EHR/CR InfoStructure

Code versus Id

2009-11-28T00:15:00.000-08:00

Why is it so difficult to see the difference between code and id?
Even in standards they mix the two. RFC3881, a standard for Audit Messages in Healthcare Applications used in NEN7513 and IHE ATNA, uses it wrong. Specificaly on EventID were the attributes are CodeSystem, etc, so it should be called EventCode.
In the ISO Datatypes used in HL7 there are two datatypes, namely II (Instance Identifier) and CD (Concept Descriptor).
I think the distinction is clear. There are codes for kinds of animals, and each animal has its own id in the form of a name. So my cat(==code) her name(==id) is Michi.
That's all folks.

Livescribe Podcast Recorder

2009-09-07T11:36:00.000-07:00

This pen also works great as a podcasts recorder! You can use the internal microphone or the 3D microphone/earphone.
The audio is in aac format and can be saved as wav from the sessions view in Livescribe Desktop or you can just search for the aac file and convert it.
Here is how using the aTunes 1.13.1 (== great audio player/manager) command line tools in the win_tools directory:

Convert the aac to a "audiodump.wav" file:
mplayer c:\My Lifescribe\Library\...\Sessions\audio-#.aac -ao pcm:fast -vc null -vo null

Encode to mp3:
lame audiodump.wav audiodump.mp3 --tl [album name] --tt [title] --ta [artist] --ty [year]

Et voila. You got the audio as a mp3 file ready for publishing and listening on your mp3 player!
On to my first Healthcare IT podcast ;-) Don't even know if anyone is interested in healthcare standards news as a podcast... but I sure want it. There is so much happening on and so little time to read all the news...

Livescribe Talking Pen First Contact

2009-08-19T00:18:00.000-07:00

Finally, almost half a year of searching for a way to get the pen in the Netherlands further; I got it on my desk!
Installing the software was easy, but then came the message "There is an important firmware upgrade...". I decided to just install it at once. Waiting, waiting, waiting.... the pen reboots and.... nothing :-(
When I used the pen, it just said "install the software..." or something like that.
Now here is why: After installing the firmware "System file" you see the pen reboot, the Livescribe logo appears and after that the time is displayed. The Livescribe Desktop now emulates a remove/reinsert of the USB device and waits for a signal that never comes on my laptop/USBport. The fix is easy, just take the pen of the cradle and put it back on again. Then Livescribe Desktop will finish the upgrade!

Up to the next challanges: writing a penlet and creating my own paper!

Paperless EHR in 1961!

2009-08-14T00:42:00.000-07:00

Great to see how far we have come. In almost 50 years of development we still want the same: "Paperless healthcare". And we still have miles and miles of paper archives... Something is very wrong here.

Services are brewing @ HL7 v3 2.0

2009-05-20T11:35:00.000-07:00

During the last few HL7 Work Group Meetings I noticed something is brewing. Specifically there are a lot of discussions on the Services (SOA) paradigm. At the last WGM in Kyoto (may 2009) someone even said "Messaging is dead, long live messaging". Originally HL7 was focused on messages and documents. The current Service idea synapse was not firing yet. The current state of technology has changed enormously since then. Most of the current ISVs are moving toward Services, even in healthcare IT. But where is HL7 in this? HL7 v3 is a perfect Common Information Model for an SOA! But HL7 v3 needs to accept and embrace the WS-* standards. The Architecture Review Board Workgroup of HL7 is working on this. They are creating the Service Aware Enterprise Architecture Framework (SAEAF) which will take HL7 v3 into the Services era.

See also: Joint OMG/HL7 Project.

XMI, UML, EMF

2009-04-29T13:20:00.000-07:00

I was trying to figure out the relationship between XMI, UML, EMF and Enterprise Architect (EA) XMI export. How was it possible that Eclipse was unable to read an EA UML XMI export. Now I know. EMF Ecore uses XMI to store the model. EA uses XMI to store the UML. The UML XMI is something completely different than Ecore XMI. The picture made it all clearer for me. If I want Eclipse to read the UML models from EA, I need the UML2 plugin from the Eclipse Modeling Framework. XMI and UML XMI are from OMG and Ecore is from Eclipse. UML2 is an implementation of UML XMI.

Clinician Desktop - New Software Paradigm?

