Michael van der Zel presented at the HL7 UK AGM and TC WGM on April 7, 2009. He works as an HIT architect at the University Medical Center Groningen in the Netherlands. In his presentation, he discussed his background and career experiences, provided an overview of the UMCG including key statistics, and outlined his vision for transitioning UMCG's electronic health records from an operational chaos to a semantic service-oriented architecture using standards like HL7, SNOMED CT and RIMBAA.
Roland Fleischhacker (Sonja Kabicher-Fuchs): Using semantic technologies to i...Semantic Web Company
This document discusses the implementation of a new solution using semantic technologies at Stadt Wien - Wiener Wohnen Kundenservice GmbH to improve their customer service process. The previous solution of searching a topic tree with keywords was inefficient and error-prone. The new solution uses DEEP.assist to analyze customer issues in real-time, propose standardized business cases, and accelerate case resolution while reducing errors. Initial results show benefits like improved agent efficiency and user acceptance. Further optimizations are ongoing to refine the system.
2010-dec-08 HL7 Detailed Clinical Modelling and ArchitectureMichael van der Zel
Michael van der Zel presented on detailed clinical models (DCM). He discussed where DCM fits within different architecture frameworks like Gartner's component model and RM-ODP. He then explained what a DCM is and the specifics of a DCM information model and toolset for creating, validating, exporting, and transforming DCMs. Finally, he discussed granularity issues around DCMs and provided an example case on propensity to adverse reactions.
Η εργασία αυτή είναι συνέχεια της συνέντευξης που έδωσαν τα αδέλφια Κωνσταντίνος και Πέτρος Ιωαννίδης, εγγονοί του ιδιοκτήτη και δημιουργού του σινεμά, στην 7η Δημοτική Κοινότητα του Δήμου Αθήνας.
Περιέχει σαρώσεις από το βιβλίο του Κωνσταντίνου Ιωαννίδη που εκδόθηκε το 2010 και, όπως μας είπε ο συγγραφέας: «έκλεισε τον κύκλο του». Τα τελευταία τεύχη της έκδοσης που βρήκε τα προσέφερε στον διοργανωτή της εκδήλωσης, Πολιτιστικό Περιβαλλοντικό Σύλλογο Κέντρου Αμπελοκήπων
56ο Γυμνάσιο Αθήνας
Συντακτική και Φωτογραφική ομάδα εργαστηρίου Πληροφορικής
The document provides an overview and demonstration of IBM's Social Media Analytics software. It discusses the architecture and framework of SMA, including its built-in analytics capabilities for tasks like sentiment analysis, influencer identification, and evolving topic detection. The presentation also covers how SMA can integrate social media insights into a 360-degree customer view and how the software has transitioned to an "application as a service" model.
First Things: A Quick Guide to Starting a Team on the Path to Agilityjaredrrichardson
This is a talk given at AgileRTP in February of 2016. It provides a path for coaches (or team members) to use as a guide for introducing agile practices. Definitely has a GROWS point of view.
Roland Fleischhacker (Sonja Kabicher-Fuchs): Using semantic technologies to i...Semantic Web Company
This document discusses the implementation of a new solution using semantic technologies at Stadt Wien - Wiener Wohnen Kundenservice GmbH to improve their customer service process. The previous solution of searching a topic tree with keywords was inefficient and error-prone. The new solution uses DEEP.assist to analyze customer issues in real-time, propose standardized business cases, and accelerate case resolution while reducing errors. Initial results show benefits like improved agent efficiency and user acceptance. Further optimizations are ongoing to refine the system.
2010-dec-08 HL7 Detailed Clinical Modelling and ArchitectureMichael van der Zel
Michael van der Zel presented on detailed clinical models (DCM). He discussed where DCM fits within different architecture frameworks like Gartner's component model and RM-ODP. He then explained what a DCM is and the specifics of a DCM information model and toolset for creating, validating, exporting, and transforming DCMs. Finally, he discussed granularity issues around DCMs and provided an example case on propensity to adverse reactions.
Η εργασία αυτή είναι συνέχεια της συνέντευξης που έδωσαν τα αδέλφια Κωνσταντίνος και Πέτρος Ιωαννίδης, εγγονοί του ιδιοκτήτη και δημιουργού του σινεμά, στην 7η Δημοτική Κοινότητα του Δήμου Αθήνας.
Περιέχει σαρώσεις από το βιβλίο του Κωνσταντίνου Ιωαννίδη που εκδόθηκε το 2010 και, όπως μας είπε ο συγγραφέας: «έκλεισε τον κύκλο του». Τα τελευταία τεύχη της έκδοσης που βρήκε τα προσέφερε στον διοργανωτή της εκδήλωσης, Πολιτιστικό Περιβαλλοντικό Σύλλογο Κέντρου Αμπελοκήπων
56ο Γυμνάσιο Αθήνας
Συντακτική και Φωτογραφική ομάδα εργαστηρίου Πληροφορικής
The document provides an overview and demonstration of IBM's Social Media Analytics software. It discusses the architecture and framework of SMA, including its built-in analytics capabilities for tasks like sentiment analysis, influencer identification, and evolving topic detection. The presentation also covers how SMA can integrate social media insights into a 360-degree customer view and how the software has transitioned to an "application as a service" model.
