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.

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Implementing dual model systems

  1. 1. ImplementingArchetype<br />BasedSystems<br />
  2. 2. Background<br />Using templates<br />Queries<br />Archetypes<br />Storing openEHR instances<br />2<br />
  3. 3. Using templates<br />There are 2 differentdefinitionsforwhat a templateis:<br />Oceantemplates<br />Zilicstemplates<br />Currentlythere are a lot of open sourceprojectsregardingopenEHR<br />Templates can notyetbecreatedwith open sourcetools<br />3<br />
  4. 4. Using templates<br />For open source (non profit) projects, the only alternative is to edit XML ‘by hand’<br />both ocean and zilics templates schemas are public<br />Open EHR-Gen isworkingonthat<br />Other commercial approaches usually transform the archetypes to their own model to simulate templates<br />4<br />
  5. 5. Using templates<br />Export the schema from a template is not viable<br />for medium sized template 1,5mb (for comparison, HL7 CDA schema is only around 700kb)<br />Currently templates mix clinical with GUI<br />Templates specifications are currently changing<br />Not yet defined, but in the future they will be (specialized) archetypes<br />5<br />
  6. 6. Queries<br />Also ADL queriessyntaxisnotdefinedyet (AQL, A-Path…). <br />Neither AQL and A-Path can yetbeconsideredstandard<br />AQL is a prototypeinside of Oceantemplatedesigner<br />A-Pathis a proposalfromZilics<br />AQL has more ‘buzz’<br />6<br />
  7. 7. Archetypes<br />Not a single archetype repository<br />CKM (primary source)<br />NEHTA (Australia)<br />SKL (Sweden)<br />Same archetype in different repositories?<br />Missing archetypes?<br />Governance?<br />Repository for multiple models?<br />7<br />
  8. 8. Storing openEHR data instances<br />openEHRdoesnotsayanythingabouthow data shouldbestored<br />Objects?<br />XML?<br />Relationaldatasources (SQL)?<br />Tokyo/Kyotocabinet?<br />RDF triplets?<br />Most of open sourceprojects use XML data sources<br />openEHR XML schemas are public<br />8<br />
  9. 9. Our philosophy<br />Archetypes (separating knowledge from systems) is a very powerful methodology.<br />Putting the clinical knowledge on the focus<br />Archetype based systems are the future…<br />9<br />…but we can not throw our current systems data!<br />
  10. 10. Looking at the play field…<br />For archetype definition:<br />Multiple models available<br />Multiple available repositories (and not all openEHR)<br />Most standards can take benefit from using archetypes<br />10<br />
  11. 11. Looking at the play field…<br />For legacy data integration:<br />Not use templates, use archetypes (specialized o not)<br />When importing legacy data, you want to use all current data<br />Current data in relational form<br />Generate unified XML views from distributed data sources<br />Output is XML (archetype data instances)<br />If both input and output are XML<br />Use Xquery (and XPath)<br />11<br />
  12. 12. IBIME<br />Leaded by PhD. Prof. Montserrat Robles<br />Ten years of experience in the field of Biomedical Informatics<br />≈ 20 members<br />Funded by Regional, National and European R&D projects and technology transfer<br /><br />12<br />
  13. 13. IBIME Group (UPV)<br />LinkEHR Archetype Editor<br />Archetype edition<br />Reference model independence<br />Open Source<br />LinkEHR Integration Archetype Editor<br />Legacy datasource mapping<br />XQuery scripts automatic generation<br />EHRFlex (EHR Viewer)<br />13<br />
  14. 14. LinkEHR Archetype Editor<br />Any model can be imported<br />Tested models: openEHR, ISO 13606, HL7 CDA, ASTM CCR and CDISC ODM. Therefore, it is possible to define archetypes based on these models.<br />Archetype creation driven by the reference model<br />Includes a syntactic and semantic validator.<br />Connection with CKM<br />In the works: sample instance generator, CDA and openEHR specific editors…<br />14<br />
  15. 15. LinkEHR Integration Archetype Editor<br />To generate XML documents conforming to the reference model is necessary to define how archetypes sources of data are related: mappings or correspondences.<br />The user must specify how to calculate from one or several values of the data source the value of an attribute of the archetype. <br />The data sources can be relational,XML or archetypes (working on it :)<br />15<br />
  16. 16. EHR Viewer (EHRflex)<br />EHRflex is an archetype-based EMR system.<br />Independent of the reference model.<br />Uses web technologies (Google Web Toolkit).<br />Automatic generation of archetype-based interfaces for view and edit clinical data.<br />Open source project.<br />
