This document summarizes a presentation given at the 1st Workshop on Scientific Computing in Health Applications. The presentation discusses healthcare information models and applications, including the challenges with current healthcare systems and a proposed new approach using multi-level modeling. It also introduces OSHIP, an open source healthcare information platform implemented in Python that uses multi-level modeling and provides a development environment for various healthcare applications.

1. Healthcare Information
Models & Applications
Timothy W. Cook, MSc.
Health Informatics Research & Consulting
timothywayne.cook@gmail.com
June 28,2010 1st Workshop on Scientific Computing in Health Applications

2. Ralph Waldo Emerson
I hate
quotations.
Tell me what
you know.
June 28,2010 1st Workshop on Scientific Computing in Health Applications

3. Keep everything as simple as possible;
but no simpler!
June 28,2010 1st Workshop on Scientific Computing in Health Applications

4. Holy Grail of Health Care
The Longitudinal, Patient Controlled,
Future Proof Electronic
Healthcare Applications
1st Workshop on Scientific Computing in Health Applications

5. Φ = Golden Ratio
June 28,2010 1st Workshop on Scientific Computing in Health Applications

6. Healthcare Information Systems

7. Current Approach
 Requirements gathering within a limited scope,
build data structures and write the software.
 For more than 45 years we have shown that in
healthcare this approach is flawed.
June 28,2010 1st Workshop on Scientific Computing in Health Applications

8. Insanity: Doing the same thing over and over again,
and expecting a different result.
June 28,2010 1st Workshop on Scientific Computing in Health Applications

9. Multi-Level Modeling
Components
 Reference Model
 Concept Constraint Definitions
 Template Constraint Definitions
 Relationship of openEHR & MLHIM
June 28,2010 1st Workshop on Scientific Computing in Health Applications

10. Words
 Observation
 Evaluation
 Instruction
 Action
 Entry
June 28,2010 1st Workshop on Scientific Computing in Health Applications

11. Words are but symbols for the relations of
things to one another and to us; nowhere
do they touch upon absolute truth.
--Friedrich Nietzsche
June 28,2010 1st Workshop on Scientific Computing in Health Applications

12. Observation
 10 entries on dictionary.com
 All nouns – all very similar
(exception:Navigation)
 One specific to medicine
June 28,2010 1st Workshop on Scientific Computing in Health Applications

13. Evaluation
 2 entries at dictionary.com
 Noun
 One specific to medicine
June 28,2010 1st Workshop on Scientific Computing in Health Applications

14. Instruction
 6 entries on dictionary.com
 Nouns
June 28,2010 1st Workshop on Scientific Computing in Health Applications

15. Action
 19 Nouns
 1 Adjective
June 28,2010 1st Workshop on Scientific Computing in Health Applications

16. Entry
 13 Nouns
June 28,2010 1st Workshop on Scientific Computing in Health Applications

17. Semantic Context
 Having all of the information about a piece of
data; available everywhere.
 Linking Concepts
 Healthcare DATA: 101
June 28,2010 1st Workshop on Scientific Computing in Health Applications

18. 101
 Is it a component of BP measured in mmMg?
 Is it body temperature in degrees Fahrenheit?
 Is it body weight measured in kg or lbs.?
 Is it body length/height in cm?
June 28,2010 1st Workshop on Scientific Computing in Health Applications

19. New Approach
 Create a complete “information” model that
encapsulates that information with the data.
 Forever in time and space.
June 28,2010 1st Workshop on Scientific Computing in Health Applications

20. Experience without theory is blind, but theory
without experience is mere intellectual play.
--Immanuel Kant
June 28,2010 1st Workshop on Scientific Computing in Health Applications

21. MLHIM Health Information
Platform
CCDs
XPath Reference TCDs
XQuery Model
CDOM XML
June 28,2010 1st Workshop on Scientific Computing in Health Applications

22. What is in the Reference Model?
The electronic health record
EHR for one person
High-level organisation of the EHR
Folders
Common
e.g. per episode, per clinical speciality
Set of entries committed at one date/time
Compositions e.g. progress note, report, letter, test result
Clinical headings reflecting the workflow
Sections and consultation/reasoning process
Clinical “statements” about Observations,
Entries Evaluations, and Instructions
Compound entries
Clusters e.g. blood pressure, full blood count
Element entries
Elements e.g. reason for encounter, body weight
e.g. Coded terms from term sets,
Data values measurements with units

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24. Package Structure
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26. Security Features
Separation
June 28,2010 1st Workshop on Scientific Computing in Health Applications

27. Principles
The components of the Reference Model are like LEGO
brick specifications
Constraint Definitions = instructions/designs
constraining the use of LEGO pieces to create
meaningful structures RM
Instances
Concept A Concept B
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30. Ordered DATA_VALUE INTERVAL<T>
(rm.support.assumed) (rm.data_types.basic) (rm.support.assumed)
June 28,2010 1st Workshop on Scientific Computing in Health Applications

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34. OSHIP
Open Source
Health Information
Platform
June 28,2010 1st Workshop on Scientific Computing in Health Applications

35. OSHIP
➔ A MLHIM implementation in Python
➔Provides a rapid application
development environment for a variety
of healthcare applications
June 28,2010 1st Workshop on Scientific Computing in Health Applications

36. OSHIP
➔Heavy re-use of existing
open source components
➔The Zope Tool Kit (ZTK)
June 28,2010 1st Workshop on Scientific Computing in Health Applications

37. OSHIP
➔ Choice of HTTP servers
➔Possible GUI interfaces
➔Choice of RDBMs and OODBMs
➔Internationalization/localization (i18n/l10n)
➔Fine-grained security framework
➔XML based configuration files
➔Designer friendly templating language
June 28,2010 1st Workshop on Scientific Computing in Health Applications

38. OSHIP – Current Status
➔ Reference Model
➔Constraint Model
➔Proven Infrastructure
➔Complete Documentation
June 28,2010 1st Workshop on Scientific Computing in Health Applications

39. Label on a 500 piece,
jigsaw puzzle box
 500­piece puzzle:
 Some assembly
required.
June 28,2010 1st Workshop on Scientific Computing in Health Applications

40. Why MLHIM?
In order to fully embrace open
source and open content ideals
and processes.
June 28,2010 1st Workshop on Scientific Computing in Health Applications

41. Thank You!
Timothy W. Cook, MSc.
Health Informatics Research & Consulting
timothywayne.cook@gmail.com
http://www.linkedin.com/in/timothywaynecook
June 28,2010 1st Workshop on Scientific Computing in Health Applications