Theera-Ampornpunt N. HL7 Clinical Document Architecture: overview and applications. Presented at: HL7 CDA Workshop at the Faculty of Medicine Ramathibodi Hospital; 2013 Jun 20-21; Bangkok, Thailand. Invited speaker, in Thai.
Earn your Child Development Associates credential in as little as 3 months. Online training can be completed in 12 weeks. http://altheapenn.tripod.com/id35.html
The document provides an introduction to FHIR (Fast Healthcare Interoperability Resources). It outlines some of the limitations of previous HL7 standards like V3 being too complex and documents (CDA) not being sufficient. It notes the need for a transition path from V2 and something to address new markets. FHIR is presented as a new approach that is focused on implementers and uses resources as the basic building block. Each resource has its own model and unique ID. The goal is to make implementation easier compared to previous standards.
FHIR for Developers tutorial as given during the HL7 WGM meetings. Good introductory text for developers getting started with FHIR, HL7's new messaging standard for healthcare.
This document provides background information on New Zealand's national maternity system called BadgerNet. It discusses the existing national programs and governance structure in place. BadgerNet is being rolled out nationally as an end-to-end maternity information system to record information from conception to six weeks postnatal. It will be used across District Health Boards and in the community. The financial model and implementation process are also outlined.
The second lecture of the course I'm giving on "Interoperability and Semantic Technologies" at Politecnico di Milano in the academic year 2015-16. It discusses interoperability using HL7 v2 and v3 as examples of syntactic and semantic interoperability, respectively.
Hl7 2016 baltimore connectathon provider directories and schedulingDavid Hay
This document discusses testing and proposed updates to Argonaut profiles for provider directories and scheduling resources. It summarizes discussions on the Endpoint resource, including proposed changes to address issues with cardinalities, value sets, and properties. It also begins drafting extensions to the Endpoint connectionType.
Theera-Ampornpunt N. HL7 Clinical Document Architecture: overview and applications. Presented at: HL7 CDA Workshop at the Faculty of Medicine Ramathibodi Hospital; 2013 Jun 20-21; Bangkok, Thailand. Invited speaker, in Thai.
Earn your Child Development Associates credential in as little as 3 months. Online training can be completed in 12 weeks. http://altheapenn.tripod.com/id35.html
The document provides an introduction to FHIR (Fast Healthcare Interoperability Resources). It outlines some of the limitations of previous HL7 standards like V3 being too complex and documents (CDA) not being sufficient. It notes the need for a transition path from V2 and something to address new markets. FHIR is presented as a new approach that is focused on implementers and uses resources as the basic building block. Each resource has its own model and unique ID. The goal is to make implementation easier compared to previous standards.
FHIR for Developers tutorial as given during the HL7 WGM meetings. Good introductory text for developers getting started with FHIR, HL7's new messaging standard for healthcare.
This document provides background information on New Zealand's national maternity system called BadgerNet. It discusses the existing national programs and governance structure in place. BadgerNet is being rolled out nationally as an end-to-end maternity information system to record information from conception to six weeks postnatal. It will be used across District Health Boards and in the community. The financial model and implementation process are also outlined.
The second lecture of the course I'm giving on "Interoperability and Semantic Technologies" at Politecnico di Milano in the academic year 2015-16. It discusses interoperability using HL7 v2 and v3 as examples of syntactic and semantic interoperability, respectively.
Hl7 2016 baltimore connectathon provider directories and schedulingDavid Hay
This document discusses testing and proposed updates to Argonaut profiles for provider directories and scheduling resources. It summarizes discussions on the Endpoint resource, including proposed changes to address issues with cardinalities, value sets, and properties. It also begins drafting extensions to the Endpoint connectionType.
This document provides an introduction and progress report on FHIR (Fast Healthcare Interoperability Resources). Key points:
- FHIR is a new, implementer-friendly standard for healthcare interoperability that has generated significant interest internationally.
- The core infrastructure is in draft form and several clinical domains are actively working on defining FHIR resources.
- FHIR can be used for RESTful exchanges, documents, messages, services, and integrating with XDS standards.
- The goal is to have more resources balloted in 2013 and release a draft standard for trial use in 2014.
Overview of the popHealth® open source population health and CQM Reporting system. Includes information on eHealthConnecticut FQHC implementation of popHealth®. Description of CCDs and QRDAs as well as pros and cons of using each. Includes popHealth® screen shots. Presented by Jackie Mulhall, eHCT, at Connecting Michigan for Health Conference June 2014.
The document discusses securing FHIR (Fast Healthcare Interoperability Resources) APIs with OAuth. It provides an overview of security considerations for FHIR including communications security, authentication, authorization, audit logs, digital signatures, attachments, and security labels. It then explains how OAuth can be used to authenticate clients and authorize access to patient data while allowing patients to retain control over their personal health information and grant access on a granular, as-needed basis.
Introduction to FHIR - New Zealand Seminar, June 2014David Hay
This document provides an overview of HL7 FHIR (Fast Healthcare Interoperability Resources) and why it is important. The agenda includes an introduction to FHIR, specialized use cases, and a deep dive for architects and developers. FHIR uses standardized "resources" and defines operations like search, read and update via RESTful web services. Resources can be combined into documents and messages to exchange clinical data between systems in a standards-based way. FHIR is gaining international adoption due to its focus on implementers and use of modern web standards.
Accessing SNOMED CT With FHIR Terminology ServicesPeter Jordan
The document discusses using FHIR terminology services to access SNOMED CT. It describes the complexity of terminologies and need for consistent implementation. FHIR provides a standard way to build terminology APIs to address common application needs like retrieving codes, validation, translation and search. Value sets in FHIR can represent subsets of codes from SNOMED CT and be expanded for use. A New Zealand implementation example is provided.
A profit maximization scheme with guaranteednexgentech15
Nexgen Technology Address:
Nexgen Technology
No :66,4th cross,Venkata nagar,
Near SBI ATM,
Puducherry.
Email Id: praveen@nexgenproject.com.
www.nexgenproject.com
Mobile: 9751442511,9791938249
Telephone: 0413-2211159.
NEXGEN TECHNOLOGY as an efficient Software Training Center located at Pondicherry with IT Training on IEEE Projects in Android,IEEE IT B.Tech Student Projects, Android Projects Training with Placements Pondicherry, IEEE projects in pondicherry, final IEEE Projects in Pondicherry , MCA, BTech, BCA Projects in Pondicherry, Bulk IEEE PROJECTS IN Pondicherry.So far we have reached almost all engineering colleges located in Pondicherry and around 90km
The speaker discusses mapping CDA (Clinical Document Architecture) documents to FHIR (Fast Healthcare Interoperability Resources). CDA was difficult to construct and read, while FHIR provides a more streamlined approach. A joint project maps CDA elements to FHIR specifications and profiles to define the relationship between the standards. The goal is a common syntax and resources that support both documents and APIs, with CDA documents eventually represented in FHIR.
The document discusses the FHIR API for .NET programmers. It provides an overview of the HL7.Fhir library, including the model classes, parsers, serializers, FhirClient for REST functionality, and validation capabilities. It also gives examples of creating and working with FHIR resources, parsing, serializing, performing REST operations, and validating resources in C#.
Generation of cda xml schema from dicom images using hl7 standard 2IAEME Publication
This document discusses generating CDA/XML schemas from DICOM images using the HL7 standard. It describes how HL7 CDA can be used to interface DICOM and HL7 formats. The process involves extracting data from DICOM images stored in a PACS archive, generating CDA-XML documents from the extracted data, and transmitting patient information summaries using HL7 messages. The research aims to improve interoperability between medical software applications and enable sharing of patient data.
This ppt is prepared for zeroth level presentation for the B - TECH project on the topic "Design and Implementation of Improved Authentication System for Android Smartphone Users". we also add the application of the upgraded locking system in lost phone detection procedure
This document proposes standards and solutions for healthcare data exchange and interoperability. It discusses the goals of electronically exchanging health information while maintaining meaning. Standards discussed include HL7, RBAC, ABAC, PBAC, and XACML for access control policies. Implementing attribute-based access control is proposed to allow flexible, multi-factor access decisions. Integrating the Healthcare Enterprise (IHE) and Oracle Entitlement Server are presented as initiatives supporting interoperability and fine-grained authorization.
This document summarizes a presentation on FHIR terminology given by Lloyd McKenzie at the FHIR Developer Days on November 25, 2014. The presentation covered how coded data is shared in FHIR using bindings and value sets, the process for creating and using value sets, and the future of FHIR terminology. The objectives of the tutorial were to explain how coded data is shared in FHIR, understand bindings and profiling vocabulary, learn the process for creating and using value sets, and discuss the future of FHIR terminology.
The document discusses techniques for detecting duplicate web pages. It introduces the problem of finding similar pages, or near duplicates, among the billions of pages on the web. It describes algorithms like minhashing and shingling that represent documents as sketches to efficiently estimate similarity and find near duplicate pairs without comparing all possible pairs. The techniques were evaluated on a dataset of 1.6 billion web pages, and precision results are reported, with minhashing showing potential to effectively detect duplicate and near duplicate web content at scale.
Conditional identity based broadcast proxy re-encryption and its application ...ieeepondy
This paper proposes a new cryptographic primitive called conditional identity-based broadcast proxy re-encryption (CIBPRE) that allows a sender to encrypt a message for multiple receivers using their identities. The sender can then delegate a re-encryption key to a proxy to convert the ciphertext into a new one for a different set of receivers, conditioned on a certain attribute. An efficient CIBPRE scheme is presented with constant-sized ciphertexts and keys. Finally, the paper discusses how CIBPRE can be applied to build a secure cloud email system.
This document provides an agenda and overview for an HL7 FHIR for Developers workshop in Auckland, New Zealand in June 2016. The workshop will cover FHIR resources, profiling, exchange, and moving forward with FHIR. Optional afternoon sessions will focus on exporting legacy content, FHIR referrals, provider directories, integrating with SMART on FHIR, and clinical FHIR. Attendees will learn about FHIR terminology standards like SNOMED CT and how to represent clinical information using FHIR resources and profiles.
