Interoperabilität zwischen HL7 CDA und Templates einerseits und ISO/CEN andererseits

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Harald Stieber
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1 Workshop Semantische Interoperabilität medizinischer Daten durch den Einsatz archetyp-basierter Informationssysteme gemäß ISO/CEN und openehr 8. September 2010 in Interoperabilität zwischen HL7 CDA und Templates einerseits und ISO/CEN andererseits, Universitätsklinikum Regensburg Vorsitzender HL7 Deutschland, Head of German Delegation to ISO TC 215 and CEN TC 251 Chair German Health Informatics Standards Group Chair EFMI WG Elektronic Health Record Regensburg, Germany

September 2010 in Interoperabilität zwischen HL7 CDA und Templates einerseits und ISO/CEN 13606 andererseits,

2 HP or HCE Action Patient Observation Data Knowledge Interpretation Information Action

3 Electronic Patient Record - Definitions Electronic Health Record Repository of Information about the patient s health available in a computer-readable format Electronic Health Record System Set of components establishing mechanisms to generate, use, store and retrieve an Electronic Patient Record Electronic Health Record Architecture Model of generic properties required for any Electronic Patient Record for providing communicable, comprehensive, useful, effective, and legally binding records, which preserve their integrity over the time independent of platforms and systems as well as of national specialities

Electronic Health Record Architecture Model of generic properties required for any Electronic Patient Record for providing communicable, comprehensive,

4 UML Class Diagram of Extract Package

6 EHR Architecture (after Sam Heard) Logical EHR Language for clinical content Terminology ~~CDA Templates LOINC for names, specific value sets, SNOMED ~CEN ADL Reduced demand on terminology openehr ADL Further commitment to manner of expression

specific value sets, SNOMED ~CEN 13606 ADL Reduced demand on

7 EHR Architecture (after Sam Heard) EHR Compositions Sections Entries Access control Attestation Organisation Currency Contribution Rewind Extracts Accountability Clinical context Human meaning Scope Ownership Versioning Unit of contribution and communication for reuse Organisation Human navigation Semantic unit for reuse HL7 CDA CEN openehr

context Human meaning Scope Ownership Versioning Unit of contribution and

8 Clinical Archetypes (after Sam Heard) Entries Evaluation Observation Instruction Action Time Action description Optional relationship to instruction Resulting state of instruction Transition (suspended) Protocol Workflow support

Optional relationship to instruction Resulting state of

9 Observation investigator Encounter opinions observations patient actions Substance Administration Act published personal knowledge experience base instructions administrative events investigator agents Supply Organiser Procedure ActReference

personal knowledge experience base instructions

10 Layered approach (after Sam Heard) 3. Implementation Templates Localised models for use 2. Knowledge model Archetypes Clinical models 1. Recording model Information Repository model

11 Archetypes and Templates (after Sam Heard) Diabetic checkup Tingling feet Feeling tired 76 kg 124/92 7.5% Excellent control Archetypes FH Weight BP HbA1c Issues Assess Antenatal visit Back pain 66 kg 102/64 mmhg 142/min NAD, see 4/52 Template Template

5% Excellent control Archetypes FH Weight BP HbA1c Issues

12 Correspondence with HL7 & CDA EHR Folder Composition (Act: classcode = EHR) (Act: classcode = Folder) Clinical Document Section Cluster Section choice of Entries: e.g. Observation, Encounter, SubstanceAdministration Element attributes of Entries

Section Cluster Section choice of Entries: e.g.

13 13606 vs HL7 v3 (after Sam Heard) CEN Concept HL7 V3 EHR / Clinical Intent (original) Admin. Workflow Reference model + Data Types Reference Model RIM + Data Types AOM Constraint Static Models Formalism One wire format Wire format 1 wire format Many wire formats

Workflow Reference model + Data Types Reference Model RIM + Data

14 13606 vs HL7 v3 (after Sam Heard) CEN Concept HL7 V3 Convergence EHR / Clinical Intent Admin. Workflow Reference model + Data Types Reference Model RIM + Data Types AOM Constraint Models Formalism One wire format Wire format 1 wire format Many wire formats

15 13606 vs HL7 v3 (after Sam Heard) CEN Concept HL7 V3 Convergence EHR / Clinical Intent Admin. Workflow Reference model + Data Types Reference Model Harmony (ISO) RIM + Data Types AOM Constraint Models Formalism One wire format Wire format 1 wire format Many wire formats

Workflow Reference model + Data Types Reference Model Harmony (ISO)