First Things: A Quick Guide to Starting a Team on the Path to Agilityjaredrrichardson
This is a talk given at AgileRTP in February of 2016. It provides a path for coaches (or team members) to use as a guide for introducing agile practices. Definitely has a GROWS point of view.
Summit 16: Deploying Virtualized Mobile Infrastructures on OpenstackOPNFV
Service Provider is evolving and competing with leaner Over the Top Providers (OTP) providers such as Google and Amazon to provide mobile services. Furture SP network has ot be agile, resilient and auto salable. SPs are leaning towards using COTS infra, open networking (OPNFV, ONOS) and VNF to run routers, switches, mobile gateways, firewall, NAT, DPI functions. Session covers design and deployment of virtualizing the mobile infra such as Virtual Evolved Packet Core, GiLAN and VoLTE as well as 5G core. We will also cover performance fine tuning using DPDK, SR-IOV etc. WE will present case study using Cisco (VNF Manager and NFVO), Redhat (NFVI), Openstack and block storage using CEPH technology. Participants will be able to understand complexities of mobile packet core, evolution NFV based solution and architecture framework for 5G mobile packet core.
Actea(cimicifuga) racemosa hmm slide show presentation By Dr.Hansraj salveDr.hansraj salve
Symptoms & drug picture of homeopathic remedy Cimicifuga racemosa beautiful Homeopaths materia medica slide show presentation for students of homoeopathy by Dr.hansraj salve. My new slide show presentation with new drug will come soon so keep in touch.
Anacardium orientale HOMOEOPATHIC MATERIA MEDICA SLIDE SHOW PRESENTATION BY...Dr.hansraj salve
Anacardium orientale is a homeopathic remedy made from the marking nut plant. It is used to treat neurasthenia, mental and physical weakness, lack of power, and trembling from overexertion. Symptoms include changing mental states, irresolution, contradictory impulses, and sensations of pressure throughout the body. Aggravation occurs from mental exertion, emotions, anger, and fright. Amelioration comes from heat, eating, and lying down. It is used for nervous disorders, headaches, skin eruptions, digestive issues, and conditions from sedentary lifestyles.
Kostas Kastrantas | Business Opportunities with Linked Open Datasemanticsconference
We are an organization that has been finding, connecting, and delivering agricultural and food information worldwide for the past 8 years. We consider ourselves pioneers in this area. We help other organizations build a better future for agriculture and food using open data. We work with major institutions and initiatives while also having a presence in Greece. For each project, we focus on the needs of the client institution and helping them achieve their vision. We are a flexible team of experts in areas like strategy, design, technology, and customer needs. We support our clients through various services around defining strategies, designing solutions, building applications, and engaging stakeholders using open data.
HPE Presentation on Internet of Things at IoT World 2016 - DubaiAlpha Data
IoT World 2016 is a conference bringing together industry experts to analyse the opportunities, challenges and help enterprise leap into a new set of challenging technologies. HPE was the Strategic Technology Partner and Alpha Data was the event Partner.
Socio-economic impact of Big Data and Smart FarmingSjaak Wolfert
Big data and smart farming technologies have the potential to significantly impact socio-economic relationships in the agriculture industry. They may lead to either strongly integrated supply chains where farmers have limited freedom, or more open collaboration networks that empower farmers. In reality, the impact is likely to fall somewhere in between these scenarios. The technologies connect sensors on farms and equipment to analyze data and optimize operations. However, their adoption also raises issues around data ownership, privacy, and the balance of power between different players in the food chain. Infrastructure and software development will be key to addressing these challenges.
The document discusses network functions virtualization (NFV) and management and orchestration (MANO). It highlights that NFV is maturing towards production use with customers deploying NFV/cloud solutions. It also discusses how MANO is responsible for performance, availability, and life-cycle management in NFV. The document promotes collaborating in open source communities to share innovations and speed solutions development.
The document introduces OPEN-O, an open source project hosted by the Linux Foundation that aims to provide an orchestration platform for network services across SDN, NFV, and traditional networks. It outlines OPEN-O's vision of providing end-to-end connectivity services tailored for operators through a modular framework that supports both new and legacy infrastructure. The document also provides details on OPEN-O's architecture, initial use case focusing on vCPE, current project status with over 100 developers, and the Linux Foundation's role in providing neutral governance.