The Diabetes Discovery Project at Austin Health aimed to use their Cerner EMR system to routinely test HbA1c levels on inpatients over 54 to identify undiagnosed and poorly controlled diabetes. Testing of over 5,000 patients found 5% had undiagnosed diabetes and 29% had known diabetes. Higher HbA1c levels were associated with increased hospital admissions and longer lengths of stay for surgical patients. The project demonstrated using health IT to identify diabetes management opportunities. Ongoing work includes refining protocols and expanding to other patient populations.
The forth lecture of the course I'm giving on "Interoperability and Semantic Technologies" at Politecnico di Milano in the academic year 2015-16. It presents an introduction to RDF. It starts presenting the data model. Then it presents the turtle serialization. It compares XML vs. RDF. Finally, it provides few informations about RDFa and Linked Data.
A study and survey on various progressive duplicate detection mechanismseSAT Journals
Abstract One of the serious problems faced in several applications with personal details management, customer affiliation management, data mining, etc is duplicate detection. This survey deals with the various duplicate record detection techniques in both small and large datasets. To detect the duplicity with less time of execution and also without disturbing the dataset quality, methods like Progressive Blocking and Progressive Neighborhood are used. Progressive sorted neighborhood method also called as PSNM is used in this model for finding or detecting the duplicate in a parallel approach. Progressive Blocking algorithm works on large datasets where finding duplication requires immense time. These algorithms are used to enhance duplicate detection system. The efficiency can be doubled over the conventional duplicate detection method using this algorithm. Severa
The document discusses SMART on FHIR, a specification for creating medical applications that can run across different electronic health record systems. It was created to facilitate sharing of clinical knowledge through interactive apps. The specification addresses challenges like defining a data model, security protocols using OAuth2 and OpenID Connect, and user interface integration. It also describes using FHIR resources and profiles to define the data contracts apps need to exchange data. The goal is to allow developers to create substitutable apps that improve care without being restricted to a single EHR vendor.
TO GET THIS PROJECT COMPLETE SOURCE ON SUPPORT WITH EXECUTION PLEASE CALL BELOW CONTACT DETAILS
MOBILE: 9791938249, 0413-2211159, WEB: WWW.NEXGENPROJECT.COM,WWW.FINALYEAR-IEEEPROJECTS.COM, EMAIL:Praveen@nexgenproject.com
NEXGEN TECHNOLOGY provides total software solutions to its customers. Apsys works closely with the customers to identify their business processes for computerization and help them implement state-of-the-art solutions. By identifying and enhancing their processes through information technology solutions. NEXGEN TECHNOLOGY help it customers optimally use their resources.
The document provides an update on the Trillium Bridge Project, which aims to build a bridge for the exchange of patient summaries across the Atlantic. It summarizes that the project is conducting a feasibility study comparing US and EU patient summary standards to identify gaps and barriers to exchange. It also outlines the technical architecture and pilot use cases being developed to test cross-border exchange of patient summaries between the US and EU.
Smart Service DesignThe design of smart services in the world of people, pro...Shaun West
You should read this if:
... you want to understand how digital can enable new value propositions for your business
... you want to gain inspiration from real industrial cases
... you want to create a family of smart twin to help your business.
The handbook‘s purpose is to formalize the lessons learnt from an Innosuisse- funded project where over twenty different Digital Twin-based use cases were developed in collaboration between ten partners. During the project, we learnt many things: the Digital Twins helped us create new innovative smart services, formalize tacit knowledge, and improve decision-making. Perhaps most important was that the design of the Digital Twin was best achieved based on (business) questions. The Digital Twin enables the development of Smart Services within complex systems. For this reason, we called the project Smart Twins – not because of the incredible technology but because of the services they supported. The handbook includes sections describing innovation processes for Smart Services, the prototyping phases, and Digital Twin based business models. The handbook also provides hands-on descriptions on how to use methods, tools, and approaches while working on a project focusing on the development of Smart Services. The handbook focuses on complex product-service systems (PSS) composed of people, processes, and things. Product-service systems are all around us, and they are used on a day-to-day basis, e.g., smartphones; they consist of tangible products and many services. Some of the services are more visible than others, remembering that there cannot be (smart) products without a service of some description. Product-service systems can be complex, and with digitalization, complexity increases distinctly. Depending on perspectives, the focus can be on efficiency or out- comes. Considering such product-service systems, it is evident that boundaries are cross-functional and cross-organizational.
This document provides an introduction and progress report on FHIR (Fast Healthcare Interoperability Resources). Key points:
- FHIR is a new, implementer-friendly standard for healthcare interoperability that has generated significant interest internationally.
- The core infrastructure is in draft form and several clinical domains are actively working on defining FHIR resources.
- FHIR can be used for RESTful exchanges, documents, messages, services, and integrating with XDS standards.
- The goal is to have more resources balloted in 2013 and release a draft standard for trial use in 2014.
Overview of the popHealth® open source population health and CQM Reporting system. Includes information on eHealthConnecticut FQHC implementation of popHealth®. Description of CCDs and QRDAs as well as pros and cons of using each. Includes popHealth® screen shots. Presented by Jackie Mulhall, eHCT, at Connecting Michigan for Health Conference June 2014.
The document discusses securing FHIR (Fast Healthcare Interoperability Resources) APIs with OAuth. It provides an overview of security considerations for FHIR including communications security, authentication, authorization, audit logs, digital signatures, attachments, and security labels. It then explains how OAuth can be used to authenticate clients and authorize access to patient data while allowing patients to retain control over their personal health information and grant access on a granular, as-needed basis.
Introduction to FHIR - New Zealand Seminar, June 2014David Hay
This document provides an overview of HL7 FHIR (Fast Healthcare Interoperability Resources) and why it is important. The agenda includes an introduction to FHIR, specialized use cases, and a deep dive for architects and developers. FHIR uses standardized "resources" and defines operations like search, read and update via RESTful web services. Resources can be combined into documents and messages to exchange clinical data between systems in a standards-based way. FHIR is gaining international adoption due to its focus on implementers and use of modern web standards.
Accessing SNOMED CT With FHIR Terminology ServicesPeter Jordan
The document discusses using FHIR terminology services to access SNOMED CT. It describes the complexity of terminologies and need for consistent implementation. FHIR provides a standard way to build terminology APIs to address common application needs like retrieving codes, validation, translation and search. Value sets in FHIR can represent subsets of codes from SNOMED CT and be expanded for use. A New Zealand implementation example is provided.
A profit maximization scheme with guaranteednexgentech15
Nexgen Technology Address:
Nexgen Technology
No :66,4th cross,Venkata nagar,
Near SBI ATM,
Puducherry.
Email Id: praveen@nexgenproject.com.
www.nexgenproject.com
Mobile: 9751442511,9791938249
Telephone: 0413-2211159.
NEXGEN TECHNOLOGY as an efficient Software Training Center located at Pondicherry with IT Training on IEEE Projects in Android,IEEE IT B.Tech Student Projects, Android Projects Training with Placements Pondicherry, IEEE projects in pondicherry, final IEEE Projects in Pondicherry , MCA, BTech, BCA Projects in Pondicherry, Bulk IEEE PROJECTS IN Pondicherry.So far we have reached almost all engineering colleges located in Pondicherry and around 90km
The speaker discusses mapping CDA (Clinical Document Architecture) documents to FHIR (Fast Healthcare Interoperability Resources). CDA was difficult to construct and read, while FHIR provides a more streamlined approach. A joint project maps CDA elements to FHIR specifications and profiles to define the relationship between the standards. The goal is a common syntax and resources that support both documents and APIs, with CDA documents eventually represented in FHIR.
The document discusses the FHIR API for .NET programmers. It provides an overview of the HL7.Fhir library, including the model classes, parsers, serializers, FhirClient for REST functionality, and validation capabilities. It also gives examples of creating and working with FHIR resources, parsing, serializing, performing REST operations, and validating resources in C#.
Generation of cda xml schema from dicom images using hl7 standard 2IAEME Publication
This document discusses generating CDA/XML schemas from DICOM images using the HL7 standard. It describes how HL7 CDA can be used to interface DICOM and HL7 formats. The process involves extracting data from DICOM images stored in a PACS archive, generating CDA-XML documents from the extracted data, and transmitting patient information summaries using HL7 messages. The research aims to improve interoperability between medical software applications and enable sharing of patient data.
This ppt is prepared for zeroth level presentation for the B - TECH project on the topic "Design and Implementation of Improved Authentication System for Android Smartphone Users". we also add the application of the upgraded locking system in lost phone detection procedure
This document proposes standards and solutions for healthcare data exchange and interoperability. It discusses the goals of electronically exchanging health information while maintaining meaning. Standards discussed include HL7, RBAC, ABAC, PBAC, and XACML for access control policies. Implementing attribute-based access control is proposed to allow flexible, multi-factor access decisions. Integrating the Healthcare Enterprise (IHE) and Oracle Entitlement Server are presented as initiatives supporting interoperability and fine-grained authorization.
This document summarizes a presentation on FHIR terminology given by Lloyd McKenzie at the FHIR Developer Days on November 25, 2014. The presentation covered how coded data is shared in FHIR using bindings and value sets, the process for creating and using value sets, and the future of FHIR terminology. The objectives of the tutorial were to explain how coded data is shared in FHIR, understand bindings and profiling vocabulary, learn the process for creating and using value sets, and discuss the future of FHIR terminology.
The document discusses techniques for detecting duplicate web pages. It introduces the problem of finding similar pages, or near duplicates, among the billions of pages on the web. It describes algorithms like minhashing and shingling that represent documents as sketches to efficiently estimate similarity and find near duplicate pairs without comparing all possible pairs. The techniques were evaluated on a dataset of 1.6 billion web pages, and precision results are reported, with minhashing showing potential to effectively detect duplicate and near duplicate web content at scale.