  17. 17. EHR Viewer (EHRflex)<br />
  18. 18. EHR Viewer (EHRflex)<br />Open source project:<br />
  19. 19. Real Experiences<br />Hospital General Universitario de Valencia<br />Pangea-LE implementation for over 5 years<br />Integration of distributed data sources (more than 25 databases).<br />Virtual Federated EHR viewer.<br />Full migration to EN13606 EHR Extracts in development.<br />
  20. 20. Real experiences<br />
  21. 21. EHR petition<br />LinkEHR-Ed<br />Pangea-LE<br />Map<br />XML<br />Archetype<br />Standardization<br />Integration<br />Legacy<br />data sources<br />Proprietary<br />XML<br />Standardized<br />XML<br />Other uses<br />EHR<br />communication<br />EHR<br />viewer<br />Sistema LinkEHR<br />21<br />Real Experiences<br />
  22. 22. Real Experiences<br />Hospital de Fuenlabrada (Madrid)<br />Use of openEHR and EN13606 archetypes for pressure ulcer nursing control.<br />The archetype creation methodology was evaluated.<br />Both reference models were compared and tested.<br />
  23. 23. Real Experiences<br />Hospital de Fuenlabrada (Madrid)<br />Use of EN13606 for medication conciliation between primary and specialised care.<br />Agreed definition of a primary-care summary archetype.<br />Communication of normalised legacy data to support patient transitions between primary care and the hospital.<br />
  24. 24. Real Experiences<br />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.<br />Based both on the Spanish and epSOS definition of the contents of the Patient Summary.<br />The information is communicated using the CEN EN13606 norm.<br />
  25. 25. Real Experiences<br />Hospital de Fuenlabrada<br />Madrid<br />Communication of standardized<br />EN13606 information<br />EHR<br />Server<br />EHR<br />Server<br />Hospital General Universitario<br />Valencia<br />
  26. 26. Methodology<br />1. Agree a concept definition and define the archetype<br />We have used two different definitions<br />Spanish National Patient Summary<br />epSOS Patient Summary final dataset<br />They can be easily edited or modified with open source archetype editors like LinkEHR-Ed<br /><br />
  27. 27. Methodology<br />2. Map the archetype to original/legacy data<br />With these mappings we can automatically generate transformation programs for the EHR system.<br />Existing<br />EHR systems<br />XML<br />
  28. 28. Methodology<br />3. Deploy the transformation program in the EHR server<br />Set up a standard EN13606 extract server in both hospitals to generate and communicate the standardized information<br />Transformation is applied on demand<br />Web-service based<br />Includes a standard EN13606 web viewer<br />Mapped<br />Archetype<br />Mapped<br />Archetype<br />EHR viewer<br />VH<br />HIS<br />FH<br />HIS<br />EHR<br />Server<br />EHR<br />Server<br />EN13606<br />Standard<br />Information<br />XML<br />
  29. 29.
  30. 30. Real Experiences<br />Virgen del Rocío Hospital<br />HL7 CDA can be archetyped. Archetypes can be used as templates for HL7.<br />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.<br />LinkEHR can use CDA archetypes to generate valid CDA instances of existing data.<br />30<br />
  31. 31. MML-openEHR-HL7 CDA Project<br />Research stay at Yoshihara Laboratory in Kyoto University<br />My thesis work: How we can integrate between different standards?<br />31<br /><ul><li>Differentparts of the world with different standards
  32. 32. Same illness!</li></li></ul><li>Work<br />Can MML concepts be represented as archetypes?<br />Can we generate correct MML XML from the MML archetypes?<br />Can we map MML to other standards?<br />32<br />
  33. 33. MML concepts as archetypes<br />MML has two kinds of concepts: Common concepts (support) and content modules (clinical concepts).<br />33<br />
  34. 34. MML concepts as archetypes<br />An archetype was created for each concept on common and content modules<br />9 archetypes for common concepts<br />12+1 archetypes for content modules<br />The extra archetype is a reused concept<br />Archetypes do not follow openEHR model<br />34<br />
  35. 35. Example<br />Patient information archetype<br />35<br />
  36. 36. Example<br />36<br />
  37. 37. Work<br />Can MML conceptsberepresentedwitharchetypes?<br />Can wegeneratecorrect MML XML fromthe MML archetypes?<br />Can wemap MML tootherstandards?<br />37<br />
  38. 38. Correct MML from archetypes<br />Fordemostration, some MML archetypesweremappedwithconstantvalues and with a sample data source<br />Theexample data instancesweremodified so theyhavejapanesewriting (kanji, hiragana)<br />38<br />
