The document summarizes a presentation given by Michael van der Zel on the tools available to healthcare information architects. It discusses modeling techniques like reference models, patterns, and detailed clinical models. It provides examples of modeling blood pressure and assessment scales. The presentation emphasizes using standards, metadata, and multiple layers of abstraction to build quality, reusable models that can support clinical care and research.

1. De gereedschapskist van
de Zorg Informatie Architect
Congres 'Architectuur in de Zorg‘
23-jun-2011
Michael van der Zel
HIT Architect
University Medical Center Groningen #CAZ2011
© 2011 M.van.der.Zel AT umcg.nl

2. De gereedschapskist van de Zorg Informatie Architect
Congres 'Architectuur in de Zorg', 23-jun-2011
University Medical Center Groningen, Netherlands
Michael van der Zel
HIT-Architect
#CAZ2011
© 2011 M.van.der.Zel AT umcg.nl

3. Michael van der Zel
● Personality (MBTI) INFJ – Idealist, Perfectionist,
Chaotic
● “INFJs prefer the future and the pathway along which
they aspire for profundity.”
● University Medical Center Groningen, Netherlands
● Healthcare Information Systems Architect
● Results 4 Care, Netherlands
● Detailed Clinical Models (ISO), HL7 v3
● HL7 WG's: RIMBAA, EHR, ArB, Patient Care
© 2011 M.van.der.Zel AT umcg.nl

4. De Architect
The Project
© 2011 M.van.der.Zel AT umcg.nl

5. )
No w :-
The baseline Infostructure in 2010. Will it fly? How long? With how much effort?
© 2011 M.van.der.Zel AT umcg.nl

6. Tool Boxes?
© 2011 M.van.der.Zel AT umcg.nl

7. Informatie Architect Tools
● Methoden & Technieken & Standaarden
● Bibliotheken
● Patterns (e.g. SCT Content Models)
● Referentie Modellen
● Producten, Software
© 2011 M.van.der.Zel AT umcg.nl

8. De IJsberg
Functioneel
Gebruikers
Wens
DAM
EHR-S FM
DCM
SNOMED CT
G-Standaard
IHE
UML
Traceability
HDF
HL7 v3
Archetypes
HL7 v2
Techologie
MLLP
XML
© 2011 M.van.der.Zel AT umcg.nl

9. Bibliotheek (1)
© 2011 M.van.der.Zel AT umcg.nl

10. Bibliotheek (2)
© 2011 M.van.der.Zel AT umcg.nl

11. Referentie Modellen
● iZiekenhuis Ref Model
● EHR-System Functional Model
– ISO 18308.2 Requirements for
an EHR Architecture
18308: Definieerd
conceptueel eisen aan
informatie modellen
iZkh: Definiteerd
conceptueel informatie
modellen
© 2011 M.van.der.Zel AT umcg.nl

12. “Stairway to Heaven”
© 2011 M.van.der.Zel AT umcg.nl

13. “Stairway to Heaven”
● Techniek: letters; chinees, arabisch
你好 ‫أهل وسهل‬
Structuur, Syntax: zin samenstelling, leesrichting
Bron: Bernd Blobel, University of Regensburg
●
Doorgaans is dit niet de belangrijkste om een
boodschap over te krijgen.
● Semantic: woordbetekenis
Als je de woorden eenmaal kan lezen moet je de
betekenis kennen.
● Acties: afspraken over uitvoeren
© 2011 M.van.der.Zel AT umcg.nl

14. Requirements for “Good” Models
● Accurate – corresponds to the real world
Bron: Stanley M. Huff, MD
● Unambiguous – only one meaning
CMIO
● Understandable
● People recognize the real world referent(s)
● Reproducible
● Different modelers would model in the same way
● Parsimonious and harmonious use of terminology
● Semantics of the model and terminology match
● Flexible
● Evolve gracefully over time
● Consistent across domains – Specimen Collection and I&O Charting
● Practical – implementable in real systems
● Minimally complex – cover only what is needed
● Common queries are easy
● Fits with available technology (OO languages)
© 2011 M.van.der.Zel AT umcg.nl

