Update to HL7 - PowerPoint PPT Presentation

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Update to HL7

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Title: SAGE VMR Update Author: craig parker Last modified by: gmansfield Created Date: 4/25/2003 2:34:54 PM Document presentation format: On-screen Show – PowerPoint PPT presentation

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Title: Update to HL7


1
Update to HL7
A collaborative project to develop a universal
framework for encoding and disseminating
electronic clinical guidelines
HL7 Working Group Meeting April-May 2003
Guy Mansfield, Ph.D. Health Informatics, IDX
Systems
2
Project Overview
  • An RD consortium to develop the technology
    infrastructure to enable computable clinical
    guidelines, that will be shareable and
    interoperable across multiple clinical
    information system platforms
  • Scope 3 year, 18 M, multi-site, collaborative
    project
  • Partners in the project are
  • IDX Systems Inc.
  • Apelon, Inc.
  • Intermountain Healthcare (IHC)
  • Mayo Clinic
  • Stanford Medical Informatics (SMI)
  • University of Nebraska Medical Center (UNMC)
  • Funded in part by NIST Advanced Technology
    Program

IDX Health Informatics
3
Project Approach
Jim Campbells Taxonomy of Guidelines
SAGE
Level 1 Original text guideline Level 2
Structured markup Level 3 Scrubbed markup
(disambiguated) Level 4 Codified markup
(vocabulary standards) Level 5 Knowledge
markup (structured knowledge) Level 6 Context
markup (specify clinical setting) Level 7
Executable form (deployable knowledge)
4
Project Approach
  • Standards-based Sharable Active Guideline
    Environment
  • Ultimate goal An infrastructure that will allow
    execution of standards-based clinical practice
    guidelines across heterogeneous CIS platforms.
  • Focus is on the goal of active deployment of
    guideline knowledge within the workflow of
    clinical information systems.
  • Employ (and extend where necessary), best
    available informatics standards and controlled
    terminologies.
  • Build on an invaluable foundation of earlier
    research and effort.
  • Close collaboration with leading Standard
    Development Organizations HL7, SNOMED, LOINC,
    others.

5
SAGE Main deliverables
  • An interoperable guideline model A computable
    knowledge representation format for encoding
    the content and logic of executable clinical
    practice guidelines.
  • A guideline workbench A software tool for
    authoring, encoding, and maintaining guidelines
    in the format of the SAGE guideline model.
  • A guideline deployment system Software that
    decodes the content of electronic guidelines
    and surfaces that content via functions of the
    local clinical information system.
  • Controlled resources -- Specification of a
    common layer of information models and
    terminologies to mediate guideline content.

Scenarios HDF
Guideline model components
CIS interoperability specifications
VMR
CEMs
Terminologies
6
SAGE Main deliverables
  • An interoperable guideline model A computable
    knowledge representation format for encoding
    the content and logic of executable clinical
    practice guidelines.
  • A guideline workbench A software tool for
    authoring, encoding, and maintaining guidelines
    in the format of the SAGE guideline model.
  • A guideline deployment system Software that
    decodes the content of electronic guidelines
    and surfaces that content via functions of the
    local clinical information system.
  • Controlled resources -- Specification of a
    common layer of information models and
    terminologies to mediate guideline content.

7
Imagine if SAGE technology were in place today .
. .
Author
Disambiguation, encoding, testing
Consolidated feedback
Research, meta analysis, crafting the guideline
Encode
Feedback
  • Guidelines would be routinely encoded in a
    standard, computable format, and would be widely
    available for downloading.
  • Healthcare organizations would be able to import
    proven guidelines, and execute them via their
    local clinical information systems.

Guidelines.net? Guidelines-R-Us.com?
Publish
Evaluate
Outcomes research
Import
In Practice
Download to local care delivery organization
Guidelines active in local CIS
Install
Clinical editing, guideline set up
8
Conceptual Overview of SAGE Architecture
Guideline content encoded using standard
terminologies and information models
Data queries and decision logic represented using
standard expression language
Expression Language
Common Layer of Terminologies and Information
Models
Care Workflow Model
Medical Ontologies
Patient Data Model (Virtual Medical Record)
Health Care Organization Model
Binding
SAGE Guideline Execution Engine
Local EMR concepts mapped to standard models for
execution
Clinical Information System
Applications
EMR
Standards-based API
9
SAGE Challenges Guideline Deployment Concepts
Local Clinical Information System
  • Guideline goals
  • Guideline context
  • Guideline actions
  • Guideline decisions

