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HL7 “Fresh Look”



gRIM

concept

Part B


PHR transformation model

J. Wittenber

May 11, 2011

D2jw_B

See also
http://mdcx73
-
working.wikispaces.com/gRIM




NOTE: 2
nd

of 2 parts; contains only Figures 3*.

Contents

Figure

Topic

Pg/Slide


Introduction omitted; see Part A


1 Conceptual model


basic, “Ecosystem” omitted; see Part A


2 Ecosystem model


topology, profiles omitted; see Part A


3 e[P]HR model


“Green CDA”, [
trans]forms 10
-
17

Appendix


A Inferences omitted; see Part A



DAM gRIM Concept

2

HL7 "Fresh Look"

DAM gRIM Concept

10

Figure 3a. PHR model
-

[“Green CDA”]
pattern

types

PATTERN

EXPLANATION

+ data / state / protocol
(/reasoning)

In observation data, separate out data (actual datum being recorded e.g. BP)
from patient state (e.g. lying, standing) and protocol (cuff type, instrument type)

+ History of events

Provide a structure containing 1..* Events, allowing data and patient state at
each one, supporting intervals, point events, and math functions, e.g.
ave/delta/max/min

+ Tree structure


Generalised free
-
form tree for containing clusters of data items, e.g. the 5+1
Apgar items, numerous microbiology result items, etc.

++ Order state machine


A way of recording current state in progression through a standard state
machine applying to any ‘order’

⬫ 䍯浰潳i瑩潮o⼠摯d畭敮u


An aggregation concept acting as a ‘bucket’ for information recorded by a
灲潦敳pi潮慬 慴a愠杩v敮e瑩浥⁦潲m愠杩v敮es畢u散琠潦oc慲攮

⬠偡牴mci灡瑩潮


A⁰慴瑥牮 摥晩湩湧n瑨攠c潮湥o瑩潮o扥瑷敥渠灡牴楥p
灥潰 攬e潲条湩o慴a潮oⰠ
devices) and other information.

+++ Party / role / accountability


A pattern defining relationships between parties, including those that are roles
played by some underlying actor.

+

… +++



䍯浰C數i瑹

l敶敬 孯映c潮o敮e畳Ⱐ慰灡牥湴ay]

Ref: “
One information model to rule them

all?
”; see also
http://wiki.hl7.org/index.php?title=GreenCDA_Project

.

HL7 "Fresh Look"

DAM gRIM Concept

11

Figure 3b


PHR model


example data pattern


XML form[at]

HL7 "Fresh Look"

DAM gRIM Concept

12

Figure 3c


PHR model


example “Green CDA” composition

Demographics


Problem List


Medications


Allergies


Progress Notes and Other
Narrative Documents



Laboratory Results


Microbiology


Images


Administrative Transactions



Quality Measures


Privacy and Security


Demographics


Content: HL7 2.x for messaging, CCD for document summaries


Vocabulary: HITSP Harmonized
codesets

for gender, marital status

Problem List


Content: HL7 2.x for messaging, CCD for document summaries


Vocabulary: SNOMED
-
CT

Medications


Content: NCPDP script for messaging, CCD for document summaries


Vocabulary:
RxNorm

and Structured SIG

Allergies


Content: HL7 2.x for messaging, CCD for document summaries


Vocabulary: UNII for foods and substances, NDF
-
RT for medication class,
RxNorm

for Medications

Progress Notes and Other Narrative Documents

(History and Physical, Operative Notes, Discharge
Summary)


Content: HL7 2.x for messaging, CCD for document summaries


Vocabulary: CDA Templates

Departmental Reports

(Pathology/Cytology, GI, Pulmonary, Cardiology etc.)


