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'''Agenda for the May 2011 WGM in Orlando FL USA'''
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[[category:RIMBAA Minutes]]'''Minutes of the May 2011 WGM in Orlando FL USA'''
  
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Notes:
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==May 16 (Monday Q3)==
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#Rene won't be attending this WGM.  
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{| border="1" cellpadding="2" cellspacing="0" style="background:#f0f0f0;" width="100%"
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#one quarter to be set aside for a joint HL7 RIMBAA & OpenEHR software implementers session.
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|-
 +
!width=”35%”|Workgroup
 +
!width="20%"| Date/Time
 +
!width="15%"| Location
 +
!width="30%"| Chair/Scribe
 +
|-
 +
|'''RIMBAA WG'''||2011-05-16, <br/>13:45-15:00||Orlando FL, US||Chair: Peter Hendler, Scribe: Peter Hendler, Michael van der Zel
 +
|}
 +
===Attendance===
 +
{| border="1" cellpadding="2" cellspacing="0"
 +
|-
 +
!width=”5%”|At
 +
!width="45%"| Name
 +
!width="50%"| Email Address
 +
|-
 +
|&nbsp;||Peter Hendler||peter@javamedical.com
 +
|-
 +
|&nbsp;||Rik Smithies||rik@nprogram.co.uk
 +
|-
 +
|&nbsp;||Amnon Shabo||shabo@il.ibm.com
 +
|-
 +
|&nbsp;||Michael Van Der Zel||m.van.der.zel@umcg.nl
 +
|-
 +
|&nbsp;||Astrid Broere||asbroere@diaconessenhuis.nl
 +
|-
 +
|&nbsp;||Gordon Raup||graup@datuit.com
 +
|-
 +
|&nbsp;||Anil Luthra||aluthra@alfisconsultants.com
 +
|-
 +
|&nbsp;||Chirag Bhatt||chirag.bhatt@feisystems.com
 +
|-
 +
|&nbsp;||Assaf Halevy||assaf.halevy@dbmotion.com
 +
|-
 +
|&nbsp;||Stacy Berger||sberger@coh.org
 +
|-
 +
|&nbsp;||Yunwei Want||yunwei.ant@seimens.com
 +
|-
 +
|&nbsp;||Chris Melo||chris.melo@philips.com
 +
|-
 +
|&nbsp;||Dave Shaver||dave.shaver@carepointhealth.com
 +
|-
 +
|&nbsp;||Brian Pech||bpech1@gmail.com
 +
|-
 +
|&nbsp;||Dale Nelson||dale.nelson@squaretrends.com
 +
|-
 +
|&nbsp;||Markbool Hussain||marqbool.hussain@seecs.edu.pk
 +
|-
 +
|&nbsp;||Lee Coller||lee.coller@oracle.com
 +
|-
 +
|&nbsp;||Nick Radov||nradov@axolotl.com
 +
|-
 +
|&nbsp;||Vassel Paytchev||vassil@epic.com
 +
|-
 +
|}
  
−
==MON Q3  [[Image:Business-Icon.jpg]] [[Image:Technical med.gif]]==
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===Minutes===
−
#Administrative agena items
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#Peter called to order at 13:43
−
#*Approval of agenda for the week
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#Administrative agenda items
−
#*Announcements
+
#*Approval of agenda for the week  
 +
#**MOTION to approve the agenda for the week (Amnon/Michael, 16-0-0 Y/Abst/no)
 +
#*No announcements
 
#*Approval of the minutes of the [[RIMBAA 201103 Agenda|Washington]] meeting.
 