16 13606 vs HL7 v3 (after Sam Heard) CEN Concept HL7 V3 Convergence EHR / Clinical Intent Admin. Workflow Reference model + Data Types Reference Model Harmony RIM + Data Types AOM Constraint Models Interconversion Formalism One wire format Wire format 1 wire format Many wire formats

Workflow Reference model + Data Types Reference Model Harmony RIM +

17 13606 vs HL7 v3 (after Sam Heard) CEN Concept HL7 V3 Convergence EHR / Clinical Intent Admin. Workflow Reference model Reference Model RIM + + Data Types Harmony Data Types AOM Constraint Models Interconversion Formalism One wire format Wire Re-evaluation format 1 wire format Many wire formats

Workflow Reference model Reference Model RIM + + Data Types Harmony Data

18 13606 vs HL7 v3 (after Sam Heard) CEN Concept HL7 V3 Convergence EHR / Clinical Intent Admin. Workflow Reference model Reference???? Model RIM + + Data Types Harmony Data Types AOM Constraint Models Interconversion Formalism One wire format Wire Re-evaluation format 1 wire format Many wire formats

??? Model RIM + + Data Types Harmony Data Types AOM Constraint Models

19 Ontology Hierarchy general ontologies upper level ontologies domain ontologies application ontologies ICT ontology

20 Designing Ontology Systems with the GCM Business Concepts Relations Networks Aggregations (Basic Services / Functions) Details (Basic Concepts) General Ontology Top-Level Ontology Development Process Perspective Domain Ontology Application Ontology Enterprise View Information View ICT Ontology Computational View Engineering View Technology View System s Architectural Perspective System Component Composition System Domain System Viewpoint

Ontology Application Ontology Enterprise View Information View ICT Ontology Computational View Engineering

21 Expressivity Interoperabilität zwischen HL7 CDA und Templates einerseits und ISO/CEN andererseits Types of Ontologies Formal ontologies General logic Modal logic Description logic First-order logic Propositional logic Formal languages Frames Formal taxonomies Meta-data and data models Data models XML Schema Database schemas Principled, informational hierarchies Thesauri and taxonomies XML DTD Structured glossaries Thesauri Data dictionaries Glossaries and data dictionaries Ad hoc hierarchies ordinary glossaries Terms Formalization

22 telligent Security and Privacy Solutions in Telemedicine/Telepathology Interoperabilität zwischen HL7 CDA und Templates einerseits und ISO/CEN andererseits 10th European Telepathology Congress 4th International Congress on Virtual Microscopy 1-3 July 2010, Vilnius, Lithuania

23 Concepts (e.g. enterprise) Relations Networks (e.g. business domain Aggregations (e.g. business process) Details (e.g. workflow) Domain n Domain 2 Domain 1 D A M D C M Enterprise View RIM SAEAF/SAIF Information View Computational View Engineering View Technology View System Component Composition System Domain System Viewpoint

26 HeartRate has Method HeartRate has Exertion HeartRate has BodyPosition HeartRate has Regularity HeartRate has FrequencyQualification HeartRate has Volume HeartRate has Location HeartRate has Strength HeartRate has Rhythm HeartRate has Frequency Location is a coded description FrequencyQualification is a coded description Information Model BodyPosition has Position Exertion is a coded description PositionMeasure is a Position Frequency is a physical quantity Volume is a coded description Regularity is a coded description Strength is a coded description Rhythm is a coded description Method is a coded description

27 Zusammenfassung 1. Wie kann man in Deutschland einen Archetyp- Entwicklungsprozess etablieren? 2. Kann die Archetyp-Methodik zu Patienten-Empowerment beitragen? 3. Wie könnte man HL7 und archetypbasierte Ansätze harmonisieren?

28 Conclusions 1 Interoperability is not first a matter of the ICT domain, but a user domains one. Interoperability is a challenge to meeting business objectives. It requires sharing of knowledge, which should be built on a hierarchical system of ontologies. Multi-disciplinary interoperability solutions require a system-theoretical, architecture-centric approach, enabling the formalization of systems representation including ontology mapping. Regarding the level of complexity of the system in consideration as well as for the level of formalization the ontologies, just the absolutely needed level should be selected.

29 Conclusions 2 In phealth environments, security and privacy solutions have to be an embedded part of the system architecture. The solutions have to tackle all technical paradigms needed for implementing phealth such as security and privacy for mobile, pervasive and autonomous systems. The solutions have to be policy driven, thereby enabling semantic interoperability between all principals by mapping their different ontologies. This also includes the different ontologies the different stakeholder groups are using.

30 Vielen Dank für Ihre Aufmerksamkeit!, PhD, Associate Professor University of Regensburg Medical Center Franz-Josef-Strauss-Allee 11 D Regensburg, Germany Phone: Fax:

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