1. IHC F2F Meeting, Washington DC
Artemis Project
A Semantic Web Service-based P2P Infrastructure for the Interoperability of Medical Information Systems
(IST STP)
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

2. IHC F2F Meeting, Washington DC
Artemis Architecture
The Artemis project addresses the interoperability problem in the healthcare domain
The Syntactic interoperability is handled through Web services
Semantic Interoperability is addressed by semantically annotating the Web services
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

3. Semantic Mediation: Ontology Mapping
To annotate Web services we propose
Service Functionality Ontologies
Service Message Ontologies
It is not realistic to expect all the healthcare institutes to use the same ontology
The differences between disparate Service Functionality and Service Message Ontologies are resolved through Ontology Mapping
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

4. Healthcare Informatics Semantics
Semantics is domain knowledge!
Medicine is one of the few domains to have extensive domain knowledge defined through standards
These standards offer significant value in developing ontologies to express the semantics of Web services
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

5. IHC F2F Meeting, Washington DC
What kind of Semantics?
Service Functionality Semantics:
HL7 has categorized the events in healthcare domain by considering service functionality which reflects the business logic in this domain
This classification can be used as a basis for defining the service action semantics through a Service Functionality Ontology
Service Message Semantics:
Electronic healthcare record (EHR) based standards like HL7 CDA (Clinical Document Architecture), GOM (GEHR Object Model), and CEN TC251's ENV define meaningful components of EHR so that when transferred, the receiving party can understand the record content better
The meaningful components defined by these standards can be used in developing service message ontologies
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

6. IHC F2F Meeting, Washington DC
HL7 and Web Services
The primary goal of HL7 is to provide standards for the exchange of data among healthcare computer applications
An event in the healthcare world, called the trigger event, causes exchange of messages between a pair of applications
When an event occurs in an HL7 compliant system, an HL7 message is prepared by collecting the necessary data from the underlying systems and it is passed to the requestor, usually as an EDI message
Mapping HL7’s message based events directly into Web services may result in several inefficiencies
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

7. IHC F2F Meeting, Washington DC
HL7 and Web Services
The input and output messages defined for HL7 events are usually very complex containing innumerous segments of different types and optionality
Furthermore, all the semantics about the business logic and the document structure are hard coded in the message
This implies that, the party invoking the Web service must be HL7 compliant to make any sense of the content of the output parameter(s) returned by the service
Furthermore, the information contained in an HL7 message may be coming from different systems either proprietary or complying to different standards
Hence, in Web services terminology, HL7 events correspond to Composite services, whereas more elementary services are needed
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

8. IHC F2F Meeting, Washington DC
HL7 and Web Services
Since HL7 has already been through an effort of categorizing the events in healthcare domain considering service functionality, it can be used as a basis for a service functionality ontology
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

9. An Example Service Functionality Ontology
HealthCareServices
PatientAdministration
PatientCare
PatientReferral
Scheduling
ObservationReporting
PatientReferralRequest
PatientInfoRequest
CancelPatientReferral
InsuranceInformation
ClinicalInformation
DemographicData
GetClinicalInformation
Properties of the
Generic Service
Class
serviceQuality
location
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

10. IHC F2F Meeting, Washington DC
Service Messages
A Web service in the healthcare domain usually accesses or updates a part of an electronic healthcare record, that is, parts of the EHR constitute the service parameters
An electronic healthcare record may get very complex with data coming from diverse systems such as lab tests, diagnosis, prescription of drugs which may be in different formats
Electronic healthcare record (EHR) based standards like HL7 CDA, GOM and CEN's ENV aim to facilitate the interoperability between Medical Information Systems
These standards provide conceptual building blocks or meaningful components
We propose to use these standards as a basis for Service Message Ontology
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

11. Good Electronic Healthcare Record (GEHR)
Transaction level
Navigation level
Content (e.g. observation, subjective, instruction) level
Data types (e.g. quantity, multimedia) level
Clinical models are expressed outside the GOM in the form of archetypes
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

12. CEN (European Committee for Standardization) TC 251 ENV 13606
Folder: High-level subdivisions of the entire EHR for a patient
Composition: A set of record entries relating to one time and place of care delivery; grouped contributions to an aspect of health care activity; composed reports and overviews of clinical progress
Headed Section: Sub-divisions used to group entries with a common theme or derived through a common healthcare process.
Cluster: Low-level aggregations of elementary entries (Record Items) to represent a compound clinical concept
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

