interlinking various personal health applications - … various...various personal health through...

Various Personal Health

through the WebApplications

Interlinking

Sukwha�� Kim,�� MD,�� PhD

Second Annual OSEHRA Summit & WorkshopSession: Open Source Technologies in Healthcare

Friday, September 6, 2013

Director,�� Department�� of�� Plastic�� Surgery,�� Seoul�� National�� University�� Hospital

“COPERNICAN REVOLUTION” DEMANDS A NEW BREED OF HEALTH INFORMATION SYSTEM

2Benson, T. (2009). Principles of Health Interoperability HL7 and SNOMED, Springer.

“The patient is the sole reason for healthcare activity, and so we should focus on meeting the patient’s needs. [...] Healthcare is changing from a paternalistic model to one of partnership between patients and healthcare professionals.”

“In the traditional healthcare model, care was based around discrete visits and episodes of care. [...] This model is disappearing fast, but we still rely on information systems that were originally conceived and designed for that environment.”

- Tim Benson

E-PATIENTS: HERE COMES HEALTH

3

- Dr. Tom Ferguson

• engaged when they seek to access their own health information

• enabled when they have access to their own health information

• equipped when they understand their own health information

• then empowered to achieve self-management of their care

1943-2006

Ferguson, T. (2007). e-Patients: How they can help us heal health care. Society for Participatory Medicine.

QUANTIFIED SELF: KNOW THYSELF

4

“Quantified Self is a collaboration of users and tool makers,who share an interest in self knowledge through self-tracking.”

The Quanti!ed Self; http://quanti!edself.com/

- Kevin Kelly - - Gary Wolf -

“DOES IT WORK FOR ME?” IS MORE IMPORTANT THAN “DOES IT WORK ON AVERAGE?”

5

• This guy measured his arithmetic speed daily:• how fast he does simple arithmetic problems, such as 3+4.• Several years ago, he discovered that butter — more precisely,

substitution of butter for port fat — made him faster.

- Prof. Seth Robert -

Seth’s Blog; http://blog.sethroberts.net/

DIFFERENT NEEDS, DIFFERENT PREFERENCES, AND DIFFERENT APPLICATIONS

6Gandhi, M. and Tecco, H. (2013). 2012 Digital Health Funding Report. Rock Health.

THERE IS NO ‘ONE-SIZE-FITS-ALL’ SOLUTION IN HEALTH CARE

7

THERE’S AN APP FOR THAT

8Estrin, D. and Sim, I. (2010). Open mHealth Architecture: An Engine for Health Care Innovation. Science Magazine, 330(6005):759-760.

“mHealth is emerging as

serving narrow, albeit valuable, needs, and thus coulda patchwork of incompatible applications

benefit from more coordinated development.”

(“apps”)

- Deborah Estrin and Ida Sim

LIQUIDITY OF DATA

9

“A prerequisite of Personal Health Records (PHR) systems is

- Tim Bensondata liquidity using open standards.”

Benson, T. (2009). Principles of Health Interoperability HL7 and SNOMED, Springer.

HOUR GLASS ARCHITECTURE

10Estrin, D. and Sim, I. (2010). Open mHealth Architecture: An Engine for Health Care Innovation. Science Magazine, 330(6005):759-760.

Mandl, K.D. and Kohane, I.S. (2009). No Small Change for the Health Information Economy. New England Journal of Medicine, 360(13):1278-1281.

“Flexibility is critical, since the system will have to function under new policies and in the service of new health care delivery mechanisms, and it will need to incorporate

emerging information technologies on an ongoing basis.”- Kenneth D. Mandl and Isaac S. Kohane

“ESCAPING THE EHR TRAP”

11Mandl, K.D. and Kohane, I.S. (2009). No Small Change for the Health Information Economy. New England Journal of Medicine, 360(13):1278-1281.

“Only a small subset of loosely coupled information technologies

- Kenneth D. Mandl and Isaac S. Kohane

need to be highly specific to health care. Many components can be generic.”

THE WORLD WIDE WEB IS THE MOST SUCCESSFUL DISTRIBUTED SYSTEM

12Jacobs, I. and Walsh, N. (2004). Architecture of the World Wide Web, Volume One. W3C.Costello, R.L. (2002). REST(Representational State Transfer). XML Technologies Course.

“A representation of the resource is returned (e.g., oaxaca.html). The representation places the client application in a state. The result of the client traversing a hyperlink in oaxaca.html is another resource is accessed. The new representation places the client application into yet another state. Thus, the client application changes (transfers) state with each resource representation.”

