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Implementing dual model systems
 

Implementing dual model systems

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Presentation of Waseda university openEHR meeting, regarding implementing archetype based systems. This presentation also includes an explanation of MML-openEHR project and IBIME group developments.

Presentation of Waseda university openEHR meeting, regarding implementing archetype based systems. This presentation also includes an explanation of MML-openEHR project and IBIME group developments.

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    Implementing dual model systems Implementing dual model systems Presentation Transcript

    • ImplementingArchetype
      BasedSystems
    • Background
      Using templates
      Queries
      Archetypes
      Storing openEHR instances
      2
    • Using templates
      There are 2 differentdefinitionsforwhat a templateis:
      Oceantemplates
      Zilicstemplates
      Currentlythere are a lot of open sourceprojectsregardingopenEHR
      Templates can notyetbecreatedwith open sourcetools
      3
    • Using templates
      For open source (non profit) projects, the only alternative is to edit XML ‘by hand’
      both ocean and zilics templates schemas are public
      Open EHR-Gen isworkingonthat
      Other commercial approaches usually transform the archetypes to their own model to simulate templates
      4
    • Using templates
      Export the schema from a template is not viable
      for medium sized template 1,5mb (for comparison, HL7 CDA schema is only around 700kb)
      Currently templates mix clinical with GUI
      Templates specifications are currently changing
      Not yet defined, but in the future they will be (specialized) archetypes
      5
    • Queries
      Also ADL queriessyntaxisnotdefinedyet (AQL, A-Path…).
      Neither AQL and A-Path can yetbeconsideredstandard
      AQL is a prototypeinside of Oceantemplatedesigner
      A-Pathis a proposalfromZilics
      AQL has more ‘buzz’
      6
    • Archetypes
      Not a single archetype repository
      CKM (primary source)
      NEHTA (Australia)
      SKL (Sweden)
      Same archetype in different repositories?
      Missing archetypes?
      Governance?
      Repository for multiple models?
      7
    • Storing openEHR data instances
      openEHRdoesnotsayanythingabouthow data shouldbestored
      Objects?
      XML?
      Relationaldatasources (SQL)?
      Tokyo/Kyotocabinet?
      RDF triplets?
      Most of open sourceprojects use XML data sources
      openEHR XML schemas are public
      8
    • Our philosophy
      Archetypes (separating knowledge from systems) is a very powerful methodology.
      Putting the clinical knowledge on the focus
      Archetype based systems are the future…
      9
      …but we can not throw our current systems data!
    • Looking at the play field…
      For archetype definition:
      Multiple models available
      Multiple available repositories (and not all openEHR)
      Most standards can take benefit from using archetypes
      10
    • Looking at the play field…
      For legacy data integration:
      Not use templates, use archetypes (specialized o not)
      When importing legacy data, you want to use all current data
      Current data in relational form
      Generate unified XML views from distributed data sources
      Output is XML (archetype data instances)
      If both input and output are XML
      Use Xquery (and XPath)
      11
    • IBIME
      Leaded by PhD. Prof. Montserrat Robles
      Ten years of experience in the field of Biomedical Informatics
      ≈ 20 members
      Funded by Regional, National and European R&D projects and technology transfer
      http://www.ibime.upv.es
      12
    • IBIME Group (UPV)
      LinkEHR Archetype Editor
      Archetype edition
      Reference model independence
      Open Source
      LinkEHR Integration Archetype Editor
      Legacy datasource mapping
      XQuery scripts automatic generation
      EHRFlex (EHR Viewer)
      13
    • LinkEHR Archetype Editor
      Any model can be imported
      Tested models: openEHR, ISO 13606, HL7 CDA, ASTM CCR and CDISC ODM. Therefore, it is possible to define archetypes based on these models.
      Archetype creation driven by the reference model
      Includes a syntactic and semantic validator.
      Connection with CKM
      In the works: sample instance generator, CDA and openEHR specific editors…
      14
    • LinkEHR Integration Archetype Editor
      To generate XML documents conforming to the reference model is necessary to define how archetypes sources of data are related: mappings or correspondences.
      The user must specify how to calculate from one or several values of the data source the value of an attribute of the archetype.