15. Model Abstractie Lagen
C M
Conceptueel
D
C M
Logisch
+ referentie model D
Fysiek /
Implementeerbaar
beton of plastic
© 2011 M.van.der.Zel AT umcg.nl

16. DCM Lagen
© 2011 M.van.der.Zel AT umcg.nl

17. Voorbeeld DAM Invulling
© 2011 M.van.der.Zel AT umcg.nl

18. DAM Voorbeeld LifeLines
Study #10 View: Study #9
“QT-IGC GWAS Phase” SBP, DBP “ICBP GWAS PP & MAP”
ECG Params Race SBP, DBP, MAP, PP Blood
pressure
Gedetaileerde specificatie
+ SNOMED CT codes
+ eenheden, max/min, etc.
© 2011 M.van.der.Zel AT umcg.nl

19. Bloeddruk DCM
class Information Model (+DefinitionCode)
Nam e: In form a tion M ode l (+Defin itionCod e) CD CD
A uthor: Abe l Enthove n, M ich ae l van de r Ze l « qua lifie r,e num eratio n» «q ua lifie r,e num eratio n»
V ersio n: 0 .98 Manchet Meetlocatie
Created : 2 1-6-20 11 23:08:12
Upd ate d: 2 1-6-20 11 23:09:43 + G root + Lin ke rbo vena rm
+ K le in + Lin ke rdi j
+ Neo na taa l + Lin ke ren ke l
+ S ta nda ard + Lin ke rpo ls
CD
+ V oo rDijb een + Rechterb oven arm
« qua lifi er,e num e rati on» + V oo rJongK in d + Rechterd ij
Meetmethode + V oo rKind ere n + Rechtere nkel
+ Rechterp ols
+ Inva si ef + V inger
tags
+ Niet-invasie f DCM ::Defi niti onCo de = S NOM ED-CT : 7 066 50 02 blo od pre ssure cuff
tags
tags DCM ::De fin itionCode = SNOM ED-CT : 39 798 700 2 m easu rem en t site
DCM ::De fini tion Code = SNOM E D-CT : 84 203 001 has m e tho d
«ro otco ncep t»
Bloeddruk
«q ual ifie r,en um era tion »
CD constraints Korotkov Geluid
« qua lifi er,e nu m e ratio n» {M a nche t a llee n b ij m eti ng m e t m anch et}
Meetapparaat {M e etlo cati e a llee n b ij m eti ng m e t m anch et} + Fa seIV
{Ko rotko v-geluid al lee n bi j ni et-i nvasie ve m eti ng} + Fa seV
+ A nde rs
+ A nero ide tags tags
+ Hybrid e DCM .id = DCM R4C2 DCM ::De fini tion Code = SNOM E D-CT : 855 49 003 koro tko ff sou nd s
+ K wi k DCM ::Defi niti onCo de = SNOM ED-CT : 7 536 70 02 blo od p ressure
tags
DCM ::Defini tion Code = SNOM ED-CT : 363 69 900 4 d ire ct de vice
B lo edd rukmeetw a ard e
B lo eddru kme etw aarde «d ata ,de rivation »
GemiddeldeArterieleDruk
«data»
Onderdruk
constraints
{waa rde ge lijk a an onderd ruk pl us 1/3 polsdru k}
tags
DCM ::DefinitionCo de = S NO M ED-CT : 2 71650 006 di astoli c blo od pre ssure tags
DCM ::De fin itio nCod e = SNO M E D-CT : 25 107 40 06 non -inva si ve m ea n a rterial pre ssure
Bl oed dru kmeetw aa rde
B loed dru kme etw aarde « data,d eriva tio n»
Polsdruk
« da ta»
Bov endruk
constraints
{wa ard e g elij k a an bo vend ruk m inu s ond erd ruk}
tags
DCM ::Defini tion Code = SNOM ED-CT : 271 64 900 6 systoli c blo od pre ssure tags
DCM ::Defi nitio nCod e = S NOM E D-CT : 8 717 900 4 a rte rial pu lse pressu re
© 2011 M.van.der.Zel AT umcg.nl

