short presentation iweee 2010

Healthcare Knowledge Modelling Projects for Multilevel-Based

Information Systems

Dra. Luciana Tricai Cavalini, MD, MSc, PhD“Multilevel Healthcare Information Modeling”Laboratory – Associated to INCT-MACCUFF/UERJ

What do the citizens want?

• And better still:▫ Prevent me getting ill▫ And don’t harm me in the

process”

• “How do you provide to me:▫ Safe▫ Effective▫ Reproducible▫ State-of-the-art ▫ 21st Century medicine▫ Wherever I am▫ Whatever the time▫ Whatever is wrong with me

Paper records can’t handle it

Hardware is not the problem anymore...

...or is it?

No, it is not!

“International Standard paper sizes should be used”

“Attention is drawn to the potentialities of the new methods of mechanical systems and data processing”

45 years later...

What about software?

Brazilian Healthcare Card

Investment:•Federal Budget (until 2009) = R$327 million•Unesco = R$74,3 million•Total (until 2009) = R$401 million

Equivalent the the Aeolian Park in Bahia:•90MW (it illuminates a 400,000 inhab city)•Annual profit estimated in R$41 million

“A Unique Health Identifier alone won't prevent duplicate creation. Make sure your strategy includes a focus on data quality and data governance, too.”

Alex Paris, “Why a Unique Health Identifier Falls Short”

- Cough-For 3 months-Low fever-A: TB? Ca?

-Chest X-ray-Nodule in Right apex-Bronchoalveolar

lavage:-Bronchogenic carcinoma

*Interoperability*

- Cough-For 3 months-Low fever-A: TB? Ca? -Chest X-ray

-Nodule in Right apex

-Bronchoalveolar lavage:-Bronchogenic carcinoma

*Interoperability*

- Cough-For 3 months-Low fever-A: TB? Ca?

-Chest X-ray-Nodule in Right apex

- Cough-For 3 months-Low fever-A: TB? Ca?

CEN 13606 Extracts

HL7v2 Messages

Garage Software

Interoperability?

- Cough-For 3 months-Low fever-A: TB? Ca?

-Chest X-ray-Nodule in Right apex-Bronchoalveolar

lavage:-Bronchogenic carcinoma

Where is the Context?

Here is the Context!

Traditional Modelling

Single-Level Modelling Issues

Information is modelled in a way that “serves” the current needs of the healthcare system The addition of new concepts or the change of existing concepts implies in re-factoring the whole

system (re-modelling, re-implementation, re-test, re-distribution) High cost, slowness in the integration of new knowledge to the systems etc.

Multilevel Modelling

The MLHIM and openEHR Specifications

• Multilevel (or dual) Modelling: software development and knowledge modelling are separated• The Reference Model is implemented in software• The knowledge is modelled in Concept Constraint

Definitions - CCDs (“archetypes” in the openEHR specs)

MLHIM and openEHR Models

Reference Model

Knowledge Modelling (CCDs or Archetypes)

ML

HIM

and

op

enE

HR

sp

ecific ation

s

Your application (EHR, CPOE etc)

FLOSS Available Tools (1)

• Implementations of the Reference Model:▫ 2 Java Implementations by the openEHR Foundation▫ 1 Grails implementation by Pablo Pazos (Uruguay)▫ 1 Python Implementation by the MLHIM Laboratory▫ 1 Ruby Implementation in course by a collaboration between a Japanese

research group and the MLHIM Laboratory▫ 2 other implementation projects by the MLHIm Laboratory:

Lua C++

http://www.openehr.org

https://launchpad.net/mlhim

https://launchpad.net/oship

http://www.mlhim.org

http://www.oship.org

FLOSS Available Tools (2)

• Archetype Editors (in ADL):▫ Ocean Archetype Editor (Windows-only)▫ LinkEHR (source code by request, there are bugs)▫ LiU Archetype Editor (outdated)

• Templates Editors (in OET, OPT):▫ None (only the proprietary Ocean Template Designer)

• Constraint Definition Designer Project (in XML):▫ Only full-FLOSS and multiplatform tool▫ Combined CCD and Template editor▫ Baseado on Freemind, Plone and other ideas

https://launchpad.net/cdd

FLOSS Available Tools (3)

• Archetype Repository:▫ None (openEHR Foundation’s CKM is proprietary)• The Healthcare Knowledge Component Repository Project:▫ Repository of the XML Schemas of CCDs▫ Based on Plone 4▫ Functionalities:

All the famous Plone’s CMS and WFM features XML Schema validation API to CDD, OSHIP and the Multilevel Authoring for Guidelines (MAG)

https://launchpad.net/hkcr

FLOSS Available Tools (4)

• Terminology and Vocabulary Servers:▫ LexGrid (http://www.lexgrid.org)▫ LexBIG (http://preview.tinyurl.com/29ybeuf)▫ Unified Medical Language System (UMLS)

(http://www.nlm.nih.gov/research/umls)

http://www.lexgrid.org

http://preview.tinyurl.com/29ybeuf

http://www.nlm.nih.gov/research/umls

Knowledge Modelling (1)

• Our governance model proposes:▫ Openness and transparency in decision making and operational

procedures▫ Deliberative systems based on universal suffrage and

representativensess▫ Cost-effective financing models, based on equitable and public

distribution of resources, including direct funding, collaborative work, research and education projects etc.▫ Coordinated and federation principles-based decentralization

Knowledge Modelling(2)• Our governance model proposes :▫ Preference for the use of validated instruments (including their

translations) for the development of CCDs ▫ Preferential use of knowledge modelling strategies derived from the

collaborative computing (web based or presential)▫ Knowledge modelling might be based on expert panels in exceptional

situations▫ Publication of the knowledge modelling artifacts on a public, open access,

FLOSS-based repository, maintained by the healthcare system manager in each one of the three levels of government

My Conclusions• I think that the path for the development of citizen-centered, longitudinal, semantic

coherent healthcare information systems is based on this tripod:▫ Multilevel modelling▫ Adoption of standardized terminologies▫ Adoption of a Unique Citizen Identifier

• Emerging countries have some competitive advantages in healthcare IT:▫ Usually, the Big Customer is just one (the government)▫ We are starting almost from scratch▫ Emerging countries are much more FLOSS-friendly▫ All needed tools are available or being developen in FLOSS

• What’s next:▫ Invite more partners to participate (government, academy, industry, third sector, FLOSS

community)

▫ Go to work!

Thank you!

lutricav@vm.uff.br

Join us:

http://www.mlhim.orghttps://launchpad.net/mlhim

Special Thanks to:Tim Cook

Mike BainbridgeSergio Freire