1. HL7 GELLO Update CDS TC – Atlanta Wed, 9/19/07, Q3 Robert Dunlop, MD Director, Clinical Development Craig Lucas, BSc PhD Analyst Programmer InferMed UK +44-7291-7410 robert.dunlop@infermed.com http://www.infermed.com Barbara McKinnon McKinnon Associates Inc. Project Lead: HL7 GELLO & Virtual Medical Record (vMR) Projects (O) 610-644-5245 (M) 484-883-6927 bmm15@comcast.net

2.  GELLO Status  GELLO BNF  GELLO Authoring Tool  Next Steps Discussion Topics 9/19/2007HL7 Atlanta – CDS TC 2

3. 2005 GELLO passed as an HL7 & ANSI standard. 2006 Industry outreach demonstrating the use of GELLO in ePrescribing Prior Authorization. Medical Objects, AU, GELLO Tool release. 2007 GELLO web discussion group established by Margarita Sordo, Harvard/Partners. InferMed continued industry outreach to: > Demonstrate use of GELLO in a Clinical Trial Roadmap. > Identify pilot opportunities. InferMed release of GELLO Authoring Tool. GELLO Status 9/19/2007HL7 Atlanta – CDS TC 3

4. GELLO BNF Feedback 9/19/2007HL7 Atlanta – CDS TC 4 #DateIssueOrganisation Raising Issue Proposed Solution 114 Dec 2006Ability to use GELLO in Arden type MLMs to work around ambiguities in IF-THEN-ELSE-ENDIF constructs. Medical ObjectsAddition of ‘conclude’ and ‘continue’ statement to BNF*  CONCLUDE statement similar in function to final GELLO expression  CONTINUE statement as a place-holder to force the parser to recognize a statement instead of an expression 214 Dec 2006Concern about single string parameter for Factory methods Medical ObjectsAllow parameter lists for object construction 312 Mar 2007Slight mismatch between OCL and GELLO, in that OCL is a pure expression language while GELLO seems to have introduced the concept of statements making it more like an imperative language. Medical ObjectsNo specific proposal 412 Mar 2007Problem with flatten() operator.Medical ObjectsCollection element types must be either all the same type, OR they may be recursively collections of the same type. 512 Mar 2007How does a GELLO user create new user-defined classes or "model processes"? University of Nebraska 612 Mar 2007"if expression" mentioned in section 5.14 of GELLO specification, but not in the BNF grammar. Stanford University 712 Mar 2007Added the “in” keyword from OCL to help with LET expressions WebReach 813 Mar 2007Need to specify exactly which model the GELLO expression conforms to. Medical Objects 913 Mar 2007Compiler needs to have some specification of the data model it is working with. Stanford University 1013 Mar 2007GELLO is not going to operate in isolation and there are no defined methods for passing parameters in and out. Medical Objects

5. GELLO BNF Feedback 9/19/2007HL7 Atlanta – CDS TC 5 #DateIssueOrganisation Raising Issue Proposed Solution 1111 Jan 2007Are “unknown” and “null" both keywords, or simply runtime constants provided by the runtime? WebReachKeywords 1211 Jan 2007Unknown and Null as third Boolean valueWebReach 1311 Jan 2007How are Collections of Collections typed, and how is that type represented in GELLO? WebReach 1411 Jan 2007no reference to how Enumeration types are referenced or used with GELLO. WebReachEnumeration are datatypes in UML and not part of GELLO. 1511 Jan 2007Why is Factory limited to a single string argument, rather than an argument list like method invocations? WebReachSee 2. above 1611 Jan 2007Why are the assorted functions (like strcat, toupper, etc.) hard coded within the grammar and simply not implemented within the runtime as any other method invocation? WebReachRequested at first ballot. Should be reviewed. 1711 Jan 2007Regarding overall case sensitivity. How case sensitive is GELLO supposed to be? Is the grammar complete in this regard? WebReachTo be decided 1811 Jan 2007As noted from the Root Symbol, GELLO seems to be (among other) a single ContextNavigationStatement. A ContextStatement is the "Context" keyword followed by ContextBody, but it allows only a single body element, and no other expressions (such as Lets or anything else). Also, there is a keyword defined later of "EndContext", but it's not referred to anywhere in the grammar. How is "EndContext" used? WebReach

6. GELLO BNF InferMed BNF Summary Comments:  GELLO BNF, posted to http://www.hl7.org/v3ballot/html/infrastructure/gello/gello.htm#BNF, http://www.hl7.org/v3ballot/html/infrastructure/gello/gello.htm#BNF contains many ambiguities, making it impossible to implement with standard compiler tools.  Syntax is difficult to read with anything more complex than one or two nested levels of if…then…else statements.  GELLO provides too many ways to describe the same semantic concept, making it difficult for a novice to determine how to develop expressions. 9/19/2007HL7 Atlanta – CDS TC 6

7. GELLO Syntax Potential Next Steps:  Schedule periodic teleconferences to set a more definitive course for GELLO via HL7 DSS Listserv.  Document teleconference recommendations in preparation for re-balloting GELLO.  Test draft recommendations in at least 2 “real life” pilot applications before re-balloting. 9/19/2007HL7 Atlanta – CDS TC 7

8. GELLO Authoring Tool New GELLO Authoring Tool, developed by InferMed UK, will be donated for industry use.  Preview: HL7 Atlanta – 9/07  Capable of defining, encoding, and exporting structured GELLO Query Expressions.  Aligned to HL7 V.3 RIM class model. 9/19/2007HL7 Atlanta – CDS TC 8

9. GELLO Authoring Tool Tool Features & Functions: > Buttons for each key word, data type, pre-defined value, and operator. > Help text associated with each button. > Drop-down lists of classifiers from HL7 RIM, associated with IntelliSense. > Ability to import and save GELLO expressions. > Color coding of key words. > Syntax checking during authoring process and when expressions are saved. 9/19/2007HL7 Atlanta – CDS TC 9

10. GELLO Authoring Tool 9/19/2007HL7 Atlanta – CDS TC 10

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15. GELLO Authoring Tool 9/19/2007HL7 Atlanta – CDS TC 15

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19. GELLO Authoring Tool 9/19/2007HL7 Atlanta – CDS TC 19

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22. GELLO Authoring Tool 9/19/2007HL7 Atlanta – CDS TC 22

23. GELLO Authoring Tool 9/19/2007HL7 Atlanta – CDS TC 23

24. GELLO Authoring Tool InferMed Next Steps:  HL7 Tools Technical Committee review.  Post on HL7 Tools & Utilities.  Create execution engine with incorporation into InferMed’s AREZZO workflow & inference engine.  Update tool based on: - Industry comments: e-mail to gello@infermed.com.gello@infermed.com - Issues uncovered in pilot testing. - HL7 GELLO-OCL Syntax changes. - HL7 RIM version changes. 9/19/2007HL7 Atlanta – CDS TC 24