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HL7 Fresh Look gRIM conceptPart B PHR transformation modelJ. WittenberMay 11, 2011D2jw_B

See also http://mdcx73-working.wikispaces.com/gRIM

NOTE: 2nd of 2 parts; contains only Figures 3*.

ContentsFigure Topic Pg/Slide Introduction omitted; see Part A 1 Conceptual model basic, Ecosystem omitted; see Part A 2 Ecosystem model topology, profiles omitted; see Part A 3 e[P]HR model Green CDA, [trans]forms 10-17 Appendix A Inferences omitted; see Part A DAM gRIM Concept2HL7 "Fresh Look"DAM gRIM Concept10Figure 3a. PHR model - [Green CDA] pattern typesPATTERNEXPLANATION+ data / state / protocol (/reasoning)In observation data, separate out data (actual datum being recorded e.g. BP) from patient state (e.g. lying, standing) and protocol (cuff type, instrument type)+ History of eventsProvide a structure containing 1..* Events, allowing data and patient state at each one, supporting intervals, point events, and math functions, e.g. ave/delta/max/min+ Tree structureGeneralised free-form tree for containing clusters of data items, e.g. the 5+1 Apgar items, numerous microbiology result items, etc.++ Order state machineA way of recording current state in progression through a standard state machine applying to any order++ Composition / documentAn aggregation concept acting as a bucket for information recorded by a professional at a given time for a given subject of care.+ ParticipationA pattern defining the connection between parties (people, organisations, devices) and other information.+++ Party / role / accountabilityA pattern defining relationships between parties, including those that are roles played by some underlying actor.+ +++ Complexity level [of consensus, apparently]Ref: One information model to rule themall?; see also http://wiki.hl7.org/index.php?title=GreenCDA_Project .HL7 "Fresh Look"DAM gRIM Concept11Figure 3b PHR model example data pattern XML form[at]

HL7 "Fresh Look"DAM gRIM Concept12Figure 3c PHR model example Green CDA compositionDemographics

Problem List

Medications

Allergies

Progress Notes and Other Narrative Documents

Laboratory Results

Microbiology

Images

Administrative Transactions

Quality Measures

Privacy and Security

Demographics Content: HL7 2.x for messaging, CCD for document summaries Vocabulary: HITSP Harmonized codesets for gender, marital statusProblem List Content: HL7 2.x for messaging, CCD for document summaries Vocabulary: SNOMED-CTMedications Content: NCPDP script for messaging, CCD for document summaries Vocabulary: RxNorm and Structured SIGAllergies Content: HL7 2.x for messaging, CCD for document summaries Vocabulary: UNII for foods and substances, NDF-RT for medication class, RxNorm for MedicationsProgress Notes and Other Narrative Documents (History and Physical, Operative Notes, Discharge Summary) Content: HL7 2.x for messaging, CCD for document summaries Vocabulary: CDA TemplatesDepartmental Reports (Pathology/Cytology, GI, Pulmonary, Cardiology etc.) Content: HL7 2.x for messaging, CCD for document summaries Vocabulary: SNOMED-CTLaboratory Results Content: HL7 2.x for messaging, CCD for document summaries Vocabulary: LOINC for lab name, UCUM for units of measure, SNOMED-CT for test ordering reasonMicrobiology Content: HL7 2.x for messaging, CCD for document summaries Vocabulary: LOINC for lab name/observationImages Content: DICOMAdministrative Transactions (Benefits/Eligibility, Referral/Authorization, Claims/Remittance) Content: X12 Vocabulary: CAQH COREQuality Measures Content: Derived from all the data elements above Vocabulary: Derived from all the data elements abovePrivacy and Security Transport: HTTPS, SOAP/REST Transport Orchestration: WS* Authorization/Access Control: XACMLAdapted from http://geekdoctor.blogspot.com/2009/04/data-elements-of-ehr.htmlHL7 "Fresh Look"DAM gRIM Concept13Figure 3d. PHR model - harmonized formHeres a snapshot of a form developed from the original (.doc format) using a conventional relational database (RDB).

It is wysiwyg (what you see is what you get) in that you can enter data directly into the form and then it can be printed out, communicated using standard protocols, and revised as needed for consultation/collaboration purposes.

HL7 "Fresh Look"DAM gRIM Concept14Figure 3e. PHR model - Green form example

My sister gend this up in .doc format over the time of my moms hip[s] replacement ordeal.

The form turned out to be very useful to help quickly convey my moms medical situation.

The idea is to transform or provide transformer middleware for this using up to date healthcare standards technology, to facilitate both composition and communication.

HL7 "Fresh Look"DAM gRIM Concept15Figure 3f. PHR model attribution and iterationFor Green CDA info, see http://wiki.hl7.org/index.php?title=GreenCDA_Project. See next slide for Pattern Type detail;.In the following table, key ePHR transform and PHR Summary content - Overview elements (at left) are related to various info pattern types (middle of table; see also Appendix A & B. Recycling, or an iterative process (at right) for convergence of ad hoc standard representation is intended synergy between patient and healthcare providers.Data layering into IT and HC format provides for key semantic mapping, particularly of demographics, health problems, medications, etc., that are coded.

HL7 "Fresh Look"DAM gRIM Concept16Appendix 3g PHR model key transformsTransforms cost and can generate value-add at various points in the system, although not necessarily ecologically. Fundamentally, each physiological observation has a semantic infrastructure as characterized in the upper part of the following diagram, e.g. NIBPsystolic 120 [mmHg]; Name coding is particularly costly, as semantic misprecision affects clinical/medical risk. The lower diagram shows how cost & risk can increase due to transforms. Moreover, there may be both pre- and post-coordination costs throughout the system life cycle. costs can be reduced if not minimized by eliminating/minimizing intermediate transforms and normalizing Coded Values..

Dev->1st link transfer [transform]1st Link nth Transforms

Coded ValueProtocol overheadCodedValueName CodeUnits Codeoverheadvalueoverhead

Highly distributed, high volume, low-latency, multi-attribute, multi-object context-sensitive thrashing is bad., and most of this is CodedValue sets.HL7 "Fresh Look"DAM gRIM Concept17Figure 3h PHR model - iteration and convergence

TransformRecycling facilitates reuse, generally involving transforming between ad hoc (end user) and standard (HC IT System) form[at[s]], the key semantic interoperability step shown at lower right, in which intermediate, standard Nomenclatures are substituted, manually (pre-coordinated) or by an adapter or intermediary.. [Note: diagram is patterned after UML interaction diagram vs. topology per last diagram.Intermediate format grammar (tags, e.g. quantity, dosage), generally also need transforming, which makes standardization significantly more complex if only Nomenclatures need to be mapped.; however, on the fly (during import/export) may be done on intermediate format, since typically only table lookups need to be done, at least on the standard side of the system, although some annotation may be needed to flag uncoded data.] RecycleIntermediate form[at]

Ad hocStandard

Gway /[R]DBDevice[s] Data AcqnApplication Domain FocusHL7 "Fresh Look"