#*Approval of the minutes of the [[RIMBAA 201103 Agenda|Washington]] meeting.
−
#Use of a [[SMIRF]] like approach (Dale Nelson, max 20 minutes)
+
#**MOTION to approve of the minutes of the [[RIMBAA 201103 Agenda|Washington]] meeting (as present on the hl7.org website) (Amnon/Michael, 16-0-0 Y/Abst/no).
−
#*Dale was involved (some year ago) in a project which used CMET-like models as the basis for data exchange and persistence. He will show the highlights of its architecture and will share best practices.
+
#*Planning of the WGM in [[RIMBAA 201109 Agenda|San Diego]] (september 2011)
−
#Report on a HL7 v3 services based project (Dale Nelson, max 20 minutes)
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#**Skipped this item; just let us know if want to present.
−
#*Dale was involved in a project that uses a RIM based services layer. Dale will discuss the  choices that were made when creating the service inventory, as well as the design of the v3 static models used as service payloads.
+
#dbMotion (Assaf Halevy, founder of the company, see [http://www.hl7.org/documentcenter/public/wg/java/dbMotionOrlandoMay2011.ppt http://www.hl7.org/documentcenter/public/wg/java/dbMotionOrlandoMay2011.ppt] for his presentation) - see also [[RIMBAA: dbMotion]]
−
#dbMotion.  A RIM based integration platform used on a very large scale at U of PItt, Israel and elsewhere. Practical experience making RIMBAA work on a large scale for integrating disparate hospitals and facilities.
+
#*dbMotion is a RIM based integration platform used on a very large scale at U of PItt, Israel and elsewhere. Practical experience making RIMBAA work on a large scale for integrating disparate hospitals and facilities.
 +
#*This is an example of using the RIM as an (semantic) integration layer.
 +
#*DbMotion is used in Israel with nearly 4 million patients.  It is also used at the University of Pittsburg Medical Center where various hospitals that use Cerner, Allscripts, Epic and other E.H.R.s are integrated with dbMotion.  DbMotion has what is called a Unified Medical Schema. It was designed by Abdul Malik Shakir and it is like a universal RMIM or [[SMIRF]] that is a patient centric representation of the entries in a patient record.  It is very close to the RIM but has had a few minor simplifications. For example, the place of birth is not represented as an entiry in a role, but was instead added as an attribute to the Person entity class.  It is easily translatable to pure RIM.
 +
#*The RIM database is the central integration repository for all clinical systems.
 +
#*If you are in on E.H.R system, you have an extra little button from an extra listener.  The button will indicate if there is other clinical information on the patient that you don't know about.  You can then use the dbMotion viewer to see the information from the other systems, and optionally, you can choose to import the new information into your current E.H.R. System.
 +
#**Idea is to share without loosing control & ownership of data.
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#**Data is federated, distributed but centralized virtually. Hide this complexity for the user. The presenter calls this “Centributed”
 +
#**Each Clinical Data Repository of each node integrated will have only his own dataset, no duplication of data.
 +
#**Business layer will expose Business oriented Services. Standards based services and data IHE, CCD, etc.
 +
#**dbMotion is not an EHR-System, it doesnot create data.
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#**Often applications claim to be standard but are not. DBMotion shields / adapts those.
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#**dbMotion provides a SDK and a platform
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#*Also interesting is the use of SNOMED.  All local codes are mapped to SNOMED. This way when the two local codes for example Warfarin and Coumadin, are found to be semantically the same, you can change your view to collapse all the medicaitons or observaitons that are semanically equivalent.
 +
#Hybrid approaches to RIMBAA (Amnon Shabo, see [http://www.hl7.org/documentcenter/public/wg/java/20110517_IBM_Hypergenes.pdf http://www.hl7.org/documentcenter/public/wg/java/20110517_IBM_Hypergenes.pdf] for his slides)
 +
#*Amnon Shabo presented the IBM research project on human genomics.  They collect genotypes including genome-wide scan of each subject and they also collect phenotypes.  The data is in a hybrid warehouse with RIM-based database for clinical data snd relational database for the genomic data (1M SNP/subject).  They are able to find new correlations between genotype and phenotypes, and if the correlation is already known, they can be used in decision support. For example, a given genotype may suggest drug resistance for a given patient and conditon. The system can warn the clinician not to prescribe it - based on the genotype. The RMIM's used for the warehouse XML database are the Pedigree and Genetic Variation (of HL7 Clinical Genomic Domain) and CDA. These RMIM's were constrained to meet the project requirements. The constrained RMIM's were interrelated under one infromation model that govern the warehouse XML database.
 +
#*Native-XML RIMBAA for semantic warehousing with XQUERY exploration. Exported data marts in RDF or relational formats for analytics and optimization. RDF-based promotion layer facilitates the definition of data marts. Data mart schemas are user-defined and mapped to the XML warehouse and/or promotion layer.
 +
#**Stage data as is fully-indexed XML and not as blob
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#**Separate databases for normal-data and mass-data (e.g. genotype data)
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#**MDHT tool used to create templates with UML/OCL.
 +
#**XML in generic layer = core model, query using XQuery.
 +
#**IHE QED implemented and tested on Connecthathon, QED connected to RIM database (XML, RIMon)
 +
#Adjournment at 15:15
  
−
==WED Q2 (hosted by I/C)==
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===Appendix A: Summary of Motions===
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*This quarter RIMBAA will have ajoint meeting with the Implementation/Conformance WG (who are hosting) and the Tooling WG.
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The table below captures all substantial motions.
 +
{| border="1" cellpadding="2" cellspacing="0"
 +
|-
 +
!width=”100%”|Motions
 +
|-
 +
|MOTION to approve of the minutes of the [[RIMBAA 201103 Agenda|Washington]] meeting (as present on the hl7.org website) (Amnon/Michael, 16-0-0 Y/Abst/no).
 +
|}
  