OPNFV: Overview and Approach to Upstream IntegrationOPNFV
The OPNFV project—a common integration and testing platform to facilitate NFV deployments that defines a consistent, functional stack—differs from more traditional code-based open source projects in that its work is focused upstream. Rather than re-event many wheels, the project leverages a variety of existing code bases from leading open source projects across compute, storage, and networking and fills gaps where needed to meet strict carrier-grade end user requirements. This approach is difficult and requires an extremely complicated set of requirements, but the result is a much needed common, de facto platform for the industry to test and build NFV products and services. OPNFV director Heather Kirksey spoke during LinuxCon North America 2016 on why the community chose to take this integrated approach, what’s been successful, and key lessons learned from this unique project.
Semantic annotation is done through first representing words and documents in the vector space model using Word2Vec and Doc2Vec implementations, the vectors are taken as features into a classifier, trained and a model is made which can classify a document with ACM classification tree categories, with the help of Wikipedia corpus.
Project Presentation: https://youtu.be/706HJteh1xc
Project Webpage: http://rohitsakala.github.io/semanticAnnotationAcmCategories/
Source Code: https://github.com/rohitsakala/semanticAnnotationAcmCategories
References:
Quoc V. Le, and Tomas Mikolov, ''Distributed Representations of Sentences and Documents ICML", 2014
DSD-INT 2016 My Deltares - Compute As A Service Cloud computing and HPC - LeupeDeltares
Nerdalize builds a sustainable cloud platform by using excess computing power to heat homes, reducing energy costs. Its MyDeltares CaaS platform provides software users freedom of choice among multiple cloud providers while ensuring the best price and performance. It addresses common questions about testing compute jobs, accessing clouds, choosing providers, avoiding vendor lock-in, integrating on-premise servers, and managing costs. The platform allows deploying simulations on any cloud through a single interface and budgets project costs upfront so they are known before projects start.
MAX is a HL7 project that defines a format called Models XML (MAX) for exchanging model information between tools in a compatible way with spreadsheets. MAX allows importing and exporting of models, validation, transformation and editing of model parts directly in spreadsheets. It is currently being used for EHR architecture modeling and validation of clinical models. MAX also defines how to transform FHIR resources and profiles to and from UML models.
UMCG All about data 2014 World of Clinical Information Models CIMIMichael van der Zel
The document discusses clinical information models (CIMs) and the Clinical Information Model Initiative (CIMI). It provides an overview of CIMI's mission and goals, which include establishing a shared repository of detailed clinical models, appropriate governance for the group, and promoting the creation of tools to translate and implement the models. It also lists organizations involved with CIMI from different parts of the world and discusses differences between models from different sources.
The document discusses a functional model (EHR-S FM) for an electronic health record system and how it relates to a reference domain model (RDZ) for a hospital. It explains that linking the two models provides a consistent set of partial requirements specifications. The presentation describes ongoing developments, including merging several domain profiles into EHR-S FM version 2 and using metadata to profile requirements at local, national and international levels. Questions from the audience are addressed, relating elements of the models and clarifying terminology.
Clinical Information Modeling Initiative, Detailed Clinical Models and Integrating the Healthcare Enterprise. CIMI and IHE are neutral, maybe they can strengthen eachother...
The document summarizes a presentation given by Michael van der Zel on the tools available to healthcare information architects. It discusses modeling techniques like reference models, patterns, and detailed clinical models. It provides examples of modeling blood pressure and assessment scales. The presentation emphasizes using standards, metadata, and multiple layers of abstraction to build quality, reusable models that can support clinical care and research.
The document discusses HL7's Service Aware Enterprise Architecture Framework (SAEAF). It provides an overview of SAEAF, explaining that it uses a multi-dimensional specification pattern to create standards that enhance healthcare interoperability. SAEAF defines specifications across various viewpoints, including enterprise, information, computational, engineering, and conformance levels. The goal of SAEAF and HL7 specifications is to define the information, functions, terminology and technology bindings needed for implemented systems to work interoperably.
Summit 16: Deploying Virtualized Mobile Infrastructures on OpenstackOPNFV
Service Provider is evolving and competing with leaner Over the Top Providers (OTP) providers such as Google and Amazon to provide mobile services. Furture SP network has ot be agile, resilient and auto salable. SPs are leaning towards using COTS infra, open networking (OPNFV, ONOS) and VNF to run routers, switches, mobile gateways, firewall, NAT, DPI functions. Session covers design and deployment of virtualizing the mobile infra such as Virtual Evolved Packet Core, GiLAN and VoLTE as well as 5G core. We will also cover performance fine tuning using DPDK, SR-IOV etc. WE will present case study using Cisco (VNF Manager and NFVO), Redhat (NFVI), Openstack and block storage using CEPH technology. Participants will be able to understand complexities of mobile packet core, evolution NFV based solution and architecture framework for 5G mobile packet core.
