Framework for an HIT standards-based approach to a nationwide Maternal Health Use Case in the
Low-and-Middle-Income-County setting (using MHealth architecture)
2013-04-10
Contributors:
 Nathan Botts
 Gora Datta
 Nadine Manjaro
 Tammara Jean-Paul
 John Ritter
1. THE NEED FOR HEALTH INFORMATION TECHNOLOGY (HIT) STANDARDS
 System and Information Interoperability
 Accountability
o Clarification of requirements
o Conformance and certification
 Support for a rational, well-conceived national policy-framework
 Identification of objective measurements (before implementation begins)
 Engineering approach to systems development
 Reproducibility and repeatability of a solution (e.g., cost, manpower, time)
 Scalability
 Ubiquitous ("borderless") access to information and services
 Endorsement opportunity: Agree to employ a standards-based approach to Health
Information Technology development
2. FUNCTIONAL REQUIREMENTS
 Health Level Seven (HL7) provides a means of specifying functional requirements for
Mobile Health (mHealth) in Low-and-Middle-Income-County (LMIC) settings via the
Electronic Health Record and Personal Health Record System Functional Models
 Electronic Health Record and Personal Health Record System Functional Models (See
Appendix 1)
 Endorsement opportunity: Agree to build Functional Profiles that are tailored to Mobile
Health in the LIMC arena
3. INFORMATION MODEL
 HL7 provides a method of developing information models
 What is an Information model?
 Mobile health Domain Analysis Model (DAM) rationale (See Appendix 2)
 Endorsement opportunity: Agree to define and build the information model
4. ENGAGEMENT MODEL / REQUIREMENTS-GATHERING APPROACH
 Patients
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Clinicians and Community Health Workers
Clinics and Hospitals
Payers
Governing Agencies
Goal-setting, directing, and coordinating authorities
Project and Program Oversight and Monitoring agencies
Legislation and Enforcement oversight organizations
Endorsement opportunity: Agree to assemble stakeholder group and gather requirements
5. LMIC-Specific USE CASEs
 HL7 provides a method of developing Use Cases, Scenarios, and Domain Analysis Models.
 Use Case: "Saving One Million Lives" (SOML) Use Case Development (see Appendix 3)
 Endorsement opportunity: Agree to identify specific Use Cases
6. GOVERNANCE MECHANISM
 Leadership team (consisting of Project Governor, MOH, vendors, implementers, providers,
educators)
 Endorsement opportunity: Agree to assemble a leadership team
7. EXPECTED OUTCOMES
 Primary stakeholders benefit
 Downstream stakeholders benefit
 Ubiquitous access to health information
 Evaluate achievement of Quality and Performance Goals (through standards-based
measurements)
 Health Information Technology (e.g., Messaging and HIT Documents)
 Cost Measurement and Control
 Enhanced Reporting and Analysis
 Capacity-building occurs
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Appendix 1
EHR-S FM and PHR-S F M
BACKGROUND
The HL7 Electronic Health Record and Personal Health Record System Functional Models (FM) describe
the functions that EHR or PHR computer systems may perform in support of the care giving process or
wellness maintenance. The FMs are written in an architectural-, realm-, and policy- neutral manner so
that they can be readily tailored to specific architectures, realms, and policies. Thus, a given realm that
desires to codify the functions that must appear in its realm's EHR or PHR systems may create
"functional profiles" using the FMs as a standards-based foundation. Licenses for the FMs are provided
by HL7 at no cost.
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Appendix 2
MOBILE HEALTH DOMAIN ANALYSIS MODEL (DAM) RATIONALE
BACKGROUND
The DAM is a set of requirements that explore and analyze the business of a particular “domain.”
Domain analysis is the first step in creating HL7 standards for a specific care or research environment.
The domain analysis process produces documentation describing the stakeholders, activities,
interactions and information for a particular domain and serves as the source of requirements used in
the design of HL7 standards.