Representational State Transfer (ReST)

EXISTING OPEN SOURCE SOFTWARE & STANDARDS

13

APACHEHTTP SERVER

OAUTH

NOT ONLY OPEN SOURCE BUT ALSO OPEN STANDARDS

14Nicolas Rougier; http://www.loria.fr/~rougier/

“POSIX, an acronym for “Portable Operating System Interface”, is a family of standards specified by the IEEE for maintaining compatibility between operating systems. POSIX defines the application programming interface (API), along with command line shells and utility interfaces, for software compatibility with variants of Unix and other operating systems.”

OPEN STANDARDS FOR HEALTH INFORMATION INTEROPERABILITY

15

“Blue Button+ is a blueprint for the structured and secure transmission of personal health data on behalf of an individual consumer. It meets and builds on the view, download, and transmit requirements in Meaningful Use Stage 2 for certified EHR technology.”

HHS (2013). Introducing Blue Button +. HHS.gov/DigitalStrategy.ONC's Standards and Interoperability Framework (2013). Blue Button+ Implementation Guide.

THE RECOMMENDED STANDARD FOR REPRESENTING THE PATIENT HEALTH RECORD

16

“The Consolidated CDA is a XML-based standard that specifies the encoding, structure, and semantics of a clinical document. Blue Button adopts the requirements for sections and fields from Meaningful Use Stage 2.”

ONC's Standards and Interoperability Framework (2013). Blue Button+ Implementation Guide.

STANDARDIZED CODING SYSTEMS

17

“Throughout the C-CDA, a variety of codes are usedto describe the valued within it.”

Software that translates from one terminology to another can be implemented as ReSTful Web services so Personal Health Applications (PHA) can harness them.

ONC's Standards and Interoperability Framework (2013). Blue Button+ Implementation Guide.

THE WEB AS A KNOWLEDGE PLATFORM

18

MusicBrainz

(zitgist)

P20

Turismo de

Zaragoza

yovisto

Yahoo! Geo

Planet

YAGO

World Fact-book

El ViajeroTourism

WordNet (W3C)

WordNet (VUA)

VIVO UF

VIVO Indiana

VIVO Cornell

VIAF

URIBurner

Sussex Reading

Lists

Plymouth Reading

Lists

UniRef

UniProt

UMBEL

UK Post-codes

legislationdata.gov.uk

Uberblic

UB Mann-heim

TWC LOGD

Twarql

transportdata.gov.

uk

Traffic Scotland

theses.fr

Thesau-rus W

totl.net

Tele-graphis

TCMGeneDIT

TaxonConcept

Open Library (Talis)

tags2con delicious

t4gminfo

Swedish Open

Cultural Heritage

Surge Radio

Sudoc

STW

RAMEAU SH

statisticsdata.gov.

uk

St. Andrews Resource

Lists

ECS South-ampton EPrints

SSW Thesaur

us

SmartLink

Slideshare2RDF

semanticweb.org

SemanticTweet

Semantic XBRL

SWDog Food

Source Code Ecosystem Linked Data

US SEC (rdfabout)

Sears

Scotland Geo-

graphy

ScotlandPupils &Exams

Scholaro-meter

WordNet (RKB

Explorer)

Wiki

UN/LOCODE

Ulm

ECS (RKB

Explorer)

Roma

RISKS

RESEX

RAE2001

Pisa

OS

OAI

NSF

New-castle

LAASKISTI

JISC

IRIT

IEEE

IBM

Eurécom

ERA

ePrints dotAC

DEPLOY

DBLP (RKB

Explorer)

Crime Reports

UK

Course-ware

CORDIS (RKB

Explorer)CiteSeer

Budapest

ACM

riese

Revyu

researchdata.gov.

ukRen. Energy Genera-

tors

referencedata.gov.

uk

Recht-spraak.

nl

RDFohloh

Last.FM (rdfize)

RDF Book

Mashup

Rådata nå!