Conditional identity based broadcast proxy re-encryption and its application ...ieeepondy
This paper proposes a new cryptographic primitive called conditional identity-based broadcast proxy re-encryption (CIBPRE) that allows a sender to encrypt a message for multiple receivers using their identities. The sender can then delegate a re-encryption key to a proxy to convert the ciphertext into a new one for a different set of receivers, conditioned on a certain attribute. An efficient CIBPRE scheme is presented with constant-sized ciphertexts and keys. Finally, the paper discusses how CIBPRE can be applied to build a secure cloud email system.
This document provides an agenda and overview for an HL7 FHIR for Developers workshop in Auckland, New Zealand in June 2016. The workshop will cover FHIR resources, profiling, exchange, and moving forward with FHIR. Optional afternoon sessions will focus on exporting legacy content, FHIR referrals, provider directories, integrating with SMART on FHIR, and clinical FHIR. Attendees will learn about FHIR terminology standards like SNOMED CT and how to represent clinical information using FHIR resources and profiles.
The Diabetes Discovery Project at Austin Health aimed to use their Cerner EMR system to routinely test HbA1c levels on inpatients over 54 to identify undiagnosed and poorly controlled diabetes. Testing of over 5,000 patients found 5% had undiagnosed diabetes and 29% had known diabetes. Higher HbA1c levels were associated with increased hospital admissions and longer lengths of stay for surgical patients. The project demonstrated using health IT to identify diabetes management opportunities. Ongoing work includes refining protocols and expanding to other patient populations.
The forth lecture of the course I'm giving on "Interoperability and Semantic Technologies" at Politecnico di Milano in the academic year 2015-16. It presents an introduction to RDF. It starts presenting the data model. Then it presents the turtle serialization. It compares XML vs. RDF. Finally, it provides few informations about RDFa and Linked Data.
A study and survey on various progressive duplicate detection mechanismseSAT Journals
Abstract One of the serious problems faced in several applications with personal details management, customer affiliation management, data mining, etc is duplicate detection. This survey deals with the various duplicate record detection techniques in both small and large datasets. To detect the duplicity with less time of execution and also without disturbing the dataset quality, methods like Progressive Blocking and Progressive Neighborhood are used. Progressive sorted neighborhood method also called as PSNM is used in this model for finding or detecting the duplicate in a parallel approach. Progressive Blocking algorithm works on large datasets where finding duplication requires immense time. These algorithms are used to enhance duplicate detection system. The efficiency can be doubled over the conventional duplicate detection method using this algorithm. Severa
The document discusses SMART on FHIR, a specification for creating medical applications that can run across different electronic health record systems. It was created to facilitate sharing of clinical knowledge through interactive apps. The specification addresses challenges like defining a data model, security protocols using OAuth2 and OpenID Connect, and user interface integration. It also describes using FHIR resources and profiles to define the data contracts apps need to exchange data. The goal is to allow developers to create substitutable apps that improve care without being restricted to a single EHR vendor.
TO GET THIS PROJECT COMPLETE SOURCE ON SUPPORT WITH EXECUTION PLEASE CALL BELOW CONTACT DETAILS
MOBILE: 9791938249, 0413-2211159, WEB: WWW.NEXGENPROJECT.COM,WWW.FINALYEAR-IEEEPROJECTS.COM, EMAIL:Praveen@nexgenproject.com
NEXGEN TECHNOLOGY provides total software solutions to its customers. Apsys works closely with the customers to identify their business processes for computerization and help them implement state-of-the-art solutions. By identifying and enhancing their processes through information technology solutions. NEXGEN TECHNOLOGY help it customers optimally use their resources.
The document provides an update on the Trillium Bridge Project, which aims to build a bridge for the exchange of patient summaries across the Atlantic. It summarizes that the project is conducting a feasibility study comparing US and EU patient summary standards to identify gaps and barriers to exchange. It also outlines the technical architecture and pilot use cases being developed to test cross-border exchange of patient summaries between the US and EU.
Smart Service DesignThe design of smart services in the world of people, pro...Shaun West
You should read this if:
... you want to understand how digital can enable new value propositions for your business
... you want to gain inspiration from real industrial cases
... you want to create a family of smart twin to help your business.
The handbook‘s purpose is to formalize the lessons learnt from an Innosuisse- funded project where over twenty different Digital Twin-based use cases were developed in collaboration between ten partners. During the project, we learnt many things: the Digital Twins helped us create new innovative smart services, formalize tacit knowledge, and improve decision-making. Perhaps most important was that the design of the Digital Twin was best achieved based on (business) questions. The Digital Twin enables the development of Smart Services within complex systems. For this reason, we called the project Smart Twins – not because of the incredible technology but because of the services they supported. The handbook includes sections describing innovation processes for Smart Services, the prototyping phases, and Digital Twin based business models. The handbook also provides hands-on descriptions on how to use methods, tools, and approaches while working on a project focusing on the development of Smart Services. The handbook focuses on complex product-service systems (PSS) composed of people, processes, and things. Product-service systems are all around us, and they are used on a day-to-day basis, e.g., smartphones; they consist of tangible products and many services. Some of the services are more visible than others, remembering that there cannot be (smart) products without a service of some description. Product-service systems can be complex, and with digitalization, complexity increases distinctly. Depending on perspectives, the focus can be on efficiency or out- comes. Considering such product-service systems, it is evident that boundaries are cross-functional and cross-organizational.
The document provides an update on the Trillium Bridge Project, which aims to study the feasibility of exchanging patient summaries across the Atlantic by comparing and mapping patient summaries from the EU and US. It discusses the project objectives, use cases, technical architecture, achievements so far including a gap analysis, and future work such as providing interoperability assets and informing standardization efforts. The project aims to help lower costs of transatlantic healthcare engagement and accelerate global standards convergence for patient summaries.
The Internet is currently the largest network of communication worldwide and is where technological advances could be observed. The original creation of the Internet was based on the idea that this network would be formed mainly by multiple independent networks with an arbitrary design. The Internet is the place where all countries communicate and disseminate information in real time, this phenomenon directly affects economies, businesses, and society. This article shows what the future of the Internet is, our research carries out a qualitative prospective analysis on projects and investigations in which the scientific community is currently working, the information is analyzed, and the highlighted topics are shown.
The document summarizes a training event on trusted digital repositories that took place in Vilnius, Lithuania from October 1-5, 2007. It discusses key initiatives and standards for digital preservation and certification of trusted repositories, including the nestor criteria catalogue. The nestor network aims to create a framework of trustworthy long-term digital archives. The document outlines criteria for organizational framework, object management, and infrastructure/security that repositories should address.
LOCAH Project and Considerations of Linked Data ApproachesAdrian Stevenson
Presentation given at JISC 'Managing Research Data International Workshop', Birmingham, UK. 29th March 2011
http://www.jisc.ac.uk/whatwedo/programmes/mrd/rdmevents/mrdinternationalworkshop.aspx
The Trillium Bridge project aims to lower the costs of transatlantic engagement in eHealth by building a bridge for the exchange of patient summaries between Europe and the United States. The project has completed a gap analysis between US and EU patient summary standards and developed a terminology service and proof of concept transformer. Current work includes refining interoperability assets and testing with EU countries and US providers to set a precedent for global eHealth interoperability.
SNOMED CT in the clinical data standards landscape THL
SNOMED CT in the clinical data standards landscape: Where does it fit and how should we use it?
Robert Hausam, Hausam Consulting LLC
SNOMED CT 2019 -seminaari (28.3.2019)
SRTD is an EU-funded program that aims to support research and innovation initiatives in Jordan through technology transfer activities. It plans to create a national technology transfer program and intellectual property commercialization office to connect researchers, universities, and businesses. This will help bridge the gap between science and business by establishing technology transfer branch offices throughout Jordan that are hosted in research centers, universities, and business organizations. The goal is to help define demand from SMEs and identify relevant research, as well as define available research that could benefit SMEs. SRTD will provide training, consulting, and internships in 2010 to help build capacity for technology transfer in Jordan.
Ensuring that an organisation's digital assets are safe, secure and accessible for the long term should (in theory) be an interesting, responsible and useful role for anyone in an organisation to accept. The critical importance of digital assets, the ubiquity of digital methods and the need for people in all walks of life to have effective means to refer to persistent sources of data reinforce this notion. How is it then that long-term asset management, information lifecycle management, data curation, digital preservation (call it what you will) is often regarded as a peripheral specialist activity that it is diffcult to resource, complex to carry out, and delivers benefits that are, at best, simply an insurance policy rather than an activity that adds value to an organisation?
This presentation will examine the importance of defining clear roles for those involved with digital preservation and will consider the importance of associating this professional activity with strategic and tactical frameworks. It is likely that automated services will increasingly be required to deal with the collosal amount of digital information that will be produced and consumed over the next century and whilst the type and nature of these services are yet to be defined, we can be fairly certain of one endurng requirement, namely, that human judgement will always be needed to curate interesting and useful content for future generations.
This document discusses open standards and open data. It provides background on open data initiatives in the UK from 2006 to 2012. It also discusses the definition and importance of open standards, giving examples of standards used for plug sockets, audio files and Microsoft Office documents. Open standards are defined as standards developed through an open process, published freely and able to be implemented by multiple vendors. The document advocates for open standards and data to ensure interoperability between systems.
OWF14 - Legal and licensing aspects of Open Source - Procurement of open sour...Paris Open Source Summit
This document summarizes a presentation by Björn Lundell on the procurement of open source software that implements open standards. It discusses the benefits of avoiding lock-in through the use of open standards and open source, including long-term access and preservation of digital assets. Open standards should be fully specified, available without dependencies on vendors, and implemented in long-term open source projects. Procurement that refers to open standards implemented in this way can minimize risks.
Ontology based top-k query answering over massive, heterogeneous, and dynamic...Daniele Dell'Aglio
This document discusses ontology-based top-k continuous query answering over streaming data from multiple heterogeneous sources. It aims to investigate how ontologies and top-k queries can improve continuous query processing by exploiting ordering. The research will analyze state of the art solutions, define an evaluation framework, and assess the effects on correctness and performance of techniques that integrate stream reasoning and top-k queries. Preliminary results include an extension of an RDF stream processor testbench and a case study on real-time social media analytics.
