presentation wscha 2010 - in english
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Desafios da Informao Mdica
Multilevel Healthcare Information Modeling
Associate Laboratory INCT-MACCMultilevel Healthcare Information ModelingUERJ/UFF
Outline
Healthcare Information: An Overview
MLHIM Fundamentals
The openEHR Specifications: An Overview
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 spaceDynamics:
The relationship between information items is variable, being the temporal variation rapid and spatial variation close
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
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
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
Where Is the Context?
Here Is the Context!
Interoperability
Interoperability!
Interoperability?
Traditional Modeling
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.
Multilevel Modeling
Multilevel Modeling
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
Standards and Specifications for HISNameWhat it isImplementedOpen
ISO/CENStandardYesNo
HL7Specification and StandardYesNo
openEHRSpecification and StandardYesYes
IHEHL7IHTSDOISOWHOSNOMED CTICDxCENASTMCDAEN13606-1CCRv2 messagesv3 messagesData typesPDQCCOWHSSPPIXHISARIDXDSPMACEN13606-4RBACEN13606-3EN13606-2TemplatesDocumentsSecurityServicesContent modelsTerminologyFonte: Thomas Beale, EFMI 2008
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"
The dual openEHR Model
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
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
Questions?
http://www.mlhim.org