2010-sep-16 services for rimbaa based on ehr-s fm

Michael van der Zel september-2010 1

HL7 ITALY “Open Days”HL7 Int. WG RIMBAA Out-of-Cycle Meeting

Rome, Italy15/16-sep-2010

Michael van der ZelRIM R1 Certified Expert, CDA R2 Certified Expert, TOGAF Certified


Agenda

Who am I? Services for RIMBAA project

Noticeable mail UMCG & RIMBAA Services Some thoughts about some RIMBAA Issues


Me

Michael van der Zel Personality (MBTI) INFJ – Idealist, Perfectionist, Chaotic “INFJs prefer the future and the pathway along which

they aspire for profundity.” University Medical Center Groningen, Netherlands

HIT Architect, Information Systems (EHR-S) Results 4 Care, Netherlands

Detailed Clinical Models (ISO), HL7 v3


I Work Here


My Office


Inside the Office

Clinical Statement CMET


Tag Cloud

ISO Detailed Clinical Model


Services for RIMBAA project

Idea approved Rio WGM may-2010 Project Scope Statement SOA WG project lead? – Ann Wrightson RIMBAA WG sponsor http://wiki.hl7.org/index.php?title=Services_for_RIMBAA

RIMBAA and SOA hl7 mailinglists


Draft Project Proposal (1)1. Project Name: Services on a RIMBAA application; V3 Services

2a. Ballot Type: Informative

3. Sponsoring Group(s) / Project Team Primary Sponsor / Work Group: SOA Co-sponsor Work Group: RIMBAA

4a. Project ScopeThe aim of this project is to develop an informative document containing a concise account of how SOA and RIMBAA concepts work together to provide working interoperability between two RIMBAA applications.

4b. Project NeedThere is limited understanding at this time within WGs of how the SAIF concept of “working interoperability” would be realized in particular contexts. This project addresses that need for understanding, in the specific context of RIMBAA applications and SOA architectural style.


Draft Project Proposal (2)

4c. Success Criteria1) The project process will enable both WGs to gain a consensus understanding of architectural principles around providing working interoperability deploying RIMBAA applications in a SOA interoperability context, informed by SAIF.2) The completed document will provide a summary of consensus thinking between RIMBAA & SOA that will inform future work in both WGs, and also be available as an informative document to the wider HL7 community.

4d. Project Objectives / Deliverables / Target DatesFirst informative ballot: Jan 2011Project End Date: May 2011

5. Project Approval DatesSponsoring Group Approval Date: 20 May 2010Steering Division Approval Date: TBDTechnical Steering Committee Approval Date: TBD


Related?

SAIF – ArB HSSP – joint HL7 + OMG

Practical Guide to SOA in Healthcare vol I & II HL7v3 WebServices?? Cannot find the doc

anymore? Thomas Erl


UMCG RIMBAAServices


Service =

1. Interface – functions a service exposes

2. Payload – data that functions work on/with

3. Behaviour – inner working of a function


http://softwareindustrialization.com/content/binary/design.jpg

The Swing


What's beneath the surface?

Traceability

User Request Functional

Techology

EHR-S FMDCM

HL7 v3

Services


What is EHR-S FM?


Summary of Care Record(KernEPD)

ICT Masterplan Project, Hospital wide Easy access to shared data, Patient Demographics,

Allergies, Patient History, Trial, Advance Directives, etc. Choices made: CUI, HL7 v3, SNOMED CT, Web, Detailed

Clinical Models, EHR-S FM


DC.1.4.1 Manage Allergy, Intolerance and Adverse Reaction List

DC.1.4.1#1 The system SHALL provide the ability to capture true allergy, intolerance, and adverse reaction to drug, dietary or environmental triggers as unique, discrete entries.

DC.1.4.1#2 The system SHOULD provide the ability to capture the reason for entry of the allergy, intolerance or adverse reaction.

DC.1.4.1#3 The system SHALL provide the ability to capture the reaction type.

