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Dunedin Southern Ophthalmology Group October 12 2007 Mike Mair FRANZCO
Dunedin Southern Ophthalmology Group October 12 2007
Mike Mair FRANZCO
Dunedin Southern Ophthalmology Group October 12 2007
EHR
An examination of the ‘act’ metaphysic in the HL7 Reference Information
Model and vs 3
Dunedin Southern Ophthalmology Group October 12 2007
Personal Project
• After a ‘unified theory’
• I studied human interaction
• Identified a ‘natural segmentation’ of language’
• Leads to a Quantal theory of human behaviour and interaction, Meeting/parting/story a key ‘parser’
Dunedin Southern Ophthalmology Group October 12 2007
The Catastrophe Theory Metaphor for the Process of Text Generation: The Predator Prey Cycle
The Process of Human Interaction
Dunedin Southern Ophthalmology Group October 12 2007
process
The Record
Meeting
Process
Parting
Dunedin Southern Ophthalmology Group October 12 2007
The basic medical input template
• SOAP: subjective, objective, assessment, plan – from Lawerence Weed
• Would the aggregation of attested SOAPs be enough for an EHR?
Dunedin Southern Ophthalmology Group October 12 2007
Zap them with templates…
Dunedin Southern Ophthalmology Group October 12 2007
Dunedin Southern Ophthalmology Group October 12 2007
The long and winding road….
Dunedin Southern Ophthalmology Group October 12 2007
DiseaseCourse
AssessmentObjects
ManagementObjects
Conceptual Model for Standards NZ work group 1997: Encounters in Two Episodes, One Disease Course
Episode of Care
Episode of Care
Dunedin Southern Ophthalmology Group October 12 2007
The Health Event Summary (HES) and the CDA
• The HES solution in search of a format
• CDA was a ‘no brainer’ for this
• A container rather than a document
• CDA format has wide global acceptance
• The CDA is an ‘attested unit’, an independent data resource
• Later proposed to ISOTC215 in the ‘immunological model’ for access control
Dunedin Southern Ophthalmology Group October 12 2007
The Immunological Model
Dunedin Southern Ophthalmology Group October 12 2007
IGM, the IGG pentameter
The Immunological Model
Dunedin Southern Ophthalmology Group October 12 2007
Regional Server data store
List of CDA Headers(or Access Objects)
Provider Server data store
Attestable UnitDocument informationEncounter dataService actorsService targetsClinical digest Locates
CDA documentsource
Accessapproved
Encrpytionkey transfer
Dunedin Southern Ophthalmology Group October 12 2007
Regional(SOAP)Server
Datastore
Regional(SOAP)Server
Datastore
Requestor
Datastore
Provider(originatingOrganization) SSLSOAP security
SOAP EnvelopeDigital signaturePublic key certificateSOAP encryptionRole-base access control
Secure Socket Layer (SSL) SecurityCleint/Server authenticationSupporting SOAP encryption
SSL
SSL
2 CDA request in SOAP envelope
3 Route
request
to
neig
bour if n
ecessa
ry
3 Get com
plete CDA from
Provider if request and
access role matched
1 Request t
o neighbour server
CDA Documentin SOAP Envelop
SOAP Security
Dunedin Southern Ophthalmology Group October 12 2007
The document exchange XDS from IHE
• Uses CDA
• Separates Header and Body and uses the Header as a pointer
• Similar in concept to the immunological model?
Dunedin Southern Ophthalmology Group October 12 2007
The First Timaru Talbot
Dunedin Southern Ophthalmology Group October 12 2007
EHR
Dunedin Southern Ophthalmology Group October 12 2007
Thanks for listening
