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RIMBAA 201105 Minutes Orlando

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Agenda for the May 2011 WGM in Orlando FL USA

WED Q2 (hosted by I/C)

  • This quarter RIMBAA will have ajoint meeting with the Implementation/Conformance WG (who are hosting) and the Tooling WG.
    • For minutes, please see the archives of the Implementation/Conformance WG.

WED Q6 (19:00-21:00) Palm Ballroom 3 Technical med.gif

  1. 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.
      • Grahame Grieve and Lloyd McKenzie will be present. This will be after the Reception and will prove to be an interesting discussion of models, RIM and other. See Grahame's blog on the HL7 Fresh Look Taskforce.
    • One of the concepts to come out of this discussion 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.

THU Q3 Technical med.gif

  1. Report on v3 implementation at Intermountain (Stan Huff)
    • 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.
  2. 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.
  3. A templated RIMBAA CDR for a Hospital Wide Continuity of Care Record (Michael van der Zel)
    • 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
  4. -------------------------

RIMBAA Wed Q6 Fresh Look Attendence to follow


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 Writeson 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 where all are encouraged to put up items for a wish list and near term activities.

May 16 (Monday Q3)

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

Attendance

At Name Affiliation Email Address
  Abdul Malik Shakir COH, US ashakir@coh.org
  Adel Ghlamallah CIHI, CA aghlamallah@infoway.ca
  Alan Nicol Informatics, UK alan.nicol@informatics.co.uk
  Alejandro Pica EMA, UK alejandro.pica@ema.europa.eu
  Alexander Henket E-Novation, NL alexander.henket@enovation.nl
  Alex de Jong Siemens, US alex.dejong@siemens.com
  Alex Zupan ItalTBS, IT alex.zupan@italtbs.com
  Ameet Pathak Dana-Farber Cancer Institute, US ameet_pathak@dfci.harvard.edu
  Amnon Shabo IBM, IL shabo@il.ibm.com
  Andrew McIntyre Medical Objects, AU andrew@medical-objects.com.au
  Andy Stechislin GordonPoint, CA andy.stechishin@gmail.com
  Anil Luthra Guidewire Architecture, US aluthra@guidewirearchitecture.com
  Ann Wrightson NHS Wales, UK ann.wrightson@wales.nhs.uk
  Bill Friggle Sanofi Aventis, US william.friggle@sanofi-aventis.com
  Brian Pech KP, US brian.pech@kp.org
  Bruce McKinnon JassCo, CA bruce.mckinnon@jassco.ca
  Charlie McCay Ramsey, UK charlie@ramseysystems.com
  Chirag Bhatt FEI Systems, US chirag.bhatt@feisystems.com
  Chris Winters Vocollect Healthcare Systems, Inc., US cwinters@healthcare.vocollect.com
  Dan Kokotov 5AM Solutions, US dkokotov@5amsolutions.com
  Dave Barnet NHS, UK david.barnet@nhs.net
  David Rowed Ocean Informatics, AU david.rowed@oceaninformatics.com
  Diane Gutiw SAIC, US gutiwd@saic.com
  Duana Bender Mohawk College, CA duane.bender@mohawkcollege.ca
  Ed Larsen Larsen Inc., US e.laresen@ix.netcom.com
  Ernst de Bel UMCN, NL e.debel@ic.umcn.nl
  Ewout Kramer Furore, NL e.kramer@furore.com
  Gavin Morris Kestral, AU gavinm@kestral.com.au
  Geoffry Roberts Blue Thread LLC, US geoffry.roberts@gmail.com
  George de la Torre Tufts Health, US delatorre.george@gmail.com
  Gordon Raup Datuit LLC, US graup@datuit.com
  Grahame Grieve AU grahameg@gmail.com
  Heath Frankel Ocean Informatics, AU heath.frankel@oceaninformatics.com
  Hugh Glover BlueWave Informatics, UK hugh_glover@bluewaveinformatics.co.uk
  Hugh Leslie Ocean Informatics, AU hugh.leslie@oceaninformatics.com
  Ian Bull ACT health, AU ian.bull@act.gov.au
  Ilia Fortunov Microsoft, US iliaf@microsoft.com
  Jane Curry HIS inc, CA JaneCurry@healthinfostrategies.com
  Jean Henri Duteau GPI, CA jean.duteau@gpinformatics.com
  John Finbraaten Marshfield Clinic, US finbraaten.john@marshfieldclinic.org
  John Harvey Iatric, US john.harvey@iatric.com
  John Koisch Guidewire Architecture, CA jkoisch@guidewirearchitecture.com
  John Timm IBM, US johntimm@us.ibm.com
  John Ulmer ??, US johnu@clemson.edu
  Kai Heitmann Heitmann Consulting, DE hl7@kheitmann.de
  Kenneth Salyards SAMSHA, US kenneth.salyards@samsha.hhs.gov
  Kenneth Weng CareFx, US kweng@carefx.com
  Linda Birn MOH Holdings, SG linda.birn@mohh.com.sg
  Lyssa Neel Infoway, CA pneel@infoway.ca
  Lorraine Constable CA lorraine@constable.ca
  Marilyn Maguire Fuji Med, US marilyn.maguire@fujimed.com
  Mario Roy Iatric, US mario.roy@iatric.com
  Mark Bevivino Iatric, US markb@iatric.com
  Mark Shafarman Shafarman Consulting, US mark.shafarman@earthlink.net
  Mark Tucker Regenstrief, US mtucker@regenstrief.org
  Massimo Frossi Ital TBS, IT massimo.frossi@italtbs.com
  Michael van der Zel Groningen University Hospital,
and Results4Care, NL
m.van.der.zel@ict.umcg.nl
  Mike Rossman KP, US michael.k.rossman@kp.org
  Muhammad Afzal SEECS, PK muhammad.afzal@seecs.edu.pk
  Patrick Loyd GPI, CA patrick.c.loyd@gmail.com
  Pascal Mattiocco KP, US pmattiocco@yahoo.com
  Paul Boyes Guidewire Architecture, CA pboyes@guidewirearchitecture.com
  Peter Gummer Ocean Informatics, AU peter.gummer@oceaninformatics.com
  Peter Hendler KP, US peter@hendler.net
  Rene Spronk Ringholm, NL rene.spronk@ringholm.com
  Richard Kronstad Carefacts, UK rkronstad@carefacts.com
  Richard Thoreson SAMSHA-CSAT, US richard.thoreson@samsha.hhs.gov
  Rik Smithies NHS, UK rik@nprogram.co.uk
  Robert Worden Charteris, UK robert.worden@charteris.com
  Sam Heard Ocean Informatics, AU sam.heard@oceaninformatics.com
  Sean Muir VA, US sean.muir@va.gov
  Scott Parkey Axolotl, US sparkey@axolotl.com
  Stacy Berger COH sberger@coh.org
  Steven Royce NEHTA, AU stephen.royce@nehta.gov.au
  Steve Fine Cerner, US sfine@cerner.com
  Tessa van Stijn Nictiz, NL stijn@nictiz.nl
  Tim Dodd CA tim.dodd@health.gov.sk.ca
  Tod Ryal Cerner, US tryal@cerner.com
  Todd Parnell 5AM Solutions, US tparnell@5amsolutions.com
  Tony Lam MOH Holdings, SG tony.lam@mohh.com.sg
  Yunwei Wang Siemens, US yunwei.wang@siemens.com
  Zhijing Liu Siemens, US zhijing.liu@siemens.com

