Combining Smart Spaces and HL7 Medical standard in telemedicine scenarios

Transcription

1 Combining Smart Spaces and HL7 Medical standard in telemedicine scenarios Mauro Giacomini i, Alessandra Arezza ii, Simone Naso ii, Viola Parodi ii, Roberta Gazzarata i, Fabio Vergari iii, Alfredo d Elia iii, Francesco Morandi iii i University Of Genoa, ii Infinity Technology Solutions S.p.A (ITS), iii University of Bologna, ARCES

2 The main CHIRON objective The fusion of the state of the art technologies and innovative solutions into an integrated framework, creating an architecture applicable to various clinical conditions and in different scenarios, thus harmonizing the needs and interests of all the three main beneficiaries of the healthcare process Statistical Plane Medical Plane : the citizens using the services (user plane), the medical professionals (medical plane) and the whole community (statistical plane). User Plane

3 Our main objective The description of how the Chiron integrated care cycle can be realized through the SMART M3 platform, supporting portable and stationary sensors, measurement instruments and actuators, personal profiling and personalized approaches. According to the existing medical information exchange standards, the communication between the user Smart Space and the medical plane is based on HL7 V3 through the Clinical Document Architecture Release 2 (CDA R2).

4 CHIRON s interoperability approach The sensor network sends data to the middleware which translate its information into HL7 v3 format using nomenclature and code indicated by standardized vocabularies (LOINC, SNOMED). The data in HL7 v3 is now ready to be sent to the Alter Ego. Medical knowledge will be semantically treated by the middleware using archetypes derived from ontologies and standard medical guide lines. In this way the Alter Ego will be able to send and receive information from EPR developed using either HL7 CDA R2 or openehr

5 HL7v3 and CDAr2 HL7v3 is a objects oriented standard and its content is based on the concept of the information model (specifically structured information which is contained within a particular interest domain). CDAr2 is a document markup standard that specifies the structure and semantics of a clinical document for the purpose of exchange. It can include text, images, sounds, and other multimedia content. It can be transferred within a message and can exist independently outside the transferring message. It is encoded in markup languages as XML or RDF. It uses HL7 v3 data types.

6 CDA release2 A CDA document is wrapped by the <ClinicalDocument> element and contains a header and a body. lies between the <ClinicalDocument> and the <structuredbody> elements and identifies and classifies the document and provides information on authentication, the encounter, the patient, and the involved providers. contains the clinical report, organized into sections whose narrative content can be encoded using standard vocabularies. It can be either an unstructured blob or can be comprised of structured markup (<structuredbody>).

7 CDA RIM CDA administrative information and CDA clinical information

8 Focus on observation

9 XML code which represents the HL7 object «Heart Rate Observation» The above illustrates the threshold values to be transmitted to the SS to set the range in which the measured values for the heart rate are tolerated for the patient (no alarm). The values refer to a particular condition, "subject to rest." This condition is expressed in the criterion defined in the preconditions.

10 In the observationrange there are the two specific threshold values for the Heart Rate in resting condition In the precondition attribute the criterion is defined in which the range values are valid. This criterion is defined using LOINC standard

11 LOINC Logical Observation Identifiers Names and Codes It is a datebase and universal standard for identifying medical laboratory observations. Specifically, LOINC provides a code system for the observation identifier field of the HL7 observationreporting message.

12 GLIF Guideline Interchange Format It is a computer interpretable language for modeling and executing clinical practice guidelines. GLIF supports sharing of computer interpretable clinical guidelines across different medical institutions and system platforms. GLIF has a formal representation. It defines an ontology for representing guidelines, as well as a medical ontology for representing medical data and concepts.

13 Web Service technology and Smart Space

14 At a lower level all clinical messages between the planes of the project (home plane, medical plane and statistical plane) and towards the rest of the world will be in HL7 v3 in XML for this reason the implementation of the middleware level communication with Web Services was chosen, to take advantage of the interoperability that they offer

15 Web Service technology "Software system designed to support interoperability between different computers on the same network." (W3C definition) Features: Interoperability Support for multiple languages Reuse of existing applications Easy to use Using standards enterprise wide supported A software interface that describes operations that are accessed through special messages, carried via the HTTP protocol, and formatted according to the XML standard.

16 In the architecture of the project, the sensor network sends data to the middleware realized through a SOA, which is able to translate information into HL7 v3 messages, using nomenclature and code indicated by standardized vocabularies (LOINC, SNOMED). Examples of three scenarios that describe the possible interactions between web services and different planes, within the architecture of the project. 1 storyboard CDA WEB SERVICE HL7v3 XML MEDICAL PLANE SMARTSPACE

17 2 storyboard This message is the HL7 message alarm. It starts automatically when the measured values are outside the allowed range WEB SERVICE HL7v3 XML HL7v3 XML MEDICAL PLANE SMARTSPACE SMS

18 3 storyboard The Medical Plane sends a notification via an HL7 message to the Web Service, which builds a new CDA updated with data drawn from the patient's Virtual Patient Repository. The CDA is sent to the Medical Plane WEB SERVICE Virtual patient repository HL7 v3 XML CDA HL7 v3 XML MEDICAL PLANE

19 Smart Space A Smart Space is a digital representation of the relevant state of an environment It turns an environment into a Smart environment Smart Space User & Mobile device Environment Digital Representation Sensors Smart Environment

20 Smart Space Typical Localizations SIB stores are located on conventional Hard Disks, Solid State Disks or RAM The SIB process is located on linux based devices like PCs, servers or Maemo smart phones (NOKIA N900) A KP is basically a program written in C,C++,C#, Java or Python with smart space access provided by multi language libraries. Most libraries access the Smart Space over TCP connections A KP can be located on embedded devices including most commercial smartphones PC, Server or Smartphone N900 SIB TCP Socket PC, Server or Smartphone KP DB on HD or RAM

21 Home PC Or Smartphone Smart Space Based User Plane Implementation Smart Space KP Alarm Generator KP HL7 Message Translator KP History Service Statistical and Medical Plane KP Service i KP Scale KP BloodPressure KP Saturimeter KP Zephyr User Plane * * * * *Legacy device KP Service examples: Visualization service SMS generator Rule engine Core services

22 HL7 Message translator KP XML KP HL7 Message Translator SSAP Smart Space

23 Thank you for your attention