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==WED Q6 (19:00-21:00) [[Image:Technical med.gif]]==
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==Wednesday Q6==
−
#XML-based (+hybrid approaches) persistence
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===Attendance===
 +
{| border="1" cellpadding="2" cellspacing="0"
 +
|-
 +
!width=”3%”|At
 +
!width="25%"| Name
 +
!width="30%"| Affiliation
 +
!width="42%"| Email Address
 +
|-
 +
|&nbsp;||Abdul Malik Shakir||COH, US||ashakir@coh.org
 +
|-
 +
|&nbsp;||Amnon Shabo||IBM, IL||shabo@il.ibm.com
 +
|-
 +
|&nbsp;||Andy Stechislin||GordonPoint, CA||andy.stechishin@gmail.com
 +
|-
 +
|&nbsp;||Ann Wrightson||NHS Wales, UK||ann.wrightson@wales.nhs.uk
 +
|-
 +
|&nbsp;||Brian Pech||KP, US||brian.pech@kp.org
 +
|-
 +
|&nbsp;||Grahame Grieve||AU||grahameg@gmail.com
 +
|-
 +
|&nbsp;||Jane Curry||HIS inc, CA||JaneCurry@healthinfostrategies.com
 +
|-
 +
|&nbsp;||Michael van der Zel||Groningen University Hospital, <br/>and Results4Care, NL||m.van.der.zel@umcg.nl
 +
|-
 +
|&nbsp;||Mike Rossman||KP, US||michael.k.rossman@kp.org
 +
|-
 +
|&nbsp;||Muhammad Afzal||SEECS, PK||muhammad.afzal@seecs.edu.pk
 +
|-
 +
|&nbsp;||Lloyd McKenzie||Lmcenzie||lloyd@lmckenzie.com
 +
|-
 +
|&nbsp;||Peter Hendler||KP||peter@javamedical.com
 +
|-
 +
|&nbsp;||Pradeep Chowdhury||KP||pradeep.k.chowdhury@kp.com
 +
|-
 +
|&nbsp;||Stan Huff|| Intermountain Health||stan.huff@imail.org
 +
|-
 +
|&nbsp;||Nick Radov||Azolotl||nradov@axolotl.com
 +
|-
 +
|&nbsp;||Galen Mulrooney||VA||galen.mulrooney@va.gov
 +
|-
 +
|&nbsp;||William Goossen||Results4care||wgoossen@results4care.nl
 +
|-
 +
|&nbsp;||Allen Hobbs||KP||Allen.Hobbs@kp.org
 +
|-
 +
|&nbsp;||Dale Neslon||SquareTrends||dale.nelson@squaretrends.com
 +
|-
 +
|&nbsp;||Gordon Raup||Datuit, LLC||graup@datuit.com
 +
|-
 +
|&nbsp;||Anneke Goossen||Results4Care||agoossen@results4care.nl
 +
|-
 +
|&nbsp;||Hugh Glover||Blue Wave Informatics||hugh_glover@bluewaveinformatics.co.uk
 +
|-
 +
|&nbsp;||Chirag Bhatt||Fei Systems||Chirag.Bhatt@feisystems.com
 +
|-
 +
|&nbsp;||John Hatem||Oracle||john.hatem@oracle.com
 +
|-
 +
|&nbsp;||Lee Coller||Oracle||lee.coller@oracle.com
 +
|-
 +
|}
 +
 
 +
===Minutes===
 +
#Peter calls to order
 +
#*Agenda for this quarter
 +
#*Announcements: None.
 +
#HL7 V3 New Look Taskforce and PIIMs
 +
#*An in person continuation of our lively online discussion (on the RIMBAA e-mail list) of what the Fresh Look Taskforce may mean to V3 implementers.
 +
#**See Grahame's blog on the [http://www.healthintersections.com.au/?p=137 HL7 Fresh Look Taskforce].
 +
#**One of the concepts to come out of discussions prior to this meeting is the creation of [[PIIM]]s, an artefact which will be of key importance to HL7 v3 implementers, and to increased adoption and uptake of HL7 v3. A PIIM is a PIM, a Platform Independent Implementable Model. All v3 static models are to be expressed as UML models, which makes life easy for the implementers when using [[MDA]]. All ITSs may be deprecated, and no new ones defined, HL7 should not be in de business of defining ITSs at all.
 +
#*Discussion:
 +
#**It has become apparent that there are many implementors who feel that HL7 V3 RIM based integration puts too much burden on the developers to learn too many unnecessary model details in order to exchange a simple set of data.  Although the RIM is needed if you are going to be able to integrate systems in different healthcare domains, you do not need all of the complexity if you only want to trade a limited let of data within one healthcare domain to a partner.
 +
#**This may even be the most typical situation.  The current HL7 V3 implementation process requires either understanding of RIM, the MIF, and vocabulary bindings to name just a few.
 +
#**The published XML schemas can not be generated without “magic”.  For example the RMIMs are missing some [[Infrastructure Root]] attributes and vocabulary binding details and other hidden things that must be added before you can go from the design model (RMIM MIF) to an implementable model (which might be XMI for example).
 +
#**Graham Greive, Lloyd McKenzie, suggested one part of the possible solution.  This would be Platform Independent Implementation models (maybe in XMI or even eCore).  These would be able to be directly transformed to XML or Objects.
 +
#**Galen Mulrooney suggested better implementation guides.  We also brought up the [[Green CDA]] approach which hides the complexity and the “magic” in the XSLT transform.
 +
#**Ann Wrightson had a different but similar suggestion of use in a special case.  In the case that a green CDA was to be only traded with a partner that you had pre agreements with, you would not need to transform the simple format to the universal valid CDA but you could just exchange the simple format on the wire.
 +
#**In summary there were four suggestions discussed but this does not preclude brain storming or completey new approaches.
 +
#**We have created a new page on the RIMBAA wiki ([[Fresh Look]]) where all are encouraged to put up items for a wish list and near term activities.
 +
#**(''added after the meeting took place, and as such not part of the official minutes''): see also Grahame's comments at [http://www.healthintersections.com.au/?p=314 http://www.healthintersections.com.au/?p=314].
 +
#Adjournment
  
