omg - march 2013 the road to semantic interoperability · 2015-11-09 · literally. – has extreme...

03-23-05 March 2013

The Road to Semantic Interoperability

The Path Not (Often) Taken

Ken Rubin

Chief Architect, Federal Healthcare Portfolio

HP Enterprise Services

[email protected]

The Road to Semantic Interoperability March 2013 Content in the presentation may be re-used so long as

attribution is provided. All rights reserved. page 2

Disclaimers

The information that follows is derived from either public

information or personal experience. This information is a good-

faith representation, and every effort has been made to assure

its accuracy, currency, and vendor/product neutrality.

Nonetheless, these slides do not necessarily reflect the official

position of HP, HL7, the US Government, the Veterans Health

Administration, or any organizational affiliation.



Understanding the Business Challenge


attribution is provided. All rights reserved.

A Little Background about Healthcare

• Healthcare is casually referred to as the “Trillion-dollar Cottage Industry”, spanning geography, organizational boundaries, languages, cultures

• Healthcare is collaborative

• Health is an incredibly complex domain (more on this later!)

• Health lags significantly behind other market sectors in % investment in IT, though the gap is narrowing

• The Health IT (HIT) Landscape is largely dominated by a select number of well established vendors

• HIT challenges are global; no country has this solved (though some are closer than others)

page 4



So why the push for interoperability?

• When was the last time you went to see a doctor?

• Were you asked for your allergies?

• Were you asked about your medical history?

• Were you asked about your current medications?

• How confident are you that you remembered every medication?

• What about your loved ones? An aging parent?

• Have you ever brought a prescription slip to a pharmacy?

• Do you know if any of your over-the-counter medications interact with your prescriptions?

• When was your last Hep-A booster? Tetanus?

page 5



So, What is Interoperability?

Quiz time. Are you interoperable if…

– …you receive data that can be manually keyed or scanned into you system?

– …batch extracts of data can be received and used on a periodic basis?

– …you are able to write an adapter to interchange with a business partner’s IT system?

– …you use accepted industry standard wire protocols?

– …you can receive and ingest an XML document on-demand (real-time, or near real-time) from a business partner into your system?

– …you use Web Services?



What is semantic interoperability?

Quiz time. Are you interoperable if…

– … you lack processes to validate accuracy of data entry?

– …data is represented differently across systems within your organization

– … you and your business partners use different codes?

– … you and your business partners use the same codes, but use them differently?

– …you use standardized codes to represent data, but allow localized extensions?



So, let’s contrast “IT” with “HIT”

• A typical info system …

– Supports the need for persistence

– Is designed to meet performance requirements

– Supports concurrency, scalability

– Is designed by a DBA in conjunction with a project team

– Are closely coupled with the application it supports

– Has a usable system life of 2-10 years

• A typical healthcare IT system…

– Impacts life-or-death decisions, literally.

– Has extreme high-availability requirements

– Has Near-real-time performance expectation

– Must be capable of integrating content from external sources

– Extreme sensitivity to privacy and security considerations

– Must maintain data access for the lifetime of the patient (or longer!)



Real Requirements for an Electronic Health Record…

• Capable of integrating data from our business partners and patients themselves

• Data from business partners must maintain consistency in its meaning

• Manage approximately 3000 unique data elements in 14 functional domains (laboratory, pharmacy, vitals, demographics, encounters, radiology/nuclear medicine, etc.)

