EMRLD
A RIM-based Data Integration Approach
Pradeep Chowdhury
Manager, Data Integration
Agenda
• Introduction and Acknowledgements
• EMRLD Approach
• Pilot Details
• Q&A
What is EMRLD
EMRLD is a proposed data integration approach for
RIM implementation connecting organization specifics
to RIM.
EMRLD (pronounced as “emerald”) encompasses:
• Extract: source data extraction
• Merge: merge and prepare data for RIM
• RIM standardization: standardization including
terminology binding
• Load: loading and persisting
• Deliver: delivering integrated data from RIM data for
consumption by multiple use cases
Key Drivers for EMRLD
 Clinical data Integration across regions and
subject areas
 Integration of EMR data with data from ancillary
systems (Labs, Rx)
 Attribution and integration of external data with
KP data
 Standardization using terminology services
Alternatives to RIM
• Build a home-grown integration model according
to business needs
• Purchase and deploy industry available models
OR
• Adopt a reference information model (model of
meaning): HL7 V3 RIM
Needs & Suggestions
Needs
 Lack of a standard-based model is
driving towards creation of many
point-to-point solutions.
 Downstream applications,
datamarts and analytics are forced
to do their own data integration.
 External agencies are favoring use
of standard-based data interchange
approach (e.g., HL7 RIM V3).
 More needs for standard-based
data integration are being driven
from Meaningful Use cases
implementation, BIOMED devices
integration, and data interchange
with CDC, VA , etc.
Suggestions
 Adopt appropriate standards to support
meaningful information integration,
representation and exchange between
disparate systems.
 Validate and adopt the HL7 Reference
Information Model as a standard,
explicitly targeted to enable “consistent
sharing and usage of data across
multiple contexts (both internal and
external).”
Model Of Meaning and EMRLD
• RIM implementation needs support for data extraction,
persistence and delivery
• EMRLD: suggested approach to adopt and
implement RIM
 Bridges model-of-use to model-of-meaning
 Modular approach to implement RIMBAA
 Scalability on addition and expansion of data sources
 Helps in achievement of semantic interoperability
 Helps in standardization, including terminology binding
 Helps in adoption of HDF ( HL7 Development Framework)
EMRLD - Logical Approach
Data Sources
Integration & Staging Layer
Implement a information model that enables “data
integration” or “staging” that provides:
EMR
•
Future scalability and extensibility and leverages
industry standards
•
Replaces point–to–point linkages and de-couples
consumption from access
•
Honors unique characteristics of healthcare data:
including sparseness, constantly changing
attributes, non-additive facts, and too many
references (dimensions)
Labs, Rxs
External
Others
•
Tie in with architectural tenets
•
Standardization including Terminology Services
•
Support multiple use cases
•
Support clinical domain and additional (financial,
administrative) and research
•
Potential Use Cases
Subject
Data Marts
NHIN
HIE
Data
Exchanges
Program
Warehouse
Regional
Data Store
Research
Security and access layer is built-in using access
policies that can be governance
HL7 v3 RIM
BIOMED
EMRLD Implementation View
Data Sources
Data Integration & Staging Layer
Data Delivery
Layer
Standard Docs
(CDA, Hl7)
EMR
Extract &
Convert to
CDA
Lab, Rx
RIM
(Integrated Data layer)
Merge
Others
External CDAs
(CDC, VA,DOD, etc.)
Bulk Load
CDA
Terminology
Services
HQL
Queries
On
Demand
Bulk Data
Extract
Use Case
Examples
Datamarts
NHIN
HIE
Data
Exchanges
Research
BIOMED
EMRLD - Pilot Details
• Imported KP EMR data via
CDEF into RIM
• Imported clinical data from
external sources (as CDA
documents) into RIM
• Created interfaces to
query/view data stored in RIM
• Exported data stored in RIM
as CDA documents
Note: Open Source Software including JSIG,
Hibernate (Object to Relational DB mapper)
and MySQL ( Database Layer) were used
for the pilot at no cost to KP
Screenshots from Pilot
EMRLD Pilot - Observations
•
Pilot was successful to demonstrate that the KP EMR clinical data can be imported and persisted
in a HL7 RIM environment.
•
In addition the pilot demonstrated capability to import external CDA documents (bulk data import),
export clinical data as CDA, and views the imported data using HQL queries.
•
This pilot was done using Open source platform created by the JavaSIG.** KP System Integration
team’s developed CDEF framework engine was used to extract information from KP EMR.
•
CDEF is Custom Data Extract Framework which extracts KP EMR real-time transaction data. The
extraction is based on pre-defined events and rules. The data is available from CDEF in table
format.
•
JSIG is an open source HL7 RIM implementation. It maps all RIM classes to SQL tables using
hibernate. Provides helper classes to create CDA document and persist in RIM data model.
•
Any database can be used to support RIM and for demonstration purposes, MySQL was used.
•
KP-JSIG is a web application built on top of JSIG to incorporate a way to import KP EMR data,
external CDA documents, export CDA documents, and execute HQL queries on RIM classes.
**Note that the HL7 Java SIG (JSIG) has been renamed to the RIM Based Application Architecture
Work Group (the RIMBAA WG).
EMRLD- RIM Data Integration
Potential Implementation Use Cases
NHIN - HIE
•
The NHIN specifications states that clinical data
should be exchanged via CDA release-2
documents (one of the HL7 v3 standards), and
that all inter-NHIE (inter National Health
Information Exchange) messages (gateway to
gateway communication) in the NHIN will use
HL7 v 3.0 RIM based messages.
•
KP context will need an integration layer of data
collected via DOD, VA and internal KP.
•
KP HIE initiative is evaluating a standard based
approach like RIM for information exchange.
Real Time Standards-based Interfaces
• KP EMR needs to interchange information with
other ancillary systems (e.g. Lab, Rx etc) in Real
Time.
• These interfaces are today built point to point
• Can be applied to situations like point-point
interfaces currently being used between EMR,
Labs, Rx
• Can be a good foundation layer for integration
while we are approaching new Lab and Pharmacy
systems
Downstream Applications, Analytics and Datamarts
 Many applications, analytics and datamarts using KP
EMR data need additional information and need to
integrate via a manually/semi automated way or using a
point solution at their end.
 This not only increases cost but also has time to market
and data quality issues.
 An integrated staging layer will not only provide a
consistent layer of information, it will reduce cost and
improve information latency.
Others
 BIOMED Devices: Information storage and retrieval of
biomedical device information is supported by an HL7 v3
RIM-mapable integrated staging approach. Device
messages, documents and services are also supported.
 External information from agencies like CDC, VA can be
made efficient and easy to implement
 PHR (Personal Health Record): Support for Patient
controlled EHR is being developed by HL7 RIM HER
Working Group
 Foundation for upcoming integration needs for upcoming
Insurance Exchanges
Questions?
pradeep.k.chowdhury@kp.org