Actea(cimicifuga) racemosa hmm slide show presentation By Dr.Hansraj salveDr.hansraj salve
Symptoms & drug picture of homeopathic remedy Cimicifuga racemosa beautiful Homeopaths materia medica slide show presentation for students of homoeopathy by Dr.hansraj salve. My new slide show presentation with new drug will come soon so keep in touch.
Anacardium orientale HOMOEOPATHIC MATERIA MEDICA SLIDE SHOW PRESENTATION BY...Dr.hansraj salve
Anacardium orientale is a homeopathic remedy made from the marking nut plant. It is used to treat neurasthenia, mental and physical weakness, lack of power, and trembling from overexertion. Symptoms include changing mental states, irresolution, contradictory impulses, and sensations of pressure throughout the body. Aggravation occurs from mental exertion, emotions, anger, and fright. Amelioration comes from heat, eating, and lying down. It is used for nervous disorders, headaches, skin eruptions, digestive issues, and conditions from sedentary lifestyles.
Kostas Kastrantas | Business Opportunities with Linked Open Datasemanticsconference
We are an organization that has been finding, connecting, and delivering agricultural and food information worldwide for the past 8 years. We consider ourselves pioneers in this area. We help other organizations build a better future for agriculture and food using open data. We work with major institutions and initiatives while also having a presence in Greece. For each project, we focus on the needs of the client institution and helping them achieve their vision. We are a flexible team of experts in areas like strategy, design, technology, and customer needs. We support our clients through various services around defining strategies, designing solutions, building applications, and engaging stakeholders using open data.
HPE Presentation on Internet of Things at IoT World 2016 - DubaiAlpha Data
IoT World 2016 is a conference bringing together industry experts to analyse the opportunities, challenges and help enterprise leap into a new set of challenging technologies. HPE was the Strategic Technology Partner and Alpha Data was the event Partner.
Socio-economic impact of Big Data and Smart FarmingSjaak Wolfert
Big data and smart farming technologies have the potential to significantly impact socio-economic relationships in the agriculture industry. They may lead to either strongly integrated supply chains where farmers have limited freedom, or more open collaboration networks that empower farmers. In reality, the impact is likely to fall somewhere in between these scenarios. The technologies connect sensors on farms and equipment to analyze data and optimize operations. However, their adoption also raises issues around data ownership, privacy, and the balance of power between different players in the food chain. Infrastructure and software development will be key to addressing these challenges.
The document discusses network functions virtualization (NFV) and management and orchestration (MANO). It highlights that NFV is maturing towards production use with customers deploying NFV/cloud solutions. It also discusses how MANO is responsible for performance, availability, and life-cycle management in NFV. The document promotes collaborating in open source communities to share innovations and speed solutions development.
The document introduces OPEN-O, an open source project hosted by the Linux Foundation that aims to provide an orchestration platform for network services across SDN, NFV, and traditional networks. It outlines OPEN-O's vision of providing end-to-end connectivity services tailored for operators through a modular framework that supports both new and legacy infrastructure. The document also provides details on OPEN-O's architecture, initial use case focusing on vCPE, current project status with over 100 developers, and the Linux Foundation's role in providing neutral governance.
OPNFV: Overview and Approach to Upstream IntegrationOPNFV
The OPNFV project—a common integration and testing platform to facilitate NFV deployments that defines a consistent, functional stack—differs from more traditional code-based open source projects in that its work is focused upstream. Rather than re-event many wheels, the project leverages a variety of existing code bases from leading open source projects across compute, storage, and networking and fills gaps where needed to meet strict carrier-grade end user requirements. This approach is difficult and requires an extremely complicated set of requirements, but the result is a much needed common, de facto platform for the industry to test and build NFV products and services. OPNFV director Heather Kirksey spoke during LinuxCon North America 2016 on why the community chose to take this integrated approach, what’s been successful, and key lessons learned from this unique project.
Semantic annotation is done through first representing words and documents in the vector space model using Word2Vec and Doc2Vec implementations, the vectors are taken as features into a classifier, trained and a model is made which can classify a document with ACM classification tree categories, with the help of Wikipedia corpus.
Project Presentation: https://youtu.be/706HJteh1xc
Project Webpage: http://rohitsakala.github.io/semanticAnnotationAcmCategories/
Source Code: https://github.com/rohitsakala/semanticAnnotationAcmCategories
References:
Quoc V. Le, and Tomas Mikolov, ''Distributed Representations of Sentences and Documents ICML", 2014
DSD-INT 2016 My Deltares - Compute As A Service Cloud computing and HPC - LeupeDeltares
Nerdalize builds a sustainable cloud platform by using excess computing power to heat homes, reducing energy costs. Its MyDeltares CaaS platform provides software users freedom of choice among multiple cloud providers while ensuring the best price and performance. It addresses common questions about testing compute jobs, accessing clouds, choosing providers, avoiding vendor lock-in, integrating on-premise servers, and managing costs. The platform allows deploying simulations on any cloud through a single interface and budgets project costs upfront so they are known before projects start.
