Short presentation IWEEE 2010


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Dr. Luciana Cavalini's short presentation at the International Workshop on e-Health in Emerging Economies - IWEEE - in 2010.
See: and for more information about semantic interoperability in healthcare.

#mlhim #semantic_interoperability #health_informatics

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Short presentation IWEEE 2010

  1. 1. Healthcare Knowledge Modelling Projects for Multilevel-Based Information SystemsDra. Luciana Tricai Cavalini, MD, MSc, PhD“Multilevel Healthcare Information Modeling”Laboratory – Associated to INCT-MACCUFF/UERJ
  2. 2. What do the citizens want?• “How do you provide to me: • And better still: ▫ Safe ▫ Prevent me getting ill ▫ Effective ▫ And don’t harm me in the ▫ Reproducible process” ▫ State-of-the-art ▫ 21st Century medicine ▫ Wherever I am ▫ Whatever the time ▫ Whatever is wrong with me
  3. 3. Paperrecords can’thandle it
  4. 4. Hardware is not the problem anymore...
  5. 5. ...or is it?
  6. 6. No, it is not!
  7. 7. “International Standard paper sizesshould be used”
  8. 8. “Attention is drawn to thepotentialities of the newmethods of mechanicalsystems and data processing”
  9. 9. 45 years later...
  10. 10. What about software?
  11. 11. Brazilian Healthcare CardInvestment:•Federal Budget (until 2009) = R$327 million•Unesco = R$74,3 million•Total (until 2009) = R$401 millionEquivalent the the Aeolian Park in Bahia:•90MW (it illuminates a 400,000 inhab city)•Annual profit estimated in R$41 million
  12. 12. “A Unique Health Identifier alone wont prevent duplicate creation.Make sure your strategy includes a focus on data quality anddata governance, too.” Alex Paris, “Why a Unique Health Identifier Falls Short”
  13. 13. *Interoperability* - Cough -For 3 months -Low fever -A: TB? Ca? -Chest X-ray -Nodule in-Bronchoalveolar Right apexlavage:-Bronchogeniccarcinoma
  14. 14. *Interoperability* - Cough -For 3 months -Low fever - Cough -A: TB? Ca? -Chest X-ray -For 3 months -Nodule in -Low fever Right apex -A: TB? Ca?- Cough -Chest X-ray-For 3 months -Nodule in-Low fever Right apex-A: TB? Ca?-Bronchoalveolar lavage:-Bronchogenic carcinoma
  15. 15. Interoperability? - Cough -For 3 months -Low fever -A: TB? Ca? Garage Software -Chest X-ray -Nodule in-Bronchoalveolar Right apexlavage:-Bronchogenic HL7v2 MessagescarcinomaCEN 13606 Extracts
  16. 16. Where is the Context?
  17. 17. Here is the Context!
  18. 18. Traditional Modelling
  19. 19. Single-Level Modelling Issues Information is modelled in a way that “serves” the current needs of the healthcare system The addition of new concepts or the change of existing concepts implies in re-factoring the whole system (re-modelling, re-implementation, re-test, re-distribution) High cost, slowness in the integration of new knowledge to the systems etc.
  20. 20. Multilevel Modelling
  21. 21. The MLHIM and openEHR Specifications• Multilevel (or dual) Modelling: software development and knowledge modelling are separated• The Reference Model is implemented in software• The knowledge is modelled in Concept Constraint Definitions - CCDs (“archetypes” in the openEHR specs)
  22. 22. MLHIM and openEHR Models Your application (EHR, CPOE etc)MLHIM and openEHR Knowledge Modelling specifications (CCDs or Archetypes) Reference Model
  23. 23. FLOSS Available Tools (1)• Implementations of the Reference Model: ▫ 2 Java Implementations by the openEHR Foundation ▫ 1 Grails implementation by Pablo Pazos (Uruguay) ▫ 1 Python Implementation by the MLHIM Laboratory ▫ 1 Ruby Implementation in course by a collaboration between a Japanese research group and the MLHIM Laboratory ▫ 2 other implementation projects by the MLHIm Laboratory:  Lua  C++
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  27. 27. http://www.mlhim.org
  28. 28. FLOSS Available Tools (2)• Archetype Editors (in ADL): ▫ Ocean Archetype Editor (Windows-only) ▫ LinkEHR (source code by request, there are bugs) ▫ LiU Archetype Editor (outdated)• Templates Editors (in OET, OPT): ▫ None (only the proprietary Ocean Template Designer)• Constraint Definition Designer Project (in XML): ▫ Only full-FLOSS and multiplatform tool ▫ Combined CCD and Template editor ▫ Baseado on Freemind, Plone and other ideas
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  30. 30. FLOSS Available Tools (3)• Archetype Repository: ▫ None (openEHR Foundation’s CKM is proprietary)• The Healthcare Knowledge Component Repository Project: ▫ Repository of the XML Schemas of CCDs ▫ Based on Plone 4 ▫ Functionalities:  All the famous Plone’s CMS and WFM features  XML Schema validation  API to CDD, OSHIP and the Multilevel Authoring for Guidelines (MAG)
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  32. 32. FLOSS Available Tools (4)• Terminology and Vocabulary Servers: ▫ LexGrid ( ▫ LexBIG ( ▫ Unified Medical Language System (UMLS) (
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  36. 36. Knowledge Modelling (1)• Our governance model proposes: ▫ Openness and transparency in decision making and operational procedures ▫ Deliberative systems based on universal suffrage and representativensess ▫ Cost-effective financing models, based on equitable and public distribution of resources, including direct funding, collaborative work, research and education projects etc. ▫ Coordinated and federation principles-based decentralization
  37. 37. Knowledge Modelling(2)• Our governance model proposes : ▫ Preference for the use of validated instruments (including their translations) for the development of CCDs ▫ Preferential use of knowledge modelling strategies derived from the collaborative computing (web based or presential) ▫ Knowledge modelling might be based on expert panels in exceptional situations ▫ Publication of the knowledge modelling artifacts on a public, open access, FLOSS-based repository, maintained by the healthcare system manager in each one of the three levels of government
  38. 38. My Conclusions• I think that the path for the development of citizen-centered, longitudinal, semantic coherent healthcare information systems is based on this tripod: ▫ Multilevel modelling ▫ Adoption of standardized terminologies ▫ Adoption of a Unique Citizen Identifier• Emerging countries have some competitive advantages in healthcare IT: ▫ Usually, the Big Customer is just one (the government) ▫ We are starting almost from scratch ▫ Emerging countries are much more FLOSS-friendly ▫ All needed tools are available or being developen in FLOSS• What’s next: ▫ Invite more partners to participate (government, academy, industry, third sector, FLOSS community) ▫ Go to work!
  39. 39. Special Thanks to: Tim Cook Mike BainbridgeThank you! Sergio Freirelutricav@vm.uff.brJoin us:http://www.mlhim.org