HL7 “Fresh Look” – gRIM concept Part B – PHR transformation model

1. HL7 “Fresh Look” – gRIM conceptPart B – PHR transformation model J. Wittenber May 11, 2011 D2jw_B See also http://mdcx73-working.wikispaces.com/gRIM NOTE: 2nd of 2 parts; contains only Figures 3*.

2. Contents Figure TopicPg/Slide Introduction omitted; see Part A 1 Conceptual model – basic, “Ecosystem” omitted; see Part A 2 Ecosystem model – topology, profiles omitted; see Part A 3 e[P]HR model – “Green CDA”, [trans]forms 10-17 Appendix A Inferences omitted; see Part A DAM gRIM Concept

3. Figure 3a. PHR model - [“Green CDA”] pattern types Ref: “One information model to rule them all?”; see also http://wiki.hl7.org/index.php?title=GreenCDA_Project . DAM gRIM Concept

4. Figure 3b – PHR model – example data pattern – XML form[at] DAM gRIM Concept

5. Figure 3c – PHR model – example “Green CDA” composition DemographicsContent: HL7 2.x for messaging, CCD for document summaries Vocabulary: HITSP Harmonized codesets for gender, marital statusProblem ListContent: HL7 2.x for messaging, CCD for document summaries Vocabulary: SNOMED-CTMedications Content: NCPDP script for messaging, CCD for document summaries Vocabulary: RxNorm and Structured SIGAllergiesContent: HL7 2.x for messaging, CCD for document summaries Vocabulary: UNII for foods and substances, NDF-RT for medication class, RxNorm for MedicationsProgress Notes and Other Narrative Documents (History and Physical, Operative Notes, Discharge Summary) Content: HL7 2.x for messaging, CCD for document summaries Vocabulary: CDA TemplatesDepartmental Reports (Pathology/Cytology, GI, Pulmonary, Cardiology etc.) Content: HL7 2.x for messaging, CCD for document summaries Vocabulary: SNOMED-CTLaboratory ResultsContent: HL7 2.x for messaging, CCD for document summaries Vocabulary: LOINC for lab name, UCUM for units of measure, SNOMED-CT for test ordering reasonMicrobiologyContent: HL7 2.x for messaging, CCD for document summaries Vocabulary: LOINC for lab name/observationImagesContent: DICOMAdministrative Transactions (Benefits/Eligibility, Referral/Authorization, Claims/Remittance) Content: X12 Vocabulary: CAQH COREQuality MeasuresContent: Derived from all the data elements above Vocabulary: Derived from all the data elements abovePrivacy and SecurityTransport: HTTPS, SOAP/REST Transport Orchestration: WS* Authorization/Access Control: XACML DemographicsProblem ListMedications AllergiesProgress Notes and Other Narrative DocumentsLaboratory ResultsMicrobiologyImagesAdministrative Transactions Quality MeasuresPrivacy and Security Adapted from http://geekdoctor.blogspot.com/2009/04/data-elements-of-ehr.html DAM gRIM Concept

6. Figure 3d. PHR model - “harmonized” form Here’s a snapshot of a form developed from the original (.doc format) using a conventional relational database (RDB).It is “wysiwyg” (what you see is what you get) in that you can enter data directly into the form and then it can be printed out, communicated using standard protocols, and revised as needed for consultation /collaboration purposes. DAM gRIM Concept

7. Figure 3e. PHR model - “Green” form example My sister gen’d this up in .doc format over the time of my mom’s hip[s] replacement ordeal. The form turned out to be very useful to help quickly convey my mom’s medical situation. The idea is to transform or provide transformer middleware for this using up to date healthcare standards technology, to facilitate both composition and communication. DAM gRIM Concept

8. Figure 3f. PHR model – attribution and iteration In the following table, key “ePHR transform” and “PHR Summary content - Overview” elements (at left) are related to various info “pattern types” (middle of table; see also Appendix A & B. “Recycling”, or an iterative process (at right) for convergence of ad hoc  standard representation is intended synergy between patient and healthcare providers. Data layering into IT and HC format provides for key semantic mapping, particularly of demographics, health problems, medications, etc., that are “coded”. For “Green CDA” info, see http://wiki.hl7.org/index.php?title=GreenCDA_Project. See next slide for “Pattern Type” detail;. DAM gRIM Concept

9. Appendix 3g – PHR model – key transforms Transforms cost and can generate “value-add” at various points in the system, although not necessarily “ecologically”. Fundamentally, each physiological “observation” has a semantic infrastructure as characterized in the upper part of the following diagram, e.g. “NIBPsystolic120 [mmHg]”; “Name” coding is particularly costly, as semantic misprecision affects clinical/medical risk. The lower diagram shows how cost & risk can increase due to transforms. Moreover, there may be both “pre-” and “post-”coordination costs throughout the system life cycle.  costs can be reduced if not minimized by eliminating/minimizing intermediate transforms and normalizing Coded Values.. overhead Name Code value Units Code overhead CodedValue Highly distributed, high volume, low-latency, multi-attribute, multi-object context-sensitive thrashing is bad., and most of this is CodedValue sets. Dev->1st link transfer [transform] 1st Link nth Transforms Protocol overhead Coded Value DAM gRIM Concept

10. Application Domain Focus Figure 3h PHR model - iteration and convergence • Recycling facilitates reuse, generally involving transforming between “ad hoc” (end user) and “standard” (HC IT System”) form[at[s]], the key semantic interoperability step shown at lower right, in which “intermediate, standard” Nomenclatures are substituted, manually (“pre-coordinated”) or by an adapter or intermediary.. • [Note: diagram is patterned after UML interaction diagram vs. topology per last diagram. • Intermediate format grammar (“tags”, e.g. “quantity”, “dosage”), generally also need transforming, which makes standardization significantly more complex if only Nomenclatures need to be mapped.; however, “on the fly” (during import/export) may be done on intermediate format, since typically only table lookups need to be done, at least on the “standard” side of the system, although some annotation may be needed to flag “uncoded” data.] “Ad hoc” Transform Device[s] Data Acq’n G’way /[R]DB Intermediate form[at] Recycle <Nomenclature> <Value> <Nomenclature> “Standard” DAM gRIM Concept