ART DECOR:an XML framework for

medical metadata

Marc de GraauwXML Amsterdam 2013

What we’ll cover

• The problem domain– medical procedures and knowledge– healthcare IT standards (HL7, Snomed, ...)– expertise involved (IT, doctor, terminologist)

• The solution– XML data model (DECOR)– XML tooling to edit (ART) – different views and output formats – code generation

• Pros and cons of an all-XML solution

A use case• Dutch colorectal cancer screening

– entire population 55+ gets screened– faeces samples collected, tested for blood– if suspect, invitation for colonoscopy– gastro-enterologist performs colonoscopy, submits findings to registry– if tissue removed, sent to pathologist– pathologist performs macro-/microscopical analysis, submits findings

• Other use cases– Perinatology, Youth Healthcare (Netherlands)– ELGA elektronische Gesundheitsakte (Austria)– QiN KfH Datenaustausch in der Nephrologie (Germany)– epSOS, trans-European medical exchange– many more

Koppelingen

HL7 V3 CDA bericht: Art-decor, via :http://decor.nictiz.nl/art-decor/decor-project--rivmsp-

PROBLEM DOMAIN - MEDICAL

Patient id

Document id

Medication

Observations

Gastro-enterologist

PROBLEM DOMAIN - TERMINOLOGY

Medical terminologies

• LOINC– Logical Observation Identifiers Names and Codes– Laboratorium Observations

• ICD-9, ICD-10• Snomed• Goals:– uniform codes for exchange– enable analysis / statistics

Example valuesetMedical terms

Snomed codes

PROBLEM DOMAIN - ICT

Just enough HL7

• HL7 version 2 : currently used a lot in hospitals• HL7v3:– Reference Information Model – XML serialization– XML Schema– CDA (part text, part structured data)– Slow uptake, new developments

0..*

1 0..*

1

RIM (Reference Information Model) Backbone

Entity Participation Act

ActRelationship

1 1

0..* 0..*

ReferralTransportationSupplyProcedureCondition NodeConsentObservationMedicationAct complexFinancial act

OrganizationLiving SubjectMaterialPlaceHealth Chart

PatientGuarantorHealthcare providerInsurerPractitioner

Role1

0..*

RIM (Reference Information Model)

HL7 in the OID tree

HL7 snippet for Gastro-enterelogical Report

The problem domain:Participants and development cycle

Healthcare

Terminologists

ICT Architects

HL7v3 modellers

Test / Qualification

IT providers

Data Set

THE SOLUTION - DECOR

DECOR overview

DECOR

dataset

project

name

scenario

copyrightversion info

descriptionauthors

issues

value sets

identi-fications

rules

conceptgroupitem

use case

transactionactor

code systemsterminology systems

validation

conditionsconstraints

OID

statusassignment

Example DECOR file

THE SOLUTION - ART

ART - editor

ART - editor

ART demo

DECOR and ART technology

• A DECOR file is an XML file– methodology developed by dr. Kai U. Heitmann– basis for transformations to other HTML / XML– fine basis for schema(tron)– has its own schema (DECOR.xsd)

• ART is tooling to make DECOR files– tooling developed by Gerrit Boers– ART is made with XQuery / XForms– open source products eXist / Orbeon

• ART and DECOR are open source (GPL / LGPL)– team: Kai, Gerrit, Alexander Henket, Maarten Ligtvoet, Marc

Healthcare

Terminologists

ICT Architects

HL7v3modellers

IT vendors

Testing

PERI

JGZ

Spoed

etc..

Stakeholders DECORXML

WEB IN

TERFACE

XForms

XQuery

eXistXM

L database

ARTtooling

THE SOLUTION – OUTPUTS

StakeholdersARTDECOR

HTML

XML

Outputs

Healthcare

Terminologists

ICT Architects

HL7v3modellers

IT vendors

Testing

dataset

project

scenario

issues

value sets

identi-fications

rules

CSV

Care provider view

Technical documentation

XML / CSV resources for implementers

THE SOLUTION – CODE GENERATION

message validation

StakeholdersARTDECOR

Schematron

Schematron generation

IT vendors

Testing

dataset

project

scenario

issues

value sets

identi-fications

rules

XML

OK

?

Schematron / test demo

StakeholdersARTDECOR

XML specs

UI generation

IT vendors

dataset

project

scenario

issues

value sets

identi-fications

rules

UI

USING XML – PROS AND CONS

Application architectures

APP

DB

XML as a storage format

APP

DB

XML

XML as exchange format

APP

DB

APP

DBAPP

XML

Web architecture 2013

Controller

Model

Browser

View

XML

HTMLCSSJS

User Interface Logic

HTMLCSSJS

non-XML vs XML application

XQueryeXist

Browser

XForm

User Interface LogicXML

HTMLCSSJS

Django

PostgreSQL

Browser

Templates

User Interface Logic

XML for application: pros and cons• versatile data structure

– easy to adapt– easy to generate different outputs

• easy to introduce bugs• learning curve

– XQuery: not too hard– XForms: steeper

• harder to debug– less tooling, especially server-side– client-side debugging: you see HTML, not XForm

• procedural versus declarative programming– procedural: here you have an X, multiply by 2 and give it back to me– declarative: if you see an X, multiply it by 2– XML all over the place: it’s magic, and sometimes you don’t get it

• (some) partners have limited XML knowledge• Schematron versus XML Schema

– co-occurrence...– error reporting

QUESTIONS ?