1. ART DECOR: an XML framework for medical metadata Marc de Graauw XML Amsterdam 2013

2. What we’ll cover The problem domain – medical procedures and knowledge – healthcare IT standards (HL7, Snomed,...) – expertise involved (IT, doctor, terminologist) The solution – XML data model (DECOR) – XML tooling to edit (ART) – different views and output formats – code generation Pros and cons of an all-XML solution

3. A use case Dutch colorectal cancer screening – entire population 55+ gets screened – faeces samples collected, tested for blood – if suspect, invitation for colonoscopy – gastro-enterologist performs colonoscopy, submits findings to registry – if tissue removed, sent to pathologist – pathologist performs macro-/microscopical analysis, submits findings Other use cases – Perinatology, Youth Healthcare (Netherlands) – ELGA elektronische Gesundheitsakte (Austria) – QiN KfH Datenaustausch in der Nephrologie (Germany) – epSOS, trans-European medical exchange – many more

4. Koppelingen HL7 V3 CDA bericht: Art-decor, via : http://decor.nictiz.nl/ art-decor/ decor-project--rivmsp-

5. PROBLEM DOMAIN - MEDICAL

8. Patient id Document id Medication Observations Gastro- enterologist

9. PROBLEM DOMAIN - TERMINOLOGY

10. Medical terminologies LOINC – Logical Observation Identifiers Names and Codes – Laboratorium Observations ICD-9, ICD-10 Snomed Goals: – uniform codes for exchange – enable analysis / statistics

13. Example valueset Medical terms Snomed codes

14. PROBLEM DOMAIN - ICT

15. Just enough HL7 HL7 version 2 : currently used a lot in hospitals HL7v3: – Reference Information Model – XML serialization – XML Schema – CDA (part text, part structured data) – Slow uptake, new developments

16. 0..* 1 1 RIM (Reference Information Model) Backbone EntityParticipationAct ActRelationship 11 0..* Referral Transportation Supply Procedure Condition Node Consent Observation Medication Act complex Financial act Organization Living Subject Material Place Health Chart Patient Guarantor Healthcare provider Insurer Practitioner Role 1 0..*

17. RIM (Reference Information Model)

18. HL7 in the OID tree

19. HL7 snippet for Gastro-enterelogical Report

20. The problem domain: Participants and development cycle Data Set

21. THE SOLUTION - DECOR

22. DECOR overview

23. DECOR dataset project name scenario copyright version info description authors issues value sets identi- fications rules concept group item use case transaction actor code systems terminology systems validation conditions constraints OID status assignment

24. Example DECOR file

25. THE SOLUTION - ART

26. ART - editor

28. ART demo

29. DECOR and ART technology A DECOR file is an XML file – methodology developed by dr. Kai U. Heitmann – basis for transformations to other HTML / XML – fine basis for schema(tron) – has its own schema (DECOR.xsd) ART is tooling to make DECOR files – tooling developed by Gerrit Boers – ART is made with XQuery / XForms – open source products eXist / Orbeon ART and DECOR are open source (GPL / LGPL) – team: Kai, Gerrit, Alexander Henket, Maarten Ligtvoet, Marc

30. HealthcareTerminologistsICT Architects HL7v3 modellers IT vendorsTesting PERI JGZ Spoed etc.. Stakeholders DECOR XML WEB INTERFACE XForms XQuery eXist XML database ART tooling

31. THE SOLUTION – OUTPUTS

32. StakeholdersARTDECOR HTML XML Outputs HealthcareTerminologistsICT Architects HL7v3 modellers IT vendorsTesting dataset project scenario issues value sets identi- fications rules CSV

33. Care provider view

34. Technical documentation

35. XML / CSV resources for implementers

36. THE SOLUTION – CODE GENERATION

37. message validation StakeholdersARTDECOR Schematron Schematron generation IT vendorsTesting dataset project scenario issues value sets identi- fications rules XML OK ?

39. Schematron / test demo

40. StakeholdersARTDECOR XML specs UI generation IT vendors dataset project scenario issues value sets identi- fications rules UI

44. USING XML – PROS AND CONS

45. Application architectures APPAPP DB

46. XML as a storage format APPAPP DB XMLXML

47. XML as exchange format APPAPP DB APPAPP APPAPP XMLXML

48. Web architecture 2013 Con trol ler Model Br ows er View XMLXML HTML CSS JS User Interface Logic

49. HTML CSS JS non-XML vs XML application XQu ery eXist Br ows er XForm User Interface Logic XML HTML CSS JS Djan go Post greSQL Br ows er Tem pla tes User Interface Logic

50. XML for application: pros and cons versatile data structure – easy to adapt – easy to generate different outputs easy to introduce bugs learning curve – XQuery: not too hard – XForms: steeper harder to debug – less tooling, especially server-side – client-side debugging: you see HTML, not XForm procedural versus declarative programming – procedural: here you have an X, multiply by 2 and give it back to me – declarative: if you see an X, multiply it by 2 – XML all over the place: it’s magic, and sometimes you don’t get it (some) partners have limited XML knowledge Schematron versus XML Schema – co-occurrence... – error reporting

51. QUESTIONS ?