Building a semantic-based decision support system to optimize the energy use ...Gonçal Costa Jutglar
The document describes a semantic decision support system called OPTIMUS that optimizes energy use in public buildings. OPTIMUS integrates data from various sources like weather forecasts, social media, occupancy sensors, energy prices and renewable energy production. It uses a semantic framework including an ontology to model this multidisciplinary data. Prediction models use historical data to forecast building behavior. Inference rules then suggest short-term action plans based on the predictions and real-time monitored data. The system interfaces display this information to support user decisions. It was tested in pilot cities to optimize actions like HVAC scheduling and electricity self-consumption or feeding to the grid.
The National Institute for Health Innovation aims to promote innovation in health technology through education, research, and collaboration. It operates the Health Technology Laboratory, a neutral environment where researchers can develop, test, and evaluate new technologies and ways of applying health informatics, with projects ranging from modeling to using robots in healthcare settings. The lab provides infrastructure, software, data access, and a place for collaborative work to advance health technology research.
Health Information Strategy Action Committee (HISAC) IHEHL7 New Zealand
The document discusses the Health Information Strategy Action Committee (HISAC) and its role in implementing New Zealand's Health Information Strategy (HIS-NZ) through 12 priority areas. It provides updates on the progress made in developing standards to enable interoperability between health systems, including the release of several messaging and data standards. It also outlines HISAC's work with various sector groups to develop frameworks and policies to further improve health information sharing and system connectivity nationally.
IHE Distributing Images: Cross-enterprise Document Sharing for Imaging (XDS-I)HL7 New Zealand
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The document provides an overview of Cross-Enterprise Document Sharing (XDS), including its actors, transactions, integration with other standards like PIX/PDQ, and use of profiles like ATNA. XDS allows clinical documents from different organizations to be indexed and queried in a shared registry, providing access to patient health records across different clinical IT systems in a standards-based way.
IHE provides a framework for implementing multiple healthcare IT standards to address specific clinical needs. It has grown from a project launched in 1998 involving healthcare providers, vendors, and standards groups. IHE defines integration profiles that specify how standards should be implemented together to enable interoperability. Examples include profiles for image and report sharing within and between healthcare enterprises using standards like DICOM and HL7.
Your One-Stop Shop for Python Success: Top 10 US Python Development Providersakankshawande
Simplify your search for a reliable Python development partner! This list presents the top 10 trusted US providers offering comprehensive Python development services, ensuring your project's success from conception to completion.
Building Production Ready Search Pipelines with Spark and MilvusZilliz
Spark is the widely used ETL tool for processing, indexing and ingesting data to serving stack for search. Milvus is the production-ready open-source vector database. In this talk we will show how to use Spark to process unstructured data to extract vector representations, and push the vectors to Milvus vector database for search serving.
Trusted Execution Environment for Decentralized Process MiningLucaBarbaro3
Presentation of the paper "Trusted Execution Environment for Decentralized Process Mining" given during the CAiSE 2024 Conference in Cyprus on June 7, 2024.
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This slide deck presents DLHT, a concurrent in-memory hashtable. Despite efforts to optimize hashtables, that go as far as sacrificing core functionality, state-of-the-art designs still incur multiple memory accesses per request and block request processing in three cases. First, most hashtables block while waiting for data to be retrieved from memory. Second, open-addressing designs, which represent the current state-of-the-art, either cannot free index slots on deletes or must block all requests to do so. Third, index resizes block every request until all objects are copied to the new index. Defying folklore wisdom, DLHT forgoes open-addressing and adopts a fully-featured and memory-aware closed-addressing design based on bounded cache-line-chaining. This design offers lock-free index operations and deletes that free slots instantly, (2) completes most requests with a single memory access, (3) utilizes software prefetching to hide memory latencies, and (4) employs a novel non-blocking and parallel resizing. In a commodity server and a memory-resident workload, DLHT surpasses 1.6B requests per second and provides 3.5x (12x) the throughput of the state-of-the-art closed-addressing (open-addressing) resizable hashtable on Gets (Deletes).
This presentation provides valuable insights into effective cost-saving techniques on AWS. Learn how to optimize your AWS resources by rightsizing, increasing elasticity, picking the right storage class, and choosing the best pricing model. Additionally, discover essential governance mechanisms to ensure continuous cost efficiency. Whether you are new to AWS or an experienced user, this presentation provides clear and practical tips to help you reduce your cloud costs and get the most out of your budget.
Skybuffer AI: Advanced Conversational and Generative AI Solution on SAP Busin...Tatiana Kojar
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With Skybuffer AI, various AI models can be integrated into a single communication channel such as Microsoft Teams. This integration empowers business users with insights drawn from SAP backend systems, enterprise documents, and the expansive knowledge of Generative AI. And the best part of it is that it is all managed through our intuitive no-code Action Server interface, requiring no extensive coding knowledge and making the advanced AI accessible to more users.
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An English 🇬🇧 translation of a presentation to the speech I gave about the main changes brought by CCS TSI 2023 at the biggest Czech conference on Communications and signalling systems on Railways, which was held in Clarion Hotel Olomouc from 7th to 9th November 2023 (konferenceszt.cz). Attended by around 500 participants and 200 on-line followers.
The original Czech 🇨🇿 version of the presentation can be found here: https://www.slideshare.net/slideshow/hlavni-novinky-souvisejici-s-ccs-tsi-2023-2023-1695/269688092 .
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Webinar Recording: https://www.panagenda.com/webinars/hcl-notes-und-domino-lizenzkostenreduzierung-in-der-welt-von-dlau/
DLAU und die Lizenzen nach dem CCB- und CCX-Modell sind für viele in der HCL-Community seit letztem Jahr ein heißes Thema. Als Notes- oder Domino-Kunde haben Sie vielleicht mit unerwartet hohen Benutzerzahlen und Lizenzgebühren zu kämpfen. Sie fragen sich vielleicht, wie diese neue Art der Lizenzierung funktioniert und welchen Nutzen sie Ihnen bringt. Vor allem wollen Sie sicherlich Ihr Budget einhalten und Kosten sparen, wo immer möglich. Das verstehen wir und wir möchten Ihnen dabei helfen!
Wir erklären Ihnen, wie Sie häufige Konfigurationsprobleme lösen können, die dazu führen können, dass mehr Benutzer gezählt werden als nötig, und wie Sie überflüssige oder ungenutzte Konten identifizieren und entfernen können, um Geld zu sparen. Es gibt auch einige Ansätze, die zu unnötigen Ausgaben führen können, z. B. wenn ein Personendokument anstelle eines Mail-Ins für geteilte Mailboxen verwendet wird. Wir zeigen Ihnen solche Fälle und deren Lösungen. Und natürlich erklären wir Ihnen das neue Lizenzmodell.
Nehmen Sie an diesem Webinar teil, bei dem HCL-Ambassador Marc Thomas und Gastredner Franz Walder Ihnen diese neue Welt näherbringen. Es vermittelt Ihnen die Tools und das Know-how, um den Überblick zu bewahren. Sie werden in der Lage sein, Ihre Kosten durch eine optimierte Domino-Konfiguration zu reduzieren und auch in Zukunft gering zu halten.
Diese Themen werden behandelt
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Monitoring and Managing Anomaly Detection on OpenShift
Overview
Dive into the world of anomaly detection on edge devices with our comprehensive hands-on tutorial. This SlideShare presentation will guide you through the entire process, from data collection and model training to edge deployment and real-time monitoring. Perfect for those looking to implement robust anomaly detection systems on resource-constrained IoT/edge devices.
Key Topics Covered
1. Introduction to Anomaly Detection
- Understand the fundamentals of anomaly detection and its importance in identifying unusual behavior or failures in systems.
2. Understanding Edge (IoT)
- Learn about edge computing and IoT, and how they enable real-time data processing and decision-making at the source.
3. What is ArgoCD?
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4. Deployment Using ArgoCD for Edge Devices
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5. Introduction to Apache Kafka and S3
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6. Viewing Kafka Messages in the Data Lake
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7. What is Prometheus?
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8. Monitoring Application Metrics with Prometheus
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9. What is Camel K?
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10. Configuring Camel K Integrations for Data Pipelines
- Learn how to configure Camel K for seamless data pipeline integrations in your anomaly detection workflow.
11. What is a Jupyter Notebook?
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12. Jupyter Notebooks with Code Examples
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Digital Marketing Trends in 2024 | Guide for Staying AheadWask
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Feeling lost in the digital marketing whirlwind of 2024? Technology is changing, consumer habits are evolving, and staying ahead of the curve feels like a never-ending pursuit. This e-book is your compass. Dive into actionable insights to handle the complexities of modern marketing. From hyper-personalization to the power of user-generated content, learn how to build long-term relationships with your audience and unlock the secrets to success in the ever-shifting digital landscape.
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See how organizational priorities and strategic approaches to data security and privacy are evolving around the globe.
