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DCS 860D – Distributed Internet ComputingDCS 860D – Distributed Internet Computing

Meg Broderick Meg Broderick April 12, 2003April 12, 2003

AgendaAgenda

Interoperability Interoperability Importance in HealthcareImportance in Healthcare HL 7 and XMLHL 7 and XML Patient Record ArchitecturePatient Record Architecture Integration BrokersIntegration Brokers DemoDemo

InteroperabilityInteroperability

“…“…the ability of a system or a product to the ability of a system or a product to work with other systems or products without work with other systems or products without special effort on the part of the customer.. special effort on the part of the customer..

“…“…Products achieve interoperability with Products achieve interoperability with other products using either or both of two other products using either or both of two approaches: approaches: By adhering to published By adhering to published interfaceinterface standards…, standards…,

e.g., HTML, TCP/IP e.g., HTML, TCP/IP By making use of a ‘broker’ of services that can By making use of a ‘broker’ of services that can

convert one product's interface into another convert one product's interface into another product's interface "on the fly“, …e.g. CORBA “product's interface "on the fly“, …e.g. CORBA “

Source: Source: www.whatis.comwww.whatis.comhttp://searchsystemsmanagement.techtarget.com/sDefinition/http://searchsystemsmanagement.techtarget.com/sDefinition/

0,,sid20_gci212372,00.html0,,sid20_gci212372,00.html

Importance of Interoperability for Importance of Interoperability for HealthcareHealthcare

Distributed Information CollectionDistributed Information Collection Multiple PlacesMultiple Places Different FunctionDifferent Function Completeness DesirableCompleteness Desirable Large Volumes of DataLarge Volumes of Data

Distributed UseDistributed Use Dispersed LocationsDispersed Locations Different Functions: Information vs Different Functions: Information vs

TransactionsTransactions Quality EssentialQuality Essential Different Levels of Computing PowerDifferent Levels of Computing Power

W3C XML Linking Work GroupW3C XML Linking Work Group

Mission:Mission: To design advanced, scalable, and To design advanced, scalable, and

maintainable hyperlinking and maintainable hyperlinking and addressing functionality for XML addressing functionality for XML

Paul V. Biron & Sandra L. Boyer, Paul V. Biron & Sandra L. Boyer, “Introduction to XML,” HL7 Fall “Introduction to XML,” HL7 Fall Plenary Meeting, Sept 27, 1999 Plenary Meeting, Sept 27, 1999

XML and HL7XML and HL7 Start first with Patient Record Start first with Patient Record

Architecture Architecture Expand Electronic Medical Record to Expand Electronic Medical Record to

include document-based clinical infoinclude document-based clinical info Exchange, reuse, longevityExchange, reuse, longevity System IndependentSystem Independent Local + Global Local + Global HierarchicalHierarchical

Adds HL7 MessagingAdds HL7 Messaging Non-proprietary, standards-based Non-proprietary, standards-based

(open)(open)

Patient Record Architecture (PRA)Patient Record Architecture (PRA)

Multilevel, XMLMultilevel, XML Level 1:Level 1: Coded HeaderCoded Header Level 2:Level 2: Coded StructureCoded Structure Level 3: Coded ContentLevel 3: Coded Content

Syntax handles recursionSyntax handles recursion Nested structuresNested structures Unify segments, fields, components and Unify segments, fields, components and

subcomponentssubcomponents Aka Clinical Document Architecture Aka Clinical Document Architecture

(CDA)(CDA) Header + BodyHeader + Body

Patient Record ArchitecturePatient Record Architecture Advantages of XMLAdvantages of XML

Parsers are “free” (utilities)Parsers are “free” (utilities) Tools and technical staffing Tools and technical staffing

availableavailable Supports type conversionSupports type conversion Order and placement of message Order and placement of message

elements specifiedelements specified RIM Attribute Level Message RIM Attribute Level Message

ElementsElements Supports primitive and Supports primitive and

composite data typescomposite data types

PRA: HL7 Conformance ProfilesPRA: HL7 Conformance Profiles Healthcare Orgs adapted HL7 message specs locallyHealthcare Orgs adapted HL7 message specs locally

Implementation specs stored in spreadsheet or wordImplementation specs stored in spreadsheet or word processing documentprocessing document

Message profile: HL7 spec + constraints + additions Message profile: HL7 spec + constraints + additions (z-segments)(z-segments)

