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Apresente um Novo Produto
Health Informatics: the
Relevance of Open Source and Multilevel Modeling
Luciana T. Cavalini, MD, PhDTimothy W. Cook, MSc
Multilevel Healthcare Information Modeling (MLHIM) Laboratory (UFF/UERJ)
Associated to the National Institute of Science and Technology Medicine Assisted by Scientific Computing
Introduction
Healthcare is a dynamic and complex systemThe spatial changes are close
The time changes are fast
The number of basic concepts is 300,000+
Cavalini's conjecture: given a group of medical experts without any hierarchical relationship among them, the probability of them reaching 100% of agreement about any set of concepts from their domain tends to zero
Introduction
A single monolithic system for the complete health record of a person from cradle to grave is not feasible
Integration projects that were successful in other businesses have been attempted in healthcare over the last 46 years, spending trillions of dollars, with a 100% failure rate
The result: healthcare is the less computerized business in economy
Introduction
Electronic Health Records (EHR) have promised (and yet not delivered): waste of citizen's time in lines for appointments and referral
waste of staff time in search of critical information
duplication of tests, medications and procedures
early detection and prevention
adherence to therapeutic protocols
risk of adverse events and medical errors
avoidable hospitalization and mortality
Total loss: 12 billion in 10 years
Total loss: not published (6 years)
Total loss: US$200 million (13 years)
Not solving a problem is usually much more profitable than solving itAre you following me, Groo?
Introduction
Currently, medical records have a chaotic mixture of old (paper) and new (computer) support medias
The electronic records already implemented seldom follow any of the ISO TC 215 recommendations or any other standardization
The mixture of incompatible systems runs across the entire system: from inside the hospitals up to the local, regional, national and international levels
The reality of British NHS
=
The reality of American Medicare
=
The reality of Brazilian SUS
etc.
Hardware is not the problem anymore
What about software?
What software???
Interoperability
- Cough- For 3 months- Low feverChest X-Ray:- Nodule in right apexBAL:- TB
Interoperability!
- Cough- For 3 months- Low feverChest X-Ray:- Nodule in right apexBAL: TB
- Cough- For 3 months- Low feverChest X-Ray:- Nodule in right apex- Cough- For 3 months- Low feverChest X-Ray:- Nodule in right apexBAL: TB
ISO 13606 messages
HL7v2 messages
MS Access formInteroperability?
- Cough- For 3 months- Low feverChest X-Ray:- Nodule in right apexBAL:- TB
xxxxveryexpensivemapping
Where is the context?
Here is the context!
IHE
HL7
IHTSDO
ISO
WHO
SNOMED CT
ICDx
CEN
ASTM
CDA
EN13606-1
CCR
v2 messages
v3 messages
Data types
PDQ
CCOW
HSSP
PIX
HISA
RID
XDS
PMAC
EN13606-4
RBAC
EN13606-3
EN13606-2
Templates
Documents
Security
Services
Content models
Terminology
Thanks to: Thomas Beale (openEHR Foundation)
Traditional Modeling
Traditional Modeling
Information is modelled to serve the current needs of the healthcare system; but those needs change very fast and they are very different from one facility to another
Adding new concepts and customizing a legate system for another facility demands the total re-make of the system (re-modelling, re-implementation, re-test, re-deployment)
Unaffordable costs, frustrated users, abandonment of the systems (average time = 2 years)
Multilevel Modeling
This approach is compliant to the ISO 20514 standard
Multilevel Modeling
Fundamental Principle: separation between the Reference Model and Knowledge Modeling
The Reference Model is a necessary and sufficient set of generic classes for the persistence of all types of health information
The Knowledge Modeling is the combination of the Reference Model classes and the definition of constraints to those very classes, enough to define a given healthcare concept
Multilevel Modeling
Reference ModelKnowledge ModelingYour Application (GUI, BI etc)
Multilevel Modeling
SpecificationCompliance to StandardsOpenImplemented
openEHRInspired ISO 20514, 18308 and 13606YesYes(RM and KM tools = Yes)
MLHIMInspired by ISO 21090, 20514, 18308 and 13606 and W3C specsYESRM and KM tools
openEHR Reference Model
(High level structure)
Composition
openEHR Reference Model
(Low level structure)
Nanos gigantium humeris insidentesBernard of Chartres
Make things as simple as possible, but no simplerAlbert Einstein
MLHIM Reference Model
ELEMENTCCD
CareEntry or AdminEntry
Cluster
QuantitativeDatatypesNon-QuantitativeDatatypesDvQuantifiedDvStringDvEncapsulatedDvParagraphDvBooleanCluster
ELEMENTELEMENTDvDate TimeDvDurationDvIntervalRefRange...and its child classes
...and its child classes
Knowledge Modeling in MLM
Name(Spec)ArchitectureOpen# of KM artifacts / conceptSolution for Cavalini's conjectureCombination of KM artifactsOpen
Archetype(openEHR)Archetype Definition LanguageYesOneSpecialisationTemplatesYes
Concept Constraint Definition CCD(MLHIM)XSDYesUndefinedNo restriction for the # of CCDs / conceptMaster CCDYes
openEHR archetypes and
MLHIM CCDs
Analogy: Lego
openEHR archetypes and
MLHIM CCDs
Archetype / CCD
Concept
MLM Principles and OS
Principle 1: The Reference Model is language-agnostic and common to all implementations
Principle 2: The Knowledge Modeling artifacts should be valid against the Reference Model
Principles 1 an 2 require open specifications and strongly support open source implementations of the RM and open source KM tools
MLM Principles and OS
Principle 3: The Knowledge Modeling artifacts should contain all the semantic context of the information
Principle 4: The Knowledge Modeling artifacts are shareable among applications
Principles 3 and 4 strongly support open instances of KM repositories
Bioethical Principles and OS
Principle of Beneficence and Non-Maleficence (primum non nocere): bad health informatics can kill (http://iig.umit.at/efmi/badinformatics.htm)
Principle of Efficiency (or cost-effectiveness): IT adoption in healthcare is a healthcare intervention such as drugs, lab tests etc and it should be submitted to the same scrutiny
The principles of Beneficence / Non-Maleficenceand Efficiency strongly support the adoptionof OS MLM-based applications in healthcare
Thank you!
Join us:
Visit us:
http://macc.lncc.br
http://www.mlhim.org
My e-mail: [email protected]
Special acknowledgements:Sergio FreireMike Bainbridge
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