art decor: an xml framework for medical metadata decor - xml amsterda… · •pros and cons of an...
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ART DECOR: an XML framework for
medical metadata
Marc de Graauw
XML 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 valueset
Medical 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
Act Relationship
1 1
0..* 0..*
Referral Transportation Supply Procedure Condition Node Consent Observation Medication Act complex Financial act
Organization Living Subject Material Place Health Chart
Patient Guarantor Healthcare provider Insurer Practitioner
Role 1
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
copyright version info
description authors
issues
value sets
identi-fications
rules
concept group
item
use case
transaction
actor
code systems
terminology systems
validation
conditions
constraints
OID
status
assignment
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
HL7v3
modellers
IT vendors
Testing
PERI
JGZ
Spoed
etc..
Stakeholders DECOR
XML
WEB
INTER
FAC
E
XFo
rms
XQu
ery
eXist
XM
L d
atabase
ART tooling
THE SOLUTION – OUTPUTS
Stakeholders ART DECOR
HTML
XML
Outputs
Healthcare
Terminologists
ICT Architects
HL7v3
modellers
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
Stakeholders ART DECOR
Schematron
Schematron generation
IT vendors
Testing
dataset
project
scenario
issues
value sets
identi-fications
rules
XM
L O
K ?
Schematron / test demo
Stakeholders ART DECOR
XML specs
UI generation
IT vendors
dataset
project
scenario
issues
value sets
identi-fications
rules
UI
USING XML – PROS AND CONS
Application architectures
A P P
DB
XML as a storage format
A P P
DB
X M L
XML as exchange format
A P P
DB
A P P
DB
A P P
X M L
Web architecture 2013
Con trol ler
Model
Br ows er
View
X M L
HTML CSS JS
User Interface Logic
HTML CSS JS
non-XML vs XML application
XQuery eXist
Br ows er
XForm
User Interface Logic XML
HTML CSS JS
Django
Post greSQL
Br ows er
Tem pla tes
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 ?