Download - Short presentation IWEEE 2010
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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
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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
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Paper records can’t handle it
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Hardware is not the problem anymore...
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...or is it?
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No, it is not!
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“International Standard paper sizes should be used”
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“Attention is drawn to the potentialities of the new methods of mechanical systems and data processing”
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45 years later...
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What about software?
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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
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“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”
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- Cough-For 3 months-Low fever-A: TB? Ca?
-Chest X-ray-Nodule in Right apex-Bronchoalveolar
lavage:-Bronchogenic carcinoma
*Interoperability*
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- 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?
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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
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Where is the Context?
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Here is the Context!
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Traditional Modelling
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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.
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Multilevel Modelling
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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)
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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)
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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++
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http://www.openehr.org
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https://launchpad.net/mlhim
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https://launchpad.net/oship
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http://www.mlhim.org
http://www.oship.org
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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
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https://launchpad.net/cdd
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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)
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https://launchpad.net/hkcr
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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)
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http://www.lexgrid.org
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http://preview.tinyurl.com/29ybeuf
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http://www.nlm.nih.gov/research/umls
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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
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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
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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!
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Thank you!
Join us:
http://www.mlhim.orghttps://launchpad.net/mlhim
Special Thanks to:Tim Cook
Mike BainbridgeSergio Freire