20. Patroon Voorbeeld
© 2011 M.van.der.Zel AT umcg.nl

21. Assessment Scale Pattern
● 1 of meer som variabelen met losse scores
● e.g. Barthel Index
of Glasgow Coma Scale
? «rootconcept»
{AssessmentScaleOrScoreName}
● Ook Requirements &
Terminology «container»
Indiv idualScores
?
«data,derivati on»
INT val ue
inv: self.val ue >= {m in-
val ue} and self.val ue <=
{TotalScore}
{m ax-value}
● Resultaat: {value}
constraints
form ula
{form ula} inv: self.val ue = sum
(Indi vidualScores)
consistente(re) modellen
? CO ? CO ? CO
«data,enum eration» «data,enum eration» «data,enum eration»
{Variable#1} {Variable#2} {Variable#3}
© 2011 M.van.der.Zel AT umcg.nl

22. SNAQ en GCS Voorbeelden
? «rootconcept»
SNAQscore
? INT
« ro otco n ce p t»
«data,derivatio...
«container» GlasgowComaScale
TotalScore
Indiv idualScores
constraints
{value}
{form ula}
0 ..1
INT
« co n tai n e r»
« da ta ,de ri va tio ...
Items
CO TotalScore
CO
«data,enum eration»
WeightLoss «data,enum erat... constraints
Appetite {valu e }
+ >3KgLastM onth = 2 {fo rm u la }
+ >6Kg6M onths = 3 + No = 0
+ No = 0 + Yes = 1
CO CO CO
« d a ta,e n u m e ra ti on » « d a ta ,e n um e ra tio n » « da ta ,e nu m e ra tio n »
E=Eye opening M=Best motor response V=Verbal reaction
« e n um » « en u m » « e nu m »
+ S po n ta n eo u s: CO = 4 + T o ve rb al co m m a n d : ob e ys: CO = 6 + Orie nte d a nd co n ve rse s: CO = 5
+ T o sp ee ch : CO = 3 + T o p a in fu l sti m ul u s: l o ca l ize s p a in: CO = 5 + Diso rie n te d a n d co nve rses: CO = 4
+ T o p a i n : CO = 2 + Flexio n -with d ra wal : CO = 4 + In a pp ro p ri a te wo rd s: CO = 3
+ No re spo n se : CO = 1 + Flexio n -a bn o rm al: CO = 3 + In co m p re h en si ble so u n d s: CO = 2
+ Not p o ssi b le to de te rm in e (C): CO = 0 + Exte n sio n : CO = 2 + No re sp o n se : CO = 1
+ No re sp o nse : CO = 1 + T u b e /T ra ch eo to m y (T ): CO = 0
+ Pa ra l ysi s (P ): CO = 0
© 2011 M.van.der.Zel AT umcg.nl

23. EHR / Research Loop
© 2011 M.van.der.Zel AT umcg.nl

24. EHR Feedback Loop
e tune process
car
e ct lab
dir medication
exam KPI knowledge
procedure
supportive
orders CDR / ODS research db
results update EHR pseudo EHR
results results
analyse
.
fo a
in fr
in
translational
ref data
knowledge medicine
2010-dec-27 Michael van der Zel, met inspiratie van Ernst de Bel
© 2011 M.van.der.Zel AT umcg.nl

25. Conclusies
● Do the simplest thing that could possibly work, but
not to simple – Albert Einstein
● Genoeg metadata toevoegen, exact genoeg
beschrijven, dan wordt werken met de informatie
triviaal, mappings, impact analyse, conversies, etc.
● Fit for purpose
● Splits het probleem op in verbonden lagen
● … geeft kwaliteit en herbruikbaarheid van
informatie
© 2011 M.van.der.Zel AT umcg.nl

26. Bedankt voor de aandacht
© 2011 M.van.der.Zel AT umcg.nl STS-134 Endeavour final launch 16-may-2011

27. © 2011 M.van.der.Zel AT umcg.nl