Presentation in the 2nd IEEE Biomedical and Healthcare Informatics Conference, Valencia, June 1st-

1. Use of the Data Model
for Communication among Components of a
Distributed Decision-support System
Arturo 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)
International IEEE Conference on Biomedical and Healthcare Informatics
(BHI), Valencia, Spain - June 2 2014

2. 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)

3. THE MOBIGUIDE SYSTEM
International IEEE Conference on Biomedical and Healthcare Informatics
(BHI), Valencia, Spain - June 2 2014 3
DSS
PHR
Computer-interpretable guideline (CIG)
BAN
EMR1
EMR2
Personalized

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

5. HL7 VIRTUAL MEDICAL RECORD
International IEEE Conference on Biomedical and Healthcare Informatics
(BHI), Valencia, Spain - June 2 2014 5
• Two axes: clinical + workflow-related

6. A REAL SCENARIO FROM GDM PRACTICE GUIDELINE
International IEEE Conference on Biomedical and Healthcare Informatics
(BHI), Valencia, Spain - June 2 2014 6
Register diet compliance
pattern detection
(≥2 non-compliance events in 7 days)
DSS recommends the physician sending
feedback to patient

7. A REAL SCENARIO FROM GDM PRACTICE GUIDELINE
International IEEE Conference on Biomedical and Healthcare Informatics
(BHI), Valencia, Spain - June 2 2014 7
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:
+/++

8. A REAL SCENARIO FROM GDM PRACTICE GUIDELINE
International IEEE Conference on Biomedical and Healthcare Informatics
(BHI), Valencia, Spain - June 2 2014 8
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:
+/++

9. A REAL SCENARIO FROM GDM PRACTICE GUIDELINE
International IEEE Conference on Biomedical and Healthcare Informatics
(BHI), Valencia, Spain - June 2 2014 9
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

10. A REAL SCENARIO FROM GDM PRACTICE GUIDELINE
International IEEE Conference on Biomedical and Healthcare Informatics
(BHI), Valencia, Spain - June 2 2014 10
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

11. A REAL SCENARIO FROM GDM PRACTICE GUIDELINE
International IEEE Conference on Biomedical and Healthcare Informatics
(BHI), Valencia, Spain - June 2 2014 11
The physician accepts
the recommendation
and saves an order
into the PHR. Note
that DSS_ID is the
same
ProcedureOrder
Instance
procedureCode:
Notification
(UMLSC0422202)
target: Patient
(UMLSC0030705)
originalText: “…”
DSS_ID (extension):
111

12. A REAL SCENARIO FROM GDM PRACTICE GUIDELINE
International IEEE Conference on Biomedical and Healthcare Informatics
(BHI), Valencia, Spain - June 2 2014 12
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

13. • 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
International IEEE Conference on Biomedical and Healthcare Informatics
(BHI), Valencia, Spain - June 2 2014 13

14. VMR USE AND EXTENSION
International IEEE Conference on Biomedical and Healthcare Informatics
(BHI), Valencia, Spain - June 2 2014 14

15. International IEEE Conference on Biomedical and Healthcare Informatics
(BHI), Valencia, Spain - June 2 2014 15
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)

16. International IEEE Conference on Biomedical and Healthcare Informatics
(BHI), Valencia, Spain - June 2 2014 16
Questions?
Arturo González-Ferrer
arturogf@gmail.com