PSH

Product Types

Ontology

ProductDB

PBAC

Poké-pédia

patentsdata.go

v.uk

OxPoints

Ord-nance Survey

Openly Local

Open Library

OpenCyc

Open Corpo-rates

OpenCalais

OpenEI

Open Election

Data Project

OpenData

Thesau-rus

Ontos News Portal

OGOLOD

JanusAMP

Ocean Drilling Codices

New York

Times

NVD

ntnusc

NTU Resource

Lists

Norwe-gian

MeSH

NDL subjects

ndlna

myExperi-ment

Italian Museums

medu-cator

MARC Codes List

Man-chester Reading

Lists

Lotico

Weather Stations

London Gazette

LOIUS

Linked Open Colors

lobidResources

lobidOrgani-sations

LEM

LinkedMDB

LinkedLCCN

LinkedGeoData

LinkedCT

LinkedUser

FeedbackLOV

Linked Open

Numbers

LODE

Eurostat (OntologyCentral)

Linked EDGAR

(OntologyCentral)

Linked Crunch-

base

lingvoj

Lichfield Spen-ding

LIBRIS

Lexvo

LCSH

DBLP (L3S)

Linked Sensor Data (Kno.e.sis)

Klapp-stuhl-club

Good-win

Family

National Radio-activity

JP

Jamendo (DBtune)

Italian public

schools

ISTAT Immi-gration

iServe

IdRef Sudoc

NSZL Catalog

Hellenic PD

Hellenic FBD

PiedmontAccomo-dations

GovTrack

GovWILD

GoogleArt

wrapper

gnoss

GESIS

GeoWordNet

GeoSpecies

GeoNames

GeoLinkedData

GEMET

GTAA

STITCH

SIDER

Project Guten-berg

MediCare

Euro-stat

(FUB)

EURES

DrugBank

Disea-some

DBLP (FU

Berlin)

DailyMed

CORDIS(FUB)

Freebase

flickr wrappr

Fishes of Texas

Finnish Munici-palities

ChEMBL

FanHubz

EventMedia

EUTC Produc-

tions

Eurostat

Europeana

EUNIS

EU Insti-

tutions

ESD stan-dards

EARTh

Enipedia

Popula-tion (En-AKTing)

NHS(En-

AKTing) Mortality(En-

AKTing)

Energy (En-

AKTing)

Crime(En-

AKTing)

CO2 Emission

(En-AKTing)

EEA

SISVU

education.data.g

ov.uk

ECS South-ampton

ECCO-TCP

GND

Didactalia

DDC Deutsche Bio-

graphie

datadcs

MusicBrainz

(DBTune)

Magna-tune

John Peel

(DBTune)

Classical (DB

Tune)

AudioScrobbler (DBTune)

Last.FM artists

(DBTune)

DBTropes

Portu-guese

DBpedia

dbpedia lite

Greek DBpedia

DBpedia

data-open-ac-uk

SMCJournals

Pokedex

Airports

NASA (Data Incu-bator)

MusicBrainz(Data

Incubator)

Moseley Folk

Metoffice Weather Forecasts

Discogs (Data

Incubator)

Climbing

data.gov.uk intervals

Data Gov.ie

databnf.fr

Cornetto

reegle

Chronic-ling

America

Chem2Bio2RDF

Calames

businessdata.gov.

uk

Bricklink

Brazilian Poli-

ticians

BNB

UniSTS

UniPathway

UniParc

Taxonomy

UniProt(Bio2RDF)

SGD

Reactome

PubMedPub

Chem

PRO-SITE

ProDom

Pfam

PDB

OMIMMGI

KEGG Reaction

KEGG Pathway

KEGG Glycan

KEGG Enzyme

KEGG Drug

Com-pound

InterPro

HomoloGene

HGNC

Gene Ontology

GeneID

Affy-metrix

bible ontology

BibBase

FTS

BBC Wildlife Finder

BBC Program

mes BBC Music

Alpine Ski

Austria

LOCAH

Amster-dam

Museum

AGROVOC

AEMET

US Census (rdfabout)

As of September 2011

Media

Geographic

Publications

Government

Cross-domain

Life sciences

User-generated content

NCBO BIOPORTAL

19Salvadores, M., Alexander, P.R., Musen, M.A., and Noy, N.F. (2013). BioPortal as a Dataset of Linked Biomedical Ontologies and Terminologies in RDF. Semantic Web, 4(3):277-284.

“BioPortal provides de-referenceable terms and ontology URIs. Individual terms can be resolved in RDF by dereferencing a specific term URI. Term URIs are normally in the name space that ontology authors have defined, which is outside of BioPortal’s domain. To provide linked data for these URIs, our Web front-end provides permanent URLs for each ontology term using a PURL server.”

THE RECOMMENDED STANDARD FOR TRANSPORTING HEALTH INFORMATION

20ONC's Standards and Interoperability Framework (2013). Blue Button+ Implementation Guide.

“In alignment with Meaningful Use Stage 2 standards, Blue Button+ uses Direct protocols to securely transport health information from providers to third party applications. Direct uses SMTP, S/MIME, and X.509 certificates to achieve security, privacy, data integrity, and authentication of sender and receiver.”

