Terminology and code system services in Finland CTS

1
Terminology and code system services in Finland
CTS

• HL7 WGM meeting, Noordwijkerhout,
• May 2005
• Juha Mykkänen (includes material from various
  other people)
• University of Kuopio, HIS R D Unit
• Finland
• SerAPI project www.centek.fi/serapi

2
This presentation

• Overview of two terminology-related developments
  in Finland
• national code server
• API interfaces for centralized terminology
  services (CodeAPI)
• Relation to CTS and future

3
Recent developments in Finnish healthcare IT

• National project for health reform started in
  2002
• has strong NHII component
• focuses in achieving interoperable EPR/EHR
  systems, HL7 CDA has a strong role
• other IT components code service, security,
  identification, regional systems, archives
• project schedule till the end of 2007
• Many R D activities, including National
  Technology Agency TEKES FinnWell-programme
• Regional systems and projects, now related to the
  two above

4
National Architecture 2005 (proposal)
User devices (PC, PDA, GPRS, GSM)
Network
Desktop
Organizational information system services
User Interface
Electronic consumer services (Call/Contact
Centre, Regional booking, etc
Desktop integration
Short-time archive Long-time archive (text,
imaging, signals, approvals, refusals, log)
Name server (OID)
Reference system (references, service chains,
adapters)
Code server
Security
Message exchange (SOAP)
Regional services
National services
Portals
Certificates of professionals
Population centre
Centre of prescriptions
Centre of certificates
Statistics
Code server
Name server (OID)
Kauko Hartikainen
5
National Code Server

• (note no speaker affiliation, thanks to
• Matti Ojala/Stakes,
• Timo Pessi/Datawell and
• Jari Lehtonen/Stakes)

6
National code server background and status

• part of National Health Project (Ministry of
  Social Affairs and Health)
• subproject in National Research and Development
  Centre for Welfare and Health (STAKES) 2003-2004
• Purpose national digital updating and
  distribution system for terms, glossaries,
  classifications and related codes
• Running since 2004 at http//koodistopalvelu.stak
  es.fi
• now 20 code systems in production environment
• e.g. ICD-10, Medical procedures, Lab test and
  physiotherapy nomenclatures, several HL7 2.3
  classifications etc.

7
Why code server?

• 1. Makes glossaries, classifications and codes
  better available and updated
• 2. Improves cooperation and boosts productivity
  in the social and health care service chains,
  compilation of statistics, monitoring, planning
  and sharing of information systems
• 3. Enables crossing of boundaries between
  sectors, service providers, units and information
  systems
• 4. Enhances electronic service production in the
  social and health care sector
• 5. Supports the creation of new operating models
  in the social and health care sector
• 6. Supports information system developers in the
  social and health care system who need
  classifications, codes, glossaries or data on
  organization units
• 7. Helps in developing electronic processes in
  the social and health care service system,
  putting functions online or reaching out
  digitally to new interest groups and user groups
• 8. Helps in harmonizing information structures
  using classifications, codes, glossaries or
  organization unit data in social and health care
  sector information systems
• 9. Creates a foundation for the development of
  information management tools for instance with
  keywords
• 10. Links the national code service to
  international code servers.

8
CodeServer - description

• CodeServer is used to create, save and update
  code sets and to publish them for health
  professionals and information systems
• CodeServer is browser-based - distributed
  maintenance to various organizations responsible
  of different code sets
• Modifications are in one location, which eases
  the maintenance and improves information quality
• Code set transformations between different
  systems
• Includes interfaces to distribute codes to
  external systems

Timo Pessi, Datawell
9
Provided functionality

• Creation, copying and modification of code sets
• Search and browse
• Code set versioning
• Validity time definitions
• Documentation and tracking of changes
• Support for multiple languages
• Support for hierarchical organizations and
  classifications
• Definition of mappings, links and synonyms
• Support for local elements
• XML/SOAP interfaces for direct integration to
  other IS
• Exporting functionality, web publishing, e.g.
  Ecomed, Excel, SAS, XML formats
• File import for code set producers