  39. 39. Result<br />Original XML<br /><patientSummary><br /> <extractTime>2010-12-21T12:14:05</extractTime><br /> <id>ID01</id><br /> <demographics><br /> <patientName>被記</patientName><br /> <patientSurname>載者</patientSurname><br /> <dateOfBirth>1974-06-12</dateOfBirth><br /> <gender>M</gender><br /> </demographics><br /></patientSummary><br />XQuery<br />Result XML<br /><?xml version="1.0" encoding="UTF-8"?><br /><mmlNm:Name mmlNm:repCode="A“ mmlNm:tableId="MML0025"><br /> <mmlNm:family>載者</mmlNm:family><br /> <mmlNm:given>被記</mmlNm:given><br /> <mmlNm:fullname>被記, 載者</mmlNm:fullname><br /> </mmlNm:Name><br />
  40. 40. Work<br />Can MML conceptsberepresentedwitharchetypes?<br />Can wegeneratecorrect MML XML fromthe MML archetypes?<br />Can wemap MML tootherstandards?<br />40<br />
  41. 41. Mapping to other standards<br />Only MML clinical modules need to be mapped, support module classes will be inserted on the archetypes before mapping<br />A project was proposed: mapping between openEHR-MML-HL7 CDA<br />Transform data from MML and HL7 CDA into openEHR XML data and store it with opereffa<br />41<br />
  42. 42. Proposed system<br />42<br />HL7 CDA<br />openEHR<br />MML<br />Transform<br />Transform<br />Transform<br />Transform<br />Opereffa<br />openEHR<br />
  43. 43. Where to start?<br />We have the MML archetypes, we can choose openEHR archetypes to create the transformation from openEHR MML<br />A set of openEHR archetypes was selected from CKM (public online archetype repository)<br />Already existing Japan related openEHR archetypes<br />43<br />
  44. 44. Mapping<br />Few MML concepts have similar scope that openEHR archetypes…<br />MML Diagnosis record ≈ openEHR-EHR-Evaluation.problem-diagnosis<br />MML Progress course ≈ openEHR-EHR-SECTION.soap.v1<br />But mostly don’t!<br />Missing archetypes<br />Multiple archetypes to represent only one concept<br />Different granularity or internal structure<br />Different codes!<br />44<br />
  45. 45. Missing archetypes<br />Some concepts on MML are not represented yet with openEHR archetypes or information is Japan specific<br />MML Health Insurance module?<br />Japanese names?<br />Subjective archetypes?<br />Create new openEHR archetypes when needed<br />45<br />
  46. 46. Multiplearchetypestorepresentone concept<br />Forthepatientidentification, 10 archetypeswherechosen.<br />8 fromtheopenEHRrepository:<br />openEHR-DEMOGRAPHIC-PERSON.person.v1<br />openEHR-DEMOGRAPHIC-PARTY_IDENTITY.person_name.v1<br />openEHR-DEMOGRAPHIC-ADDRESS.address.v1<br />openEHR-DEMOGRAPHIC-CLUSTER.person_additional_data_iso.v1<br />openEHR-DEMOGRAPHIC-CLUSTER.person_identifier_iso.v1<br />openEHR-DEMOGRAPHIC-CLUSTER.person_death_data_iso.v1<br />openEHR-DEMOGRAPHIC-CLUSTER.person_birth_data_iso.v1<br />openEHR-DEMOGRAPHIC-CLUSTER.biometric_identifier_iso.v1<br />2 providedbyKobayashiShinji:<br />openEHR-EHR-CLUSTER.person_name-japan.v1<br />openEHR-EHR-CLUSTER.address-japan.v1<br />46<br />
  47. 47. Different granularity<br />47<br />Join or split fields on the mapping process…<br />…but also, suggest improvements to current openEHR archetypes!<br />
  48. 48. Different codes<br />Both MML and openEHR archetypes rely on internal terminologies<br />Valid status<br />Valid texts or codes<br />Make table mappings between them<br />E.g. sex<br />48<br />
  49. 49. DEMO<br />49<br />
  50. 50. Work to be done<br />Create the mappings between the openEHR archetypes and the remaining MML archetypes<br />Finish and check the validity of the openEHR to MML transformation<br />Generate valid instances from openEHR archetypes for testing<br />MML to openEHR archetypes.<br />Usually, several openEHR archetypes were mapped to only one MML concept…<br />…so one MML concept can be mapped to different openEHR archetypes<br />50<br />
  51. 51. Going back to the point<br />How to use openEHR nowadays?<br />Start a new platform<br />Open source solutions<br />Commercial products<br />Integrate?<br />Templates XML schema export is experimental and does not work very well<br />However, integrating archetypes is ok<br />51<br />
  52. 52. Recommendations<br />If no templates have been developed, wait to specifications to go out<br />If there are some templates developed with ocean template editor:<br />Wait until openEHR official template specifications go out. Some kind of translation mechanism should be provided by ocean<br />Translate current templates to archetypes<br />Look to Portugal template based legacy data integration project<br />52<br />