Terminology and code system services in Finland + CTS

HL7 WGM meeting, Noordwijkerhout,

May 2005Juha Mykkänen (includes material from various other people)

University of Kuopio, HIS R & D Unit

FinlandSerAPI project – www.centek.fi/serapi

2

This presentation

• Overview of two terminology-related developments in Finland

– national code server– API interfaces for centralized terminology

services (CodeAPI)

• Relation to CTS and future

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Recent developments in Finnish healthcare IT

• National project for health reform started in 2002– has strong NHII component– focuses in achieving interoperable EPR/EHR systems, HL7 CDA

has a strong role– other IT components: code service, security, identification,

regional systems, archives…– project schedule: till the end of 2007

• Many R & D activities, including National Technology Agency TEKES FinnWell-programme

• Regional systems and projects, now related to the two above

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Organizational information system services

Organizational information system services

Electronicconsumer services

(Call/Contact Centre, Regional booking, etc

Electronicconsumer services

(Call/Contact Centre, Regional booking, etc

UserInterface

UserInterface

Code server

Code server

Des

kto

pin

teg

rati

on

Des

kto

pin

teg

rati

on

DesktopDesktop

Reference system (references,

service chains, adapters)

Reference system (references,

service chains, adapters)

Name server(OID)

Name server(OID)

Certificatesof

professionals

Certificatesof

professionalsPopulation

centre

PopulationcentrePortalsPortals

Code server

Code server

Name server(OID)

Name server(OID) Short-time

archive

Long-timearchive

(text, imaging, signals,approvals, refusals, log)

Short-time archive

Long-timearchive

(text, imaging, signals,approvals, refusals, log)

National services

Centre ofprescriptions

Centre ofprescriptions

Centre ofcertificates

Centre ofcertificates

Regional servicesSecuritySecurity Message

exchange(SOAP)

Message exchange

(SOAP)

User devices (PC, PDA, GPRS, GSM)

User devices (PC, PDA, GPRS, GSM)

NetworkNetwork

StatisticsStatistics

National Architecture 2005 (proposal)

[Kauko Hartikainen]

National Code Server

(note: no speaker affiliation, thanks to

Matti Ojala/Stakes,

Timo Pessi/Datawell and

Jari Lehtonen/Stakes)

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National code server: background and status

• part of National Health Project (Ministry of Social Affairs and Health)

• subproject in National Research and Development Centre for Welfare and Health (STAKES) 2003-2004

• Purpose: national digital updating and distribution system for terms, glossaries, classifications and related codes

• Running since 2004 at: http://koodistopalvelu.stakes.fi

• now 20 code systems in production environment– e.g. ICD-10, Medical procedures, Lab test and physiotherapy

nomenclatures, several HL7 2.3 classifications etc.

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Why code server?1. Makes glossaries, classifications and codes better available and updated;2. Improves cooperation and boosts productivity in the social and health care

service chains, compilation of statistics, monitoring, planning and sharing of information systems;

3. Enables crossing of boundaries between sectors, service providers, units and information systems;

4. Enhances electronic service production in the social and health care sector;5. Supports the creation of new operating models in the social and health care

sector;6. Supports information system developers in the social and health care

system who need classifications, codes, glossaries or data on organization units;

7. Helps in developing electronic processes in the social and health care service system, putting functions online or reaching out digitally to new interest groups and user groups;

8. Helps in harmonizing information structures using classifications, codes, glossaries or organization unit data in social and health care sector information systems;

9. Creates a foundation for the development of information management tools for instance with keywords;

10. Links the national code service to international code servers.

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CodeServer - description

• CodeServer is used to create, save and update code sets and to publish them for health professionals and information systems

• CodeServer is browser-based - distributed maintenance to various organizations responsible of different code sets

• Modifications are in one location, which eases the maintenance and improves information quality

• Code set transformations between different systems

• Includes interfaces to distribute codes to external systems

[Timo Pessi, Datawell]

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Provided functionality

• Creation, copying and modification of code sets• Search and browse• Code set versioning• Validity time definitions• Documentation and tracking of changes• Support for multiple languages• Support for hierarchical organizations and classifications• Definition of mappings, links and synonyms• Support for local elements• XML/SOAP interfaces for direct integration to other IS• Exporting functionality, web publishing, e.g. Ecomed, Excel,

SAS, XML formats• File import for code set producers

[Timo Pessi, Datawell]

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Codeset export / import interfaces

• XML messages for transferring codes from national server to regional or local applications available through HL7 Finland

– other direction also planned e.g. for organizational units

• use SOAP envelope same way as CDA (R1 and R2) adapters in Finland

• dataset (reference elements)

• major uses:– import all / new or changed codes for a given code

system

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Example<!DOCTYPE document (View Source for full doctype...)> <document> <header>Stakes koodistopalvelin ohjelmisto: Datawell: CodeServer x.x

22.09.2003</header> <body> <termSystem id="1.2.246.537.6.1.1996" language="fi" createDate="1996-10-01"

beginDate="1996-10-01" expirationDate="2005-12-31"

lastModifedDate="20030915" lastModifedBy="Stakes"> <atribute type="longname" dataType="ST" language="fi">ICD 10