      The data sources can be relational,XML or archetypes (working on it :)
      15
    • EHR Viewer (EHRflex)
      EHRflex is an archetype-based EMR system.
      Independent of the reference model.
      Uses web technologies (Google Web Toolkit).
      Automatic generation of archetype-based interfaces for view and edit clinical data.
      Open source project.
    • EHR Viewer (EHRflex)
    • EHR Viewer (EHRflex)
      Open source project: http://ehrflex.sourceforge.net/
    • Real Experiences
      Hospital General Universitario de Valencia
      Pangea-LE implementation for over 5 years
      Integration of distributed data sources (more than 25 databases).
      Virtual Federated EHR viewer.
      Full migration to EN13606 EHR Extracts in development.
    • Real experiences
    • EHR petition
      LinkEHR-Ed
      Pangea-LE
      Map
      XML
      Archetype
      Standardization
      Integration
      Legacy
      data sources
      Proprietary
      XML
      Standardized
      XML
      Other uses
      EHR
      communication
      EHR
      viewer
      Sistema LinkEHR
      21
      Real Experiences
    • Real Experiences
      Hospital de Fuenlabrada (Madrid)
      Use of openEHR and EN13606 archetypes for pressure ulcer nursing control.
      The archetype creation methodology was evaluated.
      Both reference models were compared and tested.
    • Real Experiences
      Hospital de Fuenlabrada (Madrid)
      Use of EN13606 for medication conciliation between primary and specialised care.
      Agreed definition of a primary-care summary archetype.
      Communication of normalised legacy data to support patient transitions between primary care and the hospital.
    • Real Experiences
      The semantic interoperability of the Patient Summary is being tested between the Hospital General Universitario in Valencia (HGUV) and the Hospital de Fuenlabrada in Madrid.
      Based both on the Spanish and epSOS definition of the contents of the Patient Summary.
      The information is communicated using the CEN EN13606 norm.
    • Real Experiences
      Hospital de Fuenlabrada
      Madrid
      Communication of standardized
      EN13606 information
      EHR
      Server
      EHR
      Server
      Hospital General Universitario
      Valencia
    • Methodology
      1. Agree a concept definition and define the archetype
      We have used two different definitions
      Spanish National Patient Summary
      epSOS Patient Summary final dataset
      They can be easily edited or modified with open source archetype editors like LinkEHR-Ed
      http://www.linkehr.com
    • Methodology
      2. Map the archetype to original/legacy data
      With these mappings we can automatically generate transformation programs for the EHR system.
      Existing
      EHR systems
      XML
    • Methodology
      3. Deploy the transformation program in the EHR server
      Set up a standard EN13606 extract server in both hospitals to generate and communicate the standardized information
      Transformation is applied on demand
      Web-service based
      Includes a standard EN13606 web viewer
      Mapped
      Archetype
      Mapped
      Archetype
      EHR viewer
      VH
      HIS
      FH
      HIS
      EHR
      Server
      EHR
      Server
      EN13606
      Standard
      Information
      XML
    • Real Experiences
      Virgen del Rocío Hospital
      HL7 CDA can be archetyped. Archetypes can be used as templates for HL7.
      HL7 CDA has some characteristics that do not follow Object Oriented Modelling, but are XML Schema specifications. Archetypes are only applicable to OO models, so some tweaks had to be implemented.
      LinkEHR can use CDA archetypes to generate valid CDA instances of existing data.
      30
    • MML-openEHR-HL7 CDA Project
      Research stay at Yoshihara Laboratory in Kyoto University
      My thesis work: How we can integrate between different standards?
      31
      • Differentparts of the world with different standards
      • Same illness!
    • Work
      Can MML concepts be represented as archetypes?
      Can we generate correct MML XML from the MML archetypes?
      Can we map MML to other standards?
      32
    • MML concepts as archetypes
      MML has two kinds of concepts: Common concepts (support) and content modules (clinical concepts).
      33
    • MML concepts as archetypes
      An archetype was created for each concept on common and content modules
      9 archetypes for common concepts
      12+1 archetypes for content modules
      The extra archetype is a reused concept
      Archetypes do not follow openEHR model
      34
    • Example
      Patient information archetype
      35
    • Example
      36
    • Work
      Can MML conceptsberepresentedwitharchetypes?