 
==THU Q3 [[Image:Technical med.gif]]==
 
==THU Q3 [[Image:Technical med.gif]]==
−
#Report on v3 implementation at Intermountain (Stan Huff)
+
{| border="1" cellpadding="2" cellspacing="0" style="background:#f0f0f0;" width="100%"
 +
|-
 +
!width=”35%”|Workgroup
 +
!width="20%"| Date/Time
 +
!width="15%"| Location
 +
!width="30%"| Chair/Scribe
 +
|-
 +
|'''RIMBAA WG'''||2011-05-19, <br/>13:45-15:00||Orlando FL, US||C/S: Peter Hendler
 +
|}
 +
===Attendance===
 +
{| border="1" cellpadding="2" cellspacing="0"
 +
|-
 +
!width=”5%”|At
 +
!width="45%"| Name
 +
!width="50%"| Email Address
 +
|-
 +
|&nbsp;||Nick Radov||nradov@axolotl.com
 +
|-
 +
|&nbsp;||Phil Pochan||Phill.pochon@covance.com
 +
|-
 +
|&nbsp;||Joyce Hernandez||joycehernandez@merck.com
 +
|-
 +
|&nbsp;||Amnon Shabo|| shabo@ilibm.com
 +
|-
 +
|&nbsp;||Peter Hendler|| peter@javamedical.com
 +
|-
 +
|&nbsp;||Daryl Thomas|| darly.thomas@lifetech.com
 +
|-
 +
|&nbsp;||Geoff Hyde|| ghyde@1life.com
 +
|-
 +
|&nbsp;||Grand Wood|| grant.wood@imail.org
 +
|-
 +
|&nbsp;||Chirag Bhatt|| Chirag.bhatt@feisystems.com
 +
|-
 +
|&nbsp;||Loraine Constable|| loraine@constable.ca
 +
|-
 +
|&nbsp;||Michael Van Der Zel|| m.van.der.zel@umcg.nl
 +
|-
 +
|&nbsp;||Stan Huff|| stan.huff@imail.org
 +
|-
 +
|&nbsp;||Pradeep K Chowdhury|| pradeep.k.chowdhury@kp.org
 +
|-
 +
|&nbsp;||Michael Rossman|| michael.rossman@kp.org
 +
|-
 +
|}
 +
 