• Provide medical alerts for approximately 500k drug-drug and drug-allergy interactions and contraindications

• Maintain data integrity for 75-years post mortem of patient (up to 150 years) retaining durable meanings



Tackling This Challenge…

Key Solution Elements



Role of an Information Model

• Establishes a basis for harmonizing and standardizing semantics

• Clarifies data typing

• Determines bindings to relevant terminologies

• Assures consistent information representation

• To depict structure and semantic relationships supporting (among other things)

• Provides guidance for logical database design

• Provides basis for message payload (e.g., interface parameters)



Understanding Terminology 101

• Terminology (or ontology) is a structured representation of data

• Terminology is needed to allow for data comparability and consistency

• Formal terminologies are based on concept codes that themselves have no inherent meaning

• Key to this principle is to distinguish the concept itself from the label

• Just because you have a common label (known as “surface form”) doesn’t mean you have a shared understanding

• Let me show you what I mean…




Biblioteca Medellin, photo taken from Wikipedia •Library of Congress image from visitingdc.com website

•Both photos believed to be in the public domain

Same concept, different “surface form”




Salmon photo courtesy of Carly & Art, via Flicker, Creative Commons License

•Potato Skins photo courtesy of Scorpions and Centaurs,

Creative Commons License

Same “surface form”, different concepts




First photo courtesy of avlxyz, via Flicker, Creative Commons License

Second photo taken from The Coffee Club (Australia) Website

Same surface form, different concepts



So Let’s Explore “Computable” Data…

Not all data representations are created equal

• Content stored as strings without an underlying terminology cannot be used for [clinical] reasoning, alerts, interactions, epidemiology

• Adherence to data constraints (e.g. 1000/500?)

• A simple example: how many genders are there?

• A VHA example: getting to Yes

• The effort and importance of knowledge engineering and terminology cannot be overstated



A Simple example: “Yes-No” Codes (slide adapted from VHA)

• The Standard Terminology Model for a collaborative across the US Federal Health programme reviewed “Yes-No” Code sets

• Identified were 3396 instances of “Yes-No” use in DoD, VA and IHS

• There were 30 unique ways to say it

• E.g. Yes = 1 No = 2

• E.g. Yes = 0 No = 1 etc etc



LOINC for Hgb A1c

• HEM 4547-6 HEMOGLOBIN A1/HEMOGLOBIN.TOTAL SFR PT BLD QN HAEMOGLOBIN A1 19980618 NAM

• HEM 4548-4 HEMOGLOBIN A1C/HEMOGLOBIN.TOTAL SFR PT BLD QN HGB;HAEMOGLOBIN;GLYCATED;GLYCOSYLATED 20000322 MIN A02540 16500 QU60433

• HEM 17855-8 HEMOGLOBIN A1C/HEMOGLOBIN.TOTAL SFR PT BLD QN CALCULATED HGB;HAEMOGLOBIN;GLYCATED;GLYCOSYLATED20000322 MIN

• HEM 4549-2 HEMOGLOBIN A1C/HEMOGLOBIN.TOTAL SFR PT BLD QN ELECTROPHORESIS HGB;HAEMOGLOBIN;GLYCATED;GLYCOSYLATED 19980618 NAM A02540 16500 QU60433

• HEM 17856-6 HEMOGLOBIN A1C/HEMOGLOBIN.TOTAL SFR PT BLD QN HPLC HGB;HAEMOGLOBIN;GLYCATED;GLYCOSYLATED 20000322 MIN

• HEMOGLOBIN.GLYCATED PT BLD QN HEMOGLOBIN GLYCOSYLATED;GLYCOHEMOGLOBIN; GLYCOHAEMOGLOBIN;HAEMOGLOBIN. GLYCATED;HAEMOGLOBIN GLYCOSYLATED 19980618 DEL 16500 MSH94D0 06454