Large amount of variance => maintenance nightmareLarge amount of variance => maintenance nightmare Store message profile in XML document:Store message profile in XML document:

Use XML to communicate metadata – data about dataUse XML to communicate metadata – data about data Easily converted to PDFEasily converted to PDF Tools: Messaging Work Bench, Symphonia, Tools: Messaging Work Bench, Symphonia,

Medi7 Parser ToolkitMedi7 Parser Toolkit Repository for message profiles on Repository for message profiles on www.hl7.orgwww.hl7.org Concerns: Concerns:

Vendor Competition Vendor Competition Correct with HCO pressureCorrect with HCO pressure

Concept Cluster TemplatesConcept Cluster Templates

Information StructuresInformation Structures HL7 messagesHL7 messages XML documentsXML documents

ConceptsConcepts Generalization of notion of codes, including Generalization of notion of codes, including

SNOMEDSNOMED Archetypes or templatesArchetypes or templates Defines concept, units, values, modeDefines concept, units, values, mode

e.g., BP Reading, concept ”systolic reading”, value, e.g., BP Reading, concept ”systolic reading”, value, units, method (cuff), postureunits, method (cuff), posture

Concensus DefinitionConcensus Definition HL7, British General Practitioner to General HL7, British General Practitioner to General

Practitioner, GEHR, etc.Practitioner, GEHR, etc.

Source: W. Rishel, J. Klein, “Concept Cluster Templates: Next Step in Clincal Standards,” Source: W. Rishel, J. Klein, “Concept Cluster Templates: Next Step in Clincal Standards,” Tutorials, TU-14-7758, Research Note, November 9, 2001, Garter GroupTutorials, TU-14-7758, Research Note, November 9, 2001, Garter Group

Other TechnologyOther Technology ebXMLebXML Electronic Business Extensible Markup Electronic Business Extensible Markup

LanguageLanguage XML specs to streamline online businessXML specs to streamline online business Also X12 syntaxAlso X12 syntax

ComponentsComponents Business Process SchemaBusiness Process Schema Common Business ObjectsCommon Business Objects Collaboration Protocol ProfilesCollaboration Protocol Profiles RegistryRegistry Universal DescriptionUniversal Description Secure Messaging ServiceSecure Messaging Service

CCOW CCOW HL7, Context management standardHL7, Context management standard Technology NeutralTechnology Neutral Patient Context/ User MappingPatient Context/ User Mapping

HIPAA ImpactHIPAA Impact Possible efficiencies?Possible efficiencies?

Source: W. Rishel, “Healthcare and ebXML: Rx for HIPAA Security Compliance,” Events, EV-13-8185, Research Note, Source: W. Rishel, “Healthcare and ebXML: Rx for HIPAA Security Compliance,” Events, EV-13-8185, Research Note, June 11, 2001, Garter GroupJune 11, 2001, Garter Group

Source: J. Klein, “CCOW: A Standard for Application Context Coordination,” Tutorials, TU-14-1690, Research Note, July Source: J. Klein, “CCOW: A Standard for Application Context Coordination,” Tutorials, TU-14-1690, Research Note, July 31, 2001, Garter Group31, 2001, Garter Group

Early XML AdoptersEarly XML Adopters IndustryIndustry

MetLifeMetLife To facilitate data exchange in financial To facilitate data exchange in financial

servicesservices To allow coordination across multiple To allow coordination across multiple

new business units and acquistionsnew business units and acquistions Build single customer view from back-Build single customer view from back-

end info silosend info silos Resulted in:Resulted in:

Reduction of # of interfaces and reuse Reduction of # of interfaces and reuse interfacesinterfaces

Integration of services external and internalIntegration of services external and internal Increased ease of data exchangeIncreased ease of data exchange

Source: K. Harris, “Metlife: Insurance XML Early Adopter,” Case Source: K. Harris, “Metlife: Insurance XML Early Adopter,” Case Studies, CS-15-2148, Research Note, February 11, 2002, Garter Studies, CS-15-2148, Research Note, February 11, 2002, Garter GroupGroup

Early XML AdoptersEarly XML Adopters

HealthcareHealthcare End Stage Renal Disease ReportingEnd Stage Renal Disease Reporting

Needed to automate processing of 1.5 million forms/year Needed to automate processing of 1.5 million forms/year from dialysis centersfrom dialysis centers