 +
===Minutes===
 +
#Peter calls to order
 +
#*Agenda for this quarter
 +
#*Announcements: None.
 +
#Report on v3 implementation at Intermountain (Stan Huff, see [http://www.hl7.org/documentcenter/public/wg/java/20110519_RIMBAA_Stan_Huff.ppt http://www.hl7.org/documentcenter/public/wg/java/20110519_RIMBAA_Stan_Huff.ppt] for his slides)
 +
#*There is more than one way to express a clinical statement in RIM.  If you are using a RIM model to trigger clinical decision support rules, how do you know if two different expressions represent the same thing?  Prior to the RIM and prior to OWL, Dr Huff was faced with the problem of representing clinical events in a "normalized" way so that equivalent expressions are known to be equivalent.  He will discuss the "normalized" model that he and his group developed to address this problem.
 +
#*Stan Huff and the Clinical Element Model (CEM):
 +
#**Stan Huff has used the Clinical Element Model or CEM at Intermountain Health for many years.
 +
#**This is a constrained model that consists of the following design. Everything is a Clinical Element. The clinical Element consists of sections. There is a type attribute that is human readable and tells what the element is.
 +
#**There is a Key which is usually a LOINC code that is the exact and definitive way (not just for humans to read) way of saying what the element represents.
 +
#**There is a value section that is a choice between a data element if there is only one value, or in the case where there are multiple values there is a list of items, each of which is a data value.
 +
#**There is another attrubute for a collection of “quals”.  And example of a qual would be “sitting” if the element was a blood pressure. It is an additional qualifiying bit of information.  Finally there is an optional set of mods. An example of a mod is “father of subject” which would modify the meaning of the element to indicate it was the fathers blood pressure.
 +
#**Each clinical element is modeled and put in a repository, so that there will not be more than one model for a given clinical concept.
 +
#**This system is used to unambiguate the semantic meaning of different instances. For example, in many clinical models, the RIM included, there is more than one syntactic way to express the same semantic element.  This CEM approach is a way to normalize the way things are represented so they can be checked for equality.
 +
#**The CEM models also are used in the design of the GUI input screens for the E.H.R.
 +
#Kaiser Permanente, a preliminary trial of using RIMBAA (Java SIG) to aggregate data from Epic and NHIN data sources.
 +
#*Using MySQL and the original version of the JAVA SIG API, and also developing a Clinical Data Extraction Framework (CDEF) to extract data from Epic without having to go through Clarity (Epics relational projection), Pradeep and his group at Kaiser Permanente created a system that can capture data in real time as it is being entered into Epic, and persist it in a pure RIM database (MySQL).  They have a web interface that can show the data minutes later.  So far this demo project us capturing Demographic data but it will be part of a wider effort to capture all clinical data.
 +
#*Pradeep Chowdhury from Kaiser Permanente on the EMRLD apprach for a RIMBAA data integration layer for Kaiser Permanente (see [http://www.hl7.org/documentcenter/public/wg/java/20110517_KP_EMRLD.ppt http://www.hl7.org/documentcenter/public/wg/java/20110517_KP_EMRLD.ppt] for his slides):
 +
#**EMRLD stands for an approach for handling the data of a large enterprise.
 +
#***E  is extract.  In our example them means from Epic, Pharmacy, ATD, CDA (from VA etc), Clincal devices, and various other sources.  The data is extracted from all of these proprietary or native systems.
 +
#***M is for Merge.  The data is compared using mappings to standard terminology such as SNOMED so things which may appear to be different can be discovered to be the same (Warfarin and Coumadin).
 +
#***R is for RIMify.  Once we have the merged data, they are placed into a CDA like format (uses the CDA MIF file).
 +
#***L is for Load, the data is then loaded into a pure RIM database.
 +
#***D is for Deploy.  Once we have all the data in a single RIM based persitence layer, we can use the data for many use cases.  Quality reporting, decision support, research, creating new CDAs and many other things one would want pooled data for.
 +
#**The project was built upon the HL7 Java SIG API.  It sits on top of a MySQL database.  The data extraction was custom built to extract data from Epic.
 +
#*This pilot system is not in production and we hope to find funding and come back and report later on a production version.
 +
#A templated RIMBAA CDR for a Hospital Wide Continuity of Care Record (Michael van der Zel, see [http://www.hl7.org/documentcenter/public/wg/java/RIMBAA_Impl_Aspects_2011_may_WGM_MZ.pdf http://www.hl7.org/documentcenter/public/wg/java/RIMBAA_Impl_Aspects_2011_may_WGM_MZ.pdf] for his presentation.)
 +
#*Simple CRUD CDR at UMCG, static storage is easy, the dynamic behaviour is where the fun/trouble starts, report on issues we ran into creating the CDR store. And the hybrid SQL+XML database solution applied. Plus, a discussion type of presentation were he wants to point out the Research specific issues @ LifeLines/Target
 +
#*Michael created a RIM based system for a large (about one million patients) system in the Netherlands. (UMCG).  It is a continuity of care system.  He didn't start with the Java SIG but developed the system from scratch.  They were required to use SQL server.  At first they used a pure RIM relational database but found it was too complex for the developers (who were not familiar with RIM), and it did not perform well. 
 +
#*On a second attempt they used a more constrained RMIM specific database which was adequate and more understandable to the developers.  Later experimentation proved that a third method of persistence was even better for the developers and for performance. This is an XML approach where the entire continuity of care instance is stored as an XML blob in the database. There are indexes that allow for querying of sub parts fo the whole document. This solution scales and is in production in this fairly large system.
 +
#**Peter: Our presentation from dbMotion on Monday indicates that the approach of a pure RIM database does scale.  This is done at U of Pitt and the country of Israel.  It would be interesting to see what the problems were in this present case and what the differences were in the implementions of the RIM databases.  Maybe we'd see certain patterns to avoid that effect performance?
 +
#Adjournement

Latest revision as of 12:20, 21 June 2011

Minutes of the May 2011 WGM in Orlando FL USA

May 16 (Monday Q3)

Workgroup Date/Time Location Chair/Scribe
RIMBAA WG 2011-05-16,
13:45-15:00		 Orlando FL, US Chair: Peter Hendler, Scribe: Peter Hendler, Michael van der Zel

Attendance

At Name Email Address
  Peter Hendler peter@javamedical.com
  Rik Smithies rik@nprogram.co.uk
  Amnon Shabo shabo@il.ibm.com
  Michael Van Der Zel m.van.der.zel@umcg.nl
  Astrid Broere asbroere@diaconessenhuis.nl
  Gordon Raup graup@datuit.com
  Anil Luthra aluthra@alfisconsultants.com
  Chirag Bhatt chirag.bhatt@feisystems.com
  Assaf Halevy assaf.halevy@dbmotion.com
  Stacy Berger sberger@coh.org
  Yunwei Want yunwei.ant@seimens.com
  Chris Melo chris.melo@philips.com
  Dave Shaver dave.shaver@carepointhealth.com
  Brian Pech bpech1@gmail.com
  Dale Nelson dale.nelson@squaretrends.com
  Markbool Hussain marqbool.hussain@seecs.edu.pk
  Lee Coller lee.coller@oracle.com
  Nick Radov nradov@axolotl.com
  Vassel Paytchev vassil@epic.com