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1. Fundamentals of CDA & Implementing CDA (30-31 August 2010 , Auckland) A practical hands on, international expert driven training seminar Presented by: Grahame Grieve B.Sc. MAACB. CTO, Kestral Computing P/L Thanks to… HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 1
2. Fundamentals of CDA & Implementing CDA HL7 NZ, August 2010 Grahame Grieve Acknowledgements: Bob Dolin, Rene Spronk HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 2
3. Agenda Day #1: Fundamentals of CDA Background CDA, RIM, Vocab, datatypes, templates… Messages vs Documents & Exchanging CDA Day #2: Implementing CDA Representing Data Models in CDA CDA XML – schemas, schematrons Tools for working with CDA HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 3
4. Agenda for Today Welcome CDA In Depth Exchanging CDA v2 / CDA Comparison HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 4
5. Agenda for Today Welcome Administration Biography Handouts Distribution CDA In Depth Exchanging CDA v2 / CDA Comparison HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 5
6. Grahame’s Bio B Sc Biochemistry (Auckland Uni) Clinical Biochemistry/Medical Research (6 years) Lead Developer CTO, Kestral Computing Clinical & middleware product development Chair, various HL7 Committees (incl CDA) Editor, various standards (templates & data types) Project Lead, Eclipse Open Health Framework HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 6
7. Distribution HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 7
8. Interoperability Ability of two or more systems or components to exchange information and to use the information that has been exchanged. Source: IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries, IEEE, 1990] Functional Interoperability Semantic Interoperability HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 8
9. Three Laws of Interoperability Interoperability: It’s all about the people HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 9
10. Three Laws of Interoperability Interoperability: It’s all about the people You can hide the complexity, or make it worse, but you can’t make it go away HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 10
11. Three Laws of Interoperability Interoperability: It’s all about the people You can hide the complexity, or make it worse, but you can’t make it go away Cheap, flexible, and interoperable: when developing healthcare software, you can have two of these HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 11
12. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 12
13. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 13
14. Interoperability Drive-by Interoperability Vendors with antagonistic relationships Highly variable business arrangements National Program Interoperability Large contracts with efficiency of scale Standardised business practices imposed on variable architecture HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 14
15. Agenda for Today Welcome CDA In Depth (circular) Document characteristics Document Structure CDA Reference model / Data Types Architecture, Templates, Extensibility Implementation guides / CCD Exchanging CDA v2 / CDA Comparison HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 15
16. What is CDA? A document that a human can read Computer can understand Contains clinical content Authored by a human XML “Architecture” – a way to control it’s contents HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 16
17. Where is CDA being used? http://www.google.com/maps/ms?ie=UTF8&oe=UTF8&source=embed&msa=0&msid=110535847732151766411.00047b0b46314e91435c9 HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 17
18. Clinical Documents: Documentation of clinical observations and services Attestation Persistance / Stewardship Own context Potential for authentication (whole, unchanged) Human readable HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 18
19. Clinical Documents: Used for communication & record-keeping Content is somewhat predictable Content must be understood Multi media – not just text (tables, letters, pictures, sounds, videos, hand-drawn diagrams, specimens) For humans & computers Demonstrated authorship & custodianship HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 19
20. Scope of CDA Documents for exchange Does not specify: Storage Creation Management HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 20
21. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 21
22. Parts of a CDA Document <ClinicalDocument> ... CDA Header ... <structuredBody> <section> <text>...</text> <observation>...</observation> <substanceAdministration> <supply>...</supply> </substanceAdministration> <observation> <externalObservation> ... </externalObservation> </observation> </section> <section> <section> ... </section> </section> </structuredBody> </ClinicalDocument> Document Header Body Sections Narrative (Text) Data (Entries) (Observations, Prescriptions, etc) Component Sections HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 22
23. Human Readability Clinical Content must display in a browser (transform) Compromise: This is partly infrastructural Partly the responsibility of the document author – must design according to these rules Often violated (can’t be tested) HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 23
24. Narrative Example <example> <paragraph> <caption styleCode="Bold xHead1">Introduction</caption> Thank you for referring this patient for investigation into <content ID="c1">burnt ears</content>. </paragraph> <list> <caption styleCode="Bold xHead1">Initial Observations</caption> <item>The patient presented in a very confused state.</item> <item> There was extensive damage to the outer ears: <renderMultiMedia referencedObject="i1"> <caption>Photo of left ear</caption> </renderMultiMedia> </item> </list> HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 24
25. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 25
27. Narrative Example <paragraph> <caption styleCode="Bold xHead1">Recommendations</caption> The patient should apply a cream to the outer ears until they are healed. <content revised="insert">The patient should wear a woollen balaclava in the future while ironing his shirts to prevent a re-occurence of the accident<footnote>This has been proven to offer the best protection against a repeat injury. See <linkHtml href="http://www.wikipedia.org/wiki/burnt_ears"> the wikipedia article about burnt ears</linkHtml> for further information.</footnote>.</content> </paragraph> </example> HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 27
28. CDA Narrative Functionally a stripped down version of XHTML Some key differences in scope not intended to be complete documents allow referencing into other content embedded version/change control can easily transform to XHTML Created before XHTML + new work on microformats : may migrate to XHTML HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 28
29. Conformance Must be valid against schema & specification Must use allowed codes Valid with regard to claimed templates (not stated) HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 29
30. Conformance: Receiver Know default values Parse the complete header Be able to render the body Don’t have to read the entries Don’t have to know or validate the templates May make trading partner agreements HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 30
31. Conformance: Originator Properly construct Narrative blocks Does not have to create entries May make trading partner agreements HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 31
32. CDA Content Model Multiple views of the one model RMIM diagram (Static Model) Heirarchical Description (Excel spreadsheet) Schema Narrative MIF Others could be imagined There is only one model HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 32
33. CDA Static Model HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 33
34. RIM (Reference Information Model) Basis of All HL7 V3 designs Fairly abstract (Unified Service Action Model) Act | Participation | Role | Entity Act | ActRelationship Reference Model – metadata A matter of perspective HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 34
35. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 35
36. RMIM/HD RMIM = Refined Message Information Model -> Static Model HD = HMD = Heirarchical (Message) Description A static model is a statement of constraints on a class model. It can also be seen as a class model – but this is an approximation HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 36
37. CDA - ITS The ITS (“Implementation Technology Specification”) describes how abstract concepts in HL7 model are represented in XML The CDA XML is closely based on the ITS XML Naming and Design Rules (NDR) are highly controversial. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 37
38. Basic Structure: not quite UML Header Body / Narrative Data / EntriesClinical Statement HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 38
44. Coding restrictionsHL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 39
45. Structural Vocabulary Each core RIM class has 1 or 2 structural attributes that define its meaning Primary: classCode | typeCode Secondary: moodCode | etc… Values are taken from carefully defined heirarchical vocabulary definitions classCode defines type of class Code defines type of object the class represents HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 40
46.
47.
48.
49. Graphical Elements: Shadows Shadow: a reference to a class defined elsewhere HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 44
50. Graphical Elements: Choices Content can be any one of the classes defined inside the choice box (~abstract class) Relationships outbound from the choice box are shared by all classes in the choice HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 45
51. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 46
52. Hidden Attributes HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 47
53. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 48
54. CDA Header Participants HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 49
55. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 50
56. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 51
57. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 52
58. Types of Entries HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 53
70. targetSiteCodeHL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 54
71. Mood Codes HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 55
72. Entry Participants HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 56
73. Entry Relationships HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 57
74. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 58
75. Context CDA headers establish a context Context Propagates hierarchically May be overridden Body Section Entry May be set to null Uses RIM propagation mechanisms HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 59
76. Data Types ANY.NullFlavor – incomplete data II - identifiers EN/AD – names & addresses CD – coded values ED – multimedia content PQ – measurements IVL – intervals and ranges HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 60
77. Data Types are Abstract HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 61
78. NullFlavor Incomplete / Partial Data is common in healthcare Patient is unconscious Patient was unwilling to provide information Data is not (yet?) available User does not have access to the information Other system does not collect or share data item Actual value is not a proper value HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 62
79. Not a proper value? Main case: Coded values Code must come from a code system Code system doesn’t contain concept Text alternative is “not a proper value” Other cases: Infinity (+/-) is not a valid integer A trace detected Water to 100mL (in a formulation) HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 63
80. Choice: How to handle this? By Exception extra field for providing a reason when appropriate Infrastructurally Slot for reason is always present (?) even when not appropriate May be banned when inappropriate CDA Solution: Every data element (Data Type or RIM Class) may have a nullFlavor HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 64
81. NullFlavor Domain HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 65
82. nullFlavor != null Types or classes that have a nullFlavor may also have other information:<CD nullFlavor=“OTH” codeSystem=“SNOMED”> <originalText>Burnt Ear</originalText></CD> null in implementation technologies (SQL null, OCL null, pointers) mean that no extra information is found nullFlavor is not the same as null! HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 66
83. Why “null”Flavor? If it’s not the same as null, why give it such a confusing name? “ExceptionalValueStatus” is a pig to say It is connected to the notion of a null value in v2 (Internal Continuity) It behaves like an SQL or OCL null (External Continuity) HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 67
88. HL7 null values are never equalHL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 68
89. HL7 null and equal HL7 null values’ equality is unknown<CD nullFlavor=“OTH” codeSystem=“SNOMED”> <originalText>Burnt Ear</originalText></CD><CD nullFlavor=“OTH” codeSystem=“SNOMED”> <originalText>Burnt Ear</originalText></CD> HL7 null values may be not equal<INT nullFlavor=“PINF”/><INT nullFlavor=“NINF”/> Not Equal<INT nullFlavor=“UNK”/> Unknown<INT nullFlavor=“PINF”/> No Information HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 69
90. OCL Null OCL null values propagateCD.displayName.language.equal(x) == null Unless special OCLType properties are used:CD.displayName.language.isNull == true HL7 null values work exactly the same way:CD.displayName.language.equal(x) == NICD.displayName.language.isNull == true HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 70
