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Sharing Healthcare Transactions DCS 860D – Distributed Internet Computing Meg Broderick April 12, 2003.

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Presentation on theme: "Sharing Healthcare Transactions DCS 860D – Distributed Internet Computing Meg Broderick April 12, 2003."— Presentation transcript:

1 Sharing Healthcare Transactions DCS 860D – Distributed Internet Computing Meg Broderick April 12, 2003

2 Agenda Interoperability Interoperability Importance in Healthcare Importance in Healthcare HL 7 and XML HL 7 and XML Patient Record Architecture Patient Record Architecture Integration Brokers Integration Brokers Demo Demo

3 Interoperability “…the ability of a system or a product to work with other systems or products without special effort on the part of the customer.. “…the ability of a system or a product to work with other systems or products without special effort on the part of the customer.. “…Products achieve interoperability with other products using either or both of two approaches: “…Products achieve interoperability with other products using either or both of two approaches: By adhering to published interface standards…, e.g., HTML, TCP/IP By adhering to published interface standards…, e.g., HTML, TCP/IPinterface By making use of a ‘broker’ of services that can convert one product's interface into another product's interface "on the fly“, …e.g. CORBA “ By making use of a ‘broker’ of services that can convert one product's interface into another product's interface "on the fly“, …e.g. CORBA “ Source: 0_gci212372,00.html

4 Importance of Interoperability for Healthcare Distributed Information Collection Distributed Information Collection Multiple Places Multiple Places Different Function Different Function Completeness Desirable Completeness Desirable Large Volumes of Data Large Volumes of Data Distributed Use Distributed Use Dispersed Locations Dispersed Locations Different Functions: Information vs Transactions Different Functions: Information vs Transactions Quality Essential Quality Essential Different Levels of Computing Power Different Levels of Computing Power

5 W3C XML Linking Work Group Mission: Mission: To design advanced, scalable, and maintainable hyperlinking and addressing functionality for XML To design advanced, scalable, and maintainable hyperlinking and addressing functionality for XML Paul V. Biron & Sandra L. Boyer, “Introduction to XML,” HL7 Fall Plenary Meeting, Sept 27, 1999 Paul V. Biron & Sandra L. Boyer, “Introduction to XML,” HL7 Fall Plenary Meeting, Sept 27, 1999

6 XML and HL7 Start first with Patient Record Architecture Start first with Patient Record Architecture Expand Electronic Medical Record to include document-based clinical info Expand Electronic Medical Record to include document-based clinical info Exchange, reuse, longevity Exchange, reuse, longevity System Independent System Independent Local + Global Local + Global Hierarchical Hierarchical Adds HL7 Messaging Adds HL7 Messaging Non-proprietary, standards-based (open) Non-proprietary, standards-based (open)

7 Patient Record Architecture (PRA) Multilevel, XML Multilevel, XML Level 1:Coded Header Level 1:Coded Header Level 2:Coded Structure Level 2:Coded Structure Level 3: Coded Content Level 3: Coded Content Syntax handles recursion Syntax handles recursion Nested structures Nested structures Unify segments, fields, components and subcomponents Unify segments, fields, components and subcomponents Aka Clinical Document Architecture (CDA) Aka Clinical Document Architecture (CDA) Header + Body Header + Body

8 Patient Record Architecture Advantages of XML Advantages of XML Parsers are “free” (utilities) Parsers are “free” (utilities) Tools and technical staffing available Tools and technical staffing available Supports type conversion Supports type conversion Order and placement of message elements specified Order and placement of message elements specified RIM Attribute Level Message Elements RIM Attribute Level Message Elements Supports primitive and composite data types Supports primitive and composite data types

9 PRA: HL7 Conformance Profiles Healthcare Orgs adapted HL7 message specs locally Healthcare Orgs adapted HL7 message specs locally Implementation specs stored in spreadsheet or word Implementation specs stored in spreadsheet or word processing document processing document Message profile: HL7 spec + constraints + additions Message profile: HL7 spec + constraints + additions(z-segments) Large amount of variance => maintenance nightmare Large amount of variance => maintenance nightmare Store message profile in XML document: Store message profile in XML document: Use XML to communicate metadata – data about data Use XML to communicate metadata – data about data Easily converted to PDF Easily converted to PDF Tools: Messaging Work Bench, Symphonia, Tools: Messaging Work Bench, Symphonia, Medi7 Parser Toolkit Medi7 Parser Toolkit Repository for message profiles on Repository for message profiles on Concerns: Concerns: Vendor Competition Vendor Competition Correct with HCO pressure Correct with HCO pressure

10 Concept Cluster Templates Information Structures Information Structures HL7 messages HL7 messages XML documents XML documents Concepts Concepts Generalization of notion of codes, including SNOMED Generalization of notion of codes, including SNOMED Archetypes or templates Archetypes or templates Defines concept, units, values, mode Defines concept, units, values, mode e.g., BP Reading, concept ”systolic reading”, value, units, method (cuff), posture Concensus Definition Concensus Definition HL7, British General Practitioner to General Practitioner, GEHR, etc. HL7, British General Practitioner to General Practitioner, GEHR, etc. Source: W. Rishel, J. Klein, “Concept Cluster Templates: Next Step in Clincal Standards,” Tutorials, TU , Research Note, November 9, 2001, Garter Group

