Pasi Leino :: Using XML standards for system integration

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Information about Pasi Leino :: Using XML standards for system integration

Published on September 28, 2007

Author: george.james


Pasi Leino L-Force Oy, Finland

 HL7 crash course  National efforts and applications (Finland)  Choice of Techology

 20 year old (since 1987), non-profit organisation  National standard in the US (ANSI) since 1994  Open, consensus based development process  In use? ◦ CHIME-study 2000 (153 Hospital CIOs in US)  80% using HL7, 13.5% planning  Hospitals over 400 beds: 95%  For interoperability

Process level Ability to adapt to work flow Semantic level Ability to exchange information Operational level Ability to exchange data

 Messaging standards ◦ HL7 v2.x (v2.5 ANSI-standard 2006) ◦ HL7 versio 3 RIM  CDA (clinical document architecture) R1 and R2  HL7 data types to become ISO standard  CCOW (clinical context management)  Arden syntax (represents medical algorithms in clinical information) + GLIF + Gello  + small Working Groups  Recommendations, implementation guides

 Data model (or information model) ◦ RIM (Reference Information Model) and D-MIM, R-MIM, HMD ◦ Refine by constraining  Vocabulary  Data types  Domain models  ITS (Implementation Technology Specification) ◦ XML ITS currently available

Information Model Spec Define classes, Develop Scope attributes, and Use Case Model relationships Identify actors and Use Cases RIM Spec Spec Class Diagram State Diagram Define vocabulary domains and codes Associate Actors UCM Spec and Use Cases Use Case Diagram Define states, transitions and triggers Define Application Roles Message Design Interaction Model Develop Refined Message Information Define Spec 2-nd Order h//mt:50”d” Model Interactions 1 choice of … 0-n Drug … Specify CMET Define Inter Spec 0-1 Nursing … Conformance Interaction Diagram Specify HMD & Criteria METs with constraints Source: HL7 Training, Scandinavia Tour, 2002

Relationship Act Link Relationship 0..* 0..* 0..* 0..* 1 1 1 1 0..* 0..* 1 Entity 1 Role 1 Participation 0..* Act Patient Referral Organization Employee Transportation Living Subject Practitioner Supply Material Assigned Procedure Place Practitioner Condition Node Health Chart Specimen Consent Observation Medication Act complex (Source: G.W. Beeler) Financial act

Medication (Act/ substance Administation) Is related to (ActRelationship) Dr Phil Doctor Performer (Person) (Role) (Participation) Visit (Act/ Encounter) Pasi Leino Patient Target (Entity/ Person) (Role) (Participation) Is related (ActRelationship) Study, other action

 Entities in Green ◦ Organisations, persons, devices, locations ...  Roles in yellow ◦ professionals, patients, roleLinks  Participation in Cyan  Activities (act), in Red ◦ Observations, Events, medication, Encounters, ... Relations in activities

RIM DMIM RMIM Dynaamic model: Use cases, application roles, interactions The static model an dynamic behavior is linked by interactions XML HMD Schema

 HL7 affilicate since 1995  Has earned status of respect  Receives funding from the Ministry of social affair and health  Finland is an early adopter of any technology  CDA –centric approach

CDA is defined by the RIM CDA RMIM is a constraint on the RIM Classes “cloned” (replicated, renamed, constrained with vocabulary, datatypes) CDA is Persistence, stewardship, is Potential for authentication, Whole, Human readable

CDA document Header and context to describe the document Body Narrative, Structured Human readable Machine readable Structurd data text text text

 Forms used everywhere: patient core data, health status, drivers license, leave of absence...  Very simple to define and implement  However, a single concept (diagnosis etc.) could be defied differently in different forms.  Seemingly simplistic?  In strict sence CDA document is not designed for forms

kentän pituus pakollisuus tietotyyppi toistuma max min rivi tietokenttätunnus oid tunnus tietotyyppi koodisto huom. kentän nimi 1 Label LB K lomake lomake HEN 2 1 Label LB K pääotsikko Päivitystiedot 3 2 Coded Value CV K Henkilötietojen käy 4 3 Point in Time TS K Henkilötiedot on p 5 4 Character String ST K Henkilötietojen päi 6 5 Label LB K pääotsikko Perustiedot 7 6 Instance Identifer II Henkilötunnus 8 7 Instance Identifer II Väliaikainen henki 9 8 Instance Identifer II Muut tunnisteet 10 9 Person Name PN Sukunimi, etunime 11 10 Person Name PN T Entinen sukunimim 12 11 Point in Time TS Syntymäaika

 Patient centric services, which promote continuity of care  Interoperability  Electronic archiving or EPR, prescriptions, centralised image repositories  National services for codes, classifications, archiving

 Scheduling-domain ◦ Regional shared scheduling  ePrescription ◦ Medical Records messages ◦ CDA R2 based content- prescription, delivery, locking, etc.  Death notice message ◦ V3 messaging spesifications for automatic reporting of death to National citizen registy.  eArchive messages ◦ V3 Messages, CDAR2 payload + W3C signature  Diagnostic imaging patient records and reports  CDA R2 implementation guidelines ◦ See: ◦ See:


 Structured and standardised core data  Use of national codes and OID  CDAR2 documents  Open interface to exchange CDAR2 documents  Ability to interface to national EPR archive, ePrescription, code services  Desktop integration, SSO  User authentication, electronic signing, concent management, referrals

Several Duodecim providers Stakes TEO VRK Decision Public Health I. Stakes Content Codes, Authentication support Consumer Healthcare OID- Person service providers classifications, codes of healthcare Consumer health professionals identifier statistics vocabularies health Content User Code OID-code authentication Person Decision Enabling service service & eSignature identifier support service service services service National EPR Medical EPR Service Health ePre- Core Service forms & Portal scription (Active) (Long-term) services certificates Registry Service Service Repository Archive service Secure Network & Messaging Service Enterprise applications

 Information model to be updated according to ”structured core patient date definitions”  Use of Codes and OID’s  Use of CDA R2 for document generation  Open interfaces for interchange of CDA R2 documents  Access to decision support services  Ability to use of the EPR, ePrescription etc. services  Functionality to filter user tailored views from retrieved patient documents  Desktop integration & SSO  User authentication, signature, consent management

 XML is nothing alone ◦ SOAP ◦ Custom schemas ◦ XML RPC  Decision points: the developer does not need to know what goes in the wire  Acid test of spesification: can this be done using general purpose development tools?  Caché, Enseble –objects  eXtc, DOM model  Example document

author cdaBody AD cdaHeader component BL custodian CS dataComponent documentationOf CV encompassingEncounter externalLink ED externalObservation toCDA(.. II localHeader Construct(... paragraphComponent INT textComponent Generate(... patient IVL patientSubject MO relatedPatient performer PN qualifier rtgENVEntry rtgRQOEntry rtgOBSEntry Section


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