SMART PLATFORMS DATA MODELS & RESTFUL API

21

TUTORIALSTUTORIALS

Build&a&SMART&AppBuild&a&SMART&App

Build&a&SMART&REST&AppBuild&a&SMART&REST&App

Background&+&Helper&AppsBackground&+&Helper&Apps

Frame&UI&AppsFrame&UI&Apps

Got&Statins?&AppGot&Statins?&App

RxReminder&AppRxReminder&App

USING+SMART+DATAUSING+SMART+DATA

Intro&to&RDF&and&SPARQLIntro&to&RDF&and&SPARQL

SPARQL&Examples&for&SMARTSPARQL&Examples&for&SMART

Intro&to&the&JSONJLD&APIIntro&to&the&JSONJLD&API

Query&Filtering&and&PaginationQuery&Filtering&and&Pagination

$.Deferred&for&Parallel&Queries$.Deferred&for&Parallel&Queries

SMART&Data:&Best&PracticesSMART&Data:&Best&Practices

REFERENCEREFERENCE

Data&ModelData&Model

REST&APIREST&API

Query&FiltersQuery&Filters

App&ManifestApp&Manifest

CLIENT+LIBRARIESCLIENT+LIBRARIES

Javascript&(SMART&Connect)Javascript&(SMART&Connect)

PythonPython

JavaJava

.NET.NET

ContainerJside&JavascriptContainerJside&Javascript

SMART+UPDATE+GUIDESSMART+UPDATE+GUIDES

0.4&Apps0.4&Apps

0.4&Containers0.4&Containers

0.5&Apps&+&Containers0.5&Apps&+&Containers

REFERENCE+EMR+INSTALLATIONREFERENCE+EMR+INSTALLATION

Ubuntu&LinuxUbuntu&Linux

OS&XOS&X

PRESENTATIONSPRESENTATIONS

Architecture&(2010J08)Architecture&(2010J08)

Governance&(2010J08)Governance&(2010J08)

DemoDemo

DOWNLOADSDOWNLOADS

Download&Source&+&VMDownload&Source&+&VM

1&SMART&REST&API1&SMART&REST&API

2&Changelog2&Changelog

3&Overview3&Overview

3.1&SMART&is&a&ReadJonly&API3.1&SMART&is&a&ReadJonly&API

3.2&REST&Design&Principles3.2&REST&Design&Principles

4&OWL&Ontology&File4&OWL&Ontology&File

5&SMART&REST&API&Reference5&SMART&REST&API&Reference

6&Container&Calls6&Container&Calls

6.1&App&Manifest6.1&App&Manifest

6.2&ContainerManifest6.2&ContainerManifest

6.3&Demographics6.3&Demographics

6.4&Ontology6.4&Ontology

6.5&User6.5&User

7&Record&Calls7&Record&Calls

7.1&Allergy7.1&Allergy

7.2&Clinical&Note7.2&Clinical&Note

7.3&Demographics7.3&Demographics

7.4&Encounter7.4&Encounter

7.5&Fulfillment7.5&Fulfillment

7.6&Immunization7.6&Immunization

7.7&Lab&Panel7.7&Lab&Panel

7.8&Lab&Result7.8&Lab&Result

7.9&Medication7.9&Medication

7.10&Problem7.10&Problem

7.11&Procedure7.11&Procedure

7.12&Social&History7.12&Social&History

7.13&Vital&Sign&Set7.13&Vital&Sign&Set

8&User&Calls8&User&Calls

8.1&User&Preferences8.1&User&Preferences

SMART+REST+API

N.B.&This&is&highly&preliminary,&not&a&commitment&or&final&version&of&any&particularAPI&or&data&model.&This&is&purely&for&internal&collaboration&and&preview&purposes.

Help&us&improve!&You&can&correct&errors&or&add&to&this&page&by&clicking&here&to&editthis&page&on&Github.

The&calls&below&are&all&written&with&respect&to&the&base&URL&/.&But&any&given&SMART&container&willplace&all&API&calls&its&own&base&URL,&e.g.

http://sample_smart_emr.com/smart0base/

Any&individual&item&that&can&be&retrieved&via&GET&should&have&a&fully8dereferenceable&URI.&Tocontinue&the&example&above,&a&medication&in&our&sample&EMR&might&have&the&URI:

http://sample_smart_emr.com/smart0base/records/123456/medications/664373

ChangelogClick&here&for&the&list&of&Changes&to&the&API&and&Payloads&for&the&latest&release.

