HL7 Modeling Project for Perinatology

1. HL7 Modeling Project for Perinatology Irma Jongeneel,Tom de JongHL7 the Netherlands International Affiliate Meeting

2. Agenda • Purpose and background of the Project • Conceptual domain • Implementation domain • Domain Message Information Model for Perinatology • From D-MIM to XML messages • Issues that came up. International Affiliate Meeting

3. Purpose and background for project • NICTIZ : recently established national institute for ICT in healthcare develops the information structure to support safe exchange of health information • NICTIZ sponsors the HL7 project office to run a pilot project with HL7 for Perinatology domain • conceptual domain • implementation domain • Work list with products among both domains. International Affiliate Meeting

4. What is the Perinatology domain? • Pregnancy until 28th day after childbirth • 1st line healthcare obstetrics (GP, midwife) • 2nd en 3rd line healthcare obstetrics (gynecologist) • neonatology (neonatologist) International Affiliate Meeting

5. Why perinatology? Good opportunities • Many providers (referrals) in the perinatology domain Model for information exchange in other care chains • There is consensus about care chain in the perinatology • Standards for nomenclature available • Short defined 'episodes of care‘. International Affiliate Meeting

6. Perinatology project Goal: • Improve information exchange– between healthcare providers (referrals)– with supporting departments (lab, radiology, pharmacy, …) • by using Information Technology. International Affiliate Meeting

7. Results end of 1st quarter 2002 • Domain Information Model in the conceptual domain • Version 1 based on 10 ‘pathways’ and national registration system • Based on HL7 V3 Reference Information Model (RIM) • Domain Message Information Model in the implementation domain • Message specification for part of pathway for discussion with vendors • Determine deliverables in the implementation domain • Next four quarters • Finish D-MIM • Check for general applicability for COPD and general surgery. International Affiliate Meeting

8. Project organization Program Management NICTIZ Marcel Jonker Vendors Panel International HL7 Netherlands (project office) Robert Stegwee e.a. Bert Kabbes Project team NICTIZ-HL7 Irma Jongeneel Tom de Jong William Goossen Jos Baptist Sevkan Cevirgen translator communicator Hans vd Slikke Pathway Pathway Midwifes, GP’s, gynecologists, neonatologists, nursing, supporting departments International Affiliate Meeting

9. Why start with HL7? • Advice of the panel International: • Start with HL7 version 3, focus on RIM • Parallel comparison with other international standards • Large ‘installed base’ for version 2.x • Supporting organization in the Netherlands available (project office HL7 Netherlands) • Furthest specified, for now the most practical choice. International Affiliate Meeting

10. Products Conceptual domain • 10 representative Pathways • Interaction tables • Conceptual Domain Information Model International Affiliate Meeting

11. Mapping of pathways to the HL7 V3 RIM Fragment of a ‘pathway’ The future mother has been referred by the midwife or G.P to the clinician (gynecologist) because of severe growth disorder of the child. After examination by the gynecologist the child is diagnosed with breathing problems and the decision is made to do a intra-uterine transfer to a NICU (3rd line). The gynecology department in the regional institute is contacted. International Affiliate Meeting

12. Mapping of pathways to the HL7 V3 RIM HL7-RIM Living Subject Act Observation The future mother has been referred by the midwife or G.P to the clinician (gynecologist) because of severe growth disorder of the child. After examination by the gynecologist the child is diagnosed with breathing problems and the decision is made to do a intra-uterine transfer to a NICU (3rd line). The gynecology department in the regional institute is contacted. International Affiliate Meeting

13. Alle klassen op de niveaus 3 en 4 in de tekening zijn subklassen van 'observation'. In alle gevallen moeten de waarden nog worden vastgesteld. Basis_Verpleegkundige_Anamnese Crisis_verpleegkundige_anamnese -Wensen_ouders -reden_sectio -beleving_ouders -reden_opname_kind_op_NICU -wensen_zorg_participatie -duur_zwangerschap -duur_partus_sectio +Note dit kan verder worden ingevuld() -bereikbaarheid_vader -bereikbaarheid_moeder -bereikbaarheid_contactpersoon -wens_borstvoeding -start_borstvoeding Conceptual Domain Information Model perinatology Observation class of 'Acts' -value : ANY -derivation_exp : ST -method_cd : SET <CV> -target_site_cd : SET <CD> -Interpretation_cd : SET <CS> Verpleegkundige_Anamnese -Afdeling -verpleegkundige -ouder_met_wie_gesproken International Affiliate Meeting

14. Products implementation domain Starting point: Conceptual Domain Information Model, as defined in the care domain • Transfer the conceptual model to the HL7 RIM and model the results in Domain Message Information Model (D-MIM) Perinatology • Find the types of applications for Perinatology and transfer them to generic application roles • Find interactions between application roles International Affiliate Meeting

