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
Gastroenterologist
Patient id
Document id
Medication
Observations
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
RIM (Reference Information Model)
Backbone
Act
Relationship
0..*
0..*
1
Entity
Organization
Living Subject
Material
Place
Health Chart
0..*
1
Role
Patient
Guarantor
Healthcare
provider
Insurer
Practitioner
0..*
1
Participation
1
0..*
1
Act
Referral
Transportation
Supply
Procedure
Condition Node
Consent
Observation
Medication
Act complex
Financial act
RIM (Reference Information Model)
HL7 in the OID tree
HL7 snippet for
Gastro-enterelogical Report
The problem domain:
Participants and development cycle
Healthcare
Terminologists
IT providers
Data Set
Test /
Qualification
ICT Architects
HL7v3
modellers
THE SOLUTION - DECOR
DECOR overview
name
description
authors
version info
copyright
project
concept
dataset
use case
actor
transaction
scenario
DECOR
issues
rules
status
assignment
code systems
terminology systems
value sets
identifications
group
item
OID
validation
constraints
conditions
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
ART
tooling
Stakeholders
XForms
Healthcare
DECOR
XML
PERI
Terminologists
IT vendors
Spoed
eXist
XML
database
Testing
XQuery
HL7v3
modellers
WEB INTERFACE
ICT Architects
JGZ
etc..
THE SOLUTION – OUTPUTS
Outputs
DECOR
ART
Stakeholders
Healthcare
project
HTML
dataset
Terminologists
scenario
issues
XML
ICT Architects
HL7v3
modellers
value sets
identifications
rules
Testing
CSV
IT vendors
Care provider view
Technical documentation
XML / CSV resources for implementers
THE SOLUTION – CODE
GENERATION
Schematron generation
DECOR
ART
Stakeholders
project
Testing
OK ?
dataset
issues
value sets
identifications
rules
Schematron
message
validation
XML
scenario
IT vendors
Schematron / test demo
UI generation
DECOR
ART
Stakeholders
project
dataset
scenario
issues
XML specs
UI
value sets
identifications
rules
IT vendors
USING XML – PROS AND CONS
Application architectures
DB
A
P
P
XML as a storage format
DB
X
M
L
A
P
P
XML as exchange format
DB
A
P
P
A
P
P
X
M
L
DB
A
P
P
Web architecture 2013
User Interface Logic
Model
Con
trol
ler
Br
ows
er
View
X
HTML
M
CSS
L
JS
non-XML vs XML application
User Interface Logic
Post
greSQL
Djan
go
Tem
pla
tes
eXist
Br
ows
er
User Interface Logic
XML
XQu
ery
HTML
CSS
JS
XForm
HTML
CSS
JS
Br
ows
er
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 ?