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The InterMed TM Collaboratory –the early years (1994-1996) Biomedical informatics researchers & systems developers at 5 sites: Harvard/Brigham and Women’s Hospital Harvard/Massachusetts General Hospital Columbia Presbyterian Medical Center University of Utah School of Medicine Stanford University School of Medicine
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The initial InterMed concept Biomedical application development too slow Silos, limited reuse Internet could provide common resources (middleware) Domain-specific Seven-tiered model Built on infrastructure “service” layer
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Infrastructure Classes & Services Vocabulary / Taxonomy Data Bases & Knowledge Bases Component Tools Composition Methods Applications Policies & Procedures InterMed’s Seven-Tiered Model
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SNOMED MED (Columbia) LOINC IVORY (WARP) InterMed Vocabulary Model UMLS...... InterMed Vocabulary Server Populated with sample domain-specific content Map into local vocabularies for existing applications Local vocabs for new applications Implemented using convenient representation language Input/Output Specifications and Protocols Browsing & Maintenance Requirements Define meta-terminology Keep implementation-independent Provide generic solution TheNetSys Collaborative Model Development
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Intended applications Linking DXplain to a clinical information system Internet-based clinical guidelines Internet-based clinical research queries
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Component development work DXplain access (MGH) - tiers 3,4 Guideline tools (MGH, BWH versions) - tiers 3,4 Semantic net tool: TheNetSys - tier 2,4 Semantic model for CXR reports - tier 3 Form tool (a la HTML 3) using semantic model - tiers 3,4 Development of import/export (TheNetSys/Ontolingua) Image tool (with pan, zoom, grayscale adjust) - tier 4 Tree walker for state maps & protocols - tier 4 WWW access modules - tier 4
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Application construction tools (Tier 5) Interface builder Use of visual embedding/ compound document architectures (Open Doc, OLE-2) Script-based communication among components Work-flow-management-oriented framework An approach to integration based on clinical guidelines: the GEODE-CM project
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Early findings ~ 1995 Activities weren’t converging Progress in the different labs was not aligned Each was working on what interested it Vision was too abstract Hard to identify measures of success We decided to select a single application focus to drive the project Needed to be something all of the labs cared about
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Common guideline representation as a second year focus Multiple purposes of guidelines education (reference) training (how to do something) problem-solving responding to events (alerts) protocolized care/data capture care plans/critical paths -- UR and QA consultation workflow management (GEODE)
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Multiple representation approaches Flow charts Narratives Decision tables Rule-base MLM procedures State model database
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Collaborative Model Development InterMed Guidelines Model...... InterMed Guidelines Server Populated with sample domain-specific content Map into local representation for existing applications Local versions for new applications Implemented using convenient representation language Input/Output Specifications and Protocols Browsing & Maintenance Requirements AHCPR Guidelines T-Helper Protocols CPMC Clinical Pathways & Guidelines UTI and Other Guidelines at MGH Define meta-terminology Keep implementation-independent Provide generic solution BWH GEODE Clin. Mgt. Pathways
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Goals to explore: Whether a common representation could be devised that maintains all of the information needed to support all of the applications How the guideline knowledge should interact with vocabulary knowledge What components and tools would be needed
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Work was then able to be partitioned Requirements analysis Model development Tool building Testing and refinement Application exploration Cognitive studies SDO participation, conference planning, community development
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Difficulties still occurred when: Groups disagreed about emphasis or approach No one signed up for a needed task Need for continuing work on maintaining a shared vision
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Collaboratory issues Ideal C’y needs shared vision and buy-in strong business case intellectual and practical appeal Tight project management funding dependent on performance Can peer-based C’y be productive? Can research-based C’y (vs. product- focused) be successful?
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