13. An example Service Message Ontology
DD02: Problem
DTC12: CarePlan
DF03: AllergyState
DTH03: Ongoing Problems
DTH08: Present Interpretations
DD01: Diagnosis
DTC08: Diagnostic Test Results
DS00: Patient
Concept
Property
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

14. IHC F2F Meeting, Washington DC
Semantic Mediation
In Artemis architecture, the healthcare institutes can develop their own ontologies
However these ontologies are based on standards developed by the healthcare standardization bodies like CEN TC251, ISO TC215, GEHR or HL7
The ontology mappings are achieved through semantic mediation
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

15. Mapping Message Ontologies
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

16. Semantic Mediation through MAFRA Tool
CEN ENV 13606
HL7
PID
patientName id
dateOfBirth
sex
maritialStatus
address
accountNumber
DS00
name
Surname
patientId
Date
day
month
year
Contact
phoneNo
hasContact
birthDate
Concept Bridge
Property Bridge
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

17. Relating the Web services with the semantic defined through an ontology - UDDI
HacettepeHospital
ObservationReportingServices
PatientReferralServices
getClinicalInfo .
UDDI Business Entities and Related
UDDI tModels
Medical Services
PatientCare
PatientReferral
Observation
Reporting
GetClinicalInfo
CategoryBag reference
PatientReferralReq
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

18. Associating semantics to Web services in ebXML
HealthCareServices
subclassOf
subclassOf
PatientCare
PatientAdministration
ObservationReporting
subclassOf
subclassOf
PatientInfoRequest
PatientReferralRequest
Standards
Conformed
serviceQuality
ebXML Classification Hierarchy
ebXML
associations
ebXML
ClassificationNodes
ebXMLslots
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

19. How to Define a Classification Hierarchy in ebXML?
<rim:ClassificationScheme id = ‘WebService‘ isInternal='true' nodeType='UniqueCode' >
<rim:Name>
<rim:LocalizedString value = ‘WebService'/> </rim:Name>
<rim:Description>
<rim:LocalizedString value = 'This is a sample WebServicescheme'/>
</rim:Description>
<Slot name = ‘serviceQuality' slotType= 'StringList’/>
</rim:ClassificationScheme>
WebService
(seviceQuality)
PatientAdministration
PatientReferral
(stdConformed)
<rim:ClassificationNode id = ‘PatientReferral‘ parent= ‘WebService'>
<rim:Name>
<rim:LocalizedString value = ‘PatientReferral' /> </rim:Name>
<rim:Description>
<rim:LocalizedString value = ''/>
</rim:Description>
<Slot name = ‘stdConformed' slotType= 'StringList’/>
</rim:ClassificationNode> …
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

20. ServiceToIndustryClassification:
Relating the services with the semantic defined through an ontology - ebXML
ServiceToIndustryClassification:
Classification
classificationNode
classsifiedObject
PatientReferral
serviceQuality
stdConformed
MyService
RegistryEntry
Service
Classification Hieararchy
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

21. IHC F2F Meeting, Washington DC
“SubmitObjectRequest” which declares the semantic of “MyService” and relates it with the “PatientReferral” Service
<?xml version = '1.0' encoding = 'UTF-8'?>
<SubmitObjectsRequest >
<rim:LeafRegistryObjectList>
<Service id="MyService">
<Name> <LocalizedString lang="en_US" value = “MyService"/> </Name>
<Classification classificationNode=“PatientReferral“ ClassifiedObject= "MyService" />
<Slot name = ‘stdConformed'>
<ValueList> <Value>HL7 </Value> </ValueList> </Slot>
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

22. An Example “SubmitObjectRequest” (Cont’d)
<ServiceBinding accessURI=" ndexer">
<SpecificationLink specificationObject="wsdl"> </SpecificationLink> </ServiceBinding> </Service>
<ExtrinsicObject id="wsdl" mimeType="text/xml"> </ExtrinsicObject>
</rim:LeafRegistryObjectList>
</SubmitObjectsRequest>
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

23. We need more: Archetypes for semantic Interoperability
Using archetypes is a promising approach in providing semantic interoperability among healthcare systems
Annotating the messages of services with archetypes
To realize archetype based interoperability the healthcare systems need to
Discover the existing archetypes based on their semantics
Annotate their archetypes with ontologies
Compose templates from archetypes and retrieve corresponding data from the underlying medical information systems
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

24. IHC F2F Meeting, Washington DC
Exploiting ebXML Registry Semantic Constructs for handling Archetype Metadata
ebXML Registry semantic constructs can be used for
Storing Archetype Metadata
Storing Archetypes
Associating archetypes with metadata
Retrieving archetypes by using their semantics
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