OverviewThe&SMART&API&provides&access&to&individual&resources&(medications,&fulfillment&events,prescription&events,&problems,&etc.)&and&groups&of&these&resources&in&a&RESTful&API.

SMART+is+a+Read8only+APIPlease&note&that&for&the&time&being,&the&SMART&API&remains&readJonly.&We&are&excited&aboutbuilding&out&very&basic&write&functionality&in&early&2013&—&but&we&want&make&our&early&APIs&as&easy&aspossible&for&EMR&and&PHR&vendors&to&expose.

REST+Design+PrinciplesIn&general&you&can&interact&with&a:

Group&of&resources&using:GET&to&retrieve&a&group&of&resources&such&as&/medications/

Single&resource&using:GET&to&retrieve&a&single&resource&such&as&/medications/{medication_id}

OWL+Ontology+FileThe&API&calls&listed&below,&as&well&as&the&RDF/XML&payloads,&are&also&defined&in&a&machineJreadableOWL&file.&The&OWL&file&has&been&used&to&generate&the&documentation&below,&as&well&as&our&clientJside&REST&libraries&and&API&Playground&app.

SMART+REST+API+Reference

“SMART provides a unified mechanism for diverse applications to interact with medical record data. SMART Apps built against the SMART API can be embedded within any SMART Container. A SMART Container is, most often, an Electronic Medical Record (EMR) system used by physicians, but might also be a Personal Health Record (PHR) such as Indivo used by patients, or a data-analytics platform such as i2b2 used by researchers.”

“SMART API calls return data in the form of RDF graphs. Within these graphs, top-level SMART data objects have fully dereferenceable URIs.” This means that the data representation returned by a SMART API call can be easily linked and extended with other data on the Web.

OPEN SOURCE TOOLS AROUND OPEN STANDARDS

22

• C-CDA• SMART Platforms C-CDA Scorecard• NIST Validator Web App

• Direct Protocol• .Net Reference Implementation• Java Reference Implementation• NIST Validator Web App

• SMART Platforms ReSTful API• SMART App Javascript Libraries• SMART App Python Libraries• SMART App iOS Libraries• SMART App Java Libraries• SMART App .Net Libraries• SMART Container Javascript Libraries

• Indivo X ReSTful API• Indivo X App Python Libraries• Indivo X App iOS Libraries• Indivo X App Java Libraries

SMART C-CDA ScorecardSMART C-CDA Scorecard

Paste and go.<?xml version="1.0"?>

<?xml-stylesheet type="text/xsl" href="CDA.xsl"?><ClinicalDocument xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="urn:hl7-org:v3 ../../../../../CDA%20Academy/ccda-schemas/ccda-schemas/infrastructure/cda/CDA_SDTC.xsd" xmlns="urn:hl7-org:v3" xmlns:cda="urn:hl7-org:v3" xmlns:sdtc="urn:hl7-org:sdtc">   <realmCode code="US"/>

 <typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>

  <templateId root="2.16.840.1.113883.10.20.22.1.1"/>   <templateId root="2.16.840.1.113883.10.20.22.1.2"/>

 <id extension="Test CCDA" root="1.1.1.1.1.1.1.1.1"/>

 <code codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" code="34133-9" displayName="Summarization of Episode Note"/>

 <title>Primo Adult Health: Health Summary</title>

 <effectiveTime value="20121126000000-0000"/>

 <confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>

 <languageCode code="en-US"/>

 <recordTarget>

 <patientRole>

  <id extension="123-456-7890" root="2.16.840.1.113883.4.1"/>

 <addr use="HP">  <streetAddressLine>100 Marshall Lane</streetAddressLine> <city>Springfield</city> <state>VA</state> <postalCode>22153</postalCode> <country>US</country>  </addr>