1996</atribute> <atribute type="maintainer" dataType="ST" language="fi">Stakes</atribute> <termItemEntry id="C00-D00" language="fi" createDate="1996-10-01"

beginDate="1996-10-01" expirationDate="2005-12-31" lastModifedDate="2003-09-15"

lastModifedBy="Stakes"> <atribute type="shortname" dataType="ST" language="fi" createDate="1996-

10-01" beginDate="1996-10-01" expirationDate="2005-12-31"

lastModifedDate="2003-09-15" lastModifedBy="Stakes">kasvaimet</atribute> <atribute type="hierarchylevel" dataType="ST">4</atribute> </termItemEntry>…

CodeAPI interfaces

shared services for applications using code systems

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Needs

Softw. devel.

Sales & support

R & D

Applied research

Basic research

Teach-ing

Software companies

Healthcare / welfare service providers

IS-enabled

care

IS project

IT support

Educational and research institutions

Health/welfare services

Better life

Needs

Products, consultation

Needs

Actors, methods

Intl. links

Government

Guidance, resources

Communities, citizens

Background: PlugIT project

• National R&D project to develop integration solutions for healthcare• Results: Service specifications, integration methods, centre of expertise• Oct 2001–Aug 2004, about 15 full-time + 15 part-time researcher/developers• Budget € 2 million, 84% by National Technology Agency TEKES

3 univ. depts, 1 polytechnic

12 applications vendors, 3 technology vendors

6 hospital districts, 2 municipalities

Natl. healthcare programme / National EHR project

www.plugit.fi

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Shared terminologies and code systems for applications

• National Code server– browser version in use, more code sets added to the service (including ISO OID

provider identification)– message definitions to transfer code sets to different systems

• PlugIT common service interfaces, one of which deals with code systems (CodeAPI)

– centralized functionality (and data), decrease overlapping functionality / maintenance / implementation

– application-oriented, ”user activity-related” API interface operations• search, listing, browse operations on different levels (hierarchies, several languages

etc.)

• different types of interfaces in above two services– import code sets from centralized (e.g. national) service– use (and possible refer to) codes from centralized (e.g.

regional/organizational( service– both available also through HL7 Finland

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Centrally managed (nationaland local / regional) code

sets

Code set providerapplication (e.g. regional

code server orcomponent of core

application in healthcarefacility)

CodeAPI

National code sets

NationalCode server

Web applicationusing code sets

(e.g. regionaldisease-specific

system)

Browser user Clinical user

Web serverapplication

Workstationapplication, e.g.

Code set browser(can use code setsthrough the service)

Application-specificcode set database

Workstation application,e.g. Clinical Decision

support system (can usecode sets from own

database, update sharedcode sets through the

service)

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CodeAPI: Relation to other specifications

• Used – Code transfer messages (HL7 Finland Open CDA project / national code

server)• information contents of the national code server enables conformance levels

in CodeAPI• same XML elements used where possible• less coding especially in software which uses national code server and offers

CodeAPI interfaces for local applications• ”authorized” central code service (e.g. regional), specific operations for

applications as readily-made services (search, list, browse, etc.)– OMG Terminology Query Services (TQS)

• used as a functional basis; however, only subset of functionality needed in PlugIT + project decision not to use IDL (tool dependencies, technology transition)

– other PlugIT services (user, access rights, patient etc.)• same technology and content conventions, no dependencies

– HL7 Common Terminology Services (CTS)• found extremely useful, details follow

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CodeAPI specification v2.0

normative: 5-6, appendices 2-4

informative/background: 1-4,7, appendix 1

most suitable level for international harmonization: 3-4?

1 Introduction and scope2 Background (TQS, HL7v3 data types related to codes, HL7 CTS,

National code server, OID)3 Specific integration requirements4 Technology neutral interface definitions (version 1)5 Technology-specific interfaces based on XML and http (version 2)6 Content specifications: connecting the interface to different code set

contents7 Implementations and further developmentAppendices:

Data elements in national code server and HL7 MDFListing of operationsSummary of requirements on different conformance levelsSummary of XML elements

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Conformance levels v2.0

3 API interfaces: CodeService, Codeset, Code

• minimum level– only the most necessary operations for centralized code set services for easy

connectivity with existing applications: bind to code set, bind to code, list codes, minimum information content (code + designation), get designation by code, get code by designation

• ”base”– in addition to minimum level search capabilities, metadata about supported code sets

and services, administrative information about service and code sets

• ”multilingual” – support for different languages in designations and other information

• ”hierarchy”• ”status”

– by default, also local and ”removed” codes are also returned

• ”freeElements”– in addition to minimum information, other available elements for code entries for

different operations

• ”advSearch”– more advanced search capabilities, substrings, keywords, search from arbitrary

elements, multiple search keys etc.