2009-02-16T11:14:00.000-08:00

I often ask myself the question if it is the time for a new kind of software for healthcare. America and others are investigating if Open Source software is an option for EHR Systems. I think the question should be different.
In the Netherlands hospitals are doubting if they should develop their own software or if they should buy a complete solution like McKesson Horizon, Alert, Epic, iSoft Lorenzo, Microsoft Amalga or Siemens Sorian.
They should not be looking for a complete EHR system in the commercial nor the open source space. They should ask/look for framework software that delivers all the basic functionality that healthcare providers need. They should not be forced in processes that happen to be implemented in the software. The software should support their own processes and way of work. The software should be flexible and help them.
I think you will always be developing your own solutions, so you need more than just a programming language or framework like Java or .Net. You will need a healthcare framework that understands the basis healthcare information concepts like Detailed Clinical Models, Care Pathways, Clinical Research Queries, etc.
It should be a Clinician Desktop.

Yes I Can ... CDA R2!

2009-02-02T12:20:00.000-08:00

At the HL7 Work Group Meeting in Orlando, FL January 15, 2009 I did the CDA R2 exam and now I may call myself a "Certified CDA R2 Specialist" (the list)!
It is a confirmation that I know CDA R2. The Monday after the WGM I got a mail telling me I had passed the exam. And 2 weeks later, just as I was told, I received the certificate and the pin. I think HL7 does a good job on this.
Some may think a certificate is not saying much, but I really think the exam tests your knowledge to use the CDA R2 and not just that you can learn well. Furthermore it is not just a test of CDA, but also of the RIM and interpreting the DMIM diagrams.
Just to be sure I was prepared I also followed the excellent CDA Advanced tutorial by Bob Dolin and later the CCD tutorial. In my hospital I created a CDA Implementation Guide for archiving and sending clinical documents. At the moment we are working on a SemanticSOA which uses something similar to the CDA R3 Model as it's Common Information Model. See also this great blog entry about the future roadmap of CDA R3/CCD by Rene Spronk.

HL7 Standaardisatiedag 10-12-2008 RIMBAA

2008-12-21T02:01:00.000-08:00

Het was weer een mooie dag. Veel gepraat en veel herkenning. En natuurlijk liepen de presentaties weer allemaal uit ;-) Bij de pizza party achteraf weer hele goede discussies gehad over vooral Detailed Clinical Models. Daar gaan we meer over horen!

2008 12 10 HL7 RIMBAA

View SlideShare presentation or Upload your own.

ESB is NOT a product

2008-12-08T13:16:00.003-08:00

The most common mistake with an Enterprise Service Bus is thinking it is a product. This, of cource, is not true. ESB is a pattern witch is a combination of capabilities. Some vendors do sell a product that has all the capabilities implemented. Like with an SOA... you cannot buy an ESB, you have to think ESB.
Also see the great presentation The Role of the Enterprise Service Bus by Mark Richards.

Access to Healthcare Records

2008-09-08T12:12:00.000-07:00

I got the Microsoft Architecture Journal #16 in the post and found a great article in there about 'Federated Identity and Healthcare'. It also talks about the tight security Austria knows and the Netherlands is talking about.
I think they make it to much a hassle to get to the patients information. I personally don't care what healthcare professional accesses my health records. I just want them to make be better and I know that they need information about my medical history to do so.
The only restriction for me is that I want to see who did access my health records and when. Even in case of research they may use my health records as long as it is guaranteed to be anonymized.

Preferred number in ISO II datatype

2008-08-28T05:58:00.000-07:00

I was asking myself the question of how to indicate a preferred number (NL:voorkeursnummer) for de id values of a Patient. And of course there is an answer for that:

"II.displayable: Specifies if the identifier is intended for human display and data entry (displayable = true) as opposed to pure machine interoperation (displayable = false)."

-- Source: HL7 Implementation Guidance for Unique Object Identifiers (OIDs), Release 1

NHS Connecting for Health: NHS of the future

2008-08-11T23:22:00.000-07:00

Great video about how we (IT) can help making healthcare better.

Top 10 SOA-Valkuilen

2008-07-14T00:15:00.000-07:00

Not invented here syndroom
Security
Incorrect Granularity of Services
SOA does not solve complexity automatically
Big Design Up Front (BDUF)
Incorrectly applied Canonical Data Model (CDM)
Missing skills
Unclear ownership / Project based funding
Ignoring culture when introducing SOA

Ad puntje 6: Ik zie liever het gebruik van Canonical Information Model (CIM). In de data zit informatie. Met alleen data heb je alleen een brij van getallen en letters. Met informatie staan er Nederlandse zinnen. In informatie zit de syntax en semantiek ook verwerkt. Het gaat in SSOA (Semantic SOA) juist om informatie!