DC.1.4.1#4: The system SHOULD provide the ability to capture the severity of a reaction.

DC.1.4.1#7 The system SHOULD provide the ability to capture the source of allergy, intolerance, and adverse reaction information.

DC.1.4.1#8 The system SHALL provide the ability to deactivate an item on the list.

DC.1.4.1#9 The system SHALL provide the ability to capture the reason for deactivation of an item on the list.

DC.1.4.1#10 The system MAY present allergies, intolerances and adverse reactions that have been deactivated.

DC.1.4.1#11 The system MAY NOT provide the ability to display user defined sort order of list.

DC.1.4.1#12 The system SHOULD provide the ability to indicate that the list of medications and other agents has been reviewed.

DC.1.4.1#13 They system SHALL provide the ability to capture and display the date on which allergy information was entered.

Functionally and mostly about Content

+ CUI Guidance forRecording Adverse Drug Reactions


S e e A l so (d i re c t )

DC.1.4.1 Manage Alle rgy, Intole rance and Adverse Reaction List

S . 2 . 2 . 1 H e a l t h R e c o rd O u t p u t

I N . 2 . 5 . 1 M a n a g e U n st ru c t u re d H e a l t h R e c o rd I n f o rm a t i o nI N . 2 . 5 . 2 M a n a g e S t ru c t u re d H e a l t h R e c o rd I n f o rm a t i o n

I N . 4 . 3 T e rm i n o l o g y M a p p i n gI N . 6 B u si n e ss R u l e s M a n a g e m e n t

S . 2 . 2 . 3 A d H o c Q u e ry a n d R e p o rt G e n e ra t i o n S . 3 . 7 . 1 C l i n i c a l D e c i si o n S u p p o rt S y st e m G u i d e l i n e s

U p d a t e s

I N . 4 . 1 S t a n d a rd T e rm i n o l o g i e s a n d T e rm i n o l o g y M o d e l sI N . 4 . 2 M a i n t e n a n c e a n d V e rsi o n i n g o f S t a n d a rd T e rm i n o l o g i e s

D C . 2 . 3 . 1 . 1 S u p p o rt f o r D ru g I n t e ra c t i o n C h e c ki n g

S e e A l so ( i n d i re c t )

I N . 1 . 4 P a t i e n t A c c e ss M a n a g e m e n t

I N . 2 . 4 E x t ra c t i o n o f H e a l t h R e c o rd I n f o rm a t i o n

I N . 2 . 2 A u d i t a b l e R e c o rd s

I N . 1 . 1 E n t i t y A u t h e n t i c a t i o n

I N . 1 . 2 E n t i t y A u t h o r i z a t i o n

I N . 1 . 3 E n t i t y A c c e ss C o n t ro l

I N . 5 . 1 I n t e rc h a n g e S t a n d a rd s

S . 2 . 2 R e p o rt G e n e ra t i o n

I N . 2 . 1 D a t a R e t e n t i o n , A v a i l a b i l i t y a n d D e st ru c t i o n

Function = aprox. Service

Rule Engine

Care Record Store Service

SNOMED CTTerminology Service

Authorisation Service

Widget & Service

HL7 v3

Query Tool

Document Service

Report Generator


Manage Structured Health Record Information (IN.2.5.2)

1. The system SHALL capture structured health record information as part of the patient EHR.

2. The system SHALL retrieve structured health record information as part of the patient EHR.

3. The system SHALL provide the ability to update structured health record information.

4. The system SHALL conform to function IN.2.1 (Data Retention, Availability and Destruction) to provide the ability to inactivate, obsolete, or destroy structured health record information.

5. The system SHOULD provide the ability to report structured health record information.

6. The system MAY track structured health record information over time.

7. The system SHOULD provide the ability to retrieve each item of structured health record information discretely within patient context.

8. The system SHALL provide the ability to append corrected structured health record information to the original structured health record information. A specific type of implementation is not implied.

