Presentation at the 1st Workshop on Scientific Computing Applications in Health - 2010. See: http://www.mlhim.org http://gplus.to/MLHIM and http://gplus.to/MLHIMComm for more information about semantic interoperability in healthcare. #mlhim #semantic_interoperability #health_informatics

1. Multilevel Healthcare Information Modeling
Associate Laboratory INCT-MACC
“Multilevel Healthcare Information Modeling
UERJ/UFF

2. Outline
• Healthcare Information: An Overview
• MLHIM Fundamentals
• The openEHR Specifications: An
Overview

3. The Healthcare Information is Complex...
... because the healthcare system is a complex and
dynamic system:
• Complexity: the system generates a large number of
variables that have complex interdependencies,
especially...
... space-time dependency: the information to be persisted
varies in time and space
• Dynamics:
▫ The relationship between information items is variable, being
the temporal variation rapid and spatial variation close

4. The Healthcare Policies are also Complex
• The establishment of consensus with respect to a particular
concept in healthcare is difficult:
▫ Competition between "medical schools"
▫ Multiprofessionalism but not transdisciplinarity
• The healthcare networks are hierarchical, with multiple
entry doors and without a functional mechanism of
reference and counter-reference

5. Challenges of the Healthcare System vs.
Information Technology Promises
•  % of adverse events arising from medication errors (interactions,
duplications, incorrect prescriptions)
•  Search time for critical information
•  % of patients "wasting time" in the system as due to the lack of
reference and counter-reference
•  Duplication of investigations, tests and procedures
•  Capacity of prevention and early detection
•  Capacity of long-term decision making
•  Adherence to treatment protocols
•  Effectiveness of programs targeted to a specific disease
•  % of avoidable hospitalizations and readmissions

6. Other Important Issues
• Semantic coherence: maintenance of the meaning (the
context) of the information that is persisted
• Interoperability: the ability to send information from one
location (system) to another, keeping the information
intelligible in both places (systems)
• Future-proof: the information must be perpetually kept in
the system the way it was originally persisted

7. Where Is the Context?

8. Here Is the Context!

9. Interoperability
- Cough
-F o r 3 m o n t h s
-L o w f e v e r
-D I : T B ? C a ?
-C h e s t X - r a y :
-N o d u le in r ig h t
-B r o n c h ic - a lv e o la r
apex
w ash :
-B r o n c o g e n ic
c a r c in o m a

10. Interoperability!
- Cou gh
F o r 3 m o n th s
L o w fe v e r - Cough C h e st X -ra y :
D I: T B ? C a ? F o r 3 m o n th s
N o d u le in
L o w fe v e r r ig h t a p e x
D I: T B ? C a ?
- Cough
C h e st X -ra y :
F o r 3 m o n th s N o d u le in
L o w fe v e r r ig h t a p e x
D I: T B ? C a ?
B r o n c h ic - a lv e o la r w a s h :
B r o n c o g e n ic c a r c in o m a

11. Interoperability?
- Cough
F o r 3 m o n th s
L o w fe v e r
D I: T B ? C a ?
“G a ra g e ”
s o ftw a re
C h e st X -ra y :
B r o n c h ic - a lv e o la r N o d u le in
r ig h t a p e x
w ash :
B r o n c o g e n ic H L7v2
c a r c in o m a M e ssa ge s
C E N 1 3 6 0 6 E xtra ct

12. Traditional Modeling

13. Problems of the One-Level Model
 The information is modeled in a way that "serves" the current needs of
the healthcare system
 The addition of new concepts involves redoing the whole system
(redesign, reimplementation, retest, redistribution)
 High cost, slow integration of new knowledge to HIS etc.

14. Multilevel Modeling

15. Multilevel Modeling

16. Why Adopting Standards for HIS?
• Prerequisite for effective implementation of a integrated
and universal healthcare system
• Standardization of "rules, protocols, processes" and
"activities", "for the benefit of all" (ISO)
• Democratization of the healthcare system governance
• Improvement of control and evaluation processes

17. Standards and Specifications for HIS
Name What it is Implemented Open
ISO/CEN Standard “Yes” No
HL7 Specification Yes No
and “Standard”
openEHR Specification Yes Yes
and “Standard”

18. x T
ICD es E DC
p OM
WHO a
ty SN
Dat IHTSDO
ISO PMAC
EN13606-
EN1
ASTM CCR Documents
Content models
Security
Terminology
EN
3606
Services
1
E
36
C
N1
A
0
36
-3
4
RB
6-2
Q 06
PD -1
s
ge
IHE PIX s
CEN
sa
RID age
v2
ss
es
m e
m
v3
XD
HL7
S
HI
HSSP
SA
W
CCO CD
A
s
te
pla
m
Te
Fonte: Thomas Beale, EFMI

19. The openEHR Specifications
• Multilevel (or dual) model: software development and
knowledge modeling are separated
• The reference model is implemented in software
• The knowledge is modeled on "archetypes"

20. The dual openEHR Model
Y o u r a p p lic a t io n ( E H R , D S S e t c )
o p e n E H R S p e c ific a tio n s
K n o w le d g e m o d e lin g ( A r c h e t y p e s )
R e fe re n c e M o d e l

21. Synthesis:
• The traditional modeling of information systems, in which
domain knowledge is implemented in software, is inefficient
for complex and dynamics realities such as healthcare
• The problems arising from the use of that approach in HIS
has stimulated global standardization initiatives
• The adoption of terminologies is an important element, but
does not solve the problems of the domain if the systems
continue to be implemented in one level

22. Synthesis:
• In multilevel modeling, each specialist is responsible for its
"specialty":
▫ Computer scientists implement the reference model
▫ The healthcare professionals model the knowledge
• The software+DB level is separated from the knowledge level
• Not to be confused with "three tier", which traditionally holds
the knowledge layer implemented in software and it only
separates BI and GUI

23. Questions?
http://www.mlhim.org
lutricav@vm.uff.br