MAX is a HL7 project that defines a format called Models XML (MAX) for exchanging model information between tools in a compatible way with spreadsheets. MAX allows importing and exporting of models, validation, transformation and editing of model parts directly in spreadsheets. It is currently being used for EHR architecture modeling and validation of clinical models. MAX also defines how to transform FHIR resources and profiles to and from UML models.
UMCG All about data 2014 World of Clinical Information Models CIMIMichael van der Zel
The document discusses clinical information models (CIMs) and the Clinical Information Model Initiative (CIMI). It provides an overview of CIMI's mission and goals, which include establishing a shared repository of detailed clinical models, appropriate governance for the group, and promoting the creation of tools to translate and implement the models. It also lists organizations involved with CIMI from different parts of the world and discusses differences between models from different sources.
The document discusses a functional model (EHR-S FM) for an electronic health record system and how it relates to a reference domain model (RDZ) for a hospital. It explains that linking the two models provides a consistent set of partial requirements specifications. The presentation describes ongoing developments, including merging several domain profiles into EHR-S FM version 2 and using metadata to profile requirements at local, national and international levels. Questions from the audience are addressed, relating elements of the models and clarifying terminology.
Clinical Information Modeling Initiative, Detailed Clinical Models and Integrating the Healthcare Enterprise. CIMI and IHE are neutral, maybe they can strengthen eachother...
The document summarizes a presentation given by Michael van der Zel on the tools available to healthcare information architects. It discusses modeling techniques like reference models, patterns, and detailed clinical models. It provides examples of modeling blood pressure and assessment scales. The presentation emphasizes using standards, metadata, and multiple layers of abstraction to build quality, reusable models that can support clinical care and research.
The document discusses HL7's Service Aware Enterprise Architecture Framework (SAEAF). It provides an overview of SAEAF, explaining that it uses a multi-dimensional specification pattern to create standards that enhance healthcare interoperability. SAEAF defines specifications across various viewpoints, including enterprise, information, computational, engineering, and conformance levels. The goal of SAEAF and HL7 specifications is to define the information, functions, terminology and technology bindings needed for implemented systems to work interoperably.
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
low birth weight presentation. Low birth weight (LBW) infant is defined as the one whose birth weight is less than 2500g irrespective of their gestational age. Premature birth and low birth weight(LBW) is still a serious problem in newborn. Causing high morbidity and mortality rate worldwide. The nursing care provide to low birth weight babies is crucial in promoting their overall health and development. Through careful assessment, diagnosis,, planning, and evaluation plays a vital role in ensuring these vulnerable infants receive the specialize care they need. In India every third of the infant weight less than 2500g.
Birth period, socioeconomical status, nutritional and intrauterine environment are the factors influencing low birth weight
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
1. RIMBAA Experiences
HL7 UK AGM and TC WGM, April 7th 2009
University Medical Center Groningen, Netherlands
Michael van der Zel
HIT-Architect
2. Who Am I?
Michael van der Zel
●
michael.vanderzel@skype @linkedin @facebook @gmail
●
m.van.der.zel AT ict.umcg.nl
●
36 yrs – 2 kids (aged 7 and 4)
●
Personality (MBTI) – INFJ
●
Idealist, Perfectionist, Chaotic
●
“INFJs prefer the future and the pathway along which
●
they aspire for profundity.”
Michael van der Zel april 7th, 2009
3. What Did I Do?
University Hospital Amsterdam
●
BSc Final Project: virtual EHR (Poliplus) 1997
–
0 ~1998 Dipak Kalra
–
Lead Developer & Architect
–
University Hospital Groningen
●
Architect; Healthcare Service Bus
–
Ernst de Bel (Nijmegen); got me hooked on HL7 v3
–
String-of-Pearls Dutch Biobank – Information Arch 2008
–
Co-Chair RIMBAA-NL since 2007
–
Member of RIMBAA Int'l
–
CDA Certified Specialist
–
Michael van der Zel april 7th, 2009
6. Inside the Office
Clinical
Statement SQL
Clinical
Document CMET
Clinical
Statement CMET
Michael van der Zel april 7th, 2009
7. UMCG – Some Numbers
1 of 8 UMC’s, 1 of 120 hospitals in the Netherlands
900 trauma helicopter flights
9.756 employees
1.339 beds (including cradles)
11.823 day care treatments psychiatry (2006)
20.758 day care treatments (excl. Psychiatry)
32.831 admissions
326.400 nursing days
460.297 visits to outpatient clinics
Source: annual report 31-12-2007
Michael van der Zel april 7th, 2009
8. Agenda
1 2
3 4
Michael van der Zel april 7th, 2009
9. “ Everything should be made as simple as
”
possible, but not simpler.