91. NullFlavor NullFlavor does not mean “null” But behaves like it in many ways Every data type (including properties) implicitly carries information about how or why it is incomplete or an improper value Every class and data type may carry other information even when null Implementers must always consider null value! HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 71
92. NullFlavors and Conformance NullFlavors are tied to the conformance framework A null value (has a nullFlavor) is an exception to the value domain assigned in the context of use (not an exception to the value domain assigned in the data types) A mandatory value cannot be null (must be a value from the value domain) HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 72
93. NullFlavors and Conformance If value domain is 1-100 and the attribute is not mandatory, can send<INT nullFlavor=“OTH” value=“120”/> What is an implementation supposed to do? Data types specification does not say. You can choose. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 73
94. NullFlavor Implementation When a value is not present (i.e. null) in an implementation, the nullFlavor NI (No information) is considered to apply. (No information = no information) HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 74
95. NullFlavors and Properties Sometimes the nullFlavor just doesn’t matter The ITS doesn’t need to convey it. It defaults to NI This applies to other properties too The ITS simplifies many properties to underlying primitives where some of the semantic properties are inferred HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 75
102. Authority NameHL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 76
103. II – Attributes HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 77
104. II root & extension root is required (if not null) HL7 & ISO register roots for shared identifiers extension is optional Case sensitive the concatenation of root and extension SHALL be a globally unique identifier HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 78
105. Where’s the type? No type for the identified thing Should there be? No: The identifier is not the identified thing Yes: The identified thing can never change Modeling type of identified thing is hard HL7 V2: one big mess OpenEHR: just give it a code ISO – even worse HL7 V3: lack of modeling discipline a problem! HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 79
106. The Identifier Pattern Where’s identifier type? http://wiki.hl7.org/index.php?title=Common_Design_Patterns HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 80
107. Patient CMET HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 81
108. CDA Doesn’t have this HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 82
110. EN/AD: Names and Addresses A series of parts which are strings Each part has a type Name parts have a set of qualifiers Parts may have a nullFlavor Has a set of use codes HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 84
111. Examples Name <name use="L"> <prefix>Mr</prefix><given>Grahame</given>↩ <given>David</given><family>Grieve</family> </name> <addr use="WP PHYS"> <addressLine>1050 W Wishard Blvd</addressLine> <addressLine>RG 5th floor</addressLine> <city>Indianapolis</city> <state>IN</state> <postalCode>46240</postalCode> <country nullFlavor="UNK"/> </addr> HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 85
112. Name Use Codes HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 86
113. Name Part Types HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 87
114. Name Part Qualifiers HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 88
115. Address Part Types HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 89
116. Address Use Codes HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 90
117. CD: Concept References a reference to a concept defined by a referenced code system HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 91
118. CD – Attributes (1) HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 92
119. CD Examples <example code="784.0" codeSystem="2.16.840.1.113883.6.42" codeSystemName="ICD-9" displayName="Headache"/> <originalText value="general headache"/> </example> HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 93
120. Code System Versions Different versions of one code system must be compatible. By definition a code symbol SHALL have the same meaning throughout all versions of a code system. Between versions, codes may be retired but not withdrawn or reused. Where the definition of the meaning of a code symbol changes, it must still be compatible (equal) between different code system versions. Whenever a code system changes in an incompatible way, it will constitute a new code system, not simply a different version, regardless of how the vocabulary publisher calls it. For example, the publisher of ICD-9 and ICD-10 calls these code systems, "revision 9" and "revision 10" respectively. However, ICD-10 is a complete redesign of the ICD code, not a backward compatible version. Therefore, for the purpose of this data type specification, ICD-9 and ICD-10 are different code systems, not just different versions. By contrast, when LOINC updates from revision "1.0j" to "1.0k", this would be considered as just another version of LOINC, since LOINC revisions are backwards compatible. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 94
121. CD – Qualifiers CR Attributes HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 95
122. <example code="128045006" codeSystem=“[SNOMED-CT]" displayName="cellulitis (disorder)"> <qualifier> <name code="363698007" displayName="finding site"/> <value code="56459004" displayName="foot structure"> </qualifier> </example> CD Example - Qualifier HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 96
123. CD – Attributes (cont) HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 97
124. displayName Rules The displayName SHALL conform to any rules defined by the codingSystem; if the codeSystem does not define a human representation for the code or expression, then none can be provided. displayName is a courtesy; it has no functional meaning; displayName SHALL never modify the meaning of the code. Information Processing Entities claiming direct or indirect conformance MAY choose not to implement displayName but SHALL NOT reject instances because displayName is present. display names SHOULD NOT be presented to a user without checking it Communication SHALL NOT simply rely on the display name. The display name's main purpose is to support implementation debugging. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 98
125. originalText Rules CD may store only the text that the user entered or uttered. In this situation, original text will exist without a code. In a situation where the code is assigned sometime after the text was entered, originalText is the text or phrase used as the basis for assigning the code. NullFlavor will be OTH or UNC Translations may be provided The original text SHALL be represented in plain text form (excerpt if required) originalText may be a reference to some other text artefact resolution scope must be clearly described and may be further proscribed in specifications that use this specification. Translations SHALL NOT have an originalText of their own. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 99
126. translation Rules Each translation in the set is supposed to express the same meaning "in other words." However, exact synonymy rarely exists so not all of the translations will be equally exact. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 100
127. Coding Failure Cases A common situation with CD is when the actual concept cannot be properly represented in a particular coding system. Usually this circumstance arises where the concept is expected to be represented in a particular coding system. Base case: observation value of type CD bound to the full Snomed-CT valueset Example OID for the value set = 2.16.840.1.113883.19.11.1 as published 11-June 2007 Real OID for the SNOMED-CT code system = 2.16.840.1.113883.6.96 HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 101
128. Simplest Case: <value nullFlavor="NI"/> More useful - say SNOMED: <value nullFlavor="OTH" codeSystem="2.16.840.1.113883.6.96"/> Better to give originalText: <value nullFlavor="OTH" codeSystem="2.16.840.1.113883.6.96"> <originalText value="Burnt ear with iron. Burnt other ear calling for ambulance"/> </value> Coding Failure Cases HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 102
129. Coding Failure Cases CWE: <value code="burn" codeSystem="2.16.840.1.113883.19.5.2"> <originalText value="Burnt ear with iron. Burnt other ear calling for ambulance"/> </value> CNE: <value nullFlavor="OTH" codeSystem="2.16.840.1.113883.6.96"> <originalText value="Burnt ear with iron. Burnt other ear calling for ambulance"/> <translation code="burn" codeSystem="2.16.840.1.113883.19.5.2"> </value> HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 103
130. ED – Attributes (1) HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 104
131. ED – Attributes (2) HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 105
132. PQ Main Features value, precision & Units Translations Canonical form HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 106
133. PQ – Attributes HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 107
134. UCUM Unified Code for Units of Measure Developed and maintained by Regenstrief http://aurora.regenstrief.org/ucum PQ uses case sensitive units Units are computable – canonical form can be derived HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 108
136. PQ: part of a triad Sometimes it is not clear how some measurements in healthcare map to UCUM codes. The general pattern for a measurement is valueunit of Thing. In this scheme, the PQ represents the value and the unit, and the Thing is described by some coded concept that is linked to the PQ by the context of use. This maps obviously to some measurements, such as Patient Body Temperature of 37Celsius, and 250mg/day of Salicylate. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 110
137. PQ : part of a triad However for some measurements that arise in healthcare, the scheme is not so obvious: 5 Drinks of Beer 3 Acetominophen tablets At first glance it is tempting to classify these measurments like this: 5drinks of Beer 3Acetominophentablets. UCUM does not support units of "beer", "tablets" or "scoops". HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 111
138. PQ : part of a triad Neither tablets or scoops are proper units. What kind of tablets? How big is the glass? the concept that appears to be a unit needs to further specified before interoperability is established. If a correct amount is required, use an exact measurement with a UCUM unit. If this is not possible, then the concept is not part of the measurement. UCUM provides a unit called unity for use in these cases: The proper way to understand these measurements as 31Acetominophentablets, where 1 is the UCUM unit for unity, and the Thing has a qualifier. The context of use will need to provide the extra qualifying information. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 112
139. CDA – UCUM a problem The third element of the triad is missing… HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 113
140. TS Main Features Fixed instant in time value is a string with the format "YYYYMMDDHHMMSS.UUUU[+|-ZZzz] Precision is very important Semantics are calendar based Example: <example xsi:type="TS" value="20031101234511-1100"/> 11:45pm on 01-Nov 2003 at +5 from UTC (e.g. NZ daylight) HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 114
143. max of 2000 and 20000605 is 20001231235959.999 2000HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 115
144. TS - Equality Two nonNull TS values are only equal if their time and precision are equal. If both TS value have timezones, the values should be be corrected for timezone before comparison. If neither TS value has a timezone, then they may be compared for equality without correction. If only one TS value has a timezone, then the equality is null (nullFlavor NI). HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 116
145. IVL Main Features low .. high | center width Bounds closed HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 117
146. IVL(T) – Attributes HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 118
147. IVL Examples <example> <low value='2.8' unit='m' inclusive='true' /> <high value='4.6' unit='m' inclusive='false'/> </example> <example> <low value='200012041000'/> <high value='200012041030'/> </example> <example> <low value='20001204'/> <high value='20001206'/> </example> Note: Does not include all of 6/12/2000 HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 119
148. CDA Extensibility Can add Xml in other namespaces should not change the meaning of any of the standard data items receivers must be able to safely ignore these elements recipients must be able to faithfully render the CDA document while ignoring extensions Custom: Extensions should be based on RIM, and submitted to HL7 for inclusion HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 120
149. Clinical Document Architecture CDA has a sophisticated and complex clinical information model Nice for the document author Painful for the document processor Desire for fit between complexity and requirements Need some way to say how a particular use-case is represented Template: a statement of restriction on the CDA model HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 121
152. Describing usage in a formal statement will help implementersHL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 122
153. Formal Statements - Templates There are a number of ways to make formal statements about usage: English Narrative“A valid legal authenticator must be provided” Schematron assertions“legalAuthenticator and not legalAuthenticator[@nullFlavor]” OCL statements“context ClinicalDocument: legalAuthenticator.isNonNull and legalAuthenticator.nonNull” Static ModelPublish a new static model making legalAuthenticator mandatory HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 123