NDC: 00686027720

NDC: 48695117305

NDC: 00047007032

NDC: 00047007024

NDC: 00223255002

NDC: 00223255001

NDC: 00364075690

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NDC: 52953000304

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NDC: 00102333502

NDC: 46193073810

NDC: 46193073805

NDC: 52544030505

NDC: 52544030501

NDC: 53633032116

NDC: 53633032110

NDC: 12071044010

NDC: 54441004350

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NDC: 54441004310

NDC: 54441004305

NDC: 54441004301

NDC: 49884010610

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NDC: 46193073801

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NDC: 53492301303

NDC: 53492301302

NDC: 53492301301

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NDC: 52493063960

NDC: 00839711420

NDC: 00615256113

NDC: 40039006001

NDC: 00025090152

NDC: 00025090131

NDC: 47202255103

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NDC: 12027008902

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NDC: 51316009004

NDC: 11146094210

NDC: 52544030551

NDC: 52544030510

NDC: 00839711416

NDC: 00536430910

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NDC: 00536430901

NDC: 35470050801

NDC: 00143150225

NDC: 51608042104

NDC: 51608042102

NDC: 10465042109

NDC: 00721002301

NDC: 54421011001

NDC: 19458042007

NDC: 19458042001

NDC: 50053310901

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NDC: 47679070201

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NDC: 51285032109

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NDC: 00302573210

NDC: 11146091299

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NDC: 00904041180

NDC: 00904041160

NDC: 00894633104

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NDC: 50111046703

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NDC: 00093060001

NDC: 00179038202

NDC: 00179038201

NDC: 54738046703

NDC: 54738046701

NDC: 00182181289

NDC: 00603548932



NDC: 00686027720

NDC: 48695117305

NDC: 00047007032

NDC: 00047007024

NDC: 00223255002

NDC: 00223255001

NDC: 00364075690

NDC: 00364075602

NDC: 00364075601

NDC: 52953000304

NDC: 00378018210

NDC: 00378018201

NDC: 51432097106

NDC: 00677104110

NDC: 00677104105

NDC: 00677104101

NDC: 54569055650

NDC: 00102333502

NDC: 46193073810

NDC: 46193073805

NDC: 52544030505

NDC: 52544030501

NDC: 53633032116

NDC: 53633032110

NDC: 12071044010

NDC: 54441004350

NDC: 54441004325

NDC: 54441004310

NDC: 54441004305

NDC: 54441004301

NDC: 49884010610

NDC: 49884010605

NDC: 46193073801

NDC: 00555046506

NDC: 00555046505

NDC: 00555046502

NDC: 00054475833

NDC: 00054475831

NDC: 00054475825

NDC: 54441019750

NDC: 54441019725

NDC: 54441019715

NDC: 54441019711

NDC: 54441019710

NDC: 00182175810

NDC: 00182175801

NDC: 00228232796

NDC: 00228232710

NDC: 00046042199

NDC: 00046042198

NDC: 00046042195

NDC: 00603548921

NDC: 53258015313

NDC: 54269010901

NDC: 51813007299

NDC: 51813007290

NDC: 51813007260

NDC: 53492301303

NDC: 53492301302

NDC: 53492301301

NDC: 00591555404

NDC: 00591555401

NDC: 52493063960

NDC: 00839711420

NDC: 00615256113

NDC: 40039006001

NDC: 00025090152

NDC: 00025090131

NDC: 47202255103

NDC: 47202255101

NDC: 12027008902

NDC: 12027008901

NDC: 53487014510

NDC: 00781134413

NDC: 00781134410

NDC: 00781134401

NDC: 53978003410

NDC: 00117134405

NDC: 00117134401

NDC: 51316009004

NDC: 11146094210

NDC: 52544030551

NDC: 52544030510

NDC: 00839711416

NDC: 00536430910

NDC: 00536430905

NDC: 00536430901

NDC: 35470050801

NDC: 00143150225

NDC: 51608042104

NDC: 51608042102

NDC: 10465042109

NDC: 00721002301

NDC: 54421011001

NDC: 19458042007

NDC: 19458042001

NDC: 50053310901

NDC: 47679070204

NDC: 47679070201

NDC: 46703009410

NDC: 46703009401

NDC: 52584018410

NDC: 00363690810

NDC: 53489045101

NDC: 00157052610

NDC: 00157052601

NDC: 00054875825

NDC: 00005310931

NDC: 00005310923

NDC: 00071007024

NDC: 00046042191

NDC: 00046042181

NDC: 00046042180

NDC: 00046042162

NDC: 00046042161

NDC: 00046042160