• conformance levels can be used on service or code set levels

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Interfaces and operations v2.0

• CodeService interface– GetSupportedCodeSystems: base level– GetSupportedServices: base level– GetInfo: base level

• Codeset interface– LookupCodesByDesignation: minimum level– ListCodes: minimum level– LookupCodes: base level– GetSupportedCodesetServices: base level– IsCodeValid: base level– GetCodesetInfo: base level– ListLanguages: multilingual– GetHierarchyDepth: hierarchy– GetCodes: freeElements– GetSupportedAttributes: freeElements

• Code interface– GetDesignation: minimum level– GetParent: hierarchy– GetHierarchyLevel: hierarchy– GetStatus: status– GetLocal: status– LookupCompleteCodedConcept: freeElements– LookupProperties: freeElements

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Content specifications

• How to connect a given code system to the interface– where to get code, designation, language etc…– content specification is separate from the interface, ideally one

official authoritative content specification for each code set• same interface for different code sets

• CodeAPI v2 ICD-10 content specification– mapped to national code server data elements and format

provided by the National Research and Development Centre for Welfare and Health (STAKES)

– additional content specifications• e.g. for other code sets in the national service

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CodeAPI Example: search operation on mimimum level

<?xml version=”1.0” encoding=”UTF-8”?><request xmlns=”urn:plugit:CommonServices”> <interface>Codeset</interface> <method>LookupCodesByDesignation</method> <param> <termSystem id=”1.2.246.537.6.1.1996”</termSystem> <find> <matchText>lavantauti</matchText> </find> </param></request>

<?xml version=”1.0” encoding=”UTF-8”?><response xmlns=”urn:plugit:CommonServices”> <term id=”A01.0”>Lavantauti</term></response>

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CodeAPI Example: search operation (used levels: advanced search, freeElements, multiligual, status, hierarchy)

<?xml version=”1.0” encoding=”UTF-8”?><request xmlns=”urn:plugit:CommonServices”> <interface>Codeset</interface> <method>LookupCodeByDesignation</method> <param> <termSystem id=”1.2.246.537.6.1.1996”/> <find> <matchText language=”fi” partial=”2”>avantaut</matchText> <status>1</status> <local>0</local> <parentId>A00-A09</parentId> </find> <sortBy>id</sortBy> <display> <propertyCodeList> <property>shortname</property> </propertyCodeList> </display> </param></request>

<?xml version=”1.0” encoding=”UTF-8”?>

<response xmlns=”urn:plugit:CommonServices”>

<termItemEntry id=”A01.0”>

<atribute type=”shortname” language=”fi”>Lavantauti</atribute>

</termItemEntry>

<termItemEntry id=”A01.1” >

<atribute type=”shortname” language=”fi”>Pikkulavantauti

</atribute>

</termItemEntry>

...

</response>

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HL7 CTS relationship

• CTS was ”discovered” when specifying version 2 of CodeAPI operation harmonization for CodeAPI v2

• CTS: messaging API, Vocabulary API, IDL interfaces• CTS reference model is more abstract than in CodeAPI • interface technologies:

– CTS: IDL interfaces (with IDL Java WSDL (rpc/encoded style over http) examples

– CodeAPI: XML-wrapped operations (over http) – WSDL available for other PlugIT common services

• CTS: no content specifications, recommendation to use HL7 ConceptProperty codeset

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Initial comparison / CTS / CodeAPI• semantic correspondence to all operations in CTS Vocabulary API

(except AreCodesRelated) can be found in CodeAPI operations• national code server information has resulted in more specific (and

numerous) operations and levels in CodeAPI than in CTS• not many CTS Message API operations in CodeAPI (ValueSet,

VocabularyDomain etc.), simple reference model and interfaces in CodeAPI – no mapping, code relationships etc.

• differences etc. whether to return only code id or also designations + elements for different conformance levels in CodeAPI

• hierarchy / local / status / etc. features as direct parameters in CodeAPI (can be used through reference model, relationships etc. in CTS?)

• direct use of national code server XML elements in CodeAPI• IDL interfaces in CTS (+example of Java and WSDL), XML

specifications in CodeAPI • OID in code set identification in both specifications• id value in code identification in both specifications (no CORBA-type

object references etc.)• CTS Conformance: runtime and browser separately for Message and

Vocabulary API• CodeAPI Conformance: several conformance levels for different

functionalities

End of monologue

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Possibilities / discussion• comparison of requirements for CTS II and CodeAPI

(Finland) to find possible candidates for new features or needs (for CTS II Vocabulary API?)

• examples, use cases (or conformance levels) for CTS II Vocabulary API (see conformance levels in CodeAPI) – also discussed in CTS (to get new users up to speed)

• walkthrough of export / import interface of national code server

• link to infrastructure work in HL7/OMG Healthcare Services Specification Project

• note: both national code server and CodeAPI interface specifications are in Finnish

– but requirements, functionality and products are generic / international?

• SerAPI project (SOA / web services focus) participates in Service Specification Project, HL7 Finland (Common Services SIG)

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Dank u

• SerAPI project participants: National Technology Agency TEKES (grant no 40437 / 04), Medici Data Oy, Datawell Oy, Fujitsu Services Oy, Hospital district of Northern Savo, WM-data Oy, Commit; Oy, Intersystems B.V. Finland, Mediconsult