A conceptual framework to design a dimensional model based on the HL7 Clinical Document Architecture Fabrizio Pecoraro1, Daniela Luzi1, Fabrizio L. Ricci2 1 Institute for Research on Population and Social Policies 2 Institute of Molecular Bioimaging and Physiology National Research Council, Rome – Italy
Background There is a growing attention in the use of healthcare data for secondary purposes (i.e. “non-direct care use of personal health information”) to: • improve patient care, decision making and communication processes • predict public health trends and reduce healthcare costs needs Integration of data provided by heterogeneous information systems developed for different specialties and purposes and by different organizations in a common central Data Warehouse challeng Implementation of transformation procedures to convert data from source systems to a common data model MIE 2014, 30 August – 3 September 2014, Istanbul, Turkey
Background Integration of information system has been addressed in healthcare to improve semantic interoperability Data modelling HL7 represents one of the main candidates for the exchange of information among different stakeholders mainly used for patient’s care delivery purposes (i.e. primary uses) In our vision, HL7 standards and in particular the Clinical Document Architecture (CDA) can be the basis to define a common schema to represent clinical information in a data warehouse MIE 2014, 30 August – 3 September 2014, Istanbul, Turkey
Objective Propose a conceptual framework to map the dimensional model concepts with the HL7 CDA components to facilitate the definition and implementation of ETL tools developed in a data warehouse architecture MIE 2014, 30 August – 3 September 2014, Istanbul, Turkey
Dimensional model Formalism to support the conceptual modelling phase in a Data Warehouse project It is represented by a Fact surrounded by independent Dimensions Fact: measurements of the performance of a business process in a qualitative and/or quantitative way (e.g. episodes of care, clinical outcome) Dimension: descriptive information about the fact (e.g. time, patient, location) MIE 2014, 30 August – 3 September 2014, Istanbul, Turkey
HL7 Clinical Document Architecture (CDA) Records clinical observations and services in a mark-up standard document has a textual part (human readable) and structured part (software processable) The structured part relies on coding systems to represent concepts Based on the Reference Information Model (RIM) MIE 2014, 30 August – 3 September 2014, Istanbul, Turkey
CDA main components based on RIM classes Describes health business processes decomposing it into elementary descriptions HL7 Hierarchy CDA Backbone The set of specialized Acts and their relationships are the basis to define a CDA backbone Entities, Role and Participation classes define a HL7 hierarchy that describes subjects/objects involved in the process and their role within the action MIE 2014, 30 August – 3 September 2014, Istanbul, Turkey
Methods Fact Dimensions HL7 Hierarchy CDA Backbone Map the HL7 CDA components (HL7 Hierarchy, CDA Backbone) with the dimensional model concepts (Fact, Dimension) MIE 2014, 30 August – 3 September 2014, Istanbul, Turkey
Mapping procedure Dimensional model lifecycle: 1. Choose the business process 2. Declare the grain 3. Identify the Fact & Measures 4. Identify the Dimensions 5. Refine the dimensional model Based on a case study: Continuity of Care Document (CCD) to define clinical outcome indicators for quality assessment. MIE 2014, 30 August – 3 September 2014, Istanbul, Turkey
Mapping procedure Dimensional model lifecycle: 1. Choose the business process 2. Declare the grain 3. Identify the Fact & Measures 4. Identify the Dimensions 5. Refine the dimensional model MIE 2014, 30 August – 3 September 2014, Istanbul, Turkey
Choose the business process Determining and prioritizing processes to be analysed Candidate Dimensions Di Pr P R L a o Pr D P er e a g c o Business a at fo a Description b n e d Process t ie r cti te o d u e nt m o st si ur ct er n s e allergies, adverse reactions and Alerts X X X X X alerts patient’s current medications and Medications X X X pertinent medication history results of observations generated Results by laboratories, imaging X X X X procedures, and other procedures interventional, surgical, diagnostic, Procedures therapeutic procedures, treatments X X X X pertinent to the patient historically MIE 2014, 30 August – 3 September 2014, Istanbul, Turkey