Minutes

  1. Peter called to order at 13:43
  2. Administrative agenda items
    • Approval of agenda for the week
      • MOTION to approve the agenda for the week (Amnon/Michael, 16-0-0 Y/Abst/no)
    • No announcements
    • Approval of the minutes of the Washington meeting.
      • MOTION to approve of the minutes of the Washington meeting (as present on the hl7.org website) (Amnon/Michael, 16-0-0 Y/Abst/no).
    • Planning of the WGM in San Diego (september 2011)
      • Skipped this item; just let us know if want to present.
  3. dbMotion (Assaf Halevy, founder of the company, see http://www.hl7.org/documentcenter/public/wg/java/dbMotionOrlandoMay2011.ppt for his presentation) - see also RIMBAA: dbMotion
    • dbMotion is a RIM based integration platform used on a very large scale at U of PItt, Israel and elsewhere. Practical experience making RIMBAA work on a large scale for integrating disparate hospitals and facilities.
    • This is an example of using the RIM as an (semantic) integration layer.
    • DbMotion is used in Israel with nearly 4 million patients. It is also used at the University of Pittsburg Medical Center where various hospitals that use Cerner, Allscripts, Epic and other E.H.R.s are integrated with dbMotion. DbMotion has what is called a Unified Medical Schema. It was designed by Abdul Malik Shakir and it is like a universal RMIM or SMIRF that is a patient centric representation of the entries in a patient record. It is very close to the RIM but has had a few minor simplifications. For example, the place of birth is not represented as an entiry in a role, but was instead added as an attribute to the Person entity class. It is easily translatable to pure RIM.
    • The RIM database is the central integration repository for all clinical systems.
    • If you are in on E.H.R system, you have an extra little button from an extra listener. The button will indicate if there is other clinical information on the patient that you don't know about. You can then use the dbMotion viewer to see the information from the other systems, and optionally, you can choose to import the new information into your current E.H.R. System.
      • Idea is to share without loosing control & ownership of data.
      • Data is federated, distributed but centralized virtually. Hide this complexity for the user. The presenter calls this “Centributed”
      • Each Clinical Data Repository of each node integrated will have only his own dataset, no duplication of data.
      • Business layer will expose Business oriented Services. Standards based services and data IHE, CCD, etc.
      • dbMotion is not an EHR-System, it doesnot create data.
      • Often applications claim to be standard but are not. DBMotion shields / adapts those.
      • dbMotion provides a SDK and a platform
    • Also interesting is the use of SNOMED. All local codes are mapped to SNOMED. This way when the two local codes for example Warfarin and Coumadin, are found to be semantically the same, you can change your view to collapse all the medicaitons or observaitons that are semanically equivalent.
  4. Hybrid approaches to RIMBAA (Amnon Shabo, see http://www.hl7.org/documentcenter/public/wg/java/20110517_IBM_Hypergenes.pdf for his slides)
    • Amnon Shabo presented the IBM research project on human genomics. They collect genotypes including genome-wide scan of each subject and they also collect phenotypes. The data is in a hybrid warehouse with RIM-based database for clinical data snd relational database for the genomic data (1M SNP/subject). They are able to find new correlations between genotype and phenotypes, and if the correlation is already known, they can be used in decision support. For example, a given genotype may suggest drug resistance for a given patient and conditon. The system can warn the clinician not to prescribe it - based on the genotype. The RMIM's used for the warehouse XML database are the Pedigree and Genetic Variation (of HL7 Clinical Genomic Domain) and CDA. These RMIM's were constrained to meet the project requirements. The constrained RMIM's were interrelated under one infromation model that govern the warehouse XML database.
    • Native-XML RIMBAA for semantic warehousing with XQUERY exploration. Exported data marts in RDF or relational formats for analytics and optimization. RDF-based promotion layer facilitates the definition of data marts. Data mart schemas are user-defined and mapped to the XML warehouse and/or promotion layer.
      • Stage data as is fully-indexed XML and not as blob
      • Separate databases for normal-data and mass-data (e.g. genotype data)
      • MDHT tool used to create templates with UML/OCL.
      • XML in generic layer = core model, query using XQuery.
      • IHE QED implemented and tested on Connecthathon, QED connected to RIM database (XML, RIMon)
  5. Adjournment at 15:15

Appendix A: Summary of Motions

The table below captures all substantial motions.

Motions
MOTION to approve of the minutes of the Washington meeting (as present on the hl7.org website) (Amnon/Michael, 16-0-0 Y/Abst/no).