15. Steps for the implementation domain Starting point: Conceptual Domain Information Model, as defined in the care domain • Model necessary data in interactions in Refined Message Information Model (R-MIM) • Transfer R-MIM to hierarchical message description (HMD), with general constraints and defaults • Transfer HMD to a XML message structure (ITS) International Affiliate Meeting

16. 1. Storyboards (pathways Perinatology) 6. Domain Information model Perinatology (DIM) HL7 Reference Information Model (RIM) 10. Applications & Application roles Perinatology 9. Domain Message Information Model Perinatologie (D-MIM) 11. Interactions 12. Refined Message Information Model Perinatologie (R-MIM) 13. Hierarchical Message Description Perinatology (HMD) Relationship between products from different steps Implementation Domain International Affiliate Meeting

17. Example: Mother (pregnant woman)(Information from conceptual model) International Affiliate Meeting

18. Mapping from DIM to HL7 RIM International Affiliate Meeting

19. Part of D-MIM: Pregnant woman International Affiliate Meeting

20. Part of D-MIM: Referral International Affiliate Meeting

21. Part of D-MIM: Pregnancy International Affiliate Meeting

22. HL7 version 3 in perinatology from D-MIM to XML messages: applied tools & methods and intermediate results International Affiliate Meeting

23. UML to describe conceptual DIM(visual representation)VISIO 2000 to describe D-MIM and R-MIM’s(visual representation with HL7 stencils)RoseTree to specify R-MIM’s and HMD’s(MS Access database with HL7 repository) Applied tools & methods International Affiliate Meeting

24. R-MIM Rose Tree Referral Conceptualization Rational Rose MS Access database, with HL7 repository (RIM etc.) and representation of R-MIM’s & HMD’s HMD Referral Modelling Visio 2000 XML Schema Referral International Affiliate Meeting

25. Relationships between products 1. Storyboards (perinatoloy pathways) 6. Conceptual Domain Information Model (C-DIM perinatolgy) HL7 Reference Information Model (RIM) 9. HL7 Domain Message Information Model (D-MIM perinatology) 10. Application roles 12. Refined Message Information Model (R-MIM pregnancy referral) 11. Interactions 13. Hierarchical Message Description (HMD pregnancy referral) International Affiliate Meeting

26. Application roles – interactions - messages • Application roles: • Sender: ‘pregnancy referral placer’, e.g. a primary care information system • Receiver: ‘pregnancy referral filler’, e.g.a gynecology information system • Message: • Pregnancy referral message International Affiliate Meeting

27. Diagram: perinatology pathway application roles – interactions – messages • Pilot specification for interaction referral of pregnant woman from primary care to gynecologist from one of the perinatology pathways described (pathway 2). Sender and receiver perform their application roles Information dictates content of message Healthcare process describes interaction International Affiliate Meeting

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32. What are the project deliverables? • Domain Message Information Model (D-MIM) for the perinatology domain • Specifications for information interchange • Application roles (well-defined responsibilities) • Message specifications in the form of: • R-MIM’s • HMD’s • XML schema’s. International Affiliate Meeting

33. Architecture of multi-tier systems USER INTERFACE (E.G. RICH CLIENT, WEB BASED) PROCEDURAL LOGICS TRIGGER EVENTS HL7 messages (XML format) DATA-OBJECTS (CONCEPTUAL STRUCTURE) DATABASE (DBMS) (PHYSICAL STRUCTURE) (E.G. ORACLE, MS SQL SERVER) International Affiliate Meeting

34. Issues that came up… (I) How to balance ‘horizontal’ vs.‘vertical’ standard specifications and implementationguidelines? HL7 domainPractice & OperationsLaboratory HL7 domainPractice & OperationsPharmacy HL7 domainPractice & OperationsReferral HL7 domainPractice Patient Adminstration Healthcare domain Perinatology International Affiliate Meeting

35. Issues that came up… (II) • What type of deliverables should standardization organisations (like HL7 Netherlands) provide to the marketplace? • Fully specified interactions and XML Schemas for message content • Just D-MIM or R-MIM’s, from which vendors can create messages • No specifications at all, the market will build from the RIM and the process described by the V3 backbone (a.k.a the MDF) • What are the effects of decision on ‘time to market’ for V3 and the level of ‘plug-and-play’ achieved within the marketplace? International Affiliate Meeting

36. Issues that came up… (III) • The good news: the HL7 RIM seems fully sufficient to create the D-MIM for perinatology (classes and attributes). • The bad news: • Current V3 products are not yet sufficient for the required messages. • Vocabulary domains are sometimes very hard to apply in practice. • HL7 Netherlands is extending the current V3 products to a set of interactions and messages for a specific healthcare domain: • This process is therefore ahead of the current content of V3 itself. • Is this potentially conflicting with the main standardization process? • How are results from such a project fed back into the main standard? International Affiliate Meeting

37. Questions? International Affiliate Meeting