1. Visual Modeling – HL7 Challenges, Benefits, and Applications (Is a Picture Worth 1000 Words?) Charlie Mead, MD, MSc Director, Healthcare Information Architecture Oracle Healthcare (charlie.mead@oracle.com) Director, HL7 Board of Directors Co-Chair, Patient Care Technical Committee Co-Chair, Personnel Management Technical Committee

2. Slide - 2HL7 UK December 12, 2003 This is a model… Referral Transportation Supply Procedure Consent Observation Medication Act complex Financial act Organization Place Person Living Subject Material Health Chart Patient Member Guardian Healthcare facility Practitioner Location Specimen Entity 1 0..* 1 Role Link 0..* 1,1 Role 1 0..* 1 Act Relationship 0..* 1 1 ParticipationAct Subject Beneficiary Author Consultant Referrer Informant Witness Fulfills Component Supported by Documents Replaces Direct Authority Indirect Authority Part of Replaces

3. Slide - 3HL7 UK December 12, 2003 …as is this…  RIMBig.gif RIMBig.gif

4. Slide - 4HL7 UK December 12, 2003 …and so is this!

5. Slide - 5HL7 UK December 12, 2003 The Problem vs The Solution  The Problem – Implementation-independent – Discovered by ‘analysis’ activities – One Problem  Many Solutions  The Solution – Implementation-specific – Formulated by ‘design’ activities – A set of compromises/constraints imposed in the context of a specific Problem  Often only addresses a portion of the Problem  Understand the Problem before attempting to design the Solution – This is NOT an endorsement of Waterfall  Iterative/Incremental development is best for complex problems – ‘Understand the Problem’ means ‘Understand the essence of the Problem’  Separate key structural and behavioral aspects of the problem

6. Slide - 6HL7 UK December 12, 2003 What is a Model?  A representation of “what’s important” – Emphasizes concepts and relationships  Attributes of concepts are concepts! – Hides unnecessary details  ‘Unnecessary’ is defined contextually – Focuses on elucidating structure and/or function  Syntax  Semantics  Collaborations/interactions  A ‘’human-friendly picture” of complexity – Encourages ‘encapsulation’ – Supports ‘extensibility’ – Facilitates ‘layering’ – Enables cognitive ‘chunking’  7 +- 2 ‘concepts in hand’

7. Slide - 7HL7 UK December 12, 2003 What is a Model  “Something that accurately resembles something else; a thing that represents on a small scale the structure or qualities of something greater.” [OED 2002]  “A model captures a view of a physical system. It is an abstraction of the physical system, with a certain purpose. This purpose determines what is to be included in the model and what is irrelevant. Thus the model completely describes those aspects of the physical system that are relevant to the purpose of the model, at the appropriate level of detail.” [UML 2001]  Examples of models – Business Process model – UML Diagrams (Class, State, Activity, Sequence, etc.) – ER Diagram – Java code

8. Slide - 8HL7 UK December 12, 2003 What is a Model?  A model is most correctly defined as a set of views (often expressed in the form of diagrams) of a particular system-of-interest (SOI) – Structural views – Behavioral/dynamic views  A model (or a given view) is constructed using a modeling language

9. Slide - 9HL7 UK December 12, 2003 What is a Modeling Language?  A language (syntax/grammar and semantics) for building models  An expression a Problem (or Solution) using a ML…. – Facilitates the visualization of complexity – Supports the specification of architectural details – Enables the documentation of decisions made about the system, its scope, etc. – Guides the construction of instances of the system represented by the model

10. Slide - 10HL7 UK December 12, 2003 What is a visual Model?  A model is expressed using a (primarily) visual modeling language – Based on graphic icons with defined semantics – Icons combined based on underlying syntax/grammar – Visual models have traditionally been considered ‘documentation/snapshots’ – Visual models are increasingly becoming ‘computable’  UML 2.0’s Model-Driven Architecture

11. Slide - 11HL7 UK December 12, 2003 Why model?  Models help define the scope of a problem and/or solution  Models represent an important vehicle for reaching consensus about the architecture (structure and function) of a Problem and/or a Solution  A given model of a Problem can profoundly affect the nature of the Solutions proposed and developed to solve the Problem – Seeing the Problem modeled  Imagining/Considering the possible Solutions

12. Slide - 12HL7 UK December 12, 2003 Why model?  Models are (can be)…. – Precise – Unambiguous – Complete – Verifiable between Problem and Solution Domain – Executable  ‘There are no right / correct models. Some models are more helpful than others.’  Models (i.e. the collected set of views that comprise a model) help narrow and/or bridge the inherent semantic gap that invariably exists between the various levels of the Problem and its respective Solutions