Wide scope: 300,000 patients in 4,000 centersWide scope: 300,000 patients in 4,000 centers VISION – Vital Information System to Improve Outcomes VISION – Vital Information System to Improve Outcomes

in Nephrologyin Nephrology Sponsored by Center for Medicare and Medicaid Services Sponsored by Center for Medicare and Medicaid Services

(CMS) – Distributed freely(CMS) – Distributed freely Agency controlled both ends of information interface – Agency controlled both ends of information interface –

more flexibility to evolvemore flexibility to evolve Needed rapid implementation and deploymentNeeded rapid implementation and deployment Desired resemblance to HL7 standardsDesired resemblance to HL7 standards Used RIM, a complete Unified Modeling Language (UML)Used RIM, a complete Unified Modeling Language (UML)

Source: W. Rishel, “Early XML Adoption for End Stage Renal Disease Reporting,” Case Source: W. Rishel, “Early XML Adoption for End Stage Renal Disease Reporting,” Case Studies, CD-15-6464, Research Note March 7, 2002, Gartner GroupStudies, CD-15-6464, Research Note March 7, 2002, Gartner Group

Integration BrokersIntegration Brokers

TypesTypes Message-oriented middleware Message-oriented middleware

(MOM)(MOM) TransformationTransformation Business Process ManagementBusiness Process Management Context-based routingContext-based routing TransformationTransformation

Specialized packages vs part of Specialized packages vs part of application platformapplication platform

Synchronous vs AsynchronousSynchronous vs Asynchronous

DemoDemo

PausePause

@echo offecho *************************************************echo ****** **********echo ****** LINKTools IDK Demonstration **********echo ******---------------------------------**********echo ****** This Batch file takes you **********echo ****** step-by-step through the **********echo ****** interface processes. **********echo ****** **********echo *************************************************

cd\cd C:\LINKDemo\pauseclsecho *************************************************echo *** The input files are copied from the *****echo *** C:\LINKDemo\TestFiles\ folder to the *****echo *** C:\LINKDemo\UDARecv folder. (HL7.*) *****echo *** This simulates the receipt of HL7 *****echo *** Admission, Discharge or Transfer (ADT) *****echo *** Messages *****echo *************************************************echo *** Press SPACE BAR to copy input files *****echo *************************************************pausexcopy c:\linkdemo\testfiles\HL7.* c:\linkdemo\UDARecv\cls

echo *************************************************echo *** The HL7.* files copied to the *****echo *** C:\LINKDemo\UDARecv folder will be *****echo *** processed and output to the *****echo *** C:\LINKDemo\XMLOut folder *****echo *************************************************echo *** Press SPACE BAR to run update *****echo *************************************************pausec:\linkdemo\ltup.exe c:\linkdemo\ADT2XML-Rep2HL7Demo.MPRcls

echo *************************************************echo *** To Simulate the reports passed back *****echo *** from the target we will copy the *****echo *** Report.001 file form the *****echo *** C:\LINKDemo\TestFiles\ folder to the *****echo *** C:\LINKDemo\ReportsIn folder. *****echo *************************************************echo *** Press SPACE BAR to copy input files *****echo *************************************************pausexcopy c:\linkdemo\testfiles\Report.001 c:\linkdemo\ReportsIn\cls

echo *************************************************echo *** The Report.001 file copied to the *****echo *** C:\LINKDemo\ReportsIn folder will be *****echo *** merged in the database with the *****echo *** previously received ADT data and *****echo *** output to the *****echo *** C:\LINKDemo\UDASend folder in HL7 *****echo *** format *****echo *************************************************echo *** Press SPACE BAR to run update *****echo *************************************************pause

c:\linkdemo\ltup.exe c:\linkdemo\ADT2XML-Rep2HL7Demo.MPRclsecho *************************************************echo *** Press SPACE BAR to view data ****echo *** in database with LINKSelect application ****echo *************************************************pausec:\linkdemo\ltdb.exe c:\linkdemo\ADT2XML-Rep2HL7Demo.MPRexit

The FutureThe Future

Any to Any Connectivity and Any to Any Connectivity and TransformationTransformation

Common Identification across all Common Identification across all enterprisesenterprises

Consistent and concurrent timing Consistent and concurrent timing Proprietary vs Independent Proprietary vs Independent

Integration?Integration? Improved availability and, perhaps Improved availability and, perhaps

quality, of healthcare information at quality, of healthcare information at point of carepoint of care


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