Poster IHI 2012


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Poster presented at the 2nd ACM International Health Informatics Symposium SIGHIT in 2012
See: and for more information about semantic interoperability in healthcare.

#mlhim #semantic_interoperability #health_informatics

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Poster IHI 2012

  1. 1. Migration of a Pre-Hospital Cardiology Emergency System from Data Model to Multilevel Modeling Christiano Alvernaz, Timothy Wayne Cook, Luciana Tricai Cavalini Logo caex Multilevel Healthcare Information Modeling (MLHIM) Laboratory National Institute of Science and Technology – Medicine Assisted by Scientific ComputingAbstract. This paper presents the migration of a pre-hospital cardiology emergency system from a data model to multilevel modeling. The clinicalconcepts of data model-based system were identified and modeled according to the Multilevel Healthcare Information Modeling (MLHIM)specifications. This migration is been developed in order to provide the system with the required features of interoperability and semantic coherence.Introduction. The Acute Myocardial Infarction (AMI) is placed among the leading causes of death and disability worldwide. Therefore, AMI is thepreferential target for the development of therapeutic procedures in cardiology, especially clinical guidelines 5].Decision Support Systems (DSS) are computerized guidelines. However, in healthcare, there are challenges related to the dynamic evolution ofconcepts and technology, which brings issues related to the maintenance of DSS in healthcare [2].To circumvent the need for constant changes in the persistence model systems, multilevel modeling has been proposed, whose essential feature is theseparation between the Reference Model and the Domain Model, defined as constraints on the Reference Model [1].The AMI Teleconsultation & Monitoring System (AToMS) [4] is a telemedicine system that has been developed to offer a remote second for thrombolytictherapy in patients with AMI. The objective of this paper is to describe the migration process of AtoMS from data model to a version based on multilevelmodeling.Method. AToMS version 2.0 is based on the principles of multilevel modeling of health information systems. The ecore model of the MultilevelHealthcare Information Modeling (MLHIM) specifications version 2.3.0 [3] was used to export the implementation of the MLHIM Reference Model.The openEHR Clinical Knowledge Manager ( was searched to identify the archetypes that would fit the AtoMS 1.0 datamodel. All the clinical concepts included in AToMS were matched to their correspondent archetypes.Results. All clinical concepts of AToMS 1.0 matched to existing openEHR archetypes, although two of them (“age” and “prognosis”) requiredarchetype specialization. The concepts of the Physical Examination screen form of AToMS 1.0 and their correspondent openEHR archetypes and MLHIMCCDs are shown on Table 1.Based on the findings that the MLHIM CCDs match more closely the clinical concepts expressed on AToMS, the concepts were modeled as Concept ConstraintDefinitions (CCDs), according to the MLHIM specifications version 2.3.0. The graphical representation of the CCD modeled for dyspnea is shown on Figure 1. Table 1. Mapping between the AToMS 1.0 clinical concepts, the openEHR archetypes and the MLHIM CCDs. Concept openEHR archetype Archetype root class MLHIM CCD Archetype root class Age Patient PERSON Age Person Sex Patient PERSON Sex Person Weight Body weight OBSERVATION Weight CareEntry Height Height/Length OBSERVATION Height CareEntry Systolic blood pressure Blood pressure OBSERVATION Systolic blood pressure CareEntry Heart rate Heart rate and rhythm OBSERVATION Heart rate CareEntry Respiratory rate Respirations OBSERVATION Respiratory rate CareEntry Auscultation of the lung Auscultation of the chest OBSERVATION Auscultation of the lung CareEntry Third heart sound Auscultation of the chest OBSERVATION Third heart sound CareEntry Fourth heart sound Auscultation of the chest OBSERVATION Fourth heart sound CareEntry Pericardial rub Auscultation of the chest OBSERVATION Pericardial rub CareEntry Bruits Auscultation of the chest OBSERVATION Bruits CareEntry This paper showed the feasibility of migration of a data- model healthcare application to multilevel modeling specifications (MLHIM and openEHR). Those results encourage the migration of legate systems to multilevel modeling, thus overcoming the current issues related to interoperability and semantic coherence of one-level modeling in healthcare. Figure 1. Modeling of the CCD for the clinical concept of dyspnea according to the MLHIM 2.3.0. specifications.[1] Beale, T. and Heard, S. 2008. openEHR Architecture Overview. openEHR Foundation, London, UK.[2] Brokel, J. M., Schwichtenberg, T. J., Wakefield, D. S., Ward, M. M., Shaw, M. G. and Kramer, J. M. 2011. Evaluating clinical decision support rules as anintervention in clinician workflows with technology. Comput. Inform. Nurs. 29, 1 (Jan.-Feb. 2011), 36-42.[3] Cavalini, L. T., Cook, T.W. Health informatics: the relevance of open source and multilevel modeling. IFIP Advances in Information andCommunication Technology 365 (Oct. 2011), 338-347.[4] Correa, B. S. P. M., Gonçalves, B., Teixeira, I. M., Gomes, A. T. A., Ziviani, A. AToMS: A ubiquitous teleconsultation systemfor supporting AMI patientswith prehospital thrombolysis. Int. J. Telemed. Appl. (2011). DOI = 10.1155/2011/560209[5] Thygesen, K, Alpert, J. S. and White, H. D. 2007. Universal definition of myocardial infarction. Circulation 116, 22, (Nov. 2007), 2634-2653. Visit us: