metadata requirements4healthportals mie2015
TRANSCRIPT
Metadata Requirements for Health Portals
Tim BensonAbies Ltd, R-Outcomes Ltd, UCL
[email protected] 2015 Madrid, 28 May 2015
Outline
Why metadata mattersXDS Cross Enterprise Document SharingClinical documents and clinical statementsSpecific requirements and items neededStringent standards that are fit for purpose
Background
Based on 25 years work on Interoperability standards
Wellcome Trust Sintero Project project leader Dr E Conleyhttp://sintero.vargula.co.uk/
IHE UK Affinity Domainhttp://wiki.ihe-uk.org/XDS_Metadata_specifications
Principles of health interoperability HL7 and SNOMED Springer 2012
http://www.springer.com/gb/book/9781447128007
What is a Portal?
Clinical portals
Patient portals
A single source of patient information obtained from multiple originating systems
Functionality limited to search, retrieve and display
Examples include:Summary Care Record
Hampshire Health Record
What is Metadata?
Metadata describes other data Metadata is used for indexing, discovery and searchMetadata is information about what sort of things an item contains
For example, metadata may say an entry is a diagnosis, but does not say what the diagnosis isThis is useful in information governanceMetadata is not a summary or abstractMetadata does not contain transaction data
I keep six honest serving-men (They taught me all I knew);Their names are What and Why and When And How and Where and Who.
Rudyard Kipling. The Elephant’s Child. Just So Stories. 1902
Dublin Core Metadata Element Set
Dublin Core is the best known metadata standard
Designed by librarians for librarians
Mainly for paper archives
All elements are optional and repeatable
Mostly free text
1 Title2 Creator3 Subject4 Description5 Publisher6 Contributor7 Date8 Type9 Format10 Identifier11 Source12 Language13 Relation14 Coverage15 Rights
8
Acute Care (Inpatient)
GPs and Clinics (Ambulatory)
Long Term Care
Other Specialized Care(incl. Diagnostics Services)
Patient Longitudinal Record
Typically, a patient goes through a sequence of encounters in different Care Settings. A portal allows each setting to see the whole picture. Portals are driven by metadata.
Source: IHE
XDS
Cross-enterprise Document SharingXDS is the leading industry standard for portal interoperabilityDeveloped by IHE (Integrating the Health Enterprise) industry groupBased mainly on
HL7 V2HL7 CDAebXML Registry Standard (ISO 15000-4, 2004)
1. Sources post document packages to the Repository
3. Consumers search for documents with specific information
2. Repository registers the documents metadata and pointer with the Registry
4. Consumers retrieve documents from Repository (-ies)
XDS Document (Metadata):
TypePatientAuthorFacilityAuthenticator…
Repository
Origin of Documents Package
Registry
How XDS WorksConsum
er
Source: IHE
XDS Metadata handling
Patient Identity Source
Document Registry
Document Repository
Document Source
Document Consumer
Patient Identity Feed
Query Documents
Retrieve Document
Provide and Register
Document Set
Register Document Set
Generates
Stores
Interprets
Adds
Source: IHE
Documents and Statements 1/2
Portals may support documents and/or statementsClinical Document is discrete electronic composition about one patient, intended to be read or used by a human.Clinical Statement is the smallest meaningful category of stand-alone medical information. A single data entry.
Statement is a very small structured document
Documents and Statements 2/2
Documents and statements have different uses and granularityBoth share properties of
Persistence, wholeness, coherence, human readability, stewardship and authenticationCDA, XDS and FHIR share these ideas
Both require search, sort and display by type, date, author, source
Clinical Document
Traditional document metaphorHuman-to-human communication of discrete documents
e.g. pdf report or letter, image, video
Sharing across organisation boundariesComputer-processable data is hard to extract
e.g. HL7 CDA Level 3 does not work as well as expected
Clinical Statement
Computer-processable data entriescountinganalysischarts
Content is unambiguously coded and tightly specified
e.g. diagnosis, medication entry, test resultselect and sort statements from multiple sources on the fly for lists, charts and graphs
Health Metadata
IHE XDSComplex with lots of optionsNeed to define your own local affinity domainEasier said than doneBased on ebXML Registry
HL7 CDA headerNeeds to be heavily constrainedComplex templates (e.g. NHS ITK)
Basic Requirements
WhatWho byWho aboutWhenWhereForm
Optionality
In metadata optionality and repeats are badNeed for completeness If search fails to find something, it can be a major safety riskMandatory elements
One patientOne creatorOne creation timeOne purpose
Stringent Standards
Every source feed must provide exactly the same metadata
Else data won’t be found
Stringent computer-processable dataUnique identifiers for things, people and placesCodes for concepts + content (SNOMED CT)Date/time formats
What 1
Title (free text)Class – general category, course granularity
Note: HL7 CDA does not have a slot for thisEquivalent to HL7 RIM classCode + moodCode
Type – specific category, fine granularityEquivalent to HL7 RIM code
Specialtyclinical service
CareTypecare setting
Examples
Example Document Statement
Title Urology discharge
summary Weight entry
Class Correspondence Finding
Type Discharge summary Weight
Specialty Urology General Practice
CareType Inpatient Primary care
What 2
UUIDOriginalIDConfidentialityLanguageFormat
Class, Type, Specialty, CareType, Confidentiality, Language and Format use SNOMED CT RefSets
Other
WhenCreationTimeEventTime
WhoPatientIdCreatorId
WhereLocationId
ExtensionsTag (optional, repeatable) using SNOMED CT RefSet
Discussion
Every source system must provide standard metadata
Allow default when not known
All items (except Title) are structured and computer-processable
Codes use SNOMED CT RefSets
Same structure for documents and statementsLack of metadata standards means that portal projects are
(1) expensive (2) incompatible
Summary
Why metadata is crucial in portalsDocuments and statements have similaritiesXDS and CDASpecific requirementsNeed stringent metadata standardsStandardising metadata for portals is
(1) essential (2) low hanging fruit