Timo Pessi, Datawell
10
Codeset export / import interfaces

• XML messages for transferring codes from national
  server to regional or local applications
  available through HL7 Finland
• other direction also planned e.g. for
  organizational units
• use SOAP envelope same way as CDA (R1 and R2)
  adapters in Finland
• dataset (reference elements)
• major uses
• import all / new or changed codes for a given
  code system

11
Example

• lt!DOCTYPE document (View Source for full
  doctype...)gt
• ltdocumentgt
• ltheadergtStakes koodistopalvelin ohjelmisto
  Datawell CodeServer x.x 22.09.2003lt/headergt
• ltbodygt
• lttermSystem id"1.2.246.537.6.1.1996"
  language"fi" createDate"1996-10-01"
  beginDate"1996-10-01"
• 
  expirationDate"2005-12-31" lastModifedDate"20030
  915" lastModifedBy"Stakes"gt
• ltatribute type"longname" dataType"ST"
  language"fi"gtICD 10 1996lt/atributegt
• ltatribute type"maintainer"
  dataType"ST" language"fi"gtStakeslt/atributegt
• lttermItemEntry id"C00-D00"
  language"fi" createDate"1996-10-01"
  beginDate"1996-10-01"
• expirationDate"2005-12-31"
  lastModifedDate"2003-09-15" lastModifedBy"Stake
  s"gt
• ltatribute type"shortname"
  dataType"ST" language"fi" createDate"1996-10-01
  "
• beginDate"1996-10-01"
  expirationDate"2005-12-31" lastModifedDate"2003-
  09-15"
• lastModifedBy"Stakes"gtkas
  vaimetlt/atributegt
• ltatribute type"hierarchylevel"
  dataType"ST"gt4lt/atributegt
• lt/termItemEntrygt

12
CodeAPI interfaces

• shared services for applications using code
  systems

13
Background PlugIT project
www.plugit.fi
Natl. healthcare programme / National EHR project
3 univ. depts, 1 polytechnic
12 applications vendors, 3 technology vendors
6 hospital districts, 2 municipalities

• National RD project to develop integration
  solutions for healthcare
• Results Service specifications, integration
  methods, centre of expertise
• Oct 2001Aug 2004, about 15 full-time 15
  part-time researcher/developers
• Budget 2 million, 84 by National Technology
  Agency TEKES

14
Shared terminologies and code systems for
applications

• National Code server
• browser version in use, more code sets added to
  the service (including ISO OID provider
  identification)
• message definitions to transfer code sets to
  different systems
• PlugIT common service interfaces, one of which
  deals with code systems (CodeAPI)
• centralized functionality (and data), decrease
  overlapping functionality / maintenance /
  implementation
• application-oriented, user activity-related API
  interface operations
• search, listing, browse operations on different
  levels (hierarchies, several languages etc.)
• different types of interfaces in above two
  services
• import code sets from centralized (e.g. national)
  service
• use (and possible refer to) codes from
  centralized (e.g. regional/organizational(
  service
• both available also through HL7 Finland

15
(No Transcript)
16
CodeAPI Relation to other specifications

• Used
• Code transfer messages (HL7 Finland Open CDA
  project / national code server)
• information contents of the national code server
  enables conformance levels in CodeAPI
• same XML elements used where possible
• less coding especially in software which uses
  national code server and offers CodeAPI
  interfaces for local applications
• authorized central code service (e.g.
  regional), specific operations for applications
  as readily-made services (search, list, browse,
  etc.)
• OMG Terminology Query Services (TQS)
• used as a functional basis however, only subset
  of functionality needed in PlugIT project
  decision not to use IDL (tool dependencies,
  technology transition)
• other PlugIT services (user, access rights,
  patient etc.)
• same technology and content conventions, no
  dependencies
• HL7 Common Terminology Services (CTS)
• found extremely useful, details follow

