HL7 “Fresh Look” – gRIM concept Part A – Ecosystem model

1. HL7 “Fresh Look” – gRIM conceptPart A – Ecosystem model J. Wittenber May 11, 2011 D2jw_A See also http://mdcx73-working.wikispaces.com/gRIM NOTE: 1st of 2 parts; omits Figures 3*.

2. Contents Figure TopicPg/Slide Introduction 3 1 Conceptual model – basic, “Ecosystem” 4-5 2 Ecosystem model – topology, profiles 6-9 3 e[P]HR model – “Green CDA”, [trans]forms see part B Appendix A Inferences 10 DAM gRIM Concept

3. gRIM Introduction The HC informatics scope is often considered as a “continuum” covering a wide range of rapidly evolving data communication and information system technologies, standards, and value-added implementations. As a result, synergy has been difficult to achieve, and the metaphor of an “ecosystem” has evolved to motivate synergy. Since this document got stimulated by the HL7 “fresh look” initiative (or whatever) and had to somehow try to be a coherent DAM/DCM assessment despite a number of “Long live the RIM” and “Green” CDA comments, it seemed fitting to call it “DAM gRIM”  greened RIM.  virtually green @ VMR. In this, application-specific SDO homologues are found in IHE, DICOM, and IEEE [11073] MDC. There are several models, e.g. conceptual, ecosystem, and PHR. First, in the conceptual model, a basic view (Fig 1a) is transformed into a “ecosystem” topology (Fig 1c2*). Second, a “harmonized” profile (Fig 2c) is defined using SDO-based analogues of HL7 RIM. Third, a PHR model covers a number of sub-models (Fig 3*) pertaining to key Point of Care device-originated and PHR-destined transforms. Last, some inferences are made (Appendix A). DAM gRIM Concept

4. Figure 1a. Conceptual model - basic Turn this… Into this… “Standard CDA” ePHR transformed from typical .doc PHR WAN “Cloud” Home Personal Health Devices (PHD) PC and/or “smart” phone DAM gRIM Concept

5. Figure 1b. Conceptual model – “Ecosystem” • “Collaborative” ePHR development, incl. Patient and Medical Home care providers - “Standard” eHR/ePHR - In-patient; Acute…Critical Care - Clinical- or “Professional” grade devices - Multi-device; multi-patient [Mini-?]Ass’n (DICOM-HL7) Application Domain Focus “Mini”-Ass’n (MDC-DICOM) <Vent-Xray> PCD-HL7 Mini Ass’n HL7-PCD [w]WAN Ass’n (MDC-MDC) [w][P]LAN Ass’n (PHD-PHD) Ass’n (MDC-PCD) [Mini-]Ass’n (PHD-PCD) [Recycle) • Single-/multiple PHD’s • in Disease Mgmt and • Health & Wellnes domains • - Home use context but may be • mobile with appropriate connectivity Scope: - “Ad hoc” PHR/ePHR - Single patient (ePHR) - PC and/or “Smart phone” intermediary DAM gRIM Concept

6. Figure 2a. Ecosystem model - topology In this topology, key process elements are characterized along the matrix diagonal, ranging from asymptotically small-to-large ( need log-log scaling), or from device through intermediate system infrastructure and applications, lower left to upper right. There are several RIMBAA matrix elemental analogues among harmonizing SDO’s which are denoted with subscripts; see next slide for MAPpings. Notes/Notation [Im[Persistence Add’l RIMBAA variant  Scalability: N4= Pt. Census N3= Device Census N2= PoC contexts (typ. Beds); N1= Modalities (typ. parameters” , esp. “waves”; Notes/ Notation Conventional “Flowchart” symbols in diag. = Merge  Scalar HL7 RIM[BAA] Matrix Elementx x =Context # e.g. A3S2 A3 downlinks to S2 IHE PCD -nn – Profiles @ DEC, ACM, PIV, RTM… ISO/IEEE 11073 -101xx Nom -102xx DIM -103xx Speczn -104xx PHD -20xxx MDAP -20601 PHD* -3xxxx Transport… - 305xx w*AN e.g. [wWAN] wP/LAN -9xxxx Harm’z’n PHR Controls, e.g. Silence Alarms Annotns [N]RT RT Display (may be multi) CDS Window Alerts RT Physio Annotnsv Sup’yCtl (e.g. Start/Stop; may be semi-auto) Entropy (S [bps]) Increasingly wP/L/M/WAN value set or embedded [persistent store] element of PHR module when reported.in e*H DAM gRIM Concept Stochastic Time RT  NRT

