ART DECOR: an XML framework for

medical metadata

Marc de Graauw

XML Amsterdam 2013

What we’ll cover

• The problem domain – medical procedures and knowledge – healthcare IT standards (HL7, Snomed, ...) – expertise involved (IT, doctor, terminologist)

• The solution – XML data model (DECOR) – XML tooling to edit (ART) – different views and output formats – code generation

• Pros and cons of an all-XML solution

A use case

• Dutch colorectal cancer screening – entire population 55+ gets screened – faeces samples collected, tested for blood – if suspect, invitation for colonoscopy – gastro-enterologist performs colonoscopy, submits findings to registry – if tissue removed, sent to pathologist – pathologist performs macro-/microscopical analysis, submits findings

• Other use cases

– Perinatology, Youth Healthcare (Netherlands) – ELGA elektronische Gesundheitsakte (Austria) – QiN KfH Datenaustausch in der Nephrologie (Germany) – epSOS, trans-European medical exchange – many more

Koppelingen

HL7 V3 CDA bericht: Art-decor, via : http://decor.nictiz.nl/ art-decor/ decor-project--rivmsp-

PROBLEM DOMAIN - MEDICAL

Patient id

Document id

Medication

Observations

Gastro-enterologist

PROBLEM DOMAIN - TERMINOLOGY

Medical terminologies

• LOINC

– Logical Observation Identifiers Names and Codes

– Laboratorium Observations

• ICD-9, ICD-10

• Snomed

• Goals:

– uniform codes for exchange

– enable analysis / statistics

Example valueset

Medical terms

Snomed codes

PROBLEM DOMAIN - ICT

Just enough HL7

• HL7 version 2 : currently used a lot in hospitals

• HL7v3:

– Reference Information Model

– XML serialization

– XML Schema

– CDA (part text, part structured data)

– Slow uptake, new developments

0..*

1 0..*

1

RIM (Reference Information Model) Backbone

Entity Participation Act

Act Relationship

1 1

0..* 0..*

Referral Transportation Supply Procedure Condition Node Consent Observation Medication Act complex Financial act

Organization Living Subject Material Place Health Chart

Patient Guarantor Healthcare provider Insurer Practitioner

Role 1

0..*

RIM (Reference Information Model)

HL7 in the OID tree

HL7 snippet for Gastro-enterelogical Report

The problem domain: Participants and development cycle

Healthcare

Terminologists

ICT Architects

HL7v3 modellers

Test / Qualification

IT providers

Data Set

THE SOLUTION - DECOR

DECOR overview

DECOR

dataset

project

name

scenario

copyright version info

description authors

issues

value sets

identi-fications

rules

concept group

item

use case

transaction

actor

code systems

terminology systems

validation

conditions

constraints

OID

status

assignment

Example DECOR file

THE SOLUTION - ART

ART - editor

ART - editor

ART demo

DECOR and ART technology

• A DECOR file is an XML file – methodology developed by dr. Kai U. Heitmann – basis for transformations to other HTML / XML – fine basis for schema(tron) – has its own schema (DECOR.xsd)

• ART is tooling to make DECOR files – tooling developed by Gerrit Boers – ART is made with XQuery / XForms – open source products eXist / Orbeon

• ART and DECOR are open source (GPL / LGPL) – team: Kai, Gerrit, Alexander Henket, Maarten Ligtvoet,

Marc

Healthcare

Terminologists

ICT Architects

HL7v3

modellers

IT vendors

Testing

PERI

JGZ

Spoed

etc..

Stakeholders DECOR

XML

WEB

INTER

FAC

E

XFo

rms

XQu

ery

eXist

XM

L d

atabase

ART tooling

THE SOLUTION – OUTPUTS

Stakeholders ART DECOR

HTML

XML

Outputs

Healthcare

Terminologists

ICT Architects

HL7v3

modellers

IT vendors

Testing

dataset

project

scenario

issues

value sets

identi-fications

rules

CSV

Care provider view

Technical documentation

XML / CSV resources for implementers

THE SOLUTION – CODE GENERATION

message validation

Stakeholders ART DECOR

Schematron

Schematron generation

IT vendors

Testing

dataset

project

scenario

issues

value sets

identi-fications

rules

XM

L O

K ?

Schematron / test demo

Stakeholders ART DECOR

XML specs

UI generation

IT vendors

dataset

project

scenario

issues

value sets

identi-fications

rules

UI

USING XML – PROS AND CONS

Application architectures

A P P

DB

XML as a storage format

A P P

DB

X M L

XML as exchange format

A P P

DB

A P P

DB

A P P

X M L

Web architecture 2013

Con trol ler

Model

Br ows er

View

X M L

HTML CSS JS

User Interface Logic

HTML CSS JS

non-XML vs XML application

XQuery eXist

Br ows er

XForm

User Interface Logic XML

HTML CSS JS

Django

Post greSQL

Br ows er

Tem pla tes

User Interface Logic

XML for application: pros and cons

• versatile data structure – easy to adapt – easy to generate different outputs

• easy to introduce bugs • learning curve

– XQuery: not too hard – XForms: steeper

• harder to debug – less tooling, especially server-side – client-side debugging: you see HTML, not XForm

• procedural versus declarative programming – procedural: here you have an X, multiply by 2 and give it back to me – declarative: if you see an X, multiply it by 2 – XML all over the place: it’s magic, and sometimes you don’t get it

• (some) partners have limited XML knowledge • Schematron versus XML Schema

– co-occurrence... – error reporting

QUESTIONS ?