Title: Update to HL7
1Update 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
2Project 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
3Project 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)
4Project 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.
5SAGE 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
6SAGE 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.
7Imagine 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
8Conceptual 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
9SAGE Challenges Guideline Deployment Concepts
Local Clinical Information System
- Guideline goals
- Guideline context
- Guideline actions
- Guideline decisions
CIS Order Entry
Local CIS Resources
10Imagine if . . .
11SAGE 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)
12Requirements AnalysisWork Cycle
- Select initial generic guideline
- Define/storyboard specific scenarios
- Model and evaluate user interactions
- (Mayo Usability Laboratory)
- Document use cases
- Perform UML Modeling
13Selecting 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.
14What 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
15Requirements 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?
16Making Guideline Content Specific Enough to
Encode and Execute
Generic Immunization Guideline
Scenario Outpatient Visit
Scenario Pediatric Inpatient
- Text-based
- Specificity Added
- Clinical context
- Care setting
- Care roles
- Care work flow
- Decision logic
- Actions defined
17Specify Guideline Scenarios
- Completed with Clinician input.
- Modeled initially using PowerPoint slides
18Model 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
19Usability Lab Evaluation
- Done using scenarios and prototypes
- Performed at Mayo Usability Laboratory
20Usability Lab Evaluation
- Done using scenarios and prototypes
- Performed at Mayo Usability Laboratory
21Use Case Documentation
22UML Modeling
23SAGE 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.
24Thank You www.sageproject.net