Organization Meeting & Overvie3 CAS 757: Modern SW Tech for eHealth Kamran Sartipi Theme of my...

1 CAS 757: Modern SW Tech for eHealth Kamran Sartipi

Deptartment of Computing and Software McMaster University

Canada [email protected]

http://www.cas.mcmaster.ca/~sartipi

Dr. Kamran Sartipi

January 12, 2010

CAS 757: Modern Software Technology for eHealth

Instructor:

Organization Meeting & Overview


Inst

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Bac

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  Education:   Electrical Engineering (B.Sc. & M.Sc.)   Computer Science (MMath & PhD)

  Research:   Software Engineering (my expertise)

  Forward Engineering –  View-based (scenarios to design diagrams); –  Tool development; –  HW/SW co-design

  Reverse Engineering –  Software Architecture Recovery

•  Pattern matching (Static Alborz Tool) •  Dynamic analysis (Dynamic Alborz Tool) •  Clustering; Concept lattice analysis; •  Data mining techniques in SW Eng.

–  Software Architecture Evaluation   Health Informatics (new research)

  Data and mined-knowledge interoperability (CDA, PMML)   Healthcare system integration (HL7, SNOMED, SOA)   Clinical Decision Support Systems (CDSS)   Security and privacy


Theme of my Courses Theory and Practice (Course project: design & development)

  Operating Systems (CS 3SH3)

  Simplified Unix file system using C

  Software Development for CE/EE (SE 3KO4 / SE 3MO4)   Automatic Banking Machine (ABM) using Java/C

  Software Design (CAS 703)   Fast-food restaurant system using UML and technologies

  Software Architecture & Reverse Engineering (CAS 747)   Reverse engineering of software systems using RE tools

  Formal Specification Techniques (CAS 707)   Specifying and verifying ABM/Restaurant system using FM tools

  Modern Software Technology for eHealth   Developing a prototype healthcare system using HTB


CAS 757 Course Objectives   Due to the importance of the quality of health services a major portion

of governmental spending in many countries has been allocated to these services.

  Recently, healthcare organizations have been embracing new technologies to improve the quality of health services and to reduce the error rate in patient treatment. On the other hand, several modern technologies are emerging that can perfectly address the issues in the current state of growing network of healthcare systems.

  This course exposes the graduate students with CS/SE background to the challenges in the field of Electronic Health (eHealth). The course introduces a collection of modern architectures and technologies that are recommended by standardization organizations to build the infrastructure that meets the emerging demands in the growing network

of healthcare systems.

5

Healthcare�� Costs as Main Drivers

  Healthcare consumes a large portion of the government’s spending in many countries   Total healthcare spending in Canada in 2005 was $140

billion   Ontario invested $28.1 billions for health services in 2003/04   Vascular disease (#1 cost driver in healthcare) estimated at

$18 billions each year

6

IT in Healthcare

  Healthcare system is characterized by a large number of relatively independent entities:   Hospitals; Physicians; Governmental agencies (OHIP),

Pharmacies, Laboratories, Long-term Care Facilities; Community Care Access Centres; Homecare Agencies.

  Healthcare investment in IT is about 2.5% of its total revenue, much lower than most other Canadian industries (finance, business, insurance,..)

  Healthcare and governmental organizations invest a lot to prevent duplication of information, adverse drug event, diagnosis, disease outbreaks,..

  Low IT investment leads to higher operating costs, delays in

processing patients, and errors


Health Informatics

  Health Informatics Professionals develop and deploy information and systems solutions, drawing on expert knowledge from fields such as computer science, information management, cognitive science, communications, epidemiology, management sciences and health sciences.

  Examples of health informatics applications include the design, development, implementation, maintenance and evaluation of:

  Communication protocols for the secure transmission of healthcare data   Electronic patient record systems (regionally, provincially, territorially or

nationally)   Evidence-based clinical decision support systems   Classification systems using standardized terminology and coding   Case management systems (e.g., for community, home and long-term care)

Definition by Canada’s Health Informatics Association (COACH) Health informatics (HI) is the intersection of clinical,

IM/IT and management practices to achieve better health.


Health Informatics …   Examples of health informatics applications include the design,

development, implementation,maintenance and evaluation of:

  Access and referrals systems for healthcare services   Patient monitoring systems (e.g., computer controlled bedside monitors and

patient home monitoring devices)   Digital imaging and image processing systems   Tele-health technologies to facilitate and support remote diagnosis and

treatment   Internet technology for engaging patients in their own care   Public health surveillance and protection systems   Methodologies and applications for data analysis, management and mining   Clinical information data warehouses and reporting systems   Business, financial, support and logistics systems   ePrescription involving: management, distribution, communication,

monitoring, and control of all transactions for drug prescription.   Mobile eHealth including: clinical data acquisition, representation,

distribution, and usage by mobile agents.   Medical geomatics which lies in the interface of health informatics and

techniques such as GIS, GPS, RFID, and Sensor Networks.


COACH model for Health Informatics Involving Fields


World of Healthcare is Changing

The Old World   Provider-focused   Illness   Site-of-care   Episode Management   Supply Management   Solitary decision making

  Efficiency   De-centralized, generalized

care

The New World   Patient & family-focused   Wellness   Continuum of care   Disease Management   Demand Management   Collaborative, evidence-based

decisions   Effectiveness   Centralized, specialized care

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Health Level Seven (HL7)


History of HL7   The HL7 organization was founded in 1987   In June 1994 HL7 was designated as an ANSI

accredited standards development organization (SDO)

– 

  HL7 Mission Statement:   Provide standards for the exchange, management and

integration of data that supports clinical patient care and the management, delivery and evaluation of healthcare services.

  Provide complete life cycle for standards specification, development, adoption, market recognition, utilization and adherence.