Present: Rik Smithies Amnon Shabo Peter Hendler Michael Van Der Astrid Broese Gordon Ramp Anil Luthra Chirag Bhatt Yunnei Wong Chris Melo Dave Shaver Brum Pyels Dave Nelson Margood Hussain Lee Collier Nick Radov Vassil Paytchev


Minutes

  1. Co-chairs present: Peter, Amnon
  2. Scribes: Peter, Michael
  3. Peter call to order at 13:43
  4. Administrative agenda items
    • Approval of agenda for the week (?/?, 16-0-0 Y/Abst/no)
    • No announcements
    • Approval of the minutes of the Washington meeting (as present on the hl7.org website) (?/?, 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.
  5. dbMotion (Assaf Halevy, founder of the company) - see also RIMBAA: dbMotion (have to update that page with new info of this meeting)
    • 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.
    • Assaf Halevy founder of dbMotion presented the dbMotion application.
    • Link File:RIMBAA dbMotion.ppt
    • This is a very good 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.
    • 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.
    • Michael's notes
      • Share without loosing control & ownership of data.
      • dbMotion provides a SDK and a platform
      • 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.
  6. Hybrid approaches to RIMBAA (Amnon Shabo)
    • 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.
    • Amnon Shabo presented the IBM research project on human genomics. They collect genotypes including even the full sequences of aleles and they also collect phenotypes. The data is in a hybrid database that is RIM based but more XML than RDBM. 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 that is used is the Human Genotype RMIM that was created by the Human Genetics working group.
    • Michael's notes
      • Stage data as is structured XML 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)
  7. Adjournment at 15:15