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OSS 2011 Multi-Level Modelling Presentation
The document discusses the challenges of healthcare informatics and proposes multilevel modeling (MLM) and open source software as solutions. It argues that MLM separates reference and knowledge models, allowing knowledge to adapt over time without replacing the whole system. Open specifications and tools support sharing knowledge artifacts and ensuring interoperability. MLM and open source align with principles of beneficence, non-maleficence, and efficiency in healthcare informatics. The approach has potential to address issues like information chaos, system failures, and costs that traditional approaches have faced.
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OSS 2011 Multi-Level Modelling Presentation
- 1. Health Informatics: the Relevance of Open Source and Multilevel Modeling Luciana T. Cavalini, MD, PhD Timothy W. Cook, MSc “ Multilevel Healthcare Information Modeling“ (MLHIM) Laboratory (UFF/UERJ) Associated to the National Institute of Science and Technology – Medicine Assisted by Scientific Computing
- 2. Introduction Healthcare isa dynamic and complex system The spatial changes are close
- 3. The time changesare fast
- 4. The number ofbasic concepts is 300,000+ Cavalini's conjecture: given a group of medical experts without any hierarchical relationship among them, the probability of them reaching 100% of agreement about any set of concepts from their domain tends to zero
- 5. Introduction A singlemonolithic system for the complete health record of a person “from cradle to grave” is not feasible
- 6. Integration projects thatwere successful in other businesses have been attempted in healthcare over the last 46 years, spending trillions of dollars, with a 100% failure rate
- 7. The result: healthcareis the less computerized business in economy
- 8. Introduction Electronic HealthRecords (EHR) have promised (and yet not delivered): ↓ waste of citizen's time in lines for appointments and referral
- 9. ↓ wasteof staff time in search of critical information
- 10. ↓ duplicationof tests, medications and procedures
- 11. ↑ earlydetection and prevention
- 12. ↑ adherenceto therapeutic protocols
- 13. ↓ risk of adverse events and medical errors
- 14. ↓ avoidablehospitalization and mortality
- 15. Total loss: £ 12 billion in 10 years
- 16. Total loss: notpublished (6 years)
- 17. Total loss: US$200million (13 years)
- 18.
- 19. Introduction Currently, medicalrecords have a chaotic mixture of old (paper) and new (computer) support medias
- 20. The electronic recordsalready implemented seldom follow any of the ISO TC 215 recommendations or any other standardization
- 21. The mixture ofincompatible systems runs across the entire system: from inside the hospitals up to the local, regional, national and international levels
- 22. The reality ofBritish NHS = The reality of American Medicare = The reality of Brazilian SUS etc.
- 23. Hardware is notthe problem anymore
- 24.
- 25.
- 26.
- 27.
- 28.
- 29. Where is thecontext?
- 30. Here is thecontext!
- 31. IHE HL7 IHTSDOISO WHO CEN ASTM Documents Security Services Content models Terminology Thanks to: Thomas Beale (openEHR Foundation) SNOMED CT ICDx CDA EN13606-1 CCR v2 messages v3 messages Data types PDQ CCOW HSSP PIX HISA RID XDS PMAC EN13606-4 RBAC EN13606-3 EN13606-2 Templates
- 32.
- 33. Traditional Modeling Informationis modelled to “serve” the current needs of the healthcare system; but those needs change very fast and they are very different from one facility to another
- 34. Adding new conceptsand “customizing” a legate system for another facility demands the total re-make of the system (re-modelling, re-implementation, re-test, re-deployment)
- 35. Unaffordable costs, frustratedusers, abandonment of the systems (average time = 2 years)
- 36. Multilevel Modeling Thisapproach is compliant to the ISO 20514 standard
- 37. Multilevel Modeling FundamentalPrinciple: separation between the Reference Model and Knowledge Modeling
- 38. The Reference Modelis a necessary and sufficient set of generic classes for the persistence of all types of health information
- 39. The Knowledge Modelingis the combination of the Reference Model classes and the definition of constraints to those very classes, enough to define a given healthcare concept
- 40. Multilevel Modeling ReferenceModel Knowledge Modeling Your Application (GUI, BI etc)
- 41. Multilevel Modeling SpecificationCompliance to Standards Open Implemented open EHR Inspired ISO 20514, 18308 and 13606 “ Yes“ “ Yes“ (RM and KM tools = Yes) MLHIM Inspired by ISO 21090, 20514, 18308 and 13606 and W3C specs YES RM and KM tools
- 42. open EHR ReferenceModel (High level structure) Composition
- 43. open EHR ReferenceModel (Low level structure)
- 44. “ Nanos gigantiumhumeris insidentes” Bernard of Chartres
- 45. “ Make thingsas simple as possible, but no simpler” Albert Einstein
- 46. MLHIM Reference ModelCCD CareEntry or AdminEntry Cluster Cluster ...and its child classes ...and its child classes
- 47. Knowledge Modeling inMLM Name (Spec) Architecture Open # of KM artifacts / concept Solution for Cavalini's conjecture Combination of KM artifacts Open Archetype ( open EHR) Archetype Definition Language “ Yes“ One Specialisation Templates “ Yes” Concept Constraint Definition – CCD (MLHIM) XSD Yes Undefined No restriction for the # of CCDs / concept Master CCD Yes
- 48. open EHR archetypesand MLHIM CCDs Analogy: Lego ®
- 49. open EHR archetypesand MLHIM CCDs Archetype / CCD Concept
- 50. MLM Principles andOS Principle 1: The Reference Model is language-agnostic and common to all implementations
- 51. Principle 2: TheKnowledge Modeling artifacts should be valid against the Reference Model Principles 1 an 2 require open specifications and strongly support open source implementations of the RM and open source KM tools
- 52. MLM Principles andOS Principle 3: The Knowledge Modeling artifacts should contain all the semantic context of the information
- 53. Principle 4: TheKnowledge Modeling artifacts are shareable among applications Principles 3 and 4 strongly support open instances of KM repositories
- 54. Bioethical Principles andOS Principle of Beneficence and Non-Maleficence ( primum non nocere ): bad health informatics can kill (http://iig.umit.at/efmi/badinformatics.htm)
- 55. Principle of Efficiency(or cost-effectiveness): IT adoption in healthcare is a healthcare intervention such as drugs, lab tests etc and it should be submitted to the same scrutiny The principles of Beneficence / Non-Maleficence and Efficiency strongly support the adoption of OS MLM-based applications in healthcare
- 56. Thank you! Joinus: Visit us: http://macc.lncc.br http://www.mlhim.org My e-mail: lutricav@vm.uff.br Special acknowledgements: Sergio Freire Mike Bainbridge