17
CodeAPI specification v2.0
1 Introduction and scope 2 Background (TQS, HL7v3
data types related to codes, HL7 CTS, National
code server, OID) 3 Specific integration
requirements 4 Technology neutral interface
definitions (version 1) 5 Technology-specific
interfaces based on XML and http (version 2) 6
Content specifications connecting the interface
to different code set contents 7 Implementations
and further development Appendices Data
elements in national code server and HL7
MDF Listing of operations Summary of requirements
on different conformance levels Summary of XML
elements

• normative 5-6, appendices 2-4
• informative/background 1-4,7, appendix 1
• most suitable level for international
  harmonization 3-4?

18
Conformance levels v2.0

• 3 API interfaces CodeService, Codeset, Code
• minimum level
• only the most necessary operations for
  centralized code set services for easy
  connectivity with existing applications bind to
  code set, bind to code, list codes, minimum
  information content (code designation), get
  designation by code, get code by designation
• base
• in addition to minimum level search capabilities,
  metadata about supported code sets and services,
  administrative information about service and code
  sets
• multilingual
• support for different languages in designations
  and other information
• hierarchy
• status
• by default, also local and removed codes are
  also returned
• freeElements
• in addition to minimum information, other
  available elements for code entries for different
  operations
• advSearch
• more advanced search capabilities, substrings,
  keywords, search from arbitrary elements,
  multiple search keys etc.
• conformance levels can be used on service or code
  set levels

19
Interfaces and operations v2.0

• CodeService interface
• GetSupportedCodeSystems base level
• GetSupportedServices base level
• GetInfo base level
• Codeset interface
• LookupCodesByDesignation minimum level
• ListCodes minimum level
• LookupCodes base level
• GetSupportedCodesetServices base level
• IsCodeValid base level
• GetCodesetInfo base level
• ListLanguages multilingual
• GetHierarchyDepth hierarchy
• GetCodes freeElements
• GetSupportedAttributes freeElements
• Code interface
• GetDesignation minimum level
• GetParent hierarchy
• GetHierarchyLevel hierarchy

20
Content specifications

• How to connect a given code system to the
  interface
• where to get code, designation, language etc
• content specification is separate from the
  interface, ideally one official authoritative
  content specification for each code set
• same interface for different code sets
• CodeAPI v2 ICD-10 content specification
• mapped to national code server data elements and
  format provided by the National Research and
  Development Centre for Welfare and Health
  (STAKES)
• additional content specifications
• e.g. for other code sets in the national service

21
CodeAPI Example search operation on mimimum level

• lt?xml version1.0 encodingUTF-8?gt
• ltrequest xmlnsurnplugitCommonServicesgt
• ltinterfacegtCodesetlt/interfacegt
• ltmethodgtLookupCodesByDesignationlt/methodgt
• ltparamgt
• lttermSystem id1.2.246.537.6.1.1996lt/termSyst
  emgt
• ltfindgt
• ltmatchTextgtlavantautilt/matchTextgt
• lt/findgt
• lt/paramgt
• lt/requestgt
• lt?xml version1.0 encodingUTF-8?gt
• ltresponse xmlnsurnplugitCommonServicesgt
• ltterm idA01.0gtLavantautilt/termgt
• lt/responsegt