11 Other Technology ebXMLElectronic Business Extensible Markup Language ebXMLElectronic Business Extensible Markup Language XML specs to streamline online business XML specs to streamline online business Also X12 syntax Also X12 syntax Components Components Business Process Schema Business Process Schema Common Business Objects Common Business Objects Collaboration Protocol Profiles Collaboration Protocol Profiles Registry Registry Universal Description Universal Description Secure Messaging Service Secure Messaging Service CCOW CCOW HL7, Context management standard HL7, Context management standard Technology Neutral Technology Neutral Patient Context/ User Mapping Patient Context/ User Mapping HIPAA Impact HIPAA Impact Possible efficiencies? Possible efficiencies? Source: W. Rishel, “Healthcare and ebXML: Rx for HIPAA Security Compliance,” Events, EV , Research Note, June 11, 2001, Garter Group Source: J. Klein, “CCOW: A Standard for Application Context Coordination,” Tutorials, TU , Research Note, July 31, 2001, Garter Group

12 Early XML Adopters Industry Industry MetLife MetLife To facilitate data exchange in financial services To facilitate data exchange in financial services To allow coordination across multiple new business units and acquistions To allow coordination across multiple new business units and acquistions Build single customer view from back-end info silos Build single customer view from back-end info silos Resulted in: Resulted in: Reduction of # of interfaces and reuse interfaces Reduction of # of interfaces and reuse interfaces Integration of services external and internal Integration of services external and internal Increased ease of data exchange Increased ease of data exchange Source: K. Harris, “Metlife: Insurance XML Early Adopter,” Case Studies, CS , Research Note, February 11, 2002, Garter Group

13 Early XML Adopters Healthcare Healthcare End Stage Renal Disease Reporting End Stage Renal Disease Reporting Needed to automate processing of 1.5 million forms/year from dialysis centers Needed to automate processing of 1.5 million forms/year from dialysis centers Wide scope: 300,000 patients in 4,000 centers Wide scope: 300,000 patients in 4,000 centers VISION – Vital Information System to Improve Outcomes in Nephrology VISION – Vital Information System to Improve Outcomes in Nephrology Sponsored by Center for Medicare and Medicaid Services (CMS) – Distributed freely Sponsored by Center for Medicare and Medicaid Services (CMS) – Distributed freely Agency controlled both ends of information interface – more flexibility to evolve Agency controlled both ends of information interface – more flexibility to evolve Needed rapid implementation and deployment Needed rapid implementation and deployment Desired resemblance to HL7 standards Desired resemblance to HL7 standards Used RIM, a complete Unified Modeling Language (UML) Used RIM, a complete Unified Modeling Language (UML) Source: W. Rishel, “Early XML Adoption for End Stage Renal Disease Reporting,” Case Studies, CD , Research Note March 7, 2002, Gartner Group

14 Integration Brokers Types Types Message-oriented middleware (MOM) Message-oriented middleware (MOM) Transformation Transformation Business Process Management Business Process Management Context-based routing Context-based routing Transformation Transformation Specialized packages vs part of application platform Specialized packages vs part of application platform Synchronous vs Asynchronous Synchronous vs Asynchronous

15 Demo Pause Pause

16 @echo off echo ************************************************* echo ****** ********** echo ****** LINKTools IDK Demonstration ********** echo ****** ********** echo ****** This Batch file takes you ********** echo ****** step-by-step through the ********** echo ****** interface processes. ********** echo ****** ********** echo *************************************************

17 cd\ cd C:\LINKDemo\ pause cls echo ************************************************* echo *** The input files are copied from the ***** echo *** C:\LINKDemo\TestFiles\ folder to the ***** echo *** C:\LINKDemo\UDARecv folder. (HL7.*) ***** echo *** This simulates the receipt of HL7 ***** echo *** Admission, Discharge or Transfer (ADT) ***** echo *** Messages ***** echo ************************************************* echo *** Press SPACE BAR to copy input files ***** echo ************************************************* pause xcopy c:\linkdemo\testfiles\HL7.* c:\linkdemo\UDARecv\ cls

18 echo ************************************************* echo *** The HL7.* files copied to the ***** echo *** C:\LINKDemo\UDARecv folder will be ***** echo *** processed and output to the ***** echo *** C:\LINKDemo\XMLOut folder ***** echo ************************************************* echo *** Press SPACE BAR to run update ***** echo ************************************************* pause c:\linkdemo\ltup.exe c:\linkdemo\ADT2XML- Rep2HL7Demo.MPR cls

19 echo ************************************************* echo *** To Simulate the reports passed back ***** echo *** from the target we will copy the ***** echo *** Report.001 file form the ***** echo *** C:\LINKDemo\TestFiles\ folder to the ***** echo *** C:\LINKDemo\ReportsIn folder. ***** echo ************************************************* echo *** Press SPACE BAR to copy input files ***** echo ************************************************* pause xcopy c:\linkdemo\testfiles\Report.001 c:\linkdemo\ReportsIn\ cls

20 echo ************************************************* echo *** The Report.001 file copied to the ***** echo *** C:\LINKDemo\ReportsIn folder will be ***** echo *** merged in the database with the ***** echo *** previously received ADT data and ***** echo *** output to the ***** echo *** C:\LINKDemo\UDASend folder in HL7 ***** echo *** format ***** echo ************************************************* echo *** Press SPACE BAR to run update ***** echo ************************************************* pause

21 c:\linkdemo\ltup.exe c:\linkdemo\ADT2XML- Rep2HL7Demo.MPR cls echo ************************************************* echo *** Press SPACE BAR to view data **** echo *** in database with LINKSelect application **** echo ************************************************* pause c:\linkdemo\ltdb.exe c:\linkdemo\ADT2XML- Rep2HL7Demo.MPR exit

22 The Future Any to Any Connectivity and Transformation Any to Any Connectivity and Transformation Common Identification across all enterprises Common Identification across all enterprises Consistent and concurrent timing Consistent and concurrent timing Proprietary vs Independent Integration? Proprietary vs Independent Integration? Improved availability and, perhaps quality, of healthcare information at point of care Improved availability and, perhaps quality, of healthcare information at point of care


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