–– Albert Einstein
“ ”
Technology is something that doesnot yet work.
–– Douglas Adams
“ ”
I've seen things you people will not believe...
–– BladeRunner
Michael van der Zel april 7th, 2009
10. “ If language is not correct,
then what is said is not what is meant.
If what is said is not what is meant,
”
then what ought to be done remains undone.
–– Confucius
Michael van der Zel april 7th, 2009
12. Duplicate Functionality
3 HISses, custom build, etc.
●
3 archives; DOCMA &
●
Multiple registration of for the same patient
but different specialty.
E.g. allergies or patient history.
Michael van der Zel april 7th, 2009
13. Piles of Paper Forms
“Newest
form!”
Michael van der Zel april 7th, 2009
15. !
Why?
?
Data Data
Michael van der Zel april 7th, 2009
16. What?
+ +
Reference Clinical
Terminology
Information Models
Model
= Computable
Semantic
Interoperability
Michael van der Zel april 7th, 2009
17. !
Result
!
Clinical
Clinical
Info
Info
Michael van der Zel april 7th, 2009
18. How?
+ + HL7 v3 Templates,
SNOMED CT,
HL7 v3 RIM, Detailed Clinical
ISO Datatypes LOINC Models, CCD
=
Computable
Semantic
Interoperability
Michael van der Zel april 7th, 2009
19. CSI
HL7 SAEAF – Computable
●
Semantic Interoperability
●
Report jan 2009
– Semantic InterOperability (SIOp)
Semantic SOA
●
Michael van der Zel april 7th, 2009
21. Gartner CPR Generations
D:My documentsInternationaal, Nationaal, RegioGartner2007 CPR Generation Criteria Update - Clinical Display.pdf
Michael van der Zel april 7th, 2009
22. UMCG vEHR Roadmap
5. Desicion Support
4. Regional
(RHIO)
3. Process Driven
Functionality
2. Semantic SOA
1. Operational Chaos
2008 2009 2012 2015
2010
Availability
Michael van der Zel april 7th, 2009
23. Semantic SOA
Classical Model
Tomorrows Model
Source: http://www.openhealthtools.org/Reports/Apr08/OHTStandardsVisionV2.pdf
Michael van der Zel april 7th, 2009
24. Ideal Model
Tomorrows Model
&
RIMBAA T
DC
SNOME
Ideal Model inside
Service Provider Service Provider
Message
End-To-End HL7 v3, SNOMED CT, RIMBAA, From UI to DB
Michael van der Zel april 7th, 2009
25. Architecture Overview v0.8 | mrt 2009 | Michael van der Zel
created: dec 2006
(Clinical) Portal
> Clinical Documents (CDA)
Portlet eForm > HL7 v3 Templates
> Detailed Clinical Models
> Widgets
DigiD
UZI
BSN ...
> XDS
> RFD
> RID
AORTA & Common Information
1 2 3
Parelsnoer Model
& RHIO SSZOG
Wrap
Care Doc
ETS
Plan Repos
(CTS) (XDS)
Application
Packaged
HL7 v3
Terminology
XML XML
CDR
SNOMED CT
HL7 v3 MPI
Michael van der Zel april 7th, 2009
26. Healthcare Software Toolkit!
Current apps are developed with 1960 technology
●
Develop your own (parts)
●
We need: Healthcare Software Toolkit
●
Small ISV can start fast, developing Healthcare IT instead
●
of putting IT in Healthcare.