CIS Order Entry
Local CIS Resources
10
Imagine if . . .
11
SAGE Project Plan Overview
2002
2003
2004
Aug 03
Jan 04
Jun 04
Nov 04
(timeline approximate)
  • Use Case Prototyping
  • Guideline scenario storyboarding
  • Usability evaluation use case analysis

Use Case Prototyping
Iterative Guideline Model Specification
Continuing Model Refinement
Guideline Model Requirements
End-to-end SAGE Integrated Testing
Iterative Workbench Design and Development
Guideline Workbench Requirements
Iterative Deployment Architecture Development
Deployment System Architecture Design
Deployment System Requirements
Controlled Resources (Phase 1)
Controlled Resources (Phase 2)
12
Requirements AnalysisWork Cycle
  • Select initial generic guideline
  • Define/storyboard specific scenarios
  • Model and evaluate user interactions
  • (Mayo Usability Laboratory)
  • Document use cases
  • Perform UML Modeling

13
Selecting Exemplar Guidelines
Exemplar Guideline Diabetes Management (DBM) Im
munizations (IMM) Community Acquired
Pneumonia (CAP) Total Joint Replacement (TJR)
Clinical Domain Chronic disease monitoring and
treatment. Acute exacerbation of chronic
disease. Chronic disease as a comorbidity. Routin
e health maintenance, in both outpatient and
inpatient settings. Emergency room evaluation
and diagnosis. Outpatient treatment of acute
disease. Inpatient and ICU treatment of acute
disease. Follow-up of acute disease. Surgical
guideline. Comprehensive pre-op workup,
inpatient plan of care, and post-op outpatient
management.
14
What is our Coverage of Universe of Guideline
Content ???
N scenarios for each guideline
DBM
IMM
IMM
DBM
CAP
CAP
TJR
TJR
???
???
Wide Coverage Comprehensive Guideline Model
Narrow Coverage Limited Guideline Model
15
Requirements AnalysisWork Cycle
  • Select initial generic guideline
  • Define/storyboard specific scenarios
  • (clinical setting, roles, context)
  • 3. Model and evaluate user interactions
  • (Mayo Usability Laboratory)
  • 4. Document use cases
  • 5. Perform UML Modeling

Apply HDF 101?
16
Making Guideline Content Specific Enough to
Encode and Execute
Generic Immunization Guideline
Scenario Outpatient Visit
Scenario Pediatric Inpatient
  • Text-based
  • Ambiguous
  • Encoded
  • Executable
  • Text-based
  • Specificity Added
  • Clinical context
  • Care setting
  • Care roles
  • Care work flow
  • Decision logic
  • Actions defined

17
Specify Guideline Scenarios
  • Completed with Clinician input.
  • Modeled initially using PowerPoint slides

18
Model CIS User Interfaces
  • Screens developed using VISIO/HTML
  • Guideline recommendations integrated into a nurse
    care flowsheet
  • View suggested orders
  • Submit suggested orders

Real time access to information potentially via
infobutton functionality
Next Step On to the Usability Lab
19
Usability Lab Evaluation
  • Done using scenarios and prototypes
  • Performed at Mayo Usability Laboratory

20
Usability Lab Evaluation
  • Done using scenarios and prototypes
  • Performed at Mayo Usability Laboratory

21
Use Case Documentation
22
UML Modeling
  • Sequence diagrams

23
SAGE Frequently Asked Questions
  • Is the SAGE project developing guideline content
    ?
  • No. While we are fully characterizing and
    encoding a small set of guidelines to be used in
    our RD work, the main objective of the SAGE
    project is to enable a technology infrastructure
    for encoding and wide-spread dissemination of
    active guideline content.
  • Is the SAGE project developing an IDX-specific
    solution ?
  • No. We are using IDX Carecast as our prototyping
    CIS environment during the project however, our
    goal is a universal infrastructure that will
    allow activation of guideline content in multiple
    HIS vendor systems.
  • Where can I get more information on the SAGE
    project ?
  • Our project web site www.sageproject.net/ is just
    coming online and will provide increasing
    detailed project updates in the near future.

24
Thank You www.sageproject.net
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