9. The system SHALL provide the ability to append structured health record information to the original structured health record information. A specific type of implementation is not implied.

10. The system SHALL provide the ability to append augmented structured health record information to the original structured health record information. A specific type of implementation is not implied.

The Behaviour of theCare Record Store Serviceand IF Operations


Widget for Editing

<Kerngegev en> Serv ice

Care Record Store Serv ice

Autorisatie Serv ice

Care Record CDR Database

C o m m o n M o d e l H L 7 v 3 C a re

R e c o rd

Some Application that Displays

Query Tool / Report Generator

N a m e : S t ru c t u reA u t h o r: Z e l MV e rsi o n : 1 . 0

C re a t e d : 7 -4 -2 0 1 0 1 0 : 1 0 : 2 3U p d a t e d : 2 1 -4 -2 0 1 0 1 0 : 2 4 : 4 8

Terminology Serv ice

"Bus"

Patient Identity Feed < K e rn g e g e v e n >

T e m p l a t e

« u se »

« u se »

« u se »

« u se »

« u se »

« u se »

« u se »

« u se »

« f l o w »

« a b st ra c t i o n »

Design inspiredby EHR-S FM IN*InfoStructureFunctions andSeparation of Responsibility


IF Kerngegeven Service

More Functional oriented layer GetStatus, GetSummary, GetEntries ActivateEntry, CreateEntry, CompleteEntry,

NullifyEntry


IF Care Record Store Service

CRUD Create, Read, Update, Delete And Find, Query, Link


Payload EHR-S FM function(s) Detailed Clinical Model Convert to Care Record Template

« A c t »

Reaction :Organizer

« A c t »PropensityToAdv erseReaction :Organizer

e f f e c t i v e T i m e = g e l d i g h e i d sp e ri o d e o v e rg e v o e l i g h e i dc o d e = S C T : 4 2 0 1 3 4 0 0 6 P ro p e n si t y t o a d v e rse re a c t i o n s (c l i n i c a l f i n d i n g )

st a t u sC o d e = < S t a t u sC o d ea v a i l a b i l i t y T i m e = -i d = -t e m p l a t e I d = -

« P a rt i c i p a t i o n »

dataEnterer :DataEnterer

t i m e = re g i st ra t i e d a t u m

« H L 7 R o l e »Auteur :AssignedEntity

CM ET

i d = z o rg v e rl e n e ri d

« P a rt i c i p a t i o n »recordTarget :RecordTarget

« H L 7 R o l e »Patiënt :AssignedEntity

CM ET

i d = p a t i e n t n u m m e r

« A c t »

Causativ eAgent :Observ ation

c o d e = S C T : 2 4 6 0 7 5 0 0 3 c a u sa t i v e a g e n tv a l u e < C a u sa t i v e A g e n t

« A c t »ReactionType :Observ ation

c o d e = S C T : 2 6 3 8 5 1 0 0 3 re a c t i o n

v a l u e < R e a c t i o n T y p e

« A c t »Sev erity :Observ ation

c o d e = S C T : 2 4 6 1 1 2 0 0 5 se v e ri t y

v a l u e < S e v e ri t y

« A c t »Certainty :Observ ation

c o d e = S C T : 2 4 6 1 0 3 0 0 8 c e rt a i n t y

v a l u e < C a u sa l i t y

« P a rt i c i p a t i o n »

v erifier :Verifier

« H L 7 R o l e »Superv isor :AssignedEntity

CM ET

i d = z o rg v e rl e n e ri d

« ro o t c o n c e p t »PropensityToAdv erseReaction

C D

« d a t a , e n u m e ra t i . . .