Wednesday Q6

Attendance

At Name Affiliation Email Address
  Abdul Malik Shakir COH, US ashakir@coh.org
  Amnon Shabo IBM, IL shabo@il.ibm.com
  Andy Stechislin GordonPoint, CA andy.stechishin@gmail.com
  Ann Wrightson NHS Wales, UK ann.wrightson@wales.nhs.uk
  Brian Pech KP, US brian.pech@kp.org
  Grahame Grieve AU grahameg@gmail.com
  Jane Curry HIS inc, CA JaneCurry@healthinfostrategies.com
  Michael van der Zel Groningen University Hospital,
and Results4Care, NL		 m.van.der.zel@umcg.nl
  Mike Rossman KP, US michael.k.rossman@kp.org
  Muhammad Afzal SEECS, PK muhammad.afzal@seecs.edu.pk
  Lloyd McKenzie Lmcenzie lloyd@lmckenzie.com
  Peter Hendler KP peter@javamedical.com
  Pradeep Chowdhury KP pradeep.k.chowdhury@kp.com
  Stan Huff Intermountain Health stan.huff@imail.org
  Nick Radov Azolotl nradov@axolotl.com
  Galen Mulrooney VA galen.mulrooney@va.gov
  William Goossen Results4care wgoossen@results4care.nl
  Allen Hobbs KP Allen.Hobbs@kp.org
  Dale Neslon SquareTrends dale.nelson@squaretrends.com
  Gordon Raup Datuit, LLC graup@datuit.com
  Anneke Goossen Results4Care agoossen@results4care.nl
  Hugh Glover Blue Wave Informatics hugh_glover@bluewaveinformatics.co.uk
  Chirag Bhatt Fei Systems Chirag.Bhatt@feisystems.com
  John Hatem Oracle john.hatem@oracle.com
  Lee Coller Oracle lee.coller@oracle.com

Minutes

  1. Peter calls to order
    • Agenda for this quarter
    • Announcements: None.
  2. HL7 V3 New Look Taskforce and PIIMs
    • An in person continuation of our lively online discussion (on the RIMBAA e-mail list) of what the Fresh Look Taskforce may mean to V3 implementers.
      • See Grahame's blog on the HL7 Fresh Look Taskforce.
      • One of the concepts to come out of discussions prior to this meeting is the creation of PIIMs, an artefact which will be of key importance to HL7 v3 implementers, and to increased adoption and uptake of HL7 v3. A PIIM is a PIM, a Platform Independent Implementable Model. All v3 static models are to be expressed as UML models, which makes life easy for the implementers when using MDA. All ITSs may be deprecated, and no new ones defined, HL7 should not be in de business of defining ITSs at all.
    • Discussion:
      • It has become apparent that there are many implementors who feel that HL7 V3 RIM based integration puts too much burden on the developers to learn too many unnecessary model details in order to exchange a simple set of data. Although the RIM is needed if you are going to be able to integrate systems in different healthcare domains, you do not need all of the complexity if you only want to trade a limited let of data within one healthcare domain to a partner.
      • This may even be the most typical situation. The current HL7 V3 implementation process requires either understanding of RIM, the MIF, and vocabulary bindings to name just a few.
      • The published XML schemas can not be generated without “magic”. For example the RMIMs are missing some Infrastructure Root attributes and vocabulary binding details and other hidden things that must be added before you can go from the design model (RMIM MIF) to an implementable model (which might be XMI for example).
      • Graham Greive, Lloyd McKenzie, suggested one part of the possible solution. This would be Platform Independent Implementation models (maybe in XMI or even eCore). These would be able to be directly transformed to XML or Objects.
      • Galen Mulrooney suggested better implementation guides. We also brought up the Green CDA approach which hides the complexity and the “magic” in the XSLT transform.
      • Ann Wrightson had a different but similar suggestion of use in a special case. In the case that a green CDA was to be only traded with a partner that you had pre agreements with, you would not need to transform the simple format to the universal valid CDA but you could just exchange the simple format on the wire.
      • In summary there were four suggestions discussed but this does not preclude brain storming or completey new approaches.
      • We have created a new page on the RIMBAA wiki (Fresh Look) where all are encouraged to put up items for a wish list and near term activities.
      • (added after the meeting took place, and as such not part of the official minutes): see also Grahame's comments at http://www.healthintersections.com.au/?p=314.
  3. Adjournment

THU Q3 Technical med.gif

Workgroup Date/Time Location Chair/Scribe
RIMBAA WG 2011-05-19,
13:45-15:00		 Orlando FL, US C/S: Peter Hendler

Attendance

At Name Email Address
  Nick Radov nradov@axolotl.com
  Phil Pochan Phill.pochon@covance.com
  Joyce Hernandez joycehernandez@merck.com
  Amnon Shabo shabo@ilibm.com
  Peter Hendler peter@javamedical.com
  Daryl Thomas darly.thomas@lifetech.com
  Geoff Hyde ghyde@1life.com
  Grand Wood grant.wood@imail.org
  Chirag Bhatt Chirag.bhatt@feisystems.com
  Loraine Constable loraine@constable.ca
  Michael Van Der Zel m.van.der.zel@umcg.nl
  Stan Huff stan.huff@imail.org
  Pradeep K Chowdhury pradeep.k.chowdhury@kp.org
  Michael Rossman michael.rossman@kp.org