22
CodeAPI Example search operation (used levels
advanced search, freeElements, multiligual,
status, hierarchy)

• lt?xml version1.0 encodingUTF-8?gt
• ltrequest xmlnsurnplugitCommonServicesgt
• ltinterfacegtCodesetlt/interfacegt
• ltmethodgtLookupCodeByDesignationlt/methodgt
• ltparamgt
• lttermSystem id1.2.246.537.6.1.1996/gt
• ltfindgt
• ltmatchText languagefi partial2gtavantautlt
  /matchTextgt
• ltstatusgt1lt/statusgt
• ltlocalgt0lt/localgt
• ltparentIdgtA00-A09lt/parentIdgt
• lt/findgt
• ltsortBygtidlt/sortBygt
• ltdisplaygt
• ltpropertyCodeListgt
• ltpropertygtshortnamelt/propertygt
• lt/propertyCodeListgt
• lt/displaygt
• lt/paramgt

lt?xml version1.0 encodingUTF-8?gt ltresponse
xmlnsurnplugitCommonServicesgt
lttermItemEntry idA01.0gt ltatribute
typeshortname languagefigtLavantautilt/atribut
egt lt/termItemEntrygt lttermItemEntry idA01.1
gt ltatribute typeshortname
languagefigtPikkulavantauti lt/atributegt
lt/termItemEntrygt ... lt/responsegt
23
HL7 CTS relationship

• CTS was discovered when specifying version 2 of
  CodeAPI ? operation harmonization for CodeAPI v2
• CTS messaging API, Vocabulary API, IDL
  interfaces
• CTS reference model is more abstract than in
  CodeAPI
• interface technologies
• CTS IDL interfaces (with IDL? Java ?WSDL
  (rpc/encoded style over http) examples
• CodeAPI XML-wrapped operations (over http)
  WSDL available for other PlugIT common services
• CTS no content specifications, recommendation to
  use HL7 ConceptProperty codeset

24
Initial comparison / CTS / CodeAPI

• semantic correspondence to all operations in CTS
  Vocabulary API (except AreCodesRelated) can be
  found in CodeAPI operations
• national code server information has resulted in
  more specific (and numerous) operations and
  levels in CodeAPI than in CTS
• not many CTS Message API operations in CodeAPI
  (ValueSet, VocabularyDomain etc.), simple
  reference model and interfaces in CodeAPI no
  mapping, code relationships etc.
• differences etc. whether to return only code id
  or also designations elements for different
  conformance levels in CodeAPI
• hierarchy / local / status / etc. features as
  direct parameters in CodeAPI (can be used through
  reference model, relationships etc. in CTS?)
• direct use of national code server XML elements
  in CodeAPI
• IDL interfaces in CTS (example of Java and
  WSDL), XML specifications in CodeAPI
• OID in code set identification in both
  specifications
• id value in code identification in both
  specifications (no CORBA-type object references
  etc.)
• CTS Conformance runtime and browser separately
  for Message and Vocabulary API
• CodeAPI Conformance several conformance levels
  for different functionalities

25
End of monologue
26
Possibilities / discussion

• comparison of requirements for CTS II and CodeAPI
  (Finland) to find possible candidates for new
  features or needs (for CTS II Vocabulary API?)
• examples, use cases (or conformance levels) for
  CTS II Vocabulary API (see conformance levels in
  CodeAPI) also discussed in CTS (to get new
  users up to speed)
• walkthrough of export / import interface of
  national code server
• link to infrastructure work in HL7/OMG Healthcare
  Services Specification Project
• note both national code server and CodeAPI
  interface specifications are in Finnish
• but requirements, functionality and products are
  generic / international?
• SerAPI project (SOA / web services focus)
  participates in Service Specification Project,
  HL7 Finland (Common Services SIG)

27
Dank u
www.uku.fi/tike/his/serapi/ www.plugit.fi/

• SerAPI project participants National Technology
  Agency TEKES (grant no 40437 / 04), Medici Data
  Oy, Datawell Oy, Fujitsu Services Oy, Hospital
  district of Northern Savo, WM-data Oy, Commit
  Oy, Intersystems B.V. Finland, Mediconsult Oy,
  Microsoft Oy, Oracle Finland Oy, Hospital
  District of Satakunta, Bea Systems Oy, Hospital
  District of Helsinki and Uusimaa, City of Kuopio,
  Kustannus Oy Duodecim, Mawell Oy

Juha.Mykkanen_at_uku.fi