HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. RIMBAA Overview Slide contents published under the Creative Commons / Attribute-Share Alike license Source: Full source:

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.2 René Spronk HL7/IHE roles: HL7 Fellow Co-chair of the international HL7 RIMBAA Working Group Co-chair of various Committees, HL7 Germany, HL7 Netherlands Member of HL7 UK, HL7 FR, HL7 CH, HL7 NO Contributor to the IHE Laboratory Technical Framework HL7 volunteer of the year Trainer / Senior Consultant Ringholm bv Haarlem, the Netherlands Tel. +31 (0) Fax:+31 (0) Web:

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. RIMBAA WG Activities The International RIMBAA Work Group 1. Promotes RIMBAA architectures, and 2. Gathers, documents and publishes best practices when it comes to the (model driven) implementation of HL7 version 3 Product presentations Open forum discussions Page:

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Key Objectives Understand some of the architectural approaches and techniques for using the HL7 RIM data model in clinical data repositories Show some of the ‘best practices’ collected by the HL7 RIMBAA Workgroup Note: interoperability is “out of scope” of this presentation.. and “in scope” for RIMBAA

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Scope, Origins of the Reference Information Model Slide contents published under the Creative Commons / Attribute-Share Alike license Source: The HL7 RIM

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. RIM ( ) 4/12/2015 6

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Sources of the RIM: data(base) models 4/12/ and UK / Australian national healthcare data models.

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.8 RIM (current version, 2001+)

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. The RIM as a model for persistence All healthcare domains can be represented and integrated using one single ISO standard information model (the RIM)  This means one does not have to develop and support different databases and interfaces between systems for different healthcare domains RIM Based Application Architecture (RIMBAA)

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. RIM in UML 10

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Essential components of the RIM Class Diagram Constraint Language State transition diagrams Definitions (classes, attributes,..) Data type definitions Vocabularies (notably:structural vocabularies, e.g. ActClass) Slide courtesy of Nicolas Canu (HL7 France)

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. User Interfaces Interoperability Paradigms Application Object Layer Persistence Layer RIMRIM-basedMessagesDocumentsServices Other RIM-based RIMBAA Use of RIM (-based) models

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Application Layer Slide contents published under the Creative Commons / Attribute-Share Alike license Source: Full source:

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. RIM – Generated Code RIM  MIF or XSD based class/code generators  Includes support for constraint language State transitions  Constraint on RIM classes Vocabulary definitions/bindings  Terminology Server functionality, CTS II Data type  Custom library, partly XSD generated 01/01/

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Constraint Language To express additional constraints  OCL, ADL, Gello  No solution has been formally adopted Typical (OCL) example:  The Person object should have either an id or a name  context Person inv: id.hasContent or name.hasContent 15

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Data Types – custom code Custom library with support for data types  Mostly: ISO data types, patched to support data types R1 as well  Relationship with Terminology Server (C* data types)  Needs custom coding: data types MIF is abstract. 16

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. MDD - Application Generation Software application Software application Generic Software Components -Terminology -Data types Generic Software Components -Terminology -Data types Persistence Database RIM

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. MDD –Prescription Example RIM based model for Prescription Business workflow Exchange Pattern Software application Software application

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Class Generators Class generators – XML Schema driven  Every major development platform provides tools to generate classes from XML Schemas  E.g. JAXB,.NET Framework/Mono (XSD.EXE), XML Beans… Class Generators – Model driven  Model Driven Software development environments allow classes to be generated from (UML-) models  E.g. MARC Everest API Generator (XML ITS/RIM ITS), MDHT (for CDA)

20 Example: Philips Research (1/2) Object model of MIF was generated from the MIF schemas, including read and write methods. MIF files are read as instances of the MIF model and mapped to object models. Applications are built using C# classes generated from the object models.

21 Example: Philips Research (2/2) Object models generated from MIF:

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Persistence Layer Slide contents published under the Creative Commons / Attribute-Share Alike license Source: Full source: implementation_mechanics.ppt

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Database models (Relational) 23 RIM LDM PDM RIM or RIM-based model: Conceptual Data Model Logical Data Model Not DBMS specific, no tables, no keys Physical Data Model DBMS specific, tables, keys ORM – Object Relational Mapping

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Conceptual Data model - RIM Enormous flexibility, at the cost of a very abstract structure.  makes enforcement of data integrity rules very difficult making it necessary to rely on stored procedures and application logic to enforce rules. Low number of tables  less programming work, easier to learn, easier to add new functionality. More data in each table, need to tune queries. Main use-case:  If you're creating a data store for ad-hoc queries, mining and exploration of all sorts of data from all sorts of different sources 24

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. RIM – Interoperability Focus Data types  Defined for ‘worst case’ interoperabilty scenarios; within one system this scenario doesn’t apply  HIST ; other means of supporting versioning  Normalization of data types Context Conduction RIM  Lacks certain classes for non-interoperability settings; change proposals are being made 01/01/

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. OLTP versus OLAP OLTP: Online Transaction Processing  Persists a “stack of messages”  Fast processing  Query processing requires plowing through a series of relevant transactions OLAP: Online Analytical Processing  Persists an object graph  Very flexible when it comes to querying 26

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HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. OLAP + Data mart / view model 28 User Interface View Model /Datamart View Model /Datamart RIM (OLAP) RIM (OLAP) RIM Services Events CommandsQuery View Model /Datamart User Interface

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HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Database Models EAV (“RDF Triples”)  Pure EAV considered to be too slow XML  Example implementation RDBMS (ER)  Focus of the presentation 30

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Example: RIM persistence - OntoReason / MD Anderson 31

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Example: IBM (1/2) 32

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Example: IBM (2/2) 33

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Example: UMCG – RDBMS & XML ● XML in column (e.g. SQL-Server 2005) ● With XPath index columns

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Persistence Layer Data Types Slide contents published under the Creative Commons / Attribute-Share Alike license Source: Full source:

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Hiding the complexities of the persistence model Goal: SQL that is based on ISO/R2 data types, and more complex class structures Object/Relational Mapping  Wrap database objects (tables, columns, fields…) in OO classes  Examples: Hibernate (Java), nHibernate (.NET), HyperJAXB, Jakarta OJB, JPOX Type definitions in databases  User Defined Types (e.g. to hide data type specifics)

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. UDT – Data Types User Defined Types (at the DBMS level) A form of ORM at the database level  Allows for the definition of CD with SNOMED support, II with an OID check, or PQ with UCUM validation.  Native support for HL7 datatypes in SQL.  Full nullFlavor support 37

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. UDT Example: PQ 38

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. UDT Example: IVL 39

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Summary Slide contents published under the Creative Commons / Attribute-Share Alike license Source: Full source:

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Who uses RIMBAA ? Centralized archives with medical information (research/EHR) National Cancer Registry, USA BioBank, UK Philips Research, NL CDC NEDDS, USA DRV Bund, DE Toolkits for application development PHI Technology, IT MDHT, USA MARC-HI Everest, CA Oracle HTB, US dbMotion, IL HIS/PAS systems Axolotl Elysium, USA CSC Clinical Suite, DK Siegele Software, AT PCS, AT

HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Summary The RIM is appropriate as a persistence model if there is a requirement for a generic data model (research, EHRs)  Combine with views/datamarts for specific domains or target audiences Implementation of data types (library, persistence) is key MDD (Application Generation) based on RIM-based models is definitely an option

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