A DAM produces a set of artifacts that clearly describe the healthcare business in terms familiar to the
people who work in that business area and is used as the basis for downstream specification design(s).
Those designs may be functional models, service specifications, message definitions, etc., depending on
the type of standard targeted by the project. The standard specification may be directly based on
reference information models and on the contents (the information and operations) specified in the
DAM or derived from it through mappings or transformation1.
A Domain Analysis Model is an abstract representation of a subject area of interest, complete enough
to allow instantiation of all necessary concrete classes needed to develop child design artifacts.2
1. First, a DAM should represent the semantics-of-interest in terms that are understandable to
domain experts, even though this may mean that 'not everyone gets to see their particular
words represented,' i.e., they should, however, see the familiar concepts and relationships that
describe the domain-of-interest in terms that are easily translatable to their favorite terms.
2. Second, a DAM must be semantically robust enough to support the development of downstream design artifacts. Note that, depending on the degree of rigor applied to the term
'analysis,' a DAM may or may not be bound to formal data types and may or may not be
formally/computationally traceable to one or more design artifacts
DAMs provide an 'everyman' view of the domain. That's exactly their purpose, i.e. it can be vetted by
domain experts who know nothing of RIMs, DMIMs, RMIMs, XML, Java, etc.!
A DAM has two basic uses: it reflects 'outward' to the community of SMEs who can vet it as
representative of their domain's static and dynamic semantics; and it reflects 'inward' as a formal
statement of implementation-independent semantics which an implementation tries (always
1
2
HL7 HDF: http://gforge.hl7.org/gf/download/frsrelease/608/6672/HDF_1.5.doc
HL7 WIKI DAM: http://wiki.hl7.org/index.php?title=Domain_Analysis_Model
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imperfectly) to implement, thereby becoming a negotiation tool for developers and domain experts
around the exact implications of the inevitable implementation-specific compromises.
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STORYBOARD development
MODEL development (UML representation of Use Case Diagram, Activity diagram, etc)
Areas where HL7 Mobile Health WG can facilitate:
1. MH Messaging Standards:
think of using mobile devices to send short but structured chucks for information for
rapid turnaround
2. MH Functional Models/Profiles:
“apps…apps all around but non to talk with another”
3. Document Architecture:
at a first glance this might not apply but think of this use case: then I am on the road, in
a foreign land, out of my meds, go the local pharma, can I zap my device onto the kiosk
which will then print my prescription and I then pick and choose what I need a refill for
(this is just an example, other use cases will come up)
4. Services:
many possibilities….patient education is the first that comes to mind...."Info Button"
service request, appointment service request, etc.
5. Modeling:
a Domain Analysis Model (DAM) for Mobile Health and then a Domain Information
Model (DIM) for mobile health
6. Mobile RIM / mobile FHIR Resources
do we need a “mobile RIM”, or will mobile FHIR resources meet the need? This might
come in handy for #1 of above
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Appendix 3
Saving One Million Lives Use Case Development
Mobile Health technologies are being identified as a critical bridge for addressing gaps in access to health
information and care continuity, especially as it relates to rural health environments represented by the
“Saving One Million Lives” (SOML) project of Nigeria. Effectively capturing the settings, populations and
workflows of these unique efforts assist in creating the frameworks needed to develop valuable and
sustainable health systems. Use Case development work conducted by HL7 is the foundation through
which standards development activities are undertaken, and opportunities represented by complex
environments such as those described by SOML activities are prized in that they provide a base case of
understanding as to the healthcare needs of rural populations. HL7 projects, including the Child Health
Functional Profile and related efforts such as the Child EHR Model Format conducted by the Agency for
Healthcare Research and Quality, have helped to describe the distinctive models of care required for
child and maternal health and are informing current development of health information systems. The
mobile maternal and child health model presented by the SOML project will be a valuable and informative
addition to this work and will help broaden the scope and impact of these important standards. HL7
participation in defining SOML use cases will assist in bringing expertise, documentation and
dissemination of rural maternal health needs and practice to the international community.
< End of Document >
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