HL7 Standard Versions

  2.0 (1988) Prototype   2.1 (1990) First standard   2.2 (1994) Widely Adopted   2.3 (1997) In operation   2.3.1 (1999) Current ANSI standard   2.4 (2000) In ballot   3.0 Balloting of Prototype in 2000,

balloting of formal specifications in 2001


Limitations of HL7 Version 2

  Implicit information model, not explicit   Events not tightly coupled to profiles   Need for controlled vocabularies   Limited to a single encoding syntax   No explicit support for object technologies   No explicit support for security functions   Optionality is everywhere and troublesome


Benefits of HL7 V3   Benefits to Providers

  Deals with complexity of the HC environment   Increases choices of innovative best-of-breed solutions   Provides support for legacy systems   Allows reliable verification of vendors’ conformance claims

  Benefits to Vendors   Reduces installation effort   Reduces site-specific negotiations   Simplifies interface programming   Promotes vendor specialization by allowing segmentation

of product lines into niche market spaces   Provides improved protocol for interconnecting

heterogeneous systems


Version 3 is a change to the HL7 Architecture Version

  The HL7 2.x specifications have:   Segments that imply information entities   Events that indicate implied behaviors   Descriptive content that suggests use cases   But never formally documents these

  Version 3 seeks to formalize this by applying object analytic methods and style   to improve the internal consistency of HL7   to provide sound semantic definitions   to enable future architectures   to produce an evolution not a revolution


What is HL7


Increased IS Complexity

Involved Technologies   Modeling and designing information systems

  UML diagrams (class diagram, sequence diagram, collaboration diagram, statechart, component diagram, activity chart), Message development views (separating message selection from its contents)

  Web applications   Client side programming: XHTML, JavaScript, CSS   Server side programming: Servers, Databases, Java technology

(JSP, Servlets) Microsoft technology (ASP.NET), PHP, …

  Web Services and Service Oriented Architecture (SOA):   XML/XSL, SOAP, WSDL, UDDI.   Abstract services


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Data Mining as Source of Knowledge

  Classification: mapping data into predefined classes. (e.g., whether a patient has a specific disease or not)

  Regression: mapping a data item to a prediction variable. (e.g., Estimating the probability that a patient will survive given the results of a set of diagnostic tests.)

  Clustering: To identify clusters of data items. (e.g., to identify different groups of patients and their characteristics.)

  Association Rule Mining: to find associated data based on shared attributes within database transactions. (e.g., how different patient data are related based on shared relations such as: “specific diseases”, “patients habits”, or “family disease history”.)

1/11/10 21

Canada Health Infoway


Canada Health Infoway   Canada Health Infoway (Infoway 2001) is an independent, not-

for-profit organization whose members are Canada's 14 federal, provincial and territorial Deputy Ministers of Health.

  Infoway’s mission is to accelerate the use of electronic health information systems and electronic health record (EHRs) across Canada.

  These systems are increasingly providing health care professionals with rapid access to accurate and complete patient information, enabling better decisions about treatment and diagnosis.

  The result will be a modernized and sustainable health care system offering improved accessibility, quality and productivity.


Canada Health Infoway …   The goal is to integrate information systems from different health

providers and administrations (e.g., hospitals, laboratories, pharmacies, physicians, and government agencies) within each province

  These systems then will be connected to form a nationwide healthcare network with standard data formats, communication protocols, and a unique health history file for each patient.

  The health information will be accessible everywhere and anytime, using common services according to different access privileges for patients and providers.

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Service Oriented Architecture

  Service consumers   Uses business processes and services within the system (in

Infoway infostructure: physicians, pharmacy, patient, EHR viewer)

  Service registries   Service interface and protocols, functionality and constraints

specification (registries for client, provider, location, terminology)

  Service providers   EHR data and services, and ancillary services.

  Service bus   Connects consumers to the services (Health Information Access Layer,

HIAL)

An architecture that relies on service orientation as its fundamental" design principal: based on loosely coupled and independent "

networked services; no knowledge of platform is required."

Inte

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Canada Health Infoway’s iEHR Infostructure JURISDICTIONAL INFOSTRUCTURE

Pharmacy System

EHR Data & Services

Pharmacist

EHR Viewer

Radiology Center

PACS/RIS Lab

System (LIS)

Hospital, LTC, CCC,

EPR

Physician/ Provider Lab Clinician Radiologist

Physician Office EMR

Physician/ Provider

Physician/ Provider

Public Health

Services

Public Health

Provider

Ancillary Data & Services

Outbreak Management

PHS Reporting

POINT OF SERVICE

Registries Data & Services

Client Registry

Provider Registry

Location Registry

Terminology Registry

Drug Information

Diagnostic Imaging

Laboratory Shared Health Record

Security Management Data

Privacy Data Configuration

HIAL Communication Bus Common Services

Data Warehous

e

Health Information

Longitudinal Record Services

Message Structures

EHR Index

Business Rules

Normalisation Rules

1/11/10 26

Oracle Health Transaction Base (HTB)


Oracle’s Healthcare Transaction Base (HTB)

  Oracle’s Healthcare Transaction Base (HTB) is a Service Oriented Architecture that supports the integration, development, and operation of a full spectrum of healthcare applications.

  The platform couples a comprehensive, standards-based data repository with a robust set of integrated services for data normalization, customer-defined security and auditing, and business process/workflow.

  HTB functionality includes: • Administrative and Clinical Business Services • Core Application Services • Domain-specific Architecture • Business Intelligence


Integration Overview


Deptartment of Computing and Software McMaster University

Canada [email protected]

http://www.cas.mcmaster.ca/~sartipi

Dr. Kamran Sartipi

January 12, 2010

CAS 757: Modern Software Technology for eHealth

Instructor:

Organization Meeting & Overview

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