Causativ eAgent

Reaction

C D

« d a t a , e n u m e ra t i o n »

ReactionType

C D

« d a t a , e n u m e r. . .Sev erity

C D

« d a t a , e n u m e ra t i o n »Certainty

1 . . *

t r i g g e rs

DC.1.4.1#4

DC.1.4.1#1

DC.1.4.1#4DC.1.4.1#3

Common Elementsadded from IN*Patient, Authortime, etc. Care Record Template (Logical)

DCM Information Model


<REPC_MT000100UV01.Organizer xmlns="urn:hl7-org:v3" xmlns:xsi ="http://www.w3.org/2001/XMLSchema-instance"

xsi:schemaLocation ="urn:hl7-org:v3 multicacheschemas/REPC_RM000100UV.xsd" xsi:type="REPC_MT000100UV01.Organizer"

classCode ="CATEGORY" moodCode="EVN"> <templateId root="2.16.840.1.113883.2.4.3.8.1000.9" extension="TODO" /> <id root="2.16.840.1.113883.2.4.3.8.1000.10" extension="ac13267b-a0a7-4741-9363-2230c3f1da03" /> <code displayName ="Propensity to adverse reactions (clinical finding)" code="420134006" codeSystem ="2.16.840.1.113883.6.96" codeSystemName ="SNOMED CT" /> <statusCode code="active" /> <effectiveTime ><low value="20090309" /></effectiveTime > <recordTarget typeCode ="RCT"> <patient classCode="PAT"> <id root="2.16.840.1.113883.2.4.3.8.12" extension="6022832" /> <statusCode code="active" /> <patientPerson classCode="PSN" determinerCode ="INSTANCE" /> </patient> </recordTarget > <dataEnterer typeCode="ENT"> <assignedEntity classCode="ASSIGNED" > <id root="2.16.840.1.113883.2.4.3.8.1000.2" extension="10006773" /> </assignedEntity > </dataEnterer > <component typeCode="COMP"> <observation classCode="OBS" moodCode="EVN"> <code displayName ="causative agent" code="246075003" codeSystem ="2.16.840.1.113883.6.96" codeSystemName ="SNOMED CT" /> <value displayName ="Non-steroidal anti-inflammatory agent (product)" code="16403005" codeSystem ="2.16.840.1.113883.6.96" codeSystemName ="SNOMED CT" xsi:type="CD" /> </observation > </component > <component typeCode="COMP"> <observation classCode="OBS" moodCode="EVN"> <code displayName ="certainty" code="246103008" codeSystem ="2.16.840.1.113883.6.96" codeSystemName ="SNOMED CT" /> <value displayName ="possible diagnosis" code="60022001" codeSystem="2.16.840.1.113883.6.96" codeSystemName ="SNOMED CT" xsi:type="CD" /> </observation >

Care Record XML (Physical)


Behaviour

HL7 v3 Act Life Cycle

normal

new

obsoletenullified

< n u l l >

activ e

N a m e : S M D A c t S t a t e M a c h i n e

A u t h o r: Z e l MV e rsi o n : 1 . 0C re a t e d : 1 2 -2 -2 0 1 0 8 : 1 6 : 5 5U p d a t e d : 1 2 -4 -2 0 1 0 0 : 1 4 : 5 9

completed

o b so l e t en u l l i f y

a c t i v a t e

a c t i v a t e c o m p l e t ec re a t e

re v i se

c o m p l e t e

re a c t i v a t e


Summary

The business requested a way to Record and Share Allergy Records

EHR-S FM gives base criteria further specified by interviewing the stakeholders

EHR-S FM function traceability gives necessary InfoStructure services

Record Detailed with DCM and converted to Care Record CMET


Conclusions

EHR-S FM IN* Functions are basis for Services in Healthcare

DCM great method to get details of Content HL7 v3 Care Record and Templates a great model

for Payload HL7 v3 Act State Model basis for Behaviour Traceability great tool to link Technology to

Functionality and Impact


Grazie per l'attenzioneThanks for your attention

© 2010 Michael van der Zel

mvdzel AT results4care.nl m.van.der.zel AT ict.umcg.nl

2010-sep-16 services for rimbaa based on ehr-s fm

Documents

rimbaa rimbaa

rimbaa soa

rimbaa project idea

wg rimbaa

project need

project process

project addresses

rimbaa concepts