25. Semantically annotating the archetypes
An example Archetype Metadata Ontology
Archetype
Purpose
Referral
Research
Education
Clinical
hasPurpose
ClinicalDocument
CodingScheme
DocumentTemplate
ClininalDomain
Location
Hospital
Office
Clinic
isDocumentedIn
SNOMED
LOINC
hasLinkTo
isAPartOf
fitsSlotsOf
relatedClinicalDomain
ClinicalInformation
Procedure
Plan
DiagnosticTests
Assessment
MedDRA
ICD10
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

26. Representing Archetype Metadata as ebXML Classification Scheme
OWL classes can be represented through “ClassicationNodes”
RDF properties that are used in OWL can be treated as “Associations”
“OWL ObjectProperty", “DataTypeProperty” and “TransitiveProperty” are defined by introduc ing new association types such as “objectProperty”
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

27. Representing Archetype Metadata as ebXML Classification Scheme
OWL class hierarchies
It is not possible to represent multiple inheritance in ebXML
Define a new association type “subClassOf”
Use the predefined “EquivalentTo” association to express
“owl:equivalentClass”, “owl:equivalentProperty” and “owl:sameAs“
A. Dogac, Y. Kabak, G. Laleci, C. Mattocks, F. Najmi, J. Pollock, “Enhancing ebXML Registries to Make them OWL Aware”, Submitted to the Distributed and Parallel Databases Journal, Kluwer Academic Publishers.
DAPD ebXML-OWL.pdf
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

28. Representing Archetype Metadata as ebXML Classification Scheme
Purpose
Referral
Research
Education
Clinical
hasPurpose
ClinicalDocument
CodingScheme
DocumentTemplate
ClininalDomain
Location
Hospital
Office
Clinic
isDocumentedIn
SNOMED
LOINC
hasLinkTo
isAPartOf
fitsSlotsOf
relatedClinicalDomain
ClinicalInformation
Procedure
Plan
DiagnosticTests
Assessment
MedDRA
ICD10
ebXML Registry
Classification Hierarchy
Archetype
SNOMED
Radiology
Organ
System
Central
Nervous System
Clinical
Domain
Coding
Scheme
Complete
Blood Count
Archetype Metadata
Ontology
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

29. Representing Archetypes in ebXML Registry
An “archetype” is represented in the Registry as a “Registry Information Model (RIM) Extrinsic Object”
“Extrinsic Objects” point to the Repository items where their contents are stored
OWL definition of an archetype is created from its ADL (Archetype Definition Language) definition and is stored in the Repository
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

30. Representing Archetypes in ebXML Registry
ebXML Repository
ebXML Registry
URI
Archetype OWL Definition
Classification Hierarchy
Extrinsic Objects
Archetype
Haemotology
Observation
Archetype OWL Definition
Clinical
Domain
Coding
Scheme
Archetype OWL Definition
Complete Blood
Count
URI
Organ
System
SNOMED
URI
Brain CT
Radiology
Complete
Blood Count
Central
Nervous System
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

31. Associating archetypes with metadata
ebXML Repository
ebXML Registry
URI
Archetype OWL Definition
Classification Hierarchy
Extrinsic Objects
Archetype
Haemotology
Observation
Archetype OWL Definition
Clinical
Domain
Coding
Scheme
Archetype OWL Definition
Complete Blood
Count
URI
Organ
System
SNOMED
URI
Brain CT
Radiology
Complete
Blood Count
Central
Nervous System
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

32. IHC F2F Meeting, Washington DC
ebXML Repository
ebXML Registry
URI
Archetype OWL Definition
Classification Hierarchy
Extrinsic Objects
Archetype
Haemotology
Observation
Archetype OWL Definition
Clinical
Domain
Coding
Scheme
Archetype OWL Definition
Complete Blood
Count
URI
Organ
System
SNOMED
URI
Brain CT
Radiology
Complete
Blood Count
Central
Nervous System
getContentQuery
filterQuery
Query Interface
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

33. IHC F2F Meeting, Washington DC
An Example query
A user can find all templates and archetypes that make reference to the SNOMED Complete Blood Count term
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

