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Health Level-7
Health Level-7 or HL7 refers to a set of international standards for transfer of clinical and administrative data between software applications used within a give hospital...lets a health system share data across its domains
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Problems with HL7 V3 (4 problems)
- The models and messages were too complex - Average HL7 V3 message had 5–10 times the number of XML nodes as messages in other industries
- The RIM tried to model everything, with maximum extensibility and generality
- The standard lacked a useful mechanism to add extensions
- Documentation was poor
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Fast Healthcare Interoperability Resources (FHIR) was based on
Version 3 RIM
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FHIR Adopts ____ rule to simplify things.
Goal?
- "80/20"
- make life simpler for implementers, rather than for modelers
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FIHR used a ____ approach
- modular
- "Resources"
- Small contained model
- Concepts related to a particular thing
- e.g. medication prescription, adverse reaction
- Discrete, but may reference one another, forming a graph
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FHIR was made to be easily extended by developers at deployment sites. FHIR ____ determine terminologies, restrictions, etc
"profiles"
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HL7 V2, RIM, and FHIR were designed to provide interoperability _____ institutions by modeling individual, clinically relevant concepts.
within
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CDA helps you package up data from one health system so ...
it can be shared with another health system
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Health Information Exchange (HIE) goals (3 things)
- How to package up composite information for transfer *across* institutions?
- Mobilization of patient data electronically across regions, communities, or health-care organizations
- Enables exchange of information across disparate information systems
- Goals are
- To enable more coordinated, timely, efficient care
- To aid public health reporting and clinical research
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CDA (Clinical Document Architecture) is a model for
a clinical document
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CDA (Clinical Document Architecture) based on
RIM
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CDA (Clinical Document Architecture) facilitates exchange of clinical documents ______ health care organizations.
within and between
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CDA (Clinical Document Architecture) is a _______ for marking up narrative clinical reports—putting a wrapper around packages of clinical data
XML-based language,
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CDA (Clinical Document Architecture) allows document text to be marked up with terms from the...
RIM and from controlled terminologies
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Continuity of Care Document (CCD) - A joint effort of ...
HL7 International and ASTM.
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CCD fosters interoperability of clinical data by ...
allowing physicians to send electronic medical information to other providers without loss of meaning and enabling improvement of patient care.
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CCD
Continuity of Care Document
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CCD is an implementation guide for sharing Continuity of Care Record (CCR) patient summary data using the ...
HL7 Version 3 Clinical Document Architecture (CDA)
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ontologies
- formal specification of a shared conceptualization
- Conceptualization: the way we think about a domain
- Specification: formal way of writing it down
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Levels of ontological depth (5 levels)
- lexicon
- simple taxonomy
- thesaurus
- relational model
- fully axiomatized theory
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lexicon
vocabulary, possibly with natural-language definitions
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simple taxonomy
terms with class-subclass relations
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thesaurus
taxonomy plus related terms
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relational model
unconstrained use of arbitrary relations
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Basic Formal Ontology provides an ____ that you can use to combine several lower-level ontologies
upper-level ontology
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Use cases for ontologies (3)
- Share common understanding of the entities in a given domain - Among people, software agents, between people and software
- Enable reuse of data and information - Introduce standards to allow interoperability and automatic reasoning - Create communities of researchers
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Sketch out how you will model the classes for an ontology that will be used to classify and understand the variation in doctor’s notes amongst chronically ill and acutely ill patients.
What are the classes?
- patients - chronically ill, acutely ill
- care providers - doctors, nurses
- notes - histories, updates
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Sketch out how you will model the classes for an ontology that will be used to classify and understand the variation in doctor’s notes amongst chronically ill and acutely ill patients.
What are relationships between classes?
- care providers write notes
- doctors have patients
- notes pertain to patients
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upper-level ontologies
Ontology that consists of very general terms (such as “object”, “property”, “relation”) that are common across all domains
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upper-level ontologies function (3)
- Support broad semantic interoperability among a large number of domain-specific ontologies
- Provides a common starting point for the formulation of definitions
- Domain ontology terms are ranked under terms of upper ontology - I.e. upper ontology classes are superclasses or supersets of all classes in domain ontologies
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upper-level ontologies advantages (3)
- Upper-level classes provide a useful organizing structure
- Upper-level classes minimize the chance of category errors
- Standard upper-level ontologies aid alignment and reuse across ontologies
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Basic Formal Ontology (BFO)
- Small, upper level ontology
- Designed for supporting information retrieval, analysis and integration in scientific and other domains
- Does not contain physical, chemical, biological or other terms that fall within domain ontologies
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ontology engineering: clarity
definitions should be objective and complete
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ontology engineering: coherence
- Ontology should sanction those inferences consistent with the definitions
- No concepts exist that are unsatisfiable (interpreted as a empty set)
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ontology engineering: extendibility
Should anticipate future uses
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ontology engineering: minimal encoding bias
No assumptions about knowledge representation
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ontology engineering: minimal ontological commitment
Say no more than is necessary
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6 steps in building an ontology
- Determine the scope that your ontology needs to cover - Consider how it will be used and how it might need to be used in the future when deciding how detailed you want it to be.
- Enumerate the terms that need to be covered by the ontology
- Define your classes (concepts)
- Define the roles (aka data properties and object properties) of each class
- Define constraints for these properties
- Create instances
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Important ontologies used in biomedicine (4)
- Gene Ontology (GO)
- Foundational Model of Anatomy (FMA)
- MYCIN
- INTERNIST-1/QMR
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Gene Ontology (GO): three ontologies
- 1. molecular function - elemental activity or task, DNA binding
- 2. cellular component - location or complex, cell nucleus
- 3. biological process - goal or objective within cell, secretion
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