International IEEE Conference on Biomedical and Healthcare Informatics (BHI), Valencia, Spain - June 2 2014

Use of the Virtual Medical Record Data Model for Communication among Components of a Distributed Decision-support SystemArturo González-Ferrer, Mor Peleg, Enea Parimbelli, Erez Shalom, Carlos Marcos, Guy Klebanov, Iñaki Martínez-Sarriegui, Nick Lik San Fung, Tom Broens

Special Session on EHR interoperability

International Conference on Biomedical and Healthcare Informatics (BHI)

Partner’s logo2

• UNIVERSITY OF HAIFA (HU), Israel• BEN-GURION UNIVERSITY OF THE NEGEV (BGU), Israel• UNIVERSITA DEGLI STUDI DI PAVIA (UNIPV), Italy • UNIVERSITEIT TWENTE (UT), Netherlands• TECHNISCHE UNIVERSITAET WIEN (TUV), Austria• MOBIHEALTH BV (MHBV), Netherlands• FONDAZIONE SALVATORE MAUGERI CLINICA DEL LAVORO E DELLA

RIABILITAZIONE (FSM), Italy• UNIVERSIDAD POLITECNICA DE MADRID (UPM), Spain• CORPORACIO SANITARIA PARC TAULI DE SABADELL (CSPT), Spain• ATOS SPAIN SA (ATOS), Spain• BEACON TECH LTD (BTL), Israel• ZorgGemak BV (ZORG), Netherlands• ASSOCIACIO DE DIABETICS DE CATALUNYA (ADC), Spain

www.mobiguide-project.eu 6 universities, 4 companies, 2 hospitals, 1 patients association

clinical domains: GDM (Spanish hospital) and AF (Italian hospital)

MOBIGUIDE (2011-2015)

International IEEE Conference on Biomedical and Healthcare Informatics (BHI), Valencia, Spain - June 2 2014 3

THE MOBIGUIDE SYSTEM

DSS

PHRComputer-interpretable guideline (CIG)

BAN

EMR1

EMR2

Personalized

International IEEE Conference on Biomedical and Healthcare Informatics (BHI), Valencia, Spain - June 2 2014 4

• Our presentation focuses on showing how to make the most of the HL7 vMR standard to develop

• A SOA Ubiquitous Guidance System

• Target users: physicians and patients

• Many devices/systems: Smartphone linked to BAN devices, DSS, PHR, EMRs, Caregiver UI, etc.

• The standard is used to store patient data and for coordination between system components

• Manage the complex workflow needed to support guidance of patients, Anytime and Everywhere

INTRODUCTION

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HL7 VIRTUAL MEDICAL RECORD

• Two axes: clinical + workflow-related

International IEEE Conference on Biomedical and Healthcare Informatics (BHI), Valencia, Spain - June 2 2014 6

A REAL SCENARIO FROM GDM PRACTICE GUIDELINE

Register diet compliance

pattern detection (≥2 non-compliance events in 7 days)

DSS recommends the physician sending feedback to patient

International IEEE Conference on Biomedical and Healthcare Informatics (BHI), Valencia, Spain - June 2 2014 7

A REAL SCENARIO FROM GDM PRACTICE GUIDELINE

specification of the non-compliance

event that needs to be detected for the

pattern to be calculated

observationResult instance

observationFocus= increased carbs

SNOMED 123995008

observationValue:

+/++

International IEEE Conference on Biomedical and Healthcare Informatics (BHI), Valencia, Spain - June 2 2014 8

A REAL SCENARIO FROM GDM PRACTICE GUIDELINE

The extended DSS automatically

generates the query and when any

component stores a matching data item

in the PHR a notification event is

sent back to the extended DSS.

observationResult instance

observationFocus= increased carbs

SNOMED 123995008

observationValue:

+/++

International IEEE Conference on Biomedical and Healthcare Informatics (BHI), Valencia, Spain - June 2 2014 9

A REAL SCENARIO FROM GDM PRACTICE GUIDELINE

the extended DSS generates a

recommendation to the caregiver

asking if he wants to send a message

to the patient about the

importance of diet compliance

ProcedureProposal instance

procedureCode:Notification

(UMLS C0422202)

target: Physician (UMLS:C0031831)

DSS_ID (extension): 111

International IEEE Conference on Biomedical and Healthcare Informatics (BHI), Valencia, Spain - June 2 2014 10

A REAL SCENARIO FROM GDM PRACTICE GUIDELINE

this new recommendation is then retrieved from

the PHR by the caregiver GUI

ProcedureProposal instance

procedureCode:Notification

(UMLS C0422202)

target: Physician (UMLS:C0031831)

DSS_ID (extension): 111

International IEEE Conference on Biomedical and Healthcare Informatics (BHI), Valencia, Spain - June 2 2014 11

A REAL SCENARIO FROM GDM PRACTICE GUIDELINE

The physician accepts the

recommendation and saves an order into the PHR. Note that DSS_ID is the

sameProcedureOrder

Instance

procedureCode: Notification

(UMLSC0422202)

target: Patient (UMLSC0030705)

originalText: “…”

DSS_ID (extension): 111

International IEEE Conference on Biomedical and Healthcare Informatics (BHI), Valencia, Spain - June 2 2014 12

A REAL SCENARIO FROM GDM PRACTICE GUIDELINE

The message with the

recommendation is sent to the patient who receives it in the smartphone ProcedureEvent

Instance

procedureCode: Notification

(UMLSC0422202)

target: Patient (UMLSC0030705)

originalText: “…”

DSS_ID (extension): 112

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• The “workflow management” raises new interoperability issues for distributed CDSS while keeping the usual need to link a back-end DSS with a PHR using standards.

• The pattern Proposal-Order-Event can be applied to substance administrations, encounters, observations, etc.

• Pattern Proposal-Result can be issued when no confirmation is required by physicians

• Including propietary extensions (e.g. GL-ID, DSS-ID)

• allows to follow workflow and • identify responses to concrete recommendations

easily

MANAGING CDSS WORKFLOW WITH VMR

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VMR USE AND EXTENSION

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CONCLUSIONS

• We used HL7 vMR to cope with the workflow needs of distributed CDSS with multiple systems and user roles

• HL7 vMR needs to be extended in several cases, but it provides standard mechanisms to include these extensions

• The technical solution showed relates to a concrete DSS (Picard) and a particular guideline, but it could be easily adapted to other architectures and clinical domains

• It is being validated with a pilot implementation of two guidelines within the project (to start in February 2015)

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Questions?

Arturo González-Ferrerarturogf@gmail.com