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Presentation WSCHA 2010 - in English


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Presentation at the 1st Workshop on Scientific Computing Applications in Health - 2010.
See: and for more information about semantic interoperability in healthcare.

#mlhim #semantic_interoperability #health_informatics

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Presentation WSCHA 2010 - in English

  1. 1. Multilevel Healthcare Information Modeling Associate Laboratory INCT-MACC “Multilevel Healthcare Information Modeling UERJ/UFF
  2. 2. Outline• Healthcare Information: An Overview• MLHIM Fundamentals• The openEHR Specifications: An Overview
  3. 3. The Healthcare Information is Complex... ... because the healthcare system is a complex and dynamic system: • Complexity: the system generates a large number of variables that have complex interdependencies, especially... ... space-time dependency: the information to be persisted varies in time and space • Dynamics: ▫ The relationship between information items is variable, being the temporal variation rapid and spatial variation close
  4. 4. The Healthcare Policies are also Complex • The establishment of consensus with respect to a particular concept in healthcare is difficult: ▫ Competition between "medical schools" ▫ Multiprofessionalism but not transdisciplinarity • The healthcare networks are hierarchical, with multiple entry doors and without a functional mechanism of reference and counter-reference
  5. 5. Challenges of the Healthcare System vs. Information Technology Promises•  % of adverse events arising from medication errors (interactions, duplications, incorrect prescriptions)•  Search time for critical information•  % of patients "wasting time" in the system as due to the lack of reference and counter-reference•  Duplication of investigations, tests and procedures•  Capacity of prevention and early detection•  Capacity of long-term decision making•  Adherence to treatment protocols•  Effectiveness of programs targeted to a specific disease•  % of avoidable hospitalizations and readmissions
  6. 6. Other Important Issues• Semantic coherence: maintenance of the meaning (the context) of the information that is persisted• Interoperability: the ability to send information from one location (system) to another, keeping the information intelligible in both places (systems)• Future-proof: the information must be perpetually kept in the system the way it was originally persisted
  7. 7. Where Is the Context?
  8. 8. Here Is the Context!
  9. 9. Interoperability - Cough -F o r 3 m o n t h s -L o w f e v e r -D I : T B ? C a ? -C h e s t X - r a y : -N o d u le in r ig h t -B r o n c h ic - a lv e o la r apex w ash : -B r o n c o g e n ic c a r c in o m a
  10. 10. Interoperability! - Cou gh F o r 3 m o n th s L o w fe v e r - Cough C h e st X -ra y : D I: T B ? C a ? F o r 3 m o n th s N o d u le in L o w fe v e r r ig h t a p e x D I: T B ? C a ? - Cough C h e st X -ra y : F o r 3 m o n th s N o d u le in L o w fe v e r r ig h t a p e x D I: T B ? C a ? B r o n c h ic - a lv e o la r w a s h : B r o n c o g e n ic c a r c in o m a
  11. 11. Interoperability? - Cough F o r 3 m o n th s L o w fe v e r D I: T B ? C a ? “G a ra g e ” s o ftw a re C h e st X -ra y :B r o n c h ic - a lv e o la r N o d u le in r ig h t a p e xw ash :B r o n c o g e n ic H L7v2c a r c in o m a M e ssa ge s C E N 1 3 6 0 6 E xtra ct
  12. 12. Traditional Modeling
  13. 13. Problems of the One-Level Model The information is modeled in a way that "serves" the current needs of the healthcare system The addition of new concepts involves redoing the whole system (redesign, reimplementation, retest, redistribution) High cost, slow integration of new knowledge to HIS etc.
  14. 14. Multilevel Modeling
  15. 15. Multilevel Modeling
  16. 16. Why Adopting Standards for HIS?• Prerequisite for effective implementation of a integrated and universal healthcare system• Standardization of "rules, protocols, processes" and "activities", "for the benefit of all" (ISO)• Democratization of the healthcare system governance• Improvement of control and evaluation processes
  17. 17. Standards and Specifications for HIS Name What it is Implemented Open ISO/CEN Standard “Yes” No HL7 Specification Yes No and “Standard” openEHR Specification Yes Yes and “Standard”
  18. 18. x T ICD es E DC p OM WHO a ty SN Dat IHTSDO ISO PMAC EN13606- EN1 ASTM CCR Documents Content models Security Terminology EN 3606 Services 1 E 36 C N1 A 0 36 -3 4 RB 6-2 Q 06 PD -1 s geIHE PIX s CEN sa RID age v2 ss es m e m v3 XD HL7 S HI HSSP SA W CCO CD A s te pla m Te Fonte: Thomas Beale, EFMI
  19. 19. The openEHR Specifications• Multilevel (or dual) model: software development and knowledge modeling are separated• The reference model is implemented in software• The knowledge is modeled on "archetypes"
  20. 20. The dual openEHR Model Y o u r a p p lic a t io n ( E H R , D S S e t c )o p e n E H R S p e c ific a tio n s K n o w le d g e m o d e lin g ( A r c h e t y p e s ) R e fe re n c e M o d e l
  21. 21. Synthesis:• The traditional modeling of information systems, in which domain knowledge is implemented in software, is inefficient for complex and dynamics realities such as healthcare• The problems arising from the use of that approach in HIS has stimulated global standardization initiatives• The adoption of terminologies is an important element, but does not solve the problems of the domain if the systems continue to be implemented in one level
  22. 22. Synthesis:• In multilevel modeling, each specialist is responsible for its "specialty": ▫ Computer scientists implement the reference model ▫ The healthcare professionals model the knowledge• The software+DB level is separated from the knowledge level• Not to be confused with "three tier", which traditionally holds the knowledge layer implemented in software and it only separates BI and GUI
  23. 23. Questions?