13. Slide - 13HL7 UK December 12, 2003 Understanding the Problem: The Communications Pyramid  Express the Problem in ‘domain-speak’ rather than ‘solution-speak’ – GLOSSARY, GLOSSARY, GLOSSARY  Express the Problem using multiple nearly independent views – A set of ‘layered views’  Structure vs Behavior  Express structure and behavior visually/graphically (rather than textually) whenever possible – Core concepts and their relationships  UML Class Diagram – Core responsibilities, process flows, and interactions  UML Activity Diagram ­UML Use Case Diagram  UML Sequence/Collaboration Digram  UML State Diagram

14. Slide - 14HL7 UK December 12, 2003 ` The Communication Pyramid Communication Free-text Documents Structured Documents ad hoc Drawings Non-standard Graphics Discussions Standardized Models (UML) Implementation-Independent Implementation-Specific

15. Slide - 15HL7 UK December 12, 2003 The Unified Modeling Language (UML)  UML is a modeling language – (mostly) Visual  Syntax  Semantics  Object Constraint Language (the ‘non-visual’ part) – Extensible  Tags and Profiles  UML is NOT – A modeling process – A modeling tool  Learning UML: Suzuki’s ‘language learning levels – Exposure, Imitation, Usage, Understanding, Composition

16. Slide - 16HL7 UK December 12, 2003 The UML is…  A well-defined (mostly) visual language for describing the structure and/or function of complex systems. – A language supporting well-formed models  The UML is a language that facilitates…. – ….visualizing complexity – ….specifying relationships and interactions – ….guiding the construction of the modeled system – ….documenting the decisions made about the modeled system  The de facto modeling language standard managed, maintained, and evolved by the Object Management Group (omg.org) – 10-15 years in develop – Convergence of multiple perspectives and agendas

17. Slide - 17HL7 UK December 12, 2003 Primary Design Goals of the UML  Provide users with a ready-to-use, expressive visual modeling language to develop and exchange meaningful models  Furnish extensibility and specialization mechanisms to extend the core concepts – e.g. HL7 Profile  Provide a formal basis for understanding the modeling language  Encourage the growth of the object-orient tools market  Support higher-level development concepts such as components, collaborations, frameworks and patterns  Integrate best practices in complex system development

18. Slide - 18HL7 UK December 12, 2003 UML Building Blocks  Things – Classes – Objects – Activities  Relationships – Syntactic – Semantic  Diagrams – Static Structure – Dynamic Behavior

19. Slide - 19HL7 UK December 12, 2003 UML Model Views  Static Diagrams – Class Diagram – Object Diagram – Implementation Diagrams  Deployment Diagram  Component Diagram  Behavioral Diagrams – Use Case Diagram – Activity Diagram – State-chart Diagram – Activity Diagram – Interaction Diagrams  Sequence Diagram  Collaboration Diagram

20. Slide - 20HL7 UK December 12, 2003 The RIM and Modeling  RIMBig.gif RIMBig.gif  PRPA_NA000002.gif PRPA_NA000002.gif  QUQI_NA000001.gif QUQI_NA000001.gif

21. Slide - 21HL7 UK December 12, 2003 DMIMs, RMIMs and Modeling  PM DMIM 03-nov-12 visio5.vsd PM DMIM 03-nov-12 visio5.vsd  RMIM1.gif RMIM1.gif  RMIM3.gif RMIM3.gif  RMIM5.gif RMIM5.gif  RMIM6.gif RMIM6.gif  RMIMSimple.gif RMIMSimple.gif  ‘Increasing constraints on the RIM’ – Class – Attributes – Relationships – Multiplicities – Data Types – Vocabulary

22. Slide - 22HL7 UK December 12, 2003 The HL7 Development Framework (HDF): What Models Should We Build?  The HDF recognizes the importance of separating analysis activities from design activities – Use ‘domain-friendly’ terms to build ‘analysis’ views – ‘Map’ analysis views to design views  A given concept or relationship in the Domain Analysis model may map to a RIM ­Class ­Attribute ­Vocabulary

23. Slide - 23HL7 UK December 12, 2003 Requirements Gathering and Analysis  Prepare storyboards that elaborate upon the project scope statement.  Build one or more UML Activity Diagram(s) detailing the behavioral component of the requirements (including Storyboard materials)  Build a Domain Analysis Model (UML Class Diagram) to define the structural aspects of the requirements.  Build a domain-specific Glossary for use in down-stream RIM mapping.  Prepare UML Use Case and derived Collaboration and/or Sequence diagrams to depict the interaction requirements.