154. 3 meanings for “Template” Example (i.e. Word Document) Something that builds (i.e. Templated classes in Object Orientation) Something that restricts (i.e. Lego Pattern) All: constrain to extend, restrict to free HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 124
155. HL7 Templates A set of constraints on the RIM Formally defined Formal definition in one of more human readable languages (optional) Formal definition as a static model Implementation Specific representations for validation Applied “over-the-top” on the data HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 125
156. Applied “Over-the-top”? This instance conforms to all three models. Which is the class? HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 126
157. Simple Class Model HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 127
158. “Student” as a template ? Student is treatedas a set of rules instead of a “class”definition – doesn’ttake ownership HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 128
159. “Student” as a template Use Stereotype “Student” to markthe relationship HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 129
160. “IdentifiedPerson” as a template Use Stereotype “Student” and “IdentifiedPerson” to markthe relationships HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 130
161. HL7 Templates A set of constraints on the RIM Formally defined Applied “over-the-top” on the data Implicitly Explicitly CDA templates are explicit Data must conform to the constraints HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 131
162. templateId A template makes statements about how a CDA document is actually used Identify templates in specifications Implementers know how CDA document will be used Identify templates in CDA documents Processors (Systems) know how this bit of the document is actually used – can process accordingly Validators can check that the document conforms to the rules But templateIds may be ignored HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 132
163. Document Processing Process by semantics (codes) Slow. Hard? Thorough Process by TemplateId Fast Unreliable? Incomplete? HL7 deeply conflicted about this HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 133
164. Template Registration Well designed templates might be able to used in many contexts A common format and a template registry would allow both humans and computers to find, retrieve and use templates, and re-use the work of experts Template Registry standards are under development HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 134
165. Mandatory Template Metadata HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 135
166. Implementation Guides CDA is too general to use without further rules Communities agree how to use CDA National Programs / Standards Authorities Projects, Colleges, Vendors etc Publish a set of templates called “Implementation Guides” HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 136
167. Implementation Guide Samples Procedure Note (HL7) Etc CCD HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 137
168. CCD : Background CCR: Continuity of Care Record (ASTM E2369-05) most relevant administrative, demographic, and clinical information covering one or more healthcare encounters. means for healthcare entities to aggregate all of a patient’s data and forward it to another one primary use case is a snapshot in time HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 138
169. CCD CCR caused a turf war Resolution was to define a CDA profile that covered the same information Continuity of Care Document: A joint standard between HL7 and ASTM Wide Adoption (especially in USA) HITSP/NIEM(?) Microsoft/Google HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 139
170. CCD: CDA Templates <ClinicalDocument xmlns='urn:hl7-org:v3'> <typeId extension='POCD_HD000040' root='2.16.840.1.113883.1.3'/> <templateId root='2.16.840.1.113883.10.20.1'/> … </ClinicalDocument> HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 140
171. CCD: CDA Templates HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 141
172. CCD : CDA Templates HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 142
173. CCD : CDA Templates <!-- CCD v1.0 Templates Root: 2.16.840.1.113883.10.20.1 --> <!-- errors --> ... <pattern id='p-2.16.840.1.113883.10.20.1-errors‘ see='#p-2.16.840.1.113883.10.20.1-errors'> <assert test='count(.//cda:templateId[@root="2.16.840.1.113883.10.20.1.13"]) <= 1'> CCD MAY contain exactly one and SHALL NOT contain more than one Purpose section (templateId 2.16.840.1.113883.10.20.1.13). </assert> HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 143
174. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 144
175. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 145
176. CCD Problem A “problem concern” act A Problem Observation An Alert Observation A problem status observation Episode Observations Patient Awareness Report Fit for purpose for Continuity of Care HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 146
177. Agenda for Today Welcome CDA In Depth Exchanging CDA CDA in v2 (Documents vs messages) CDA & web Services IHE XDS V2 / CDA Comparison HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 147
178. Exchanging CDA All parts included (i.e. multimedia) Links maintained Required Stylesheets included No change to existing references No change to XML ID attribute No restrictions on directory structure Document Metadata (state etc) included in transfer HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 148
179. Exchanging CDA in v2 MDM message OBX segment for document, TXA for metadata HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 149
180. MSH|... EVN|... PID|... PV1|... TXA|... OBX|1|ED|11492-6^History and Physical^LN|| ^multipart^related^A^ MIME-Version: 1.0 Content-Type: multipart/related; boundary="HL7-CDA-boundary"; type="text/xml"; start="10.12.45567.43" Content-Transfer-Encoding: BASE64 --HL7-CDA-boundary Content-Type: text/xml; charset="US-ASCII" Content-ID: <10.12.45567.43> ... Base 64 of base CDA document, which contains ... <observationMedia classCode="OBS" moodCode="EVN"> <id root="10.23.4567.345"/> <value mediaType="image/jpeg"> <reference value="left_hand_image.jpeg"/> </value> </observationMedia> ... --HL7-CDA-boundary Content-ID: <10.23.4567.345> Content-Location: canned_left_hand_image.jpeg Content-Type: image/JPEG ... Base64 image ... --HL7-CDA-boundary-- ... HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 150
181. Interoperability paradigms HL7 has 3 major interoperability paradigms: Messages Documents Services HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 151
182. Interoperability Paradigms Messages: Messages exchange documents around to build services Documents:Documents implement services when passed around in messages Services: Services exchange documents in messages HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 152
183. Interoperability Paradigms The 3 paradigms differ in the following: Who decides what happens Who decides what technology is used When the decisions are made When content is bound to business processes What is explicit in an exchange, and what is delegated to the trading agreement Approach the same place from different directions Document = late binding by humans HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 153
184. Document vs Workflow Documents do not convey instructions i.e. Record of prescription Document says “Adam Smith (pharmacist) to prescribe Lasix” Adam’s Pharmacy system receives a copy of document Is Adam authorised to prescribe to patient? No – the record of Adam being asked is not the same as asking Adam HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 154
185. Document vs Workflow Documents never convey instructions A wrapper may reference a section of the document and indicate it is an instruction The exchange needs some choreography to make this safe Multiple sources of choreography V2 / v3 / IHE / National Programmes Trading Partner Agreement HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 155
186. IHE XDS Cross-Enterprise(X) Document Sharing Distributed solution for sharing clinical documents Tailored for CDA (? exclusive) Scalable, Standards based Widely adopted HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 156
187. XDS Architecture HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 157
188. CDA vs HL7 v2 An article I wrote for Pulse in Australia(Healthcare IT magazine) Addresses the question of whether we should use CDA instead of HL7 for pathology reports 99+% of lab reports distributed using v2 HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 158
189. Is HL7 v2 enough? The industry is now close to achieving plug-and-play interoperability with regard to pathology and radiology reports. Increasingly I am hearing comments suggesting that the job is done, that we have met the industry needs, and that there is no need to consider further changes, at least for the time being. I hear these comments at industry groups, standards meetings, and in discussions with our customers. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 159
190. Reporting Requirements Fidelity – reporting conventions Structured Data – proper grouping, computable model Explicit link between presentation and data Multimedia support Cross-Industry standard formats Clearly understood responsibilities (for legal liability) Ability to integrate reports and reporting in a greater context HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 160
191. Advantages of CDA Clinical Safety Document Management Presentation Content Expressivity Alignment HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 161
192. Disadvantages of CDA Based on reference model CDA documents are big No skills in CDA Change Process scary HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 162
197. Not safeHL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 163
198. End of Day #1 Fundamentals of CDA What it is & what parts it has How to navigate the defining standards How/When to use CDA Tomorrow Mapping Data into CDA documents Understanding the XML CDA Tools HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 164
199. Day #2: Implementing CDA Mapping Data to CDA: NZ Example CDA XML Implementation Considerations Tools Many miscellanea HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 165
200. CDA Certification You sit a multi-choice exam. Requirements Read the CDA Specification Listen to this talk Attend the CDA tutorial at the Working Meeting It’s easy (David H says so!) Only at the Working Meeting (Come to Sydney…) HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 166
201. How hard to implement CDA? Unconstrained CDA presents some challenges There is some additional complexity from CDA/RIM/Templates Requires buy in, commitment to architecture Saves more complexity in the long run Alternatives are even more unattractive Implementation Guides are your friend! You’ll get good at mapping…. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 167
202. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 168
203. Alternative? A patient should have had an immunisation as per a standard plan, but an alternative was given instead. Two records for an immunisation where an alternative was given: the original scheduled immunisation (where the completion status will be AG) and the actual alternative, where all the details will be complete and the indication will be stated. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 169
204. What is CDA to be used for? Submit to NIR: Immunization administered Immunization administered elsewhere Immunization Refused Opt out of NIR? Is Opt In/Out by patient or by immunization? HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 170
205. CDA Header Contents HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 171
206. CDA Sections Single Section vs. Multiple Sections Data/Entries go in the same section as the narrative Is it safe to extract the narrative & data apart from the rest of the document? Custom is that there will be a special section for immunizations (CCD) Sections need Loinc Codes (CCD code not suitable?) HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 172
207. Entry – what Base Act? (1) Consider definitions HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 173
208. Entry – what base Act? (2) CCD: one or more supply or medication sections (either “Supply” or “SubstanceAdministration”) A medication activity (templateId 2.16.840.1.113883.10.20.1.24)is used to describe what is administered whereas a supply activity (templateId 2.16.840.1.113883.10.20.1.34) is used to describe what has been dispensed. Else consider other HL7 / IHE Igs Finally, look at available attributes HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 174
209. SubstanceAdministration HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 175
210. Candidate Mappings HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 176
211. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 177
212. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 178
213. Candidate Mappings HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 179
214. Remaining Mappings HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 180
215. Mapping Language What we’d really like would be a mapping language Express mappings formally Feed instance and mapping into an engine to transform from one model to another HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 181
216. Mapping Language Requirements Be Linked to a Semantic Model Have Well-Defined Meaning Be Semantically Expressive Be Easy to Understand and Review Be Easy to Write Have Static Validation Criteria Be Declarative rather than Procedural Be Executable Have Editing Support Have Automated Validation Be open and neutral, not proprietary HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 182
217. OpenEHR Archetypes OpenEHR defined ADL – “Archetype Definition Language” ADL and Static models are alternative syntaxes for very nearly the same thing ADL doesn’t allow choices at entry point Static Models have some artificial graphical restrictions Reference Model | Constraint | XML But the reference models differ greatly HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 183