Bron: Computable

HL7 UML Conventions for Derived Information Models

2008-07-11T13:50:00.000-07:00

I received the Formal Namers documentation on the tooling hl7 mailinglist and there was a section on HL7 UML Notation and what it failes to illustratie. For most of the issues I found a solution or workaround using Enterprise Architect:

The associative function of the "arrow classes" > Cannot be fixed

The cardinality constraints imposed on attributes > Attributes / Details / Multiplicity

The appearance constraints (mandatory and required) imposed on attributes.. > Add '*' to attribute name

Vocabulary domain constraints applied to classCode, typeCode and moodCode values which establish the essential semantic meaning of each class > Initial value

The coding strength constraint applied to coded attributes > Include in attribute type

Infopath Template Parts impossibilities

2008-07-08T10:16:00.000-07:00

We tried to use Infopath forms to be composed out of Infopath Template Parts. Each Template Part is a Section that represents the UI of a HL7v3 Template. To our surprise all functionality is stripped from Template Parts. E.g. it is not possible to add datasources that submit data and it is not possible to add script to e.g. validate input. Short summary, for now Infopath 2007 Template Parts are useless to us and the only alternative is to generate xsn's on the server side.

See Features that are unavailable in template parts.

Kenn Lunn (NHS) - Healthcare Service Bus

2008-07-06T02:53:00.000-07:00

Integrating Standards to Achieve Semantic Interoperability (pdf). In deze presentatie over de HealthCare Service Bus zoals de 'NHS Connecting for Health' dat ziet. Hier wordt het concept wel heel volledig uitgelegd.
Fantastisch om te zien hoe een ander op dezelfde visie uitkomt als de Ziekenhuis Service Bus (artikel uit thema uitgave HL7 Magazine nr.5).

JAXB icm JAX-WS bugjes?

2008-07-06T02:31:00.000-07:00

Volgens mij heb ik 2 bugs gevonden in JAXB en JAX-WS in Java 6u10. Namelijk:

Ik weet niet precies wat het doet, maar voor e.g. recordTarget wordt een JAXBElement gebruikt, en dat geeft niet het gewenste resultaat. Dus ik heb het hele (lastige) JAXBElement stuk weggehaald en dan werkt het wel goed in Java en in .Net

Bij Observation.value wordt met xsi:type het type van de value opgegeven, alleen in de combinatie JAXB en WebService (JAX-WS) gaat het mis. De datatypes zitten in namespace hl7.org, maar ze hebben daar geen annotatie voor, JAX-WS "vergist zich" dan in de namespace en maakt er store.hl7.umcg.nl van. En dan kan hij het type dus niet vinden. Ik heb handmatig de annotatie van de datatypes uitgebreid met de namespace attribute en voila!

Zie ook HL7Book.

UMCG HL7v3 Templates

2008-07-06T02:26:00.000-07:00

Het had wel wat voeten in de aarde, maar het is gelukt!
ASP.NET 3.5 WebSite die een JAX-WS HL7v3 CDR Service aanroept.

Goed stuk over Microsoft SOA

2008-07-06T02:25:00.000-07:00

Bron: Microsoft SOA: a failure to communicate..

Een stukje eruit, maar de rest is ook het lezen waard!

"Microsoft is open when it comes to other objects and formats coming into their environment, but the stuff doesn't go out nearly as easily," he said. "There isn't really heterogeneity in principle. It's strategy really still favors Microsoft trying to grow its footprint at the expense of the larger SOA ideals, which is that it shouldn't matter what goes in and what goes out. What should matter is the ease of creating business processes that can extend across multiple environments, data types, application silos, and formats."

Wij weten er alles van. Een voorbeeld van bovenstaande quote is het feit dat SharePoint wel een WSRP Client (Portlets integreren in SharePoint) heeft, maar geen WSRP Server (WebParts in een andere Portal).

Wel grappig dat wij ook andersom bewijzen. Wij gebruiken de SharePoint WebServices om SharePoint lists in P+ te tonen!