f Model-centric approaches for HIS development 1 Model-Centric Approaches for the Development of Health Information Systems Medinfo 2007, Brisbane Tue 21 Aug, Session S090, 4 PM Mika Tuomainen a, Juha Mykkänen a, Heli Luostarinen a, Assi Pöyhölä b, Esa Paakkanen a University of Kuopio, Finland a Health Information Systems (HIS) R&D Unit b Shiftec, Department of Health Policy and Management

f Model-centric approaches for HIS development 2 Overview of presentation  Analysis of three model-centric approaches in the context of health information systems development  Model-Driven Architecture  Process modeling with BPMN (Business Process Modeling Notation) and BPEL (Business Process Execution Language)  Health Level Seven Development Framework  Motivation and introduction of the study  Materials and methods  Analysis framework for modeling approaches  Results of the analysis  Conclusions and implications

f Model-centric approaches for HIS development 3 Motivation of the study  Modeling is used increasingly in healthcare  to increase shared knowledge  to document and improve the processes  to document the requirements and solutions related to health information systems (HIS)  Numerous modeling approaches available  Modeling approaches need to be selected and assessed (strengths, deficiencies, support for specifics of healthcare)  In this study, we analyzed three model-centric approaches in the context of HIS development:  Model-Driven Architecture (in general and MDA toolkit [7])  Business Process Modeling with BPMN and BPEL  HL7 Development Framework

f Model-centric approaches for HIS development 4 Introduction of the study  The analysis was based on literature and  the use of a conceptual framework  our previous studies and experience of applying these approaches in HIS development and integration (interoperability, service-oriented solution specification and standardization projects)  Results of previous research [4] stated that in the modeling of healthcare solutions  traceability is crucial between development phases  special emphasis should be paid to semantic elements  illustration of solutions to the end users in early phases of the development lifecycle is beneficial  documentation of accurate, consistent, atomic and unambiguous requirements should be supported

f Model-centric approaches for HIS development 5 Analysis approach  Conceptual comparison of model-centric approaches  Analysis framework  Main purpose  Phases of the information systems development value chain (and traceability throughout the chain)  Aspects of information systems [5]  structure, function, behavior  Semantic elements and entities (in different phases)  Illustration of solutions to end users  Quality of requirements (accuracy, consistency, atomicity, unambiguity)  Definitiveness of the approach for the modeler  Visibility of end users and other health care stakeholders  Automation of model transformations  Dissemination, usage

f Model-centric approaches for HIS development 6 Model-centric approaches (main features briefly) CIM PIM PSM Code......

f Model-centric approaches for HIS development 7 Model Driven Architecture (MDA)  The Model-Driven Architecture (MDA) by the Object Management Group (OMG) supports software development through modeling techniques such as Unified Modeling Language (UML)  Main modeling and abstraction levels  CIM: computation-independent model  PIM: platform-independent model  PSM: platform-specific model  Primary goals of the MDA are ( through architectural separation of concerns)  portability, separation of application logic from platforms  interoperability, by mapping a higher level model to different lower level models  reusability of models, platforms and solutions  Transformation of system specifications between models (and platforms), including a utomated implementation (the transformations of PSM models to executable code by MDA tools)  models can be realized on many platforms (Web Services,.NET, CORBA, J2EE and others)

f Model-centric approaches for HIS development 8 Business process modeling with BPMN and BPEL  BPMN (Business Process Modeling Notation)  A graphical notation for process modeling  Aim: understandable by users, business analysts, developers, managers  Private, Public and Collaboration process models  BPEL (Business Process Execution Language for Web Services)  an XML-based language for the specification and automation of processes and interaction protocols  BPMN specification contains a mapping to BPEL  BPMN and BPEL can be used together for the modeling and web services-based (WSDL) implementation of processes

f Model-centric approaches for HIS development 9 HL7 Development Framework (HDF)  Model-driven framework for the analysis and design of processes, actors, rules for the HL7 version 3 standards development  All information models in the HL7 version 3 standards are based on the Reference Information Model (RIM)  Domain information models (DIM / D-MIM)  Constrained information models (CIM / R-MIM)  serialized constrained information models (HMD)  message specifications  supported by structured vocabulary and glossaries  Dynamic and user-level documentation: storyboards, use cases, triggers, constraints, UML activity and state diagrams  Out of seven phases, requirements analysis and documentation, specification modeling and standard profiling are especially within the scope of this work  HDF uses and extends UML class diagrams and other diagram types, extensions to UML meta-model in the HDF UML profile