34. IHC F2F Meeting, Washington DC
Filter Query
< FilterQuery >
< ExtrinsicObjectQuery >
< ClassifiedByBranch >
< ClassicationNodeQuery >
< NameBranch >
< LocalizedStringFilter >
< Clause >
< SimpleClause leftArgument = \value" >
< StringClause stringPredicate =
\Equal" > CompleteBloodCount < /StringClause >
< /SimpleClause >
< /Clause >
< /LocalizedStringFilter >
< /NameBranch >
< /ClassicationNodeQuery >
< /ClassiedByBranch >
< /ExtrinsicObjectQuery >
< /FilterQuery >
Result
ExtrinsicObjects IDs classied with the “CompleteBloodCount" ClassicationNode
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

35. Retrieving Archetype Definitions
ebXML Repository
ebXML Registry
URI
Archetype OWL Definition
Classification Hierarchy
Extrinsic Objects
Archetype
Haemotology
Observation
Archetype OWL Definition
Clinical
Domain
Coding
Scheme
Archetype OWL Definition
Complete Blood
Count
URI
Organ
System
SNOMED
URI
Brain CT
Radiology
Complete
Blood Count
Central
Nervous System
<GetContentRequest>
<rim:ObjectRefList>
<rim:ObjectRef id="urn:uuid:368661c9-b733-4c14-96a3 -eabbdf36ff5b"/>
</rim:ObjectRefList>
</GetContentRequest>
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

36. IHC F2F Meeting, Washington DC
Continuing..
There may be other archetypes classified with
MedDRA - Full Blood Count
Read Codes Full Blood Count
These may have been defined to be equivalent to SNOMED Complete Blood Count Term
Through ebXML “EquivalentTo“ association
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

37. A Stored Procedure to find Equivalent Class Instances…
CREATE PROCEDURE findEquivalentInstances($className)
BEGIN
SELECT N.value FROM ExtrinsicObject EO, Name_ N
WHERE EO.id IN (
SELECT classifiedObject
FROM Classification
WHERE classificationNode IN (
SELECT id
FROM ClassificationNode
WHERE id IN (
SELECT parent
FROM name_
WHERE value LIKE $className )
UNION
SELECT A.targetObject
FROM Association A, Name_ N, ClassificationNode C
WHERE A.associationType LIKE 'EquivalentTo' AND
C.id = N.parent AND
N.value LIKE $className AND
A.sourceObject = C.id
) AND EO.id=N.parent
END;
GUI sends this stored procedure
It becomes possible to automatically obtain the archetype instances that are classified with SNOMED
As well as those instances classified with
MEdDRA “Full Blood Count" term
Read Codes “Full Blood Count” term
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

38. An Overview of a Mediator
Mediator Components
Ontology Server
- Functional Ontology
Semantic Mediator
HealthCareServices
PatientAdministration
PatientCare
PatientReferral
Scheduling
ObservationReporting
PatientInfoRequest
CancelPatientReferral
PatientReferralRequest
InsuranceInformation
ClinicalInformation
DemographicData
GetClinicalInformation
PID id
date
DS00
name
Surname
patientId
Date
day
Contact
address
Concept Bridge
Property Bridge
CEN/HL7/Gehr
Encapsulation
Legacy
System
VWS
Semantic Mapping via Bridges
- Clinical Concept Ontology
Web Service
Enactment
ebXML
UDDI
SuperPeer
Services
Hospital B
tModel
KlinikBilgiServisi
Client
Interface
BindingTemp
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

39. Summary: Artemis Architecture
GUI based tools for deploying existing healthcare applications as Web services
Service functionality ontologies
Service message ontologies
We are working on archetype based service message ontologies
Semantic mediator
Semantically enriched Web service registries
Semantically enriched P2P Infrastructure for scalability and resource discovery
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

40. Artemis Project: References
Dogac, A., Laleci, G., Kirbas S., Kabak Y., Sinir S., Yildiz A. Gurcan, Y., "Artemis: Deploying Semantically Enriched Web Services in the Healthcare Domain", Information Systems Journal (Elsevier), accepted for publication
Dogac, A., Laleci, G.B., Kabak, Y., Unal, S., Beale, T., Heard, S., Elkin, P., Najmi, F., Mattocks, C., Webber, D., “Exploiting ebXML Registry Semantic Constructs for Handling Archetype Metadata in Healthcare Informatics”, submitted for publication.
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

41. IHC F2F Meeting, Washington DC
Finally…
If you Google with “web service semantics healthcare”, Artemis project ranks the first 
If you Google with “web service semantics”, out of docs :
[PPT] Semantics of Web Services grenoble/_DogacSematicWS_FV.ppt
[PPT] A Semantic-Based Web Service Composition Facility for ebXML ...
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC

42. Thank you for your attention!
Questions?
Asuman Dogac
Nov. 17, 2004
IHC F2F Meeting, Washington DC