Health Informatics: the  Relevance of Open Source and Multilevel Modeling Luciana T. Cavalini, MD, PhD Timothy W. Cook, MS...
Introduction <ul><li>Healthcare is a dynamic and complex system </li><ul><li>The spatial changes are close
The time changes are fast
The number of basic concepts is 300,000+ </li></ul><li>Cavalini's conjecture: given a group of medical experts without any...
Introduction <ul><li>A single monolithic system for the complete health record of a person “from cradle to grave” is not f...
Integration projects that were successful in other businesses have been attempted in healthcare over the last 46 years, sp...
The result: healthcare is the less computerized business in economy </li></ul>
Introduction <ul><li>Electronic Health Records (EHR) have promised (and yet not delivered): </li><ul><li>↓  waste of citiz...
↓  waste of  staff time in search of critical information
↓  duplication of tests, medications and procedures
↑  early detection and prevention
↑  adherence to therapeutic protocols
↓   risk of adverse events and medical errors
↓  avoidable hospitalization and mortality </li></ul></ul>
Total loss:  £ 12 billion in 10 years
Total loss: not published (6 years)
Total loss: US$200 million (13 years)
 
Introduction <ul><li>Currently, medical records have a chaotic mixture of old (paper) and new (computer) support medias
The electronic records already implemented seldom follow any of the ISO TC 215 recommendations or any other standardization
The mixture of incompatible systems runs across the entire system: from inside the hospitals up to the local, regional, na...
The reality of British NHS = The reality of American Medicare = The reality of Brazilian SUS etc.
Hardware is not the problem anymore
What about software?
What software???
Interoperability
Interoperability!
Interoperability?
Where is the context?
Here is the context!
<ul>IHE </ul><ul>HL7 </ul><ul>IHTSDO </ul><ul>ISO </ul><ul>WHO </ul><ul>CEN </ul><ul>ASTM </ul><ul>Documents </ul><ul>Secu...
Traditional Modeling
Traditional Modeling <ul><li>Information is modelled to “serve” the current needs of the healthcare system; but those need...
Adding new concepts and “customizing” a legate system for another facility demands the total re-make of the system (re-mod...
Unaffordable costs, frustrated users, abandonment of the systems (average time = 2 years) </li></ul>
Multilevel Modeling This approach is compliant to the ISO 20514 standard
Multilevel Modeling <ul><li>Fundamental Principle: separation between the Reference Model and Knowledge Modeling
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OSS 2011 Multi-Level Modelling Presentation

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Dr. Luciana Cavalini's presentation at the OSS 2011 conference on multi-level modelling in healthcare.

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OSS 2011 Multi-Level Modelling Presentation

