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International IEEE Conference on Biomedical and Healthcare Informatics (BHI), Valencia, Spain - June 2 2014
Use of the Virtual Medical Record Data Model for Communication among Components of a Distributed Decision-support SystemArturo González-Ferrer, Mor Peleg, Enea Parimbelli, Erez Shalom, Carlos Marcos, Guy Klebanov, Iñaki Martínez-Sarriegui, Nick Lik San Fung, Tom Broens
Special Session on EHR interoperability
International Conference on Biomedical and Healthcare Informatics (BHI)
Partner’s logo2
• UNIVERSITY OF HAIFA (HU), Israel• BEN-GURION UNIVERSITY OF THE NEGEV (BGU), Israel• UNIVERSITA DEGLI STUDI DI PAVIA (UNIPV), Italy • UNIVERSITEIT TWENTE (UT), Netherlands• TECHNISCHE UNIVERSITAET WIEN (TUV), Austria• MOBIHEALTH BV (MHBV), Netherlands• FONDAZIONE SALVATORE MAUGERI CLINICA DEL LAVORO E DELLA
RIABILITAZIONE (FSM), Italy• UNIVERSIDAD POLITECNICA DE MADRID (UPM), Spain• CORPORACIO SANITARIA PARC TAULI DE SABADELL (CSPT), Spain• ATOS SPAIN SA (ATOS), Spain• BEACON TECH LTD (BTL), Israel• ZorgGemak BV (ZORG), Netherlands• ASSOCIACIO DE DIABETICS DE CATALUNYA (ADC), Spain
www.mobiguide-project.eu 6 universities, 4 companies, 2 hospitals, 1 patients association
clinical domains: GDM (Spanish hospital) and AF (Italian hospital)
MOBIGUIDE (2011-2015)
International IEEE Conference on Biomedical and Healthcare Informatics (BHI), Valencia, Spain - June 2 2014 3
THE MOBIGUIDE SYSTEM
DSS
PHRComputer-interpretable guideline (CIG)
BAN
EMR1
EMR2
Personalized
International IEEE Conference on Biomedical and Healthcare Informatics (BHI), Valencia, Spain - June 2 2014 4
• Our presentation focuses on showing how to make the most of the HL7 vMR standard to develop
• A SOA Ubiquitous Guidance System
• Target users: physicians and patients
• Many devices/systems: Smartphone linked to BAN devices, DSS, PHR, EMRs, Caregiver UI, etc.
• The standard is used to store patient data and for coordination between system components
• Manage the complex workflow needed to support guidance of patients, Anytime and Everywhere
INTRODUCTION
International IEEE Conference on Biomedical and Healthcare Informatics (BHI), Valencia, Spain - June 2 2014 5
HL7 VIRTUAL MEDICAL RECORD
• Two axes: clinical + workflow-related
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A REAL SCENARIO FROM GDM PRACTICE GUIDELINE
Register diet compliance
pattern detection (≥2 non-compliance events in 7 days)
DSS recommends the physician sending feedback to patient
International IEEE Conference on Biomedical and Healthcare Informatics (BHI), Valencia, Spain - June 2 2014 7
A REAL SCENARIO FROM GDM PRACTICE GUIDELINE
specification of the non-compliance
event that needs to be detected for the
pattern to be calculated
observationResult instance
observationFocus= increased carbs
SNOMED 123995008
observationValue:
+/++
International IEEE Conference on Biomedical and Healthcare Informatics (BHI), Valencia, Spain - June 2 2014 8
A REAL SCENARIO FROM GDM PRACTICE GUIDELINE
The extended DSS automatically
generates the query and when any
component stores a matching data item
in the PHR a notification event is
sent back to the extended DSS.
observationResult instance
observationFocus= increased carbs
SNOMED 123995008
observationValue:
+/++
International IEEE Conference on Biomedical and Healthcare Informatics (BHI), Valencia, Spain - June 2 2014 9
A REAL SCENARIO FROM GDM PRACTICE GUIDELINE
the extended DSS generates a
recommendation to the caregiver
asking if he wants to send a message
to the patient about the
importance of diet compliance
ProcedureProposal instance
procedureCode:Notification
(UMLS C0422202)
target: Physician (UMLS:C0031831)
DSS_ID (extension): 111
International IEEE Conference on Biomedical and Healthcare Informatics (BHI), Valencia, Spain - June 2 2014 10
A REAL SCENARIO FROM GDM PRACTICE GUIDELINE
this new recommendation is then retrieved from
the PHR by the caregiver GUI
ProcedureProposal instance
procedureCode:Notification
(UMLS C0422202)
target: Physician (UMLS:C0031831)
DSS_ID (extension): 111
International IEEE Conference on Biomedical and Healthcare Informatics (BHI), Valencia, Spain - June 2 2014 11
A REAL SCENARIO FROM GDM PRACTICE GUIDELINE
The physician accepts the
recommendation and saves an order into the PHR. Note that DSS_ID is the
sameProcedureOrder
Instance
procedureCode: Notification
(UMLSC0422202)
target: Patient (UMLSC0030705)
originalText: “…”
DSS_ID (extension): 111
International IEEE Conference on Biomedical and Healthcare Informatics (BHI), Valencia, Spain - June 2 2014 12
A REAL SCENARIO FROM GDM PRACTICE GUIDELINE
The message with the
recommendation is sent to the patient who receives it in the smartphone ProcedureEvent
Instance
procedureCode: Notification
(UMLSC0422202)
target: Patient (UMLSC0030705)
originalText: “…”
DSS_ID (extension): 112
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• The “workflow management” raises new interoperability issues for distributed CDSS while keeping the usual need to link a back-end DSS with a PHR using standards.
• The pattern Proposal-Order-Event can be applied to substance administrations, encounters, observations, etc.
• Pattern Proposal-Result can be issued when no confirmation is required by physicians
• Including propietary extensions (e.g. GL-ID, DSS-ID)
• allows to follow workflow and • identify responses to concrete recommendations
easily
MANAGING CDSS WORKFLOW WITH VMR
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VMR USE AND EXTENSION
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CONCLUSIONS
• We used HL7 vMR to cope with the workflow needs of distributed CDSS with multiple systems and user roles
• HL7 vMR needs to be extended in several cases, but it provides standard mechanisms to include these extensions
• The technical solution showed relates to a concrete DSS (Picard) and a particular guideline, but it could be easily adapted to other architectures and clinical domains
• It is being validated with a pilot implementation of two guidelines within the project (to start in February 2015)
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Questions?
Arturo González-Ferrerarturogf@gmail.com