ No re sp o nse : CO = 1 + T u b e /T ra ch eo to m y (T ): CO = 0
+ Pa ra l ysi s (P ): CO = 0
© 2011 M.van.der.Zel AT umcg.nl
24. EHR Feedback Loop
e tune process
car
e ct lab
dir medication
exam KPI knowledge
procedure
supportive
orders CDR / ODS research db
results update EHR pseudo EHR
results results
analyse
.
fo a
in fr
in
translational
ref data
knowledge medicine
2010-dec-27 Michael van der Zel, met inspiratie van Ernst de Bel
© 2011 M.van.der.Zel AT umcg.nl
25. Conclusies
● Do the simplest thing that could possibly work, but
not to simple – Albert Einstein
● Genoeg metadata toevoegen, exact genoeg
beschrijven, dan wordt werken met de informatie
triviaal, mappings, impact analyse, conversies, etc.
● Fit for purpose
● Splits het probleem op in verbonden lagen
● … geeft kwaliteit en herbruikbaarheid van
informatie
© 2011 M.van.der.Zel AT umcg.nl
26. Bedankt voor de aandacht
© 2011 M.van.der.Zel AT umcg.nl STS-134 Endeavour final launch 16-may-2011