ABD-HDWA-2011x - University of California, Irvine

burnwholeInternet and Web Development

Feb 5, 2013 (4 years and 4 months ago)

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HDWA
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University of California, Irvine

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Introduction


Problem and Solution Path


Includes system demonstration


Ongoing Work


Challenges and Future Work

University of California, Irvine

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Work done at UCI Medical Center


Collaboration between:


Medical Center Clinical Informatics Department


UCI “Calit2” Institute and Information & Computer
Sciences


Team


Lisa Dahm


Charles Boicey


Naveen Ashish

University of California, Irvine

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University of California, Irvine Medical Center is a 422 bed
tertiary teaching hospital with a commitment to education,
research and quality patient care. UCI Medical Center is a
Magnet Designated facility with a Level 1 Trauma Center,
Burn Center and Level II Neonatal Care Center.




Not
-
for
-
Profit


4,500 Employees


35,340 ER Visits


17,500 Admissions





University of California, Irvine

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System Hardware & Software


HP Blades


Clustered MS SQL Server 2008 R2


HP SAN


VM Ware


MS Server 2003 R2 for Microsoft Products



Red Hat, Cent OS & Ubuntu for Linux Products


Data Sources


EMR (Current & Legacy)


Billing System


University of California, Irvine

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UCI Clinical Informatics Team


Director


Informatics Solutions Architect


Principal Statistician/Advisor


Informatics Outreach Architect


Clinical Practice Engineer


Clinical Research Informatics Lead


Clinical Research Informatics Analyst


Clinical Informatics Analyst


Business Intelligence Developer (3)


NLP Specialist


DBA (.25 FTE)


University of California, Irvine

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University of California, Irvine

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University of California, Irvine

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Continuity of Care Document (CCD)



Core data set of the most relevant administrative,
demographic, and
clinical information about a patients healthcare.



CCD is a Health Level 7 (HL7) standard that resulted from
a collaborative
effort between HL7 and ASTM to harmonize
the data
format between
ASTM’s Continuity of Care Record (
CCR) standard
and HL7’s Clinical
Document Architecture (
CDA) standard



HL7 CDA


C
reated
for the exchange of clinical
documents


Human
readable in addition to machine
processable



Generally
created once the process is complete



A subset of data to be exchanged from one system to another

University of California, Irvine

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Standard for electronic document exchange that can
be shared
by all
computer applications, from web
browsers to
electronic health record
(EHR) systems and
personal health
record (PHR) systems.



Can be used system to system. Sending system
sends XML
file which is
received, parsed, and stored by
the receiving
system without any human
intervention.



Can be used as a human readable document.



Print copy and hand to patient as they leave the office.



Fax copy to provider.

University of California, Irvine

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Significant value in the capability of
structured
,
aggregated

querying over
large

collection of CCD


For instance:


“find the number of patients that have had an

allergic
reaction

to
penicillin




“find the
number (or set)
of patients
reporting
skin
rashes

as a
side effect


University of California, Irvine

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Comprehensive Patient Portal Services Appliance
proposal


Covers


EMR/HER


Telemedicine


CCD


….

University of California, Irvine

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University of California, Irvine

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University of California, Irvine

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University of California, Irvine

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For the collection of CCD (XML)


Representation


Storage


Retrieval


Visualization

University of California, Irvine

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Our choice


Storage in “NOSQL” database as opposed to
traditional relational or XML storage


What is
NoSQL

?


Schema
-
less


Key
-
value


University of California, Irvine

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Advantages


Elastic


Big data


Maintenance


Cost


Flexibility


Vendors


CouchDB
,
Memcached
,
m
ongoDB
,
SimpleDB
, neo4j,
AllegroGraph
,
BigTable
,
Hbase


University of California, Irvine

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“fat
-
free” alternative to XML


Example:

University of California, Irvine

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Simple


Readable


Expressive


Easy to parse and process


Interoperable


Open

University of California, Irvine

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University of California, Irvine

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XML to JSON


Java code using SAX


Agnostic to schema

University of California, Irvine

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XML to JSON

MongoExplorer

MongoDB

CCD (XML)

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What is node.js ?


Essentially
server side
Javascript


Node.js


Event driven I/O framework


UNIX like platforms


V8 Java scripting engine


By Google


NPM


Node Package Manager

University of California, Irvine

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Hailed as “new ruby on rails”


Simple


Fast


Low latency


It’s all JSON (being
Javascript
) !


Thus native to
MongoDB

!


University of California, Irvine

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Advantages


The primary advantage to server
-
side scripting is the
ability to highly customize the response based on the
user's requirements, access rights, or queries into
data stores.


From a
security

point of view, server
-
side scripts are
never visible to the browser as these scripts are
executed on the server and emit HTML corresponding
to user's input to the page.


Same framework allows both client side and server
side programming as appropriate


University of California, Irvine

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Solution stack


MongoDB+node.js+mongodb

driver

University of California, Irvine

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MongoDB

n
ode.js

m
ongodb

d
river

Client

JavaScript

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University of California, Irvine

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Plethora of frameworks


Ajax


Javascript


PHP,
PHP+Apache


Node, node.js


Rhino


Prudence


Python


Ruby on Rails


This (node.js) worked most effectively and
comprehensively


University of California, Irvine

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Mongodb+node.js


Advantages


Very flexible


Light
-
weight


Schema agnostic


Challenges


Emerging technology


Ad
-
hoc documentation


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A NoSQL Data Warehouse provides a low cost high
value option for the storage of CCD documents.


A Clinical/Research Inquiry User Interface allows for
both clinicians and researchers to query the NoSQL
Data Warehouse without the need for programming
skills.


The architecture allows for the clinician to view
identified data and the researcher to view de
-
identified data in using the same UI.


University of California, Irvine

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CCD


Retrieval in structured manner


Solution


Technology Stack


Ongoing work

University of California, Irvine

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Please contact:


Naveen
Ashish


ashish@ics.uci.edu


Tel: 949 824 2991


http://www.ics.uci.edu/~ashish


University of California, Irvine

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