NDC: 00814644630

NDC: 54697006305

NDC: 54697006304

NDC: 54697006303

NDC: 54697006302

NDC: 49884010601

NDC: 00686018201

NDC: 51079027760

NDC: 00349845190

NDC: 00349845110

NDC: 00349845101

NDC: 50053310902

NDC: 51285032190

NDC: 51285032160

NDC: 52985003606

NDC: 52985003601

NDC: 51285032112

NDC: 51285032109

NDC: 51285032105

NDC: 51285032102

NDC: 00555036505

NDC: 00555036502

NDC: 00308627099

NDC: 00308627060

NDC: 00308627030

NDC: 54697006301

NDC: 00302573210

NDC: 11146091299

NDC: 00719179413

NDC: 00719179410

NDC: 00904041180

NDC: 00904041160

NDC: 00894633104

NDC: 00894633103

NDC: 00894633102

NDC: 00894633101

NDC: 10647042101

NDC: 50111046707

NDC: 50111046703

NDC: 50111046701

NDC: 52555001010

NDC: 52555001001

NDC: 00093060010

NDC: 00093060001

Propranolol

10Mg Tab



Designing for

Interoperability

Ab

ilit

y t

o I

nte

rop

erate

High

Low



Localization Concept: The Virtual Boundary

Organizational Compliance

- Organizational Semantics (Info Model) - Integration compliance (SOA services) - Governance

• External Standards

•Legacy Applications



Semantic Support in HIT Standards…

V2 Msgs

V3 Msgs

CDA Services

Data Descriptions are Explicit •

Behavior is Explicit • • •

Has medico-legal Meaning • • •

Provides clinical context • •

Allows customization/extensibility •

Allows for ontologically-based data

Allows for non-ontologically-based data

Provides for self-discovered semantics •

* Dependent upon implementation or use



Enterprise Architecture

• Done correctly, EA establishes the target to which the organization is heading

• EA models typically address business, information, and technology views

• An EA program establishes a “source of truth” for standards

• More importantly, the EA specifies not just stds & technologies are to be used, but how

• EA is only effective when supporting and engaging stakeholders, and where the program has governance authority

The Pragmatists View



EASE ON DOWN THE ROAD…

3/20/2013 26



First Stop: Version Management

01/01/2011 27

Why include it?

• EVERYTHING is going to change, that includes:

– The data and the structures containing it

– The expectations of the data

– The terminology(ies)

– The interfaces

– The applications

How to approach it:

• Apply a formal, rigorous approach to version management (perhaps the MOST IMPORTANT element in managing continuous change)

• Every time something is deployed that is changed, version it. Not just software, but also information assets

• Understand and get religious about dependency management

• Be very cautions and judicious about any “physical” deletes



Second Stop: Legacy Enablement

01/01/2011 28

Why include it?

• Investment in current systems and infrastructure is too significant to ignore or to start ‘green field’

• Neither business case nor organizational ‘will’ (not to mention budget) exists to replace all of your existing IT

• New infrastructure will need to more effectively interact with legacy

How to approach it:

• Use EA to determine system role, especially where its data is the “authoritative source”

• Review information exchange needs within and outside of the organization

• Map current messaging and interfaces into logical information constructs

• “Service-enable” the legacy by adding request/response interfaces carrying structured payload (e.g., SOA)



Third Stop: Foster Peaceful Co-Existence of Structured and

Unstructured Data

01/01/2011 29

Why include it?

• Health today significantly depends on unstructured data

• Huge push worldwide to move to structured information (SNOMED, ICD-10/11)

• Structured information offers many benefits (e.g., analytics, comparability, decision-support), but

• Structured information does not come ‘free’

Key Solution Considerations

• Consider structured information with the end objectives in mind (e.g., clinical quality, process improvement, epidemiology)

• TCO of structured information must consider organizational adoption (staff training, quality/oversight processes, etc.)