24. Slide - 24HL7 UK December 12, 2003 Requirements Normalization and Harmonization  Map models from the Requirements Specification to Reference Models (e.g. RIM, DMIMs, RMIMs).  Revise models in the Requirements Specification based upon discoveries made during the mapping process.  Document proposed changes to Reference Models to accommodate unmapped requirements.  Follow the reference model harmonization process to adjudicate the proposed changes to Reference Models.  Revise the Requirements Specification as needed and its mapping to the Reference Models.

25. Slide - 25HL7 UK December 12, 2003 HDF Requirements and Analysis: A ‘minimal set of UML diagrams’ needed to express domain knowledge  Class Diagram  Static Structure  Activity Diagram  Dynamic Behavior – Grounded in ‘real-world’ storyboards  Glossary – NOT an UML diagram – NOT fun (or easy) to develop – ESSENTIAL FOR SUCCESS

26. Slide - 26HL7 UK December 12, 2003 HL7 Modeling Challenges  HL7 has assembled a considerable amount of process and number of artifacts without too much concern to UML et al – Inhibits organization’s (person-to-person) communication with non-healthcare organizations, etc.  HL7 is not (in general) interested in software systems – UML is primarily designed to facilitate OO software development  Only a partially true statement  HL7 does not have extensive internal modeling/UML expertise – How should membership’s responsibilities be partitioned/best utilized?  Model building vs Model reviewing ­Level of abstraction of models based on perspective

27. Slide - 27HL7 UK December 12, 2003 HL7 Modeling Benefits  Leverage the increasing presence of a de facto standard (UML) in terms of – Tool support – Interchange standards (e.g. XMI) – Mappings to other technologies (UML  XML) – Increasing knowledge base among non-healthcare professionals  Decreasing the semantic impedance between the Problem Domain and the Solution Domain

28. Slide - 28HL7 UK December 12, 2003 HL7 Modeling Applications: Past, Present, Future  Past: – RIM/DMIMs/RMIMs:  Loose compliance with UML in both RIM and DMIM/RMIM  Non-standard icons ­RMIM icons (based on Peter Coad ‘UML in Color’)  Non-standard adornments ­Inconsistent treatment of association names vs role names  Non-standard structures ­Clones ­Hybrid object/class diagrams ­HL7 Interactions vs UML Interaction diagrams ­Use Cases vs Storyboards – Other HL7 specifications not rigorously represented in UML

29. Slide - 29HL7 UK December 12, 2003 HL7 Modeling Applications: Past, Present, Future  Present: – HDF is committed to bringing HL7 into ‘maximum possible UML compliance’  HL7 is registering a UML Profile with OMG ­Applies UML’s extensibility constructs ­Addresses many of the previously ‘non-standard’ HL7 concepts  HL7 meta model derived from UML meta model  HDF is NOT limited to message development ­Can (and should) be applied to all HL7 Specifications – Visio diagrams can be made UML compliant  ?? Necessary ??  “HL7 will deviate from UML only in those cases where UML is not able to express/support the needed semantics” (HDF)

30. Slide - 30HL7 UK December 12, 2003 HL7 Modeling Applications: Past, Present, Future  Future: – Increasing semantics of v3 Conformance Profiles  Interactions, Triggers, Application Roles, Receiver Responsibilities et al  HL7 v3 will need specify certain aspects of system behavior ­Aspects that affect semantic interoperability ­Use Cases in which actors are Application Roles – UML 2.0 (MDA) offers considerable opportunities – HlL7 artifacts are (increasingly) 100% UML compliant  facilitates tool-independent exchange – Opportunities for HL7 Facilitators etc. to become more involved with OMG processes

31. Slide - 31HL7 UK December 12, 2003 The RIM Backbone Referral Transportation Supply Procedure Consent Observation Medication Act complex Financial act Organization Place Person Living Subject Material Health Chart Patient Member Guardian Healthcare facility Practitioner Location Specimen Entity 1 0..* 1 Role Link 0..* 1,1 Role 1 0..* 1 Act Relationship 0..* 1 1 ParticipationAct Subject Beneficiary Author Consultant Referrer Informant Witness Fulfills Component Supported by Documents Replaces Direct Authority Indirect Authority Part of Replaces

32. Slide - 32HL7 UK December 12, 2003 References  www.omg.org www.omg.org – The core UML site including UML 2.0  www.ectoset.com www.ectoset.com – Affordable (<$100) UML modeling tool  www.rational.com www.rational.com – White papers on tools and the use of the UML in building ‘real-world’ systems

33. Slide - 33HL7 UK December 12, 2003