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Presentation HealthCom 2012


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Presentation at the 14th International Conference on e-Health Networking - Application and Services in 2012 .
See: and for more information about semantic interoperability in healthcare.

#mlhim #semantic_interoperability #health_informatics

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Presentation HealthCom 2012

  1. 1. KNOWLEDGE ENGINEERING OF HEALTHCARE APPLICATIONS BASED ON MINIMALIST MULTILEVEL MODELS EXPANDING THE SCOPE OF EHEALTH: FROM ELECTRONIC HEALTH RECORDS TO BIOMEDICAL APPLICATIONSLuciana Tricai Cavalini Timothy Wayne CookDepartment of Health Information Technology MLHIM Associated LaboratoryMedical Sciences College National Institute of Science and Technology –Rio de Janeiro State University Medicine Assisted by Scientific Computing
  2. 2. DYNAMICS AND COMPLEXIT Y IN HEALTHCARE Time Healthcare systems areSpace much more complex than any other sector of human society, regarding 3 dimensions: Ontology
  3. 3. WHY HEALTHCARE IS SO COMPLEX? Healthcare is the only economic sector that deals with biological production processes (which are created by nature) All other economic sectors deal with industrial production processes (which are created by the man) Production processes that are created by the man are much simpler than the biological processes, because: Civilization starts just dozens of Evolution had millions of years to thousands of years ago reach to that complexity Biological systems are as complex as Industrial systems are as simple as necessary to guarantee the survival possible to maximize profit of the species See Dawkins R. The greatest show on earth, pp. 204-5, and Marx K. Complete works.
  4. 4. THE ONTOLOGICAL COMPLEXIT Y In practical terms; building aThe greatest medical Thus, in “megalithic system” terminology medicine, there are that all healthcare (SNOMED-CT) has roughly 310,000 settings could use more than 310,000 concepts, connected would require aterms, connected by to each other by great amount of more than millions of different tables with 310,000 1,000,000 links ways fields and millions of relationships Cavalini-Cook Conjecture: The probability of consensus between 2 or more experts from the same field regarding which would be the “maximum data model” for any given healthcare concept tends to zero
  5. 5. THE CONSEQUENCES OF HEALTHCARE COMPLEXIT Y (1)This complexity turns a computer science problem that does not exist (or at least it is notcritical) in any other sector of human society into a very important issue in healthcare.This problem is:
  6. 6. Chest X-Ray:- Nodule in right apex- Cough- For 3 months - Cough- Low fever - For 3 monthsBAL: - Low fever- TB Chest X-Ray: - Nodule in right apexBAL:- TBChest X-Ray:- Nodule in right apex- Cough- For 3 months- Low fever
  7. 7. A UNDERESTIMATED PROBLEM Semantic interoperability in healthcare is not perceived as aproblem by the vast majority of health informaticians because: Apparently, it only Academic projects concerns national Most software are usually focused governments, and no companies are on a very specificcountry nowadays has satisfied with their subject, and recording the required customer portfolio or their data in isolated combination of still dream the old silos is not seen as a technical monopolistic dream problem, because capability, political of taking over the they do not regard will and transparency whole global market their data as part of to run a semantically for themselves the patient’s Lifeinteroperable national Health Record ehealth project
  8. 8. THE CONSEQUENCES OF HEALTHCARE COMPLEXIT Y (2)Semantic interoperability is critical, but healthcare complexity bringsanother intractable issue even for self-contained systems: maintenanceIn healthcare, you define your data model today and it does not last 6 months, becausehealthcare concepts evolve fast and new concepts come along every dayIt is virtually impossible to make a customer satisfied with a default application; therequisites are completely different, even for the simpler cases (e.g. two NHS GPs)In real life, the average time for a medical software to be abandoned is2 years and the abandon rate is 70% (source: CHAOS Report)
  9. 9. MULTILEVEL MODELING APPROACHESModels openEHR MLHIM 13606Approach Maximalist Minimalist ReductionistRM residualcontext Intense Minimal IntermediateData model Maximum Any size MaximumPossible Only message EMR Any applicationimplementation exchange
  10. 10. KNOWLEDGE MODELING APPROACHESModels openEHR MLHIM 13606 Concept ConstraintStructure Archetype Definition (CCD) ArchetypeLanguage ADL XML Schema ADL# of One Any number Onestructures /conceptGovernance Top- Bottom-up, Top-model down, consensus merit down, consensus
  11. 11. THE MLHIM SPECIFICATIONS IMPLEMENTATION The MLHIM Reference Model  XML Schema  Graphical representation Examples of CCDs  ICD-10 4-digit codes for Respiratory Tuberculosis (A15. -)  Demography NCI Standard Template The Data Model Converter to CCD The CCD Repository Uploader Code available at: or
  12. 12. THANK YOU! 谢谢!OBRIGADA!