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.
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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"
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