Content: HL7 2.x for messaging, CCD for document summaries


Vocabulary: SNOMED
-
CT

Laboratory Results


Content: HL7 2.x for messaging, CCD for document summaries


Vocabulary: LOINC for lab name, UCUM for units of measure, SNOMED
-
CT for test ordering reason

Microbiology


Content: HL7 2.x for messaging, CCD for document summaries


Vocabulary: LOINC for lab name/observation

Images


Content: DICOM

Administrative Transactions

(Benefits/Eligibility, Referral/Authorization, Claims/Remittance)


Content: X12


Vocabulary: CAQH CORE

Quality Measures


Content: Derived from all the data elements above


Vocabulary: Derived from all the data elements above

Privacy and Security


Transport: HTTPS, SOAP/REST


Transport Orchestration: WS*


Authorization/Access Control: XACML

Adapted from http://geekdoctor.blogspot.com/2009/04/data
-
elements
-
of
-
ehr.html

HL7 "Fresh Look"

DAM gRIM Concept

13

Figure

3d. PHR model
-

“harmonized” form

Here’s a snapshot of a
form developed from
the original (.doc
format) using a
conventional
relational
database (RDB).


It is “wysiwyg” (what
you see is what you
get) in that you can
enter data directly into
the form and then it
can be printed out,
communicated using
standard protocols,
and revised as
needed
for consultation

/collaboration
purposes.


HL7 "Fresh Look"

DAM gRIM Concept

14

Figure 3e. PHR model
-

“Green” form example

My sister
gen’d

this
up
in .doc format over
the
time of my mom’s
hip[s] replacement
ordeal
.


The form turned out to
be very useful to help
quickly convey my
mom’s medical
situation.


The idea is to
transform
or provide
transformer
middleware for this
using
up to date
healthcare standards
technology, to facilitate
both composition and
communication.


HL7 "Fresh Look"

DAM gRIM Concept

15

Figure 3f. PHR model


attribution and iteration

For “Green CDA” info, see
http://wiki.hl7.org/index.php?title=GreenCDA_Project
. See next slide for “Pattern Type” detail;.

In the following table, key “ePHR transform” and “PHR Summary content
-

Overview” elements (at left) are related to
various info “pattern types” (middle of table; see also Appendix A & B. “Recycling”, or an iterative process (at right) for

convergence of ad hoc


standard representation is intended synergy between patient and healthcare providers.

Data layering into IT and HC format provides for key semantic mapping, particularly of demographics, health problems,
medications, etc., that are “coded”.

HL7 "Fresh Look"

DAM gRIM Concept

16

Appendix
3g


PHR model


key transforms

Transforms cost and can generate “value
-
add” at various points in the system, although not necessarily “ecologically”.
Fundamentally, each physiological “observation” has a semantic infrastructure as characterized in the upper part of the follo
win
g
diagram, e.g. “
NIBPsystolic

120
[mmHg]

; “Name” coding is particularly costly, as semantic misprecision affects clinical/medical
risk. The lower diagram shows how cost & risk can increase due to transfo
rms
. Moreover, there
may be both “pre
-
” and “post
-
”coordination costs throughout the system life cycle.


costs can be
reduced if not minimized by eliminating/minimizing intermediate tr
ans
forms and normalizing
Coded Values..

Dev
-
>1
st

link
transfer [transform]

1
st

Link


n
th

Transforms

Coded
Value

Protocol
overhead

CodedValue

Name Code

Units Code

overhead

value

overhead

Highly distributed, high
volume, low
-
latency, multi
-
attribute, multi
-
object context
-
sensitive thrashing is bad.,
and most of this is
CodedValue sets.

HL7 "Fresh Look"

DAM
gRIM

Concept

17

Figure 3h PHR model
-

iteration and convergence




Trans
form

Recycling facilitates reuse, generally involving transforming between “ad hoc” (end user) and “standard” (HC IT System”)
form[at[s]], the key semantic interoperability step shown at lower right, in which “intermediate, standard” Nomenclatures
are substituted, manually (“pre
-
coordinated”) or by an adapter or intermediary..


[Note: diagram is patterned after UML interaction diagram vs. topology per last diagram.

Intermediate format grammar (“
tags”
, e.g.
“quantity”, “dosage”),
generally also need transforming, which makes
standardization significantly more complex if only Nomenclatures need to be mapped.; however, “on the fly” (during
import/export) may be done on intermediate format, since typically only table lookups need to be done, at least on the
“standard” side of the system, although some annotation may be needed to flag “uncoded” data.]





Recycle




Intermediate form[at]

<Nomenclature
>

<Value>

<Nomenclature
>




“Ad hoc”

“Standard”

G’way
/[R]DB

Device[s]


Data
Acq’n

Application Domain Focus

HL7 "Fresh Look"