• User experience is of paramount importance



Fourth Stop: Metadata Management

01/01/2011 30

Why include it?

• As information interchange increases, data content will increasingly come from multiple sources

• Today, metadata management is done implicitly based upon source (e.g. “This record is from the xxxx General Hospital”)

• We will never see ubiquity of data representation and use (e.g., variance is here to stay)


• Note that metadata describes what is in the “container”, allowing the recipient to comprehend what they received

• Use models based on ontologically as the basis for your metadata

• Version management applies to metadata too

• Allow for discovery via use of [public] registries



Final Stop: Context Management

Why include it?

• Information structures are an implicit component of healthcare and used in business terms today (e.g., “Blood Pressure Reading”, “Discharge Summary”, etc.)

• As [clinical] information flow grows, receipt of standalone data items is insufficient

• Current transport model either predicates that the sender “knows” what the recipient will need, or that the recipient will “know” what to ask for

01/01/2011 31


• Thoughtful units of composition

• Applied metadata management

• Ability for constructs to retain medico-legal meaning

• Seek out existing sources for representing contextual elements (structure-oriented standards)



RELEVANT WORK

3/20/2013 32



Asset Inventory Asset What it is for What it does

Common

Terminology Service

(CTS II)

Establish a standards-based way of interacting

with and managing complex coding systems

and vocabularies.

Defines interfaces for the storage, management,

and maintenance of terminology

API for

Knowledgebases

(API4KB)

Integrates various reasoning systems in a

loosely coupled, hybrid environment, to allow

complex sets of services to be developed and

combined.

Defines APIs for Parsing,. Reasoning, Persistent

Storage, Queries, Rules and query of metadata to

understand the capabilities of the service offering

behind the API

Ontology Definition

Metamodel (ODM)

Bridges traditional UML modeling and software

engineering popular ontology languages, (RDF,

RDF /S), the Web Ontology Language (OWL),

Topic Maps (TM), and Common Logic (CL).

Supports interchange and management of

vocabularies and ontologies with MOF/XMI tools

and repositories, as well profiles and graphical

representation for developing vocabularies and

ontologies in UML tools

Retrieve Locate

Update Service

(RLUS)

To manage location and retrieval of healthcare

content

Defines an abstract service interface for create,

read, update, delete functions

hDATA RESTful

Transport Specification

REST binding for data retrieval using SOA

(RLUS for REST)

Provides a REST binding for create, read, update,

delete functions

Clinical Decision

Support Service (DSS)

To analyze patient data / assess knowledge

rules.

Establish interface for passing in patient data and

returning relevant clinical protocol

hDATA Record Format

Specification

A hierarchical format with metadata tagging for

organizing / representing [clinical] data

Provides a superstructure into which [clinical] data

can be slotted and transported.

http://www.omgwiki.org/API4KB/doku.php?id=api4kb_parsing

http://www.omgwiki.org/API4KB/doku.php?id=api4kb_reasoning

http://www.omgwiki.org/API4KB/doku.php?id=api4kb_persistent_storage

http://www.omgwiki.org/API4KB/doku.php?id=api4kb_persistent_storage

http://www.omgwiki.org/API4KB/doku.php?id=api4kb_queries

http://www.omgwiki.org/API4KB/doku.php?id=api4kb_rules



Acknowledgements

Several of these slides have been shamelessly borrowed from the Healthcare Services Specification Project, a joint standards collaboration between OMG and Health Level Seven (HL7) Their slideware licensing allows reuse with attribution. This is attribution



Thank you!

Ken Rubin

Chief Architect, Federal Healthcare

[email protected]

omg - march 2013 the road to semantic interoperability · 2015-11-09 · literally. – has extreme...

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