220. Usage in templateHL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 184
221. CDA XML XML policy CDA XML Example CDA Schema Transform Schematron HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 185
222. XML NDR Specify the XML form Names & namespaces Attributes vs elements Compositional form i.e. schema form Naming & Design rules are highly controversial The NDR is not well documented. Use the schema as the final arbiter of XML format HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 186
223. General XML method Namespace = “urn:hl7-org:v3” Root element = “ClinicalDocument” XML Attributes for “Immutable RIM attributes” (no namespaces) XML elements for other attributes (1st) or associations (2nd) Choice naming complicated Data Types from XML Data Types HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 187
224. CDA Schemas CDA.xsd – empty pointer to main schema POCD_MT000040.xsd – HL7 meaningless identifier for CDA – main schema datatypes.xsd & datatypes-base.xsd – datatypes schemas Infrastucture root – not used Voc.xsd – vocabulary as xsd enumerations NarrativeBlock.xsd – text format specification HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 188
225. Schema Conformance “CDA instances are valid against the CDA Schema” Schema are not normative (except Narrative Block) Schema conformance is necessary but not sufficient “checking an instance against the CDA Schema is a surrogate for validating conformance against the normative XML ITS” HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 189
226. Extra Contents All associations have: nullFlavor (attribute) (not commonly used) realmCode (do not use) typeId (do not use) templateId ID Attribute (ObservationMedia, RegionOfInterest, Section) POCD_MT000040.RegionOfInterest.value Narrative Block Schema (ISO 21090) ED/ST content model HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 190
227. XML Design Principles HL7 Priorities: Density Human readability Validation & PSVI Missing: Computer Processibility HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 191
228. Schema and Extensions What to do about extensibility and schemas HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 192
229. Transform Simple Transform to convert CDA to XHTML The transform has known issues No registry of known issues exists, nor a registry of alternatives You can write your own Doing so may be a good idea HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 193
230. Schematron Abstract Rules in data types schema CCD.sch – CCD schematron Why no CCD schema? HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 194
232. ED Forms Plain Text Base64 content Embedded XML <example language="EN">This is some text</example> <example mediaType="image/jpeg" representation="B64"> omSJUEdmde … MIjdMDSsWdIJdksIJR3373jeu83== </example> <example mediaType="text/xhtml"> <html xmlns:xh="...“> </html> </example> HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 196
234. Entry/Narrative Linking HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 198
235. Multimedia Linking HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 199
236. Multimedia Attachment renderMultiMedia refers to an observation media class Observation media Includes data directly in document refers to an attachment by a URL Possible schemes for URL Default http(s): / ftp: / file: / nfs: cid: - Mime Package Reference II reference HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 200
238. II Reference URL form is hl7-att:[II.literal]hl7-att:2.1.16.3.9.12345.2.39.3:ABC123 Attachment Id SHALL be globally unique Receiver stores attachment for later use Sender does not need to send again. Resolve against all stored attachments Forward references are allowed within an instance but not to other instances. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 202
239. Multimedia Attachment Store attachment inline in ED Store attachment in mime package with CDA Describe attachment as if it is in the same “place” as CDA, and require infrastructure to handle this Store attachment on some [globally] available server (by url or id) HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 203
241. Renormalisation Relational databases should be normalised Normalization (can) increase efficiency and control Exchange formats are very denormalised HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 205
242. Security Considerations Possible sources of insecurity Alteration of document “in flight” Denial of service attacks Alteration of document in storage HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 206
243. Security Considerations No schema location or transform location in documents No general web protocols in attachments (cid: only) Strictly limited attachment types Pay special attention to length issues in implementation HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 207
244. Length No length limitations in CDA (none!) (unlike v2) Implementation Guides may fix lengths (not usual practice in HL7) v2 length practice is not really sustainable to v2.7 Always check anything you decompose into a relational database HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 208
245. v2 CDA migration Data comes inwards in both HL7 v2 and CDA. Data must be compared and/or reassembled from both Some CDA data has no equivalent in v2 (or vice versa) Other must be converted HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 209
246. Interconversion problems Inconsistent nullFlavor handling in v2 Scope mismatch between EI and II Mapping problems between CD and CWE FT Narrative (?) effectiveTime can’t be represented in v2 More mapping…. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 210
255. OWL toolsSpecifying Writing Transporting Transforming Storing Validating Displaying Mining/ Extraction HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 211
256. Implementing CDA? Biggest Issue: One profile / one set of templates Many Profiles / General CDA HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 212
257. RIMBAA matrix HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 213
258. Introducing greenCDA HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 214
259. The Problem Creation of an instance conforming to a particular CDA IG may require knowledge of: CDA R2 base specification; HL7 Version 3 data type specification; CDA templates defined in the particular IG; CDA templates referenced by the particular IG; Terminology code lists defined/referenced by the particular IG; Validation of an instance conforming to a particular CDA IG may require: W3C Schema validation; Schematron validation; HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 215
260. A Solution Create an “authoring schema” that simplifies the creation and validation of a particular CDA IG: Clinically meaningful XML element and attribute names; 100% transformable into conformant CDA IG; Hides certain CDA complexities (such as moodCodes, fixed attributes, etc). We call this strategy: greenCDA greenCDA schemas are modular, corresponding to CDA templates. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 216
261. The Process – build the greenCDA module HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 217
262. The Process – create a conformant instance HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 218
263. An example – build the greenCDA module Requirements greenCDAschema <result> <resultID> <resultDateTime> <resultType> <resultStatus> <resultValue> <resultInterpretation> <resultReferenceRange> </result> HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 219
264. An example – create a conformant instance greenCDAinstance <result> <resultID> <resultDateTime> <resultType> <resultStatus> <resultValue> <resultInterpretation> <resultReferenceRange> </result> Conformant CDA instance HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 220
265. Methodology Begin with a complete set of data elements that need to be represented in CDA Must have business names and cardinality defined as well as a mapping to CDA constructs Example: HITSP C32/C83 Must include all required underlying CDA constructs HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 221
266. Methodology (cont) Create a simple XML structure based on the business names Stick to the basics of XML 1.0 + namespaces. Use minimal nesting Used primarily when constructs are repeatable, or for complex data types Lean towards elements vs. attributes Limit the use of complex types (don’t use them when a basic element definition will do the job). Facilitate the use of off the shelf XML data binding tools to make class generation easy in any programming language HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 222
267. Methodology (cont) Datatypes Datatypes will be bound early to avoid xsi:type Use elements and choice constructs where multiple datatypes are allowed For example: physicalQuantity or integer Datatypes will also be greened a bit to reduce complexity, but should be close to the base CDA types. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 223
268. Methodology (cont) Terminology Static value sets should be recorded in the XML schema Reduces (but does not entirely eliminate) the need for secondary validation Schematron and/or a terminology lookup service still needed for dynamic value sets HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 224
269. Methodology (cont) All GreenCDA modues must be transformable to full CDA Transform should be possible with XSLT (preferably 1.0) Source instance must contain sufficient data to populate all required CDA elements Some data may be implied by the constraints, so need not be physically present in the GreenCDA instance HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 225
270. Demonstration Instance Schema HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 226
271. Open Issues Issues with defining a greenCDA module? Consider adding business names into templates, so as to automate the greenCDA module generation. There are design considerations for the green modules in order to create corresponding java or dot net classes (that are used in the construction of a greenCDA instance). Formal definition of what needs to be defined up front to create a GreenCDA module The info in the HITSP C32/C83 tables is not 100% complete Goal is to support automation Narrative block Use existing CDA markup or XHTML? Is a narrative block required for all GreenCDA schemas? If optional, the CDA transform MUST have narrative generation capabilities. How does greenCDA overlap with other HL7 initiatives (microITS, hData, …)? What to include in the greenCDA for CCD Informative Ballot? Non-normative greenCDA xsd Corresponding non-normative greenCDA transform. Methodology that enables ability to transform any greenCDA instance into canonical form. Description of how local implementations can alter the greenCDA xsd if they want to extend; Make the point that greenCDA doesn’t even have to be XML, the xslt could instead be Java code, etc. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 227
272. What is required? <doc> <serviceEvent> <effectiveTimeLow value=“…”/> <effectiveTimeHigh value=“…”/> </serviceEvent> </doc> HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 228
273. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 229
274. Green CDA: Requirements Implementation Guide needs to be completely nailed down The more nailed down it is, the more useful Green CDA is The more nailed down the implementation guide is, the more specific to a particular use i.e. GreenCDA is a software methodology, not a ballotable standard HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 230
275. Validation Is CDA valid against the schema? Is the document valid against CDA? Are the data types valid? Is the document valid against it’s templates? Is the document valid against an implementation guide? HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 231
276. Validation Tools Schema +/- schematron Eclipse Instance Editor Alschuler Validator Templates Registry…. HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 232
277. Eclipse Instance Editor Demonstration HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 233
279. Template Registry Under development Database where CCD-type templates can be registered English definitions Schematrons Commercial(?) product from Alschuler Associates Will have a service API HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 235
288. OWL toolsSpecifying Writing Transporting Transforming Storing Validating Displaying Mining/ Extraction HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 236
289. Generation Language Demonstration (cda generation.ksp) HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 237
290. HL7Connect V2 / CDA interface engine Free personal copy included on flash drive Only suitable for desktop / developer use HL7Connect COM library is free for use CDA reading / writing support CCD reading / writing support UCUM + LOINC Support Demonstration Knowledge base (UCUM / LOINC) + C# code HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 238
291. MIF “Model Interchange Format” HL7’s master internal format Not designed for production use But does contain all the definitions and documentation in one place And can be used by implementers HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 239
292. Implementing CDA Many meanings to “implement” Many ways to do things Constants: Knowledge of CDA specification Connectedness to CDA implementer community Ability to do mappings (analysis / implement) HL7 New Zealand - www.hl7.org.nz - Fundamentals of CDA & Implementing CDA (30-31 August 2010, Auckland) 240
Editor's Notes
Ancient historyCausing changeChoosing the right personPeople in standardsGrowing the workforce
3 sources of complexity (problem, business variability, incompetence / inappropriate solutions)Externalising complexityCompeting perspectives on simplicityBad metaphorsAll models are wrong
DisagreementAverage cost of existenceExamplesQualifications – not quite true