tag:blogger.com,1999:blog-4384692836709903146.post3462550366230182203..comments2024-03-27T09:55:23.143-07:00Comments on Dispatch from the Digital Health Frontier: A Universal Exchange Language ExampleJohn Halamkahttp://www.blogger.com/profile/04550236129132159307noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-4384692836709903146.post-78665506647003912011-01-15T10:40:50.266-08:002011-01-15T10:40:50.266-08:00BTW an RDF triple is made of an object, a property...BTW an RDF triple is made of an object, a property, and a value. RDF is a standardized and vendor-neutral incarnation of the EAV model and is already used today in the fields of medical terminologies and biomedical ontologies.Vidjinnagni Amoussouhttps://www.blogger.com/profile/06437681488603449364noreply@blogger.comtag:blogger.com,1999:blog-4384692836709903146.post-75042628654647709372011-01-15T10:25:47.839-08:002011-01-15T10:25:47.839-08:00Dr. David McCallie said it very well: "PCAST ...Dr. David McCallie said it very well: "PCAST vision will require combinations of all our best practices." And that's the challenge: building a unified framework that combines the wisdom of many communities of interest (HL7, OpenEHR, biomedical ontologies, etc.)<br /><br />See my thoughts <a href="http://efasoft.blogspot.com/2010/12/toward-universal-exchange-language-for.html" rel="nofollow">here</a>.Vidjinnagni Amoussouhttps://www.blogger.com/profile/06437681488603449364noreply@blogger.comtag:blogger.com,1999:blog-4384692836709903146.post-77445416430275261882011-01-15T02:28:11.852-08:002011-01-15T02:28:11.852-08:00But this approach has exactly the same problem as ...But this approach has exactly the same problem as any other proprietary approach at defining standards. Microsoft HealthVault have decided that a blood pressure measurement consists of a systolic and diastolic reading, at a certain date/time with a certain device/manufacturer number.<br /><br />And if every device manufacturer and every application uses that definition then it will all work. If they don't they'll have to transform it to their use. <br /><br />But in reality, if there's just one use case where a blood pressure measurement is different - say it needs to record whether the reading was for the patient standing or lying down - and that different attribute is not in the HealthVault model - then the whole thing falls apart. <br /><br />HealthVault (and any other simplistic model like it) is based on the premise that Microsoft is big enough to dictate the standard (a proprietary standard) then force everyone else to use it. <br /><br />A conceptual model that may work much better is the ISO13606 approach which splits the information concepts into a structural component and an information component, using the concept of information archetypes to provide a flexible and extensible model. This approach uses XML but has a much more sophisticated approach to semantics, structure, composition and context.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4384692836709903146.post-15347976245381080552011-01-15T02:11:55.250-08:002011-01-15T02:11:55.250-08:00So could someone explain why it is that a report p...So could someone explain why it is that a report published with the seal of the President so directly recommends three technologies:<br />- personal health records<br />- data aggregation middleware<br />- cloud computing and search/indexing<br /><br />... and has two authors from industry - Craig Mundie from Microsoft who leads the Microsoft Health Solutions Group, and Eric Schmidt, CEO of Google.<br /><br />... who just happen to have launched products that target precisely the same technologies recommended: HealthVault for a personal health record, Amalga for data aggregation middleware and Google/Bing for search and indexing.<br /><br />The report has plenty of simplistic recommendations in its pages. One thing it doesn't contain is a statement of the clear and real conflict of interest that it's authors have.<br /><br />I guess that's what $1.6 million of lobbying buys you (Microsoft's declared spending on lobbying last year)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4384692836709903146.post-4862884297677927652011-01-13T23:00:08.936-08:002011-01-13T23:00:08.936-08:00This captures the reality of data transfer: we fac...This captures the reality of data transfer: we face many idioms, many means of expression and there's no esperanto that will ever capture it all.<br /><br />But I think this comes out best not with vitals or medications which reduce to standard equivalents with little sweat, not even for labs - let's see how we do with them in the coming year - but with all those questionnaires and check-lists that populate nursing notes. ADLs, your functional status. They're not free text but nor are they codes and they reflect the approach to care at a given institution.Unknownhttps://www.blogger.com/profile/15188931029985588635noreply@blogger.comtag:blogger.com,1999:blog-4384692836709903146.post-37053762673223917072011-01-13T21:57:45.974-08:002011-01-13T21:57:45.974-08:00Where does the information for "Device manufa...Where does the information for "Device manufacturer", "Model #" and "Serial #" come from? Does it have to be manually entered every time a blood pressure is taken? Seems like a very expensive approach!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4384692836709903146.post-6787400310396195172011-01-13T21:30:15.780-08:002011-01-13T21:30:15.780-08:00Sean provides a nice explanation of the EAV approa...Sean provides a nice explanation of the EAV approach to granular data storage. This well-proven approach works well for those data elements that do not require a lot of "structure" to qualify their meaning. A routine BP provides a good example.<br /><br />But many medical data elements are more complex, and require structured modifiers to be adequately captured. Even a BP can be modified by relevant factors like "large cuff, left arm, standing, automatic device." To store this kind of structured data in an EAV model requires either a combinatorial explosion of pre-coordinated "entity names" or some kind of non-trivial post-coordination of multiple "rows" of EAV data. <br /><br />Another issue is that if only granular data is stored, then the clinical "story" can get lost in all the numbers. Granular EAV models work well for flow-sheet data, vital signs, labs, etc. But if the "cloud" doesn't contain the textual story, a clinician may have trouble correctly interpreting all the EAV-coded facts.<br /><br />The HL7 CDA (clinical document architecture) offers a mixed approach to creating structured documents which allow the preservation of both the "story" and the discrete data. Unfortunately, CDA-encoded documents are still rare in most settings, and of course the vast historical archive of documents are not CDA-encoded.<br /><br />Another approach to preserving the narrative text while exposing codified data is to store the original documents in the cloud and also to use NLP (language parsing) tools to recognize and extract the clinically relevant data elements (SNOMED, etc.) from the text. These machine-encoded documents can then be stored in a searchable index along with the original text and the EAV data, providing searchable, structured access to both discrete and narrative data.<br /><br />Of course, these are not mutually-exclusive approaches. The PCAST vision will require combinations of all our best practices.<br /><br />David McCallie, MD<br />Cernerdmccalliehttps://www.blogger.com/profile/01502489960893539450noreply@blogger.com