Common User Interface, Models, Standard Components
●
Master Patient Index
–
Clinical Data Repository
–
Template Repository
–
Michael van der Zel april 7th, 2009
27. RIMBAA
Experiences
Michael van der Zel april 7th, 2009
28. UMCG RIMBAA
Technology Matrix (1/2)
Persistent Object Serialized
Representation Representation Representation
(generic)
Model
RIM
Constrained
Information
SQL JAXB &
Clinical
Model
JPA Web
Server JAX-WS
Statement
RIM
Services
2005 WCF
Mapper
Application
specific
Model
Legacy
non HL7v3
XJC
HL7 XSDs
Michael van der Zel april 7th, 2009
29. UMCG RIMBAA
Technology Matrix (2/2)
Processing Object User
Logic Representation Interface
XPath
Binding
InfoPath (MOSS),
Java
ASP.NET (Ajax)
.Net C#
NHS CUI
Delphi, Java
(Applet)
(at a 90 ̊ angle to the matrix on the previous slide)
Michael van der Zel april 7th, 2009
30. Interoperability Paradigms
Services
●
More real-time
●
Level
of
Current HL7 v3 are messages wrapped Shared
●
Context
double Sending Identity (WS-Security)
–
double Operation (e.g. Schedule Appointment)
–
Documents
●
Messages (between systems and institutions)
●
Mainframe
●
Michael van der Zel april 7th, 2009
31. Code Model Generation
NE2008 XSD's; Clinical Document, Clinical
●
Statement, Patient, Assigned Entity
Java 6 XJC
●
Java 6 WebService Glassfish
●
WSDL > .Net WSDL.exe
●
Convert Arrays to Collections script
●
ObjectFactory and converters, e.g. DateTime > TS
●
Some minor simplifications (see Limitations)
●
Michael van der Zel april 7th, 2009
32. CDR Persistance
ORM JPA Toplink / MS-SQL & Derby
●
Datatypes R1, Clinical Statement, Patient,
●
Assigned Entity, Clinical Document
SQL generated from Java (with annotations)
●
Table per concrete base class (Act/Role)
–
Side table for datatypes (Patient_II)
–
Simplified BL (bit) and ST (varchar)
–
Table per Hierarchy for CD, CE, CV, CS
–
ANY as multiple; e.g. CD, ST, PQ
–
TS-like-types as serialized XML
–
Michael van der Zel april 7th, 2009
33. JPA Query Example
<named-query name=quot;findOrganizersByTemplateAndPatientIdquot;>
<query>
SELECT o
FROM A_Organizer o
JOIN o.templateId1 tid
JOIN o.recordTarget recordTarget
JOIN recordTarget.patient patient
JOIN patient.id id
WHERE tid.root = :templateRoot
AND tid.extension = :templateExtension
AND id.root = :patientRoot
AND id.extension = :patientExtension
</query>
</named-query>
ISO Datatypes as User Defined Types!
> Demo SQL Server UDT II
Michael van der Zel april 7th, 2009
34. Query CDR by Example
<organizer>
<templateId assigningAuthorityName=quot;UMCGquot;
extension=quot;5ae9e3b0-7295-4798-a34a-26229f3e8075quot;
root=quot;2.16.840.1.113883.2.4.3.8.1000.9quot; />
<recordTarget typeCode=quot;RCTquot;>
<patient classCode=quot;PATquot;>
<id assigningAuthorityName=quot;UMCGquot;
extension=quot;1010101quot;
root=quot;2.16.840.1.113883.2.4.3.8.12quot; />
</patient>
</recordTarget>
</organizer>
Michael van der Zel april 7th, 2009
35. Current Limitations
Clinical Document CS != Care Provision CS
●
XSD Enumerations for ValueSets > want CTS use
●
fixed / default values
●
XML Validation (Schematron)
●
Current HL7 doesnot have inheretance
●
PatientNL extends PatientLite extends PatientIdentified
ISO Datatypes not native, result is complex coding
●
required (in C#, Java and SQL)
Reuse types e.g. with VSTS Add Web/Service
●
Reference
Michael van der Zel april 7th, 2009
36. Results
Cookbooks & Guidances (NL Realm)
●
HL7 v3 Templates
●
Mapper Services
●
Widgets
●
Terminology Services (CTS)
●
Clinical Statement CDR (Templates & Instances)
●
HL7 v3 .Net Framework
●
Excel Template Editor, OID Registry
●
Michael van der Zel april 7th, 2009
37. Patient History Widget
HL7 v3
End
Modeller
Users
Other Apps (RO) Template Editor
CUI Widgets
Template Browser
(RW)
HL7 v3
Templates
OID Registry
MOSS List
Clinical Statement
OID
HIS LOB Repository
Master
Michael van der Zel april 7th, 2009
38. ENT (KNO) Patient History Widget
CUI
DateInputBox
Relevant?