 <telecom value="tel:+1(571)555-0189" use="HP"/> 

 <patient>

 <name use="L">  <given>Nikolai</given> <family>Bellic</family> </name> <administrativeGenderCode code="M" codeSystem="2.16.840.1.113883.5.1" displayName="Male" codeSystemName="AdministrativeGender"/> <birthTime value="19330316"/> <maritalStatusCode code="M" displayName="Married" codeSystem="2.16.840.1.113883.5.2" codeSystemName="MaritalStatus"/> <religiousAffiliationCode code="1041" displayName="Roman Catholic" codeSystem="2.16.840.1.113883.5.1076" codeSystemName="ReligiousAffiliation"/> <raceCode code="2106-3" displayName="White" codeSystem="2.16.840.1.113883.6.238" codeSystemName="OMB Standards for Race and Ethnicity"/> <ethnicGroupCode code="2186-5" displayName="Not Hispanic or Latino" codeSystem="2.16.840.1.113883.6.238" codeSystemName="OMB Standards for Race and Ethnicity"/> <languageCommunication>  <languageCode code="en"/> <modeCode code="ESP" displayName="Expressed spoken" codeSystem="2.16.840.1.113883.5.60" codeSystemName="LanguageAbilityMode"/> </languageCommunication> </patient> </patientRole> </recordTarget> <author> <time value="20121126000000"/> <assignedAuthor>  <id extension="12345" root="2.16.840.1.113883.4.6"/> <code code="207QA0505X" codeSystem="2.16.840.1.113883.6.101" displayName="Adult Medicine" codeSystemName="NUCC"/> <addr> <streetAddressLine>1400 Main Street Ste G</streetAddressLine> <city>Springfield</city> <state>VA</state> <postalCode>22150</postalCode> <country>US</country> </addr> <telecom use="WP" value="tel:+1(571)555-0179;ext=221"/> <assignedPerson> <name> <given>Raymond</given> <family>Boccino</family> <suffix>MD</suffix> </name> </assignedPerson> </assignedAuthor> </author> <dataEnterer> <assignedEntity> <id extension="678910" root="1.1.1.1.1.1.1.1.2"/> <code code="364SA2200X" displayName="Adult Health" codeSystem="2.16.840.1.113883.6.101" codeSystemName="NUCC"/> <addr> <streetAddressLine>1400 Main Street Ste G</streetAddressLine> <city>Springfield</city> <state>VA</state> <postalCode>22150</postalCode> <country>US</country> </addr> <telecom use="WP" value="tel:+1(571)555-0179;ext=222"/> <assignedPerson> <name> <given>Mallory</given> <family>Bardas</family> <suffix>RN</suffix> </name> </assignedPerson> </assignedEntity> </dataEnterer> <custodian> <assignedCustodian> <representedCustodianOrganization> <id root="1.1.1.1.1.1.1.1.2"/> <name>Primo Adult Health</name> <telecom use="WP" value="tel:+1(571)555-0179"/> <addr> <streetAddressLine>1400 Main Street Ste G</streetAddressLine> <city>Springfield</city> <state>VA</state> <postalCode>22150</postalCode> <country>US</country> </addr> </representedCustodianOrganization> </assignedCustodian> </custodian> <informationRecipient> <intendedRecipient>  <id extension="23456" root="2.16.840.1.113883.4.6"/> <informationRecipient> <name> <given>Bernard</given> <family>Crane</family> <suffix>MD</suffix> </name> </informationRecipient> <receivedOrganization> <name>Springfield Geriatric Associates</name> <telecom use="WP" value="tel:+1(571)555-0165"/> <addr> <streetAddressLine>202 County Line Rd</streetAddressLine> <city>Springfield</city> <state>VA</state> <postalCode>22150</postalCode> <country>US</country> </addr> <standardIndustryClassCode code="207QG0300X" displayName="Geriatric Medicine" codeSystem="2.16.840.1.113883.6.101" codeSystemName="NUCC"/> </receivedOrganization> </intendedRecipient> </informationRecipient> <legalAuthenticator> <time value="20121126000000"/> <signatureCode code="S"/> <assignedEntity>  <id extension="12345" root="2.16.840.1.113883.4.6"/> <code code="207QA0505X" codeSystem="2.16.840.1.113883.6.101" displayName="Adult Medicine" codeSystemName="NUCC"/> <addr> <streetAddressLine>1400 Main Street Ste G</streetAddressLine> <city>Springfield</city> <state>VA</state> <postalCode>22150</postalCode> <country>US</country> </addr> <telecom use="WP" value="tel:+1(571)555-0179;ext=221"/> <assignedPerson> <name> <given>Raymond</given> <family>Boccino</family> <suffix>MD</suffix> </name> </assignedPerson> </assignedEntity> </legalAuthenticator> <participant typeCode="IND"> <associatedEntity classCode="PRS"> <addr> <streetAddressLine>100 Marshall Lane</streetAddressLine> <city>Springfield</city> <state>VA</state> <postalCode>22153</postalCode> <country>US</country> </addr> <telecom value="tel:+1(571)555-0189"/> <associatedPerson> <name> <given>Kathleen</given> <family>McReary</family> </name> </associatedPerson> </associatedEntity> </participant> <documentationOf> <serviceEvent classCode="PCPR"> <effectiveTime> <low value="19330316"/> <high value="20121126"/> </effectiveTime> <performer typeCode="PRF"> <assignedEntity>  <id extension="34567" root="2.16.840.1.113883.4.6"/> <code code="207RC0000X" codeSystem="2.16.840.1.113883.6.101" codeSystemName="NUCC" displayName="Cardiovascular Disease"/> <addr> <streetAddressLine>209 County Line Rd</streetAddressLine> <city>Springfield</city> <state>VA</state> <postalCode>22150</postalCode> </addr> <telecom use="WP" value="tel:+1(571)555-0155"/> <assignedPerson> <name> <given>Dwayne</given> <family>Forge</family> <suffix>MD</suffix> </name> </assignedPerson> </assignedEntity> </performer> <performer typeCode="PRF"> <functionCode code="PCP" displayName="Primary Care Physician" codeSystem="2.16.840.1.113883.5.88" codeSystemName="participationFunction"/> <assignedEntity>  <id extension="12345" root="2.16.840.1.113883.4.6"/> <code code="207QA0505X" codeSystem="2.16.840.1.113883.6.101"