      Can wegeneratecorrect MML XML fromthe MML archetypes?
      Can wemap MML tootherstandards?
      37
    • Correct MML from archetypes
      Fordemostration, some MML archetypesweremappedwithconstantvalues and with a sample data source
      Theexample data instancesweremodified so theyhavejapanesewriting (kanji, hiragana)
      38
    • Result
      Original XML
      <patientSummary>
      <extractTime>2010-12-21T12:14:05</extractTime>
      <id>ID01</id>
      <demographics>
      <patientName>被記</patientName>
      <patientSurname>載者</patientSurname>
      <dateOfBirth>1974-06-12</dateOfBirth>
      <gender>M</gender>
      </demographics>
      </patientSummary>
      XQuery
      Result XML
      <?xml version="1.0" encoding="UTF-8"?>
      <mmlNm:Name mmlNm:repCode="A“ mmlNm:tableId="MML0025">
      <mmlNm:family>載者</mmlNm:family>
      <mmlNm:given>被記</mmlNm:given>
      <mmlNm:fullname>被記, 載者</mmlNm:fullname>
      </mmlNm:Name>
    • Work
      Can MML conceptsberepresentedwitharchetypes?
      Can wegeneratecorrect MML XML fromthe MML archetypes?
      Can wemap MML tootherstandards?
      40
    • Mapping to other standards
      Only MML clinical modules need to be mapped, support module classes will be inserted on the archetypes before mapping
      A project was proposed: mapping between openEHR-MML-HL7 CDA
      Transform data from MML and HL7 CDA into openEHR XML data and store it with opereffa
      41
    • Proposed system
      42
      HL7 CDA
      openEHR
      MML
      Transform
      Transform
      Transform
      Transform
      Opereffa
      openEHR
    • Where to start?
      We have the MML archetypes, we can choose openEHR archetypes to create the transformation from openEHR MML
      A set of openEHR archetypes was selected from CKM (public online archetype repository)
      Already existing Japan related openEHR archetypes
      43
    • Mapping
      Few MML concepts have similar scope that openEHR archetypes…
      MML Diagnosis record ≈ openEHR-EHR-Evaluation.problem-diagnosis
      MML Progress course ≈ openEHR-EHR-SECTION.soap.v1
      But mostly don’t!
      Missing archetypes
      Multiple archetypes to represent only one concept
      Different granularity or internal structure
      Different codes!
      44
    • Missing archetypes
      Some concepts on MML are not represented yet with openEHR archetypes or information is Japan specific
      MML Health Insurance module?
      Japanese names?
      Subjective archetypes?
      Create new openEHR archetypes when needed
      45
    • Multiplearchetypestorepresentone concept
      Forthepatientidentification, 10 archetypeswherechosen.
      8 fromtheopenEHRrepository:
      openEHR-DEMOGRAPHIC-PERSON.person.v1
      openEHR-DEMOGRAPHIC-PARTY_IDENTITY.person_name.v1
      openEHR-DEMOGRAPHIC-ADDRESS.address.v1
      openEHR-DEMOGRAPHIC-CLUSTER.person_additional_data_iso.v1
      openEHR-DEMOGRAPHIC-CLUSTER.person_identifier_iso.v1
      openEHR-DEMOGRAPHIC-CLUSTER.person_death_data_iso.v1
      openEHR-DEMOGRAPHIC-CLUSTER.person_birth_data_iso.v1
      openEHR-DEMOGRAPHIC-CLUSTER.biometric_identifier_iso.v1
      2 providedbyKobayashiShinji:
      openEHR-EHR-CLUSTER.person_name-japan.v1
      openEHR-EHR-CLUSTER.address-japan.v1
      46
    • Different granularity
      47
      Join or split fields on the mapping process…
      …but also, suggest improvements to current openEHR archetypes!
    • Different codes
      Both MML and openEHR archetypes rely on internal terminologies
      Valid status
      Valid texts or codes
      Make table mappings between them
      E.g. sex
      48
    • DEMO
      49
    • Work to be done
      Create the mappings between the openEHR archetypes and the remaining MML archetypes
      Finish and check the validity of the openEHR to MML transformation
      Generate valid instances from openEHR archetypes for testing
      MML to openEHR archetypes.
      Usually, several openEHR archetypes were mapped to only one MML concept…
      …so one MML concept can be mapped to different openEHR archetypes
      50
    • Going back to the point
      How to use openEHR nowadays?
      Start a new platform
      Open source solutions
      Commercial products
      Integrate?
      Templates XML schema export is experimental and does not work very well
      However, integrating archetypes is ok
      51
    • Recommendations
      If no templates have been developed, wait to specifications to go out
      If there are some templates developed with ocean template editor:
      Wait until openEHR official template specifications go out. Some kind of translation mechanism should be provided by ocean
      Translate current templates to archetypes
      Look to Portugal template based legacy data integration project
      52