f Model-centric approaches for HIS development 10 Analysis (1): purpose and IS viewpoints

f Model-centric approaches for HIS development 11 Analysis (2): approaches in relation to the phases of the ISD value chain

f Model-centric approaches for HIS development 12 Analysis (3) ConsiderationModel-Driven Architecture Business Process Modeling with BPMN and BPEL HL7 Development Framework Main users of the method CIM: domain practitioners, PIM, PSM: IT experts business analysts, business process owners and designers accurate user roles specified for different phases Semantic specification details CIM focuses on information viewpoint, including vocabulary, more specific in PIM and PSM little emphasis on information or semantics other than parameters of interfaces glossaries, data types and vocabularies specified for more rigorous information support Illustration to end users CIM: vocabulary, environment, functionality BPMN: visualized processes can be examined storyboards, use cases and activity diagrams Requirements quality documentation identified but not specified for the requirements many requirements are implicit in the process descriptions on generalized level (for all standards), but traceable due to definitive phases Definitivenessvery loosely defined, accurate methods and tools needed not in notations and languages but in tools and methods accurate phases and outcomes specified, messaging presumed

f Model-centric approaches for HIS development 13 Analysis (4)

f Model-centric approaches for HIS development 14 Conclusions: different model-centric approaches  The studied approaches support the documentation and communication purposes and shared understanding in the development of HIS  MDA: a generic and overarching approach, isolates technology changes from the logical solutions; no unified application or requirements to include MDA meta-level foundations in tools or projects; no "one MDA" but situation- and tool-specific application, other approaches could be MDA subsets  BPMN + BPEL: valuable for process abstraction and automation but requires many additional considerations for holistic modeling (excludes organizational resources, functional breakdowns, data and information models and business rules, no consideration of users except "tasks")  HDF: Definitive, support for different phases especially for information aspects and healthcare specifics, functionality implicit to some extent, applied differently in different (HL7 v3) domains, method evolution hinders learnability and implementation tools

f Model-centric approaches for HIS development 15 Conclusions: implications for the modeling of health information systems in general  The selection of a modeling approach (according to the main purpose and definitiveness) must be locally complemented to compensate the definiciencies  Generic needs for improvement  Illustration of solutions to the end users  Supportive notations for missing aspects  Traceability and atomicity of requirements  Requirements dilemma of model-centric approaches:  model "is" the solution, justifications and rationale easily remain ambiguous and implicit to the modeler  generic models and standards are a result of generalization and negotiation which risks traceability to accurate requirements and health care activities

f Model-centric approaches for HIS development 16 other results from the SerAPI project in Medinfo'07  Conformance Testing of Interoperability in Health Information Systems in Finland (Toroi et al.)  A National Study of eHealth Standardization in Finland - Goals and Recommendations (Mykkänen et al.)

f Model-centric approaches for HIS development 17 Thank you  The SerAPI project participants: National Technology Agency TEKES (grants no 40437/04, 40353/05, 40251/06 ), Medici Data Oy, Datawell Oy, Fujitsu Services Oy, Hospital district of Northern Savo, WM-data Oy, Commit; Oy, Intersystems B.V. Finland, Mediconsult Oy, Microsoft Oy, Oracle Finland Oy, Hospital District of Satakunta, Bea Systems Oy, Hospital District of Helsinki and Uusimaa, City of Kuopio, The Finnish Medical Society Duodecim, Mawell Oy, Oy Prowellness Ltd. first author: Mika Tuomainen presenter: Dr. Juha Mykkänen University of Kuopio HIS R&D Unit

f Model-centric approaches for HIS development 18 Main efforts which the analysis is based on (in addition to the literature and tool trials)  various activities in SerAPI and PlugIT projects in  MDA:  development of integration specification methodology, utilization of this methodology in 10+ interface specification (sub)projects  Healthcare Services Specification Project (HSSP) in HL7 and OMG, whose methodology is MDA-based  BPMN + BPEL:  specification and assessment of processes (e.g. endoscopy) and generic integration solutions for departmental information systems in a Finnish hospital district (in SerAPI project), a study and examples of BPMN and BPEL  HDF:  specification of scheduling services and interfaces for regional scheduling using HL7 version 3, application of HL7 version 3 messaging standards for scheduling and medical records (in SerAPI project and HL7 Finland)