  1. 1. Health Informatics: the Relevance of Open Source and Multilevel Modeling Luciana T. Cavalini, MD, PhD Timothy W. Cook, MSc “ Multilevel Healthcare Information Modeling“ (MLHIM) Laboratory (UFF/UERJ) Associated to the National Institute of Science and Technology – Medicine Assisted by Scientific Computing
  2. 2. Introduction <ul><li>Healthcare is a dynamic and complex system </li><ul><li>The spatial changes are close
  3. 3. The time changes are fast
  4. 4. The number of basic concepts is 300,000+ </li></ul><li>Cavalini's conjecture: given a group of medical experts without any hierarchical relationship among them, the probability of them reaching 100% of agreement about any set of concepts from their domain tends to zero </li></ul>
  5. 5. Introduction <ul><li>A single monolithic system for the complete health record of a person “from cradle to grave” is not feasible
  6. 6. Integration projects that were successful in other businesses have been attempted in healthcare over the last 46 years, spending trillions of dollars, with a 100% failure rate
  7. 7. The result: healthcare is the less computerized business in economy </li></ul>
  8. 8. Introduction <ul><li>Electronic Health Records (EHR) have promised (and yet not delivered): </li><ul><li>↓ waste of citizen's time in lines for appointments and referral
  9. 9. ↓ waste of staff time in search of critical information
  10. 10. ↓ duplication of tests, medications and procedures
  11. 11. ↑ early detection and prevention
  12. 12. ↑ adherence to therapeutic protocols
  13. 13. ↓ risk of adverse events and medical errors
  14. 14. ↓ avoidable hospitalization and mortality </li></ul></ul>
  15. 15. Total loss: £ 12 billion in 10 years
  16. 16. Total loss: not published (6 years)
  17. 17. Total loss: US$200 million (13 years)
  18. 19. Introduction <ul><li>Currently, medical records have a chaotic mixture of old (paper) and new (computer) support medias
  19. 20. The electronic records already implemented seldom follow any of the ISO TC 215 recommendations or any other standardization
  20. 21. The mixture of incompatible systems runs across the entire system: from inside the hospitals up to the local, regional, national and international levels </li></ul>
  21. 22. The reality of British NHS = The reality of American Medicare = The reality of Brazilian SUS etc.
  22. 23. Hardware is not the problem anymore
  23. 24. What about software?
  24. 25. What software???
  25. 26. Interoperability
  26. 27. Interoperability!
  27. 28. Interoperability?
  28. 29. Where is the context?
  29. 30. Here is the context!
  30. 31. <ul>IHE </ul><ul>HL7 </ul><ul>IHTSDO </ul><ul>ISO </ul><ul>WHO </ul><ul>CEN </ul><ul>ASTM </ul><ul>Documents </ul><ul>Security </ul><ul>Services </ul><ul>Content models </ul><ul>Terminology </ul><ul>Thanks to: Thomas Beale (openEHR Foundation) </ul><ul>SNOMED CT </ul><ul>ICDx </ul><ul>CDA </ul><ul>EN13606-1 </ul><ul>CCR </ul><ul>v2 messages </ul><ul>v3 messages </ul><ul>Data types </ul><ul>PDQ </ul><ul>CCOW </ul><ul>HSSP </ul><ul>PIX </ul><ul>HISA </ul><ul>RID </ul><ul>XDS </ul><ul>PMAC </ul><ul>EN13606-4 </ul><ul>RBAC </ul><ul>EN13606-3 </ul><ul>EN13606-2 </ul><ul>Templates </ul>
  31. 32. Traditional Modeling
  32. 33. Traditional Modeling <ul><li>Information is modelled to “serve” the current needs of the healthcare system; but those needs change very fast and they are very different from one facility to another
  33. 34. Adding new concepts and “customizing” a legate system for another facility demands the total re-make of the system (re-modelling, re-implementation, re-test, re-deployment)
  34. 35. Unaffordable costs, frustrated users, abandonment of the systems (average time = 2 years) </li></ul>
  35. 36. Multilevel Modeling This approach is compliant to the ISO 20514 standard
  36. 37. Multilevel Modeling <ul><li>Fundamental Principle: separation between the Reference Model and Knowledge Modeling
  37. 38. The Reference Model is a necessary and sufficient set of generic classes for the persistence of all types of health information
  38. 39. The Knowledge Modeling is the combination of the Reference Model classes and the definition of constraints to those very classes, enough to define a given healthcare concept </li></ul>
  39. 40. Multilevel Modeling Reference Model Knowledge Modeling Your Application (GUI, BI etc)
  40. 41. Multilevel Modeling Specification Compliance to Standards Open Implemented open EHR Inspired ISO 20514, 18308 and 13606 “ Yes“ “ Yes“ (RM and KM tools = Yes) MLHIM Inspired by ISO 21090, 20514, 18308 and 13606 and W3C specs YES RM and KM tools
  41. 42. open EHR Reference Model (High level structure) <ul>Composition </ul>
  42. 43. open EHR Reference Model (Low level structure)
  43. 44. “ Nanos gigantium humeris insidentes” Bernard of Chartres
  44. 45. “ Make things as simple as possible, but no simpler” Albert Einstein
  45. 46. MLHIM Reference Model CCD CareEntry or AdminEntry Cluster Cluster ...and its child classes ...and its child classes
  46. 47. Knowledge Modeling in MLM Name (Spec) Architecture Open # of KM artifacts / concept Solution for Cavalini's conjecture Combination of KM artifacts Open Archetype ( open EHR) Archetype Definition Language “ Yes“ One Specialisation Templates “ Yes” Concept Constraint Definition – CCD (MLHIM) XSD Yes Undefined No restriction for the # of CCDs / concept Master CCD Yes
  47. 48. open EHR archetypes and MLHIM CCDs Analogy: Lego ®
  48. 49. open EHR archetypes and MLHIM CCDs Archetype / CCD Concept
  49. 50. MLM Principles and OS <ul><li>Principle 1: The Reference Model is language-agnostic and common to all implementations
  50. 51. Principle 2: The Knowledge Modeling artifacts should be valid against the Reference Model </li></ul>Principles 1 an 2 require open specifications and strongly support open source implementations of the RM and open source KM tools
  51. 52. MLM Principles and OS <ul><li>Principle 3: The Knowledge Modeling artifacts should contain all the semantic context of the information
  52. 53. Principle 4: The Knowledge Modeling artifacts are shareable among applications </li></ul>Principles 3 and 4 strongly support open instances of KM repositories
  53. 54. Bioethical Principles and OS <ul><li>Principle of Beneficence and Non-Maleficence ( primum non nocere ): bad health informatics can kill (http://iig.umit.at/efmi/badinformatics.htm)
  54. 55. Principle of Efficiency (or cost-effectiveness): IT adoption in healthcare is a healthcare intervention such as drugs, lab tests etc and it should be submitted to the same scrutiny </li></ul>The principles of Beneficence / Non-Maleficence and Efficiency strongly support the adoption of OS MLM-based applications in healthcare
  55. 56. Thank you! Join us: Visit us: http://macc.lncc.br http://www.mlhim.org My e-mail: lutricav@vm.uff.br Special acknowledgements: Sergio Freire Mike Bainbridge

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