1. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Template Exchange ITS Preliminary Report Project #885 Dr Kai U. Heitmann Heitmann Consulting and Services, Germany Past Board Member, HL7 International Chair, HL7 Germany HL7 Working Group Meeting Baltimore, US, September 2012 Andy Stechishin, Mark Shafarman, Kai Heitmann

2. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Agenda History and driving force Objectives Requirement analysis DECOR Chapter I: C-CDA and Trifolia Coming up next

3. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. History and driving force Multiple (national/international) groups creating HL7 CDA templates independently

4. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Objectives Knowledge sharing Creating new templates or new versions of templates Version management support Support implementations using templates Persistent storage Consistent documentation of templates

5. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Step 1: Requirements analysis Existing template tools  Model-Driven Health Tools (MDHT)  Trifolia Workbench  DECOR  Templates Registry Business Process Requirements  Model Interchange Format (MIF)  Several other approaches, e.g. UK, NZ  How fits FHIR into the game?

6. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Project #885 HL7 Templates ITS Pilot  sub-project of #272 (Templates DSTU) Creating an ITS that supports an interchange format in a canonical form for HL7 CDA templates DECOR methodology as a candidate for that format

7. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. DECOR: Skills +development cycle

8. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. DECOR’s “separation of concerns” DECOR  => Data-Elements, Codes, OID‘s and Rules  Goal: consistent artefact documentation, generation of supporting materials for Implementation Validation Testing, Qualification, Certification Change Management TerminologistsArchitectsHL7 ExpertsCertificators Software- Vendors

9. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. DECOR projects “worldwide”  ELGA (AT), national infrastructure – CDA  RIVM (NL), national screening programme on bowel cancer – CDA  QiN /KfH (DE), dialysis treatment data exchange – Care Provision  Nictiz (NL), multiple projects, e.g. Perinatology – CDA and Care Provision Laboratory results for pharmacists – Orders Care Transfer Data – CDA GP Acute Care – Care Provision Youth Health Care – Care Provision, Immunization

10. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.

11. Chapter I: C-CDA and Trifolia Trifolia templates “data”  DECOR template 2 step conversion (by xslt’s)  Keith Boone: extract from sql database  Kai: transform to DECOR

12. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Overview templates (in ART, the interface to DECOR)

13. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Value Sets Integrated terminology services

14. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Chapter I: C-CDA and Trifolia Material  ~ 140 templates of various types  ~ 40 value sets Results  Conversion succeeded  DECOR Value set and templates documentation  Generation of schematron

15. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Tabular view One of many ways to present DECOR templates Distraction from “fixed” items Focus on instance construction Validation as a “side-effect” One of many ways to present DECOR templates Distraction from “fixed” items Focus on instance construction Validation as a “side-effect” Your actual work starts here!!!

16. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Chapter I: C-CDA and Trifolia Further findings  Need of an extended version management (which is required by DECOR) Id and Name Version date Status code Template life cycle support  Templates Meta Data (see Templates Registry Business Process Requirements)  Artefact Registry (HingX)

17. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Chapter I: C-CDA and Trifolia Further findings  DECOR would use less embedded schematron assertions e.g. for choices, data type assertions count(cda:assignedPerson | cda:representedOrganization)=1 SHALL contain exactly one [1..1] assignedPerson exactly one [1..1] representedOrganization C-CDA: mean # of schematron per template: 1.1 ELGA: 133 templates, 17 inline asserts (mean 0.13)  General problem: expression of co-constraints

18. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Chapter I: C-CDA and Trifolia Further findings  Reuse „This reference/@value SHALL begin with a '#' and SHALL point to its corresponding narrative (using the approach defined in...“ Repeated 14 times with different conf-x  Consistency

19. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Chapter I: C-CDA and Trifolia

20. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Coming up next Model-Driven Health Tools (MDHT)  Completely different approach Model Interchange Format (MIF) FHIR  Profiles ~ Templates  Not really in the focus of the group yet  XML based profiles, small group of volunteers to proceed on expressing FHIR profiles in DECOR Results will be available on the HL7 wiki

21. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Thank you! More questions? Templates Exchange ITS Dr Kai U. Heitmann Later? mailto:hl7@kheitmann.de