7. Figure 2b – Ecosystem model– transformation profile The harmonization model is a model of model of a system of systems isingGreenNormativetransforms. This diagram comprises extracts from a single [very] large worksheet of others in the workbook. e[P]HR artifacts with embedded, reversible HDCRE’s (for algorithmic reuse) HCDRE are integrated [/embedded] into ePHR in iterative fashion, resolving from “Green” to normative EHR[/RIM] form[at[s]]. ECOSYSTEM model Data PATTERN types vMR OO Class model Device model DIM model (x73 “RIM”) vMR map An “object” vMR elements DIM maps , e.g. [NI]Bpsystolic O---…gvMR –o-- …Transform “MAPping” Elements [Vector] …--o Health Care Device Result reporting Element (HCDRE) XML transforms IDL Abstract Syntax Optimized reporting format (binary) ConcreteTransfer syntax transform DAM gRIM Concept

8. Figure 2c – Ecosystem model – e[P]HR transformation harmonization RIMBAA matrix cell analogues are shown in the following diagram. Theoretically, analogues could become [RIM] homologues (or vice versa! ; ). vMR denotes a “gluonic” analogue of VMR, which extends MAPpers to Appl contexts. D e[P]HR artifacts with embedded, reversible HCDRE’s (for algorithmic reuse) HCDRE’s are integrated [/embedded] into ePHR in iterative fashion, resolving from “Green” to normative EHR[/RIM] form[at[s]]. ECOSYSTEM model O Data PATTERN types vMR OO Class model C Device model DIM model (x73 “RIM”) vMR map An “object” vMR elements DIM maps , e.g. [NI]Bpsystolic DIRECT (Meaured) or DERIVED (/Calculated ) OBSREVATIONS P O O---…gvMR –o-- …Transform “MAPping” Elements [Vector] …--o Health Care Device Result reporting Element (HCDRE) XML transforms IDL Abstract Syntax Optimized reporting format (binary) ConcreteTransfer syntax transform A S S DAM gRIM Concept

9. Figure 2d. Ecosystem model – entropy scalability Patient Monitoring System entropy is logarithmic w.r.t. S = ∫dsdt (N patient * Info /patient) dT for all data types dsdt. Processing entropy is increased significantly if semantic normality is post-coordinated en masse as response time  vital signs RT. Logarithmic in Y=F(S [bps]) and X=T; S varies @ Census / response T Continuity of Care Record [N]RT for LOS can be disjoint for e.g. Pt Trf & Transport or for Weaning from Ventilator Coded Value Parameter Arrays I/O’d , esp. [Near] RT requiring normative reformatting, esp. normative Parameter Name, has burdensome cost if distributed multi-patient, very low packet latency end-to-end [“reliably”]. Esp. if high-freq Import/Export Context =sensitive dispersion  To facilitate scalability and lowest latency, esp. through algorithms, transform Physio Fmt only when needed for external presentation. DAM gRIM Concept

10. Appendix A - Inferences A main implication is to maximize computability of payload data but minimize post-coordinated re-normalization of nomenclature [codes] in [N]RT, multi-parameter normalized CodedValueSet (CVS) use contexts. Compositions would be formed from ANY DEFINED BY < EVRI AVA [OID] > DAM gRIM Concept