Continuity of Care Document – Result Section CDA Components CDA Backbone HL7 Hierarchy MIE 2014, 30 August – 3 September 2014, Istanbul, Turkey
Mapping procedure Dimensional model lifecycle: 1. Choose the business process 2. Declare the grain 3. Identify the Fact & Measures 4. Identify the Dimensions 5. Refine the dimensional model MIE 2014, 30 August – 3 September 2014, Istanbul, Turkey
Declare the grain Specifying the level of detail of the dimensional model (i.e. what an individual fact table row represents) High level Low level atomic information captured by a transactions are aggregated business process over dimensions (e.g. value of a vital sign (e.g. average value of a vital analysis observed during a test) sign over a specific time interval) The grain declaration is subjected to the granularity of data contained in the clinical document MIE 2014, 30 August – 3 September 2014, Istanbul, Turkey
Mapping procedure Dimensional model lifecycle: 1. Choose the business process 2. Declare the grain 3. Identify the Fact & Measures 4. Identify the Dimensions 5. Refine the dimensional model MIE 2014, 30 August – 3 September 2014, Istanbul, Turkey
Identify the Fact Identify a CDA concept that represents a “measurement of the healthcare business process”. An action performed to determine an answer or a result value Acts that define the CDA Backbone are suitable candidates to identify Fact MIE 2014, 30 August – 3 September 2014, Istanbul, Turkey
Identify the Measures Attributes of the chosen Act are used to identify measures of the Fact table value and interpretationCode attributes that represent a quantitative and qualitative description of the event observed. MIE 2014, 30 August – 3 September 2014, Istanbul, Turkey
Mapping procedure Dimensional model lifecycle: 1. Choose the business process 2. Declare the grain 3. Identify the Fact & Measures 4. Identify the Dimensions 5. Refine the dimensional model MIE 2014, 30 August – 3 September 2014, Istanbul, Turkey
Identify Dimensions Dimensions are determined by answering the following questions: • Who participates (person): patient, provider, responsible parties • What is studied (fact): encounter, hospitalization, adverse reaction • When has been performed (time): date, year, month, week-day • Where has been placed (location): facility, hospital, patient’s home • Why has been performed (reason): pathology, adverse reaction • How has been measured (manner): visit, hospitalization (Zachman framework, Inmon et al., 1997) Our approach, Identify CDA concepts able to answer these questions ( CDA Backbone, HL7 Hierarchies, Classes and Attributes ) MIE 2014, 30 August – 3 September 2014, Istanbul, Turkey
Identify Dimensions: CDA Backbone Range of values of the observation Healthcare service (what) provided over a period of time (what) ClinicalDocument and Section can be included in the model to provide low-level of details additional information MIE 2014, 30 August – 3 September 2014, Istanbul, Turkey
Identify Dimensions: CDA Backbone Other Dimensions (why): Has reason (RSON): reason or rational for a service (e.g. “treadmill test” has reason “chest pain”) Is etiology for (CAUS): what caused the observation (e.g. “diabetes mellitus” is the cause of “kidney disease”) MIE 2014, 30 August – 3 September 2014, Istanbul, Turkey
Identify Dimensions: HL7 Hierarchies Performer (who): the physician(s) that carried out the clinical event RecordTarget (who): represents the medical record that this document belongs to Both are related with the “scoper” Entity Organization through a Role. This class can be used to identify where the observation has been placed MIE 2014, 30 August – 3 September 2014, Istanbul, Turkey
Identify Dimensions: HL7 Hierarchies Participant (who): • Authenticator: A verifier who legally authenticates the accuracy of an act (who) • Consultant: An advisor participating in the service by performing evaluations and making recommendations • Responsible party: the provider (person or organization) who has primary responsibility for the act MIE 2014, 30 August – 3 September 2014, Istanbul, Turkey
Identify Dimensions: HL7 Hierarchies Specimen (what): • part of some entity, typically the subject, that is the target of focused laboratory, radiology or other observations • used when observations are made against some substances or objects that are taken or derived from the subject MIE 2014, 30 August – 3 September 2014, Istanbul, Turkey
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