CUI
DateLabel
http://digizorgo1.umcg.nl/PatientHistory/
Michael van der Zel april 7th, 2009
39. Diagnosis HL7 v3 Template
class PatientHistory.Diagnoses
«Pa rticipa tion» «Ro le»
«Act»
:RecordTarget :PatientIdentified CMET
Diagnoses :Organize r
code = RJM
«Participati on» «Role »
« Act» :DataEntere r :AssignedEntityIdentified CMET
Diagnosis :Observ ation id = Zorgve rlenerId
text = Glob ale beschrijvin g van d e diag nose
c od e = DX
«Role »
effe ctiveT im e = di agnose datum «Pa rticipati on»
:AssignedEntityIdentified CMET
valu e < KNO Diag nose :Author
0..*
id = Specia lism eCode of Zorgverlener
HL7 v3 ClinicalStatement Observation value ContentObject / ZIS
{text OR value}
dbc.reg.getAlleZorgtrajectenV
anPatient
id<II>.root “2.16.840.1.113883.2.4.3.8.1000.31”
id<II>.assigningAuthorityName “UMCG”
id<II>.extension 6. zorgtrajectid^INTEGER
moodCode “EVN”
HL
7v
Zo
value<CD>.code “DX”
u
3C
value<CD>.codeSystem “2.16.840.1.113883.1.11.16228”
ga
lin
(
value<CD>.codeSystemName “ObservationDiagnosisTypes”
LO
i ca
B
code<CD>.code
l
Ad
St
code<CD>.originalText 3. diagnose
at
ap
em
te
code<CD>.codeSystem
r)
en
code<CD>.codeSystemName “KNO Diagnosen”
t
effectiveTime<IVL_TS>.min.value 0. begindatum^DATE
effectiveTime<IVL_TS>.max.value 5. einddatum^DATE
author.assignedEntity.id<II>.root “2.16.840.1.113883.2.4.3.8.1000.8”
author.assignedEntity.id<II>.extension 1. specialisme
author.assignedEntity.id<II>.assigningAuthorityName “UMCG”
Michael van der Zel april 7th, 2009
41. Procedure HL7 v3 Template
class PatientHistory.Procedures
« Participation » «Role»
:RecordTarget :PatientIdentified CMET
«Role»
« Participation »
:AssignedEntityIdentified CMET
:DataEntere r
{text OR code}
«Act»
«A ct» :Procedure
Procedures :Organize r
e ffectiveT ime = jaa rtal
code = COT G code
text = operatie
i d = Id
0..*
«Role»
« Participation »
:AssignedEntityIdentified CMET
:Performe r
id = S pecialism eCode of Zorgverlener
Michael van der Zel april 7th, 2009
42. Rudimentary Templates Viewer
http://digizorgo1.umcg.nl/Templates.WebApplication/
Michael van der Zel april 7th, 2009
43. OID Registry
https://www.surfgroepen.nl/personal/michael_vanderzel/Lists/OID%20Registry/AllItems.aspx
Michael van der Zel april 7th, 2009
44. Document Services
UMCG CDA Implementation Guide
●
Modelled after IHE XDS
●
Virtual to make our archives
●
standards compliant
Move to full IHE XDS
●
compliance
Michael van der Zel april 7th, 2009
45. Used Standards
EHR-S-FM
PKI
Michael van der Zel april 7th, 2009
47. Conclusions 1/2
Querytool Essential
●
Paradigm Shift (Monilite > SOA > Semantic SOA CSI)
●
We need: “Let's make this work!”
●
instead of “Is this the way to go?”
Use standards as jump starts
●
Michael van der Zel april 7th, 2009
48. Conclusions 2/2
Tooling constrains developers
●
When .Net or Java would provide a HL7 framework &
guidance they will use it.
Standards give jump start to design and
●
implementation, but current design/developers
don't know how to integrate this into their process.
They want to start from scratch.
Michael van der Zel april 7th, 2009
51. Content Modeling
HL7 v3 Templates
●
Detailed Clinical Models (ISO)
●
Archetypes
●
HealthVault Things
●
Google Health
●
Michael van der Zel april 7th, 2009
52. Building Block
M
C
D
Electronic Health Records
RIMBAA
Michael van der Zel april 7th, 2009
53. William Goossen DCM sum up
20 februari 2009
“DCM = clinical concepts (blood pressure, Apgar score,
Glasgow Coma scale and a milion others)
with a slot binding to terminology for code
with a UML representation similar to DAM but
detailed level
with a HL7 v3 (XML) representation to fit the clinical
statement and its use in CDA and Message
with a OpenEHR/ 13606 archetype
with a screen design
with a database table suggestion
with XYZ upon request.”
Michael van der Zel april 7th, 2009
55. DCM's under Development
Evolution of “Zorginformatiemodellen”
●
NICTIZ – Results4Care / Patient Care
●
BMI, Weight, Length
●
Body Temperature
●
Vital Signs
●
Scores and Scales
●
Allergies
●
UMCG Patient History, TNM
●
String-of-Pearls Dutch Biobank
●
Michael van der Zel april 7th, 2009
56. DCM
Patterns, Score, Scale, Finding, Conclusion
●
extends mechanism; KNO Oncology Diagnosis
●
extends Generic Diagnosis
Tool Chain
●
CIM
●
Examples
●
Implicit Rules for transformations
●
Michael van der Zel april 7th, 2009
57. Together with William / ISO
XMI Export
●
> RTF Document
> Spreadsheet Mapping Table
> HL7 v3 Template XML
Michael van der Zel april 7th, 2009
59. More Info
Email
●
m.van.der.zel AT ict.umcg.nl
●
Wiki
●
RIMBAA-NL http://hl7book.net
●
RIMBAA http://wiki.hl7.org/index.php?title=RIMBAA
●
Blog
●
My Healthcare SOA http://hl42.blogspot.com
●
Michael van der Zel april 7th, 2009