Score me!

Your C-CDA's overallscore: 60%

Share your C-CDA with the SMART Community!Share your C-CDA with the SMART Community!P.S. We love works in progress :-)P.S. We love works in progress :-)

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General 64% SNOMED CT, LOINC, and RxNorm codes validate against UMLS 0/5

points

Best Practice: Codes that claim to be from SNOMED CT, LOINC, and RxNorm should be present in UMLS2012AB.

Your Results:

3 of 68 codes weren't found in UMLS 2012ABYour code What now?

SNOMED CT:5962100 "Essential Hypertension" Check mapping

SNOMED CT:5582204 "Hyperlipidemia" Check mapping

SNOMED CT:49038010 "EKG" Check mapping

SNOMED CT, LOINC, and RxNorm codes match their displayName 3/3points

Best Practice: Codes in a C-CDA should assign a valid @displayName that reflects the meaning of the underlyingconcept. A best practice is to use preferred labels from UMLS.

Your Results:

1 of 61 codes didn't match their displayNameYour code Preferred

termWhat now?

SNOMEDCT:64572001

"Condition" "Disease" Seehttp://purl.bioontology.org/ontology/SNOMEDCT/64572001

Document uses sensible datetime precision 0/1points

Best Practice: C-CDA's datetimes should use ISO8601 strings to express appropriate precision.

Your Results:

1 issue.20121126000000-0000 Confirm this is the intended level of precision

Document uses official C-CDA templateIds whenever possible 5/5points

Best Practice: C-CDA's prescribed templateIds should be used whenever possible. Additional templateIdelements are allowed, but official C-CDA templateIds should always be present when they apply.

Physical units are valid UCUM expressions 3/3points

Best Practice: Any time a physical unit is used, it should be a valid UCUM expression

Lab Results 66% Lab Results coded with LOINC's top 2K codes 2/3

points

Best Practice: Lab results should be coded using LOINC. In pratice LOINC is huge, but 2000 codes cover 98%of real-world usage. This means that most results should be covered by the 2000+ most common LOINC codespublished by Regenstrief.

Your Results:

3 of 7 lab result codes weren't in the recommended value setNote: This may be normal, if this C-CDA document includes unusual labs for which no common LOINC codeexists. But look through the un-matched codes below to make sure you don't have a mapping error in your exportpipeline.

Recommended value set:

LOINC Top 2000 Codes

Your code The issue What now?

LOINC:18041-4

"Aortic valve Ejection [Time] byUS.doppler"

Not invalue set

Seehttp://purl.bioontology.org/ontology/LNC/18041-4

LOINC:18089-3

"AV Orifice Area US" Not invalue set


LOINC:18844-1

"EKG impression Narrative" Not invalue set


Medications100%

Medications coded with RxNorm SCD, SBD, GPCK, or BPCPK codes 3/3points

Best Practice: C-CDA medication lists should contain medications coded as RxNorm Semantic Clinical Drugs,Semantic Branded Drugs, and packs. This means prescribable products on the level of 'loratadine 10mg oraltablet'.)

Problems 83% Problems coded with HITSP's 16K SNOMED subset 2/3

points

Best Practice: Each problem in the problem list should be coded with a SNOMED code from the HITSP ProblemList valueset (OID 2.16.840.1.113883.3.88.12.3221.7.4).

Your Results:

4 of 8 problem codes weren't in the recommended value setsNote: This may be normal, if this C-CDA document includes unusual problems for which no appropriateSNOMED code exists. But look through the un-matched codes below to make sure you don't have a mappingerror in your export pipeline.

Recommended value sets:

HITSP Problem ListSNOMED CT CORE Problem List

Your code The issue What now?

SNOMEDCT:5962100

"EssentialHypertension"

Code notfound inUMLS2012AB

Check mapping

SNOMEDCT:5582204

"Hyperlipidemia" Code notfound inUMLS2012AB

Check mapping

SNOMEDCT:8957000

"Coronary ArteryDisease"

Obsolete Seehttp://purl.bioontology.org/ontology/SNOMEDCT/8957000

SNOMEDCT:238134004

"Generalizedobesity"

Not in valueset

Seehttp://purl.bioontology.org/ontology/SNOMEDCT/238134004

Problem statuses are internally consistent 3/3points

Best Practice: Each concern act should contain exactly one problem. If there is a status attached to the concernact as well as the problem, these should not contradict. A concern status of 'completed' is compatible with aproblem status of 'Resolved' or 'Inactive'. A concern status of 'active' is compatible with a problem status of'Active'.

Social History 0% Smoking Status Observations have the correct template ID 0/1

points

Best Practice: Smoking status observations should have template ID 2.16.840.1.113883.10.20.22.4.78

Structured Smoking Status Observations use correct SNOMED CT Codes N/A

Best Practice: Smoking Status obervations should be coded according to an explicit list of eight SNOMED CTCodes.

Only structured Smoking Status Observations are used N/A

Best Practice: Smoking status should be recorded in a discrete 'smoking status observation', not in the moregeneric, less-computable 'social history observation'.

Vitals 0% Vitals are represented using structured entries 0/5

points

Best Practice: Vitals in C-CDA should be represented with individual structured entries corresponding to BP,Heart Rate, etc.

Vitals are expressed with LOINC codes N/A

Best Practice: Vitals in C-CDA should be coded with LOINC. Specifically, with codes from the HITSP Vital SignResult value set.

Vitals are expressed with UCUM units N/A

Best Practice: Vitals in C-CDA should be represented with physical quantities that have appropriate UCUMcodes.

Your C-CDA.Beautiful.

Help improve the Scorecard!Four ways to help improve the SMART C-CDA Scorecard:1. Try out the Scorecard and tweet about it @SMARTHealthIT2. Share your sample C-CDA documents with the public3. Suggest new rubrics, or improvements to the existing ones4. Contribute code to improve the Scorecard

About the ScorecardThe SMART C-CDA Scorecard promotes best practices in C-CDA implementation by assessing keyaspects of the structured data found in invididual documents. It's a tool to help implementers gain visibilityinto how well and how often best practices are followed — and also to summarize progress with a roughquantitative assessment, highlighting improvements that can be made today.

Fills gaps and complements official validation toolsThe Scorecard runs alongside official C-CDA validation tools like the Transport Testing Tool provided byNIST and Model-Driven Health Tools. The official validation tools provide comprehensive assessment ofsyntactic conformance to the C-CDA specification, but they don't always enforce higher-level best practicesin C-CDA implementation. The Scorecard fills gaps and provides visibility into constraints missing from theofficial specifications, or features missing from the official validation tools. Our initial focus is on value setmembership for three key vocabularies used in C-CDA: LOINC, RxNorm, SNOMED CT.

Powered by SMART PlatformsVisit smartplatforms.org to learn more about the ONC-funded, SHARP III project.

© Harvard Medical School / Boston Children's Hospital, 2013. Source on GitHub.

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O'REILLY RADAR COVERSINDIVO X USERS' CONFERENCE

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THE PHA PLATFORM AND ITS ECOSYSTEM

23

“The platform approach to software design can be used to create and sustain an extensible ecosystem of applications and

to stimulate a market for competition on value and price.”

Attributes Potential Notes

Data Source(s) High Virtually any pertinent data source

Control High Strong consumer control of data

Interoperability High Adoption of Open Systems and standards

Portability Medium Still under development

Tools Very Good Multiple tools/widgets, communications???

Personalization High Farther down the road

Adoption High Perceived value?

Estrin, D. and Sim, I. (2010). Open mHealth Architecture: An Engine for Health Care Innovation. Science Magazine, 330(6005):759-760.Mandl, K.D. and KohMoore, J. (2010). PHRs: Where We've Been, Where We're Going. Chilmark Research.

Thank You.

interlinking various personal health applications - … various...various personal health through...

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