Minutes

  1. Peter calls to order
    • Agenda for this quarter
    • Announcements: None.
  2. Report on v3 implementation at Intermountain (Stan Huff, see http://www.hl7.org/documentcenter/public/wg/java/20110519_RIMBAA_Stan_Huff.ppt for his slides)
    • There is more than one way to express a clinical statement in RIM. If you are using a RIM model to trigger clinical decision support rules, how do you know if two different expressions represent the same thing? Prior to the RIM and prior to OWL, Dr Huff was faced with the problem of representing clinical events in a "normalized" way so that equivalent expressions are known to be equivalent. He will discuss the "normalized" model that he and his group developed to address this problem.
    • Stan Huff and the Clinical Element Model (CEM):
      • Stan Huff has used the Clinical Element Model or CEM at Intermountain Health for many years.
      • This is a constrained model that consists of the following design. Everything is a Clinical Element. The clinical Element consists of sections. There is a type attribute that is human readable and tells what the element is.
      • There is a Key which is usually a LOINC code that is the exact and definitive way (not just for humans to read) way of saying what the element represents.
      • There is a value section that is a choice between a data element if there is only one value, or in the case where there are multiple values there is a list of items, each of which is a data value.
      • There is another attrubute for a collection of “quals”. And example of a qual would be “sitting” if the element was a blood pressure. It is an additional qualifiying bit of information. Finally there is an optional set of mods. An example of a mod is “father of subject” which would modify the meaning of the element to indicate it was the fathers blood pressure.
      • Each clinical element is modeled and put in a repository, so that there will not be more than one model for a given clinical concept.
      • This system is used to unambiguate the semantic meaning of different instances. For example, in many clinical models, the RIM included, there is more than one syntactic way to express the same semantic element. This CEM approach is a way to normalize the way things are represented so they can be checked for equality.
      • The CEM models also are used in the design of the GUI input screens for the E.H.R.
  3. Kaiser Permanente, a preliminary trial of using RIMBAA (Java SIG) to aggregate data from Epic and NHIN data sources.
    • Using MySQL and the original version of the JAVA SIG API, and also developing a Clinical Data Extraction Framework (CDEF) to extract data from Epic without having to go through Clarity (Epics relational projection), Pradeep and his group at Kaiser Permanente created a system that can capture data in real time as it is being entered into Epic, and persist it in a pure RIM database (MySQL). They have a web interface that can show the data minutes later. So far this demo project us capturing Demographic data but it will be part of a wider effort to capture all clinical data.
    • Pradeep Chowdhury from Kaiser Permanente on the EMRLD apprach for a RIMBAA data integration layer for Kaiser Permanente (see http://www.hl7.org/documentcenter/public/wg/java/20110517_KP_EMRLD.ppt for his slides):
      • EMRLD stands for an approach for handling the data of a large enterprise.
        • E is extract. In our example them means from Epic, Pharmacy, ATD, CDA (from VA etc), Clincal devices, and various other sources. The data is extracted from all of these proprietary or native systems.
        • M is for Merge. The data is compared using mappings to standard terminology such as SNOMED so things which may appear to be different can be discovered to be the same (Warfarin and Coumadin).
        • R is for RIMify. Once we have the merged data, they are placed into a CDA like format (uses the CDA MIF file).
        • L is for Load, the data is then loaded into a pure RIM database.
        • D is for Deploy. Once we have all the data in a single RIM based persitence layer, we can use the data for many use cases. Quality reporting, decision support, research, creating new CDAs and many other things one would want pooled data for.
      • The project was built upon the HL7 Java SIG API. It sits on top of a MySQL database. The data extraction was custom built to extract data from Epic.
    • This pilot system is not in production and we hope to find funding and come back and report later on a production version.
  4. A templated RIMBAA CDR for a Hospital Wide Continuity of Care Record (Michael van der Zel, see http://www.hl7.org/documentcenter/public/wg/java/RIMBAA_Impl_Aspects_2011_may_WGM_MZ.pdf for his presentation.)
    • Simple CRUD CDR at UMCG, static storage is easy, the dynamic behaviour is where the fun/trouble starts, report on issues we ran into creating the CDR store. And the hybrid SQL+XML database solution applied. Plus, a discussion type of presentation were he wants to point out the Research specific issues @ LifeLines/Target
    • Michael created a RIM based system for a large (about one million patients) system in the Netherlands. (UMCG). It is a continuity of care system. He didn't start with the Java SIG but developed the system from scratch. They were required to use SQL server. At first they used a pure RIM relational database but found it was too complex for the developers (who were not familiar with RIM), and it did not perform well.
    • On a second attempt they used a more constrained RMIM specific database which was adequate and more understandable to the developers. Later experimentation proved that a third method of persistence was even better for the developers and for performance. This is an XML approach where the entire continuity of care instance is stored as an XML blob in the database. There are indexes that allow for querying of sub parts fo the whole document. This solution scales and is in production in this fairly large system.
      • Peter: Our presentation from dbMotion on Monday indicates that the approach of a pure RIM database does scale. This is done at U of Pitt and the country of Israel. It would be interesting to see what the problems were in this present case and what the differences were in the implementions of the RIM databases. Maybe we'd see certain patterns to avoid that effect performance?
  5. Adjournement
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