1. 1 April 28, 2002International Affiliate Meeting1 HL7 Modeling Project for Perinatology Irma Jongeneel, Tom de Jong HL7 the Netherlands

2. 2 April 28, 2002International Affiliate Meeting2 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.

3. 3 April 28, 2002International Affiliate Meeting3 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.

4. 4 April 28, 2002International Affiliate Meeting4 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)

5. 5 April 28, 2002International Affiliate Meeting5 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.

6. 6 April 28, 2002International Affiliate Meeting6 Perinatology project Goal: Improve information exchange –between healthcare providers (referrals) – with supporting departments (lab, radiology, pharmacy, …) by using Information Technology.

7. 7 April 28, 2002International Affiliate Meeting7 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.

8. 8 April 28, 2002International Affiliate Meeting8 Midwifes, GPs, gynecologists, neonatologists, nursing, supporting departments Project organization Vendors Program Management NICTIZ Panel International HL7 Netherlands (project office) Project team NICTIZ-HL7 Irma Jongeneel Tom de Jong William Goossen Jos Baptist Sevkan Cevirgen Marcel Jonker Bert KabbesRobert Stegwee e.a. translator communicator Hans vd Slikke Pathway

9. 9 April 28, 2002International Affiliate Meeting9 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.

10. 10 April 28, 2002International Affiliate Meeting10 Products Conceptual domain 10 representative Pathways Interaction tables Conceptual Domain Information Model

11. 11 April 28, 2002International Affiliate Meeting11 Mapping of pathways to the HL7 V3 RIM 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. Fragment of a pathway

12. 12 April 28, 2002International Affiliate Meeting12 Mapping of pathways to the HL7 V3 RIM Living SubjectAct HL7-RIM 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. Observation

13. 13 April 28, 2002International Affiliate Meeting13 Conceptual Domain Information Model perinatology Observation class of 'Acts' -value : ANY -derivation_exp : ST -method_cd : SET -target_site_cd : SET -Interpretation_cd : SET Alle klassen op de niveaus 3 en 4 in de tekening zijn subklassen van 'observation'. In alle gevallen moeten de waarden nog worden vastgesteld. Verpleegkundige_Anamnese -Afdeling -verpleegkundige -ouder_met_wie_gesproken Crisis_verpleegkundige_anamnese -reden_sectio -reden_opname_kind_op_NICU -duur_zwangerschap -duur_partus_sectio -bereikbaarheid_vader -bereikbaarheid_moeder -bereikbaarheid_contactpersoon -wens_borstvoeding -start_borstvoeding Basis_Verpleegkundige_Anamnese -Wensen_ouders -beleving_ouders -wensen_zorg_participatie +Note dit kan verder worden ingevuld()

14. 14 April 28, 2002International Affiliate Meeting14 Products implementation 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 Starting point: Conceptual Domain Information Model, as defined in the care domain

15. 15 April 28, 2002International Affiliate Meeting15 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) Starting point: Conceptual Domain Information Model, as defined in the care domain Steps for the implementation domain

16. 16 April 28, 2002International Affiliate Meeting16 Relationship between products from different steps 6. Domain Information model Perinatology (DIM) HL7 Reference Information Model (RIM) 1. Storyboards (pathways Perinatology) 9. Domain Message Information Model Perinatologie (D-MIM) 10. Applications & Application roles Perinatology 11. Interactions 12. Refined Message Information Model Perinatologie (R-MIM) 13. Hierarchical Message Description Perinatology (HMD) Implementation Domain

17. 17 April 28, 2002International Affiliate Meeting17 Example: Mother (pregnant woman) (Information from conceptual model)

18. 18 April 28, 2002International Affiliate Meeting18 Mapping from DIM to HL7 RIM

19. 19 April 28, 2002International Affiliate Meeting19 Part of D-MIM: Pregnant woman

20. 20 April 28, 2002International Affiliate Meeting20 Part of D-MIM: Referral

21. 21 April 28, 2002International Affiliate Meeting21 Part of D-MIM: Pregnancy

22. 22 April 28, 2002International Affiliate Meeting22 HL7 version 3 in perinatology from D-MIM to XML messages: applied tools & methods and intermediate results

23. 23 April 28, 2002International Affiliate Meeting23 UML to describe conceptual DIM (visual representation) VISIO 2000 to describe D-MIM and R-MIMs (visual representation with HL7 stencils) RoseTree to specify R-MIMs and HMDs (MS Access database with HL7 repository) Applied tools & methods

24. 24 April 28, 2002International Affiliate Meeting24 Modelling Visio 2000 Conceptualization Rational Rose R-MIM Referral HMD Rose Tree XML Schema Referral MS Access database, with HL7 repository (RIM etc.) and representation of R-MIMs & HMDs

25. 25 April 28, 2002International Affiliate Meeting25 Relationships between products 6. Conceptual Domain Information Model (C-DIM perinatolgy) HL7 Reference Information Model (RIM) 1. Storyboards (perinatoloy pathways) 9. HL7 Domain Message Information Model (D-MIM perinatology) 10. Application roles 11. Interactions 12. Refined Message Information Model (R-MIM pregnancy referral) 13. Hierarchical Message Description (HMD pregnancy referral)

26. 26 April 28, 2002International Affiliate Meeting26 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

27. 27 April 28, 2002International Affiliate Meeting27 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 Healthcare process describes interaction Information dictates content of message

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32. 32 April 28, 2002International Affiliate Meeting32 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-MIMs HMDs XML schemas.

33. 33 April 28, 2002International Affiliate Meeting33 Architecture of multi-tier systems DATABASE (DBMS) (PHYSICAL STRUCTURE) (E.G. ORACLE, MS SQL SERVER) DATA-OBJECTS (CONCEPTUAL STRUCTURE) USER INTERFACE (E.G. RICH CLIENT, WEB BASED) PROCEDURAL LOGICS TRIGGER EVENTS HL7 messages (XML format)

34. 34 April 28, 2002International Affiliate Meeting34 Issues that came up… (I) HL7 domain Practice & Operations Laboratory HL7 domain Practice & Operations Pharmacy HL7 domain Practice & Operations Referral HL7 domain Practice Patient Adminstration Healthcare domain Perinatology How to balance horizontal vs.vertical standard specifications and implementation guidelines?

35. 35 April 28, 2002International Affiliate Meeting35 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-MIMs, 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?

36. 36 April 28, 2002International Affiliate Meeting36 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?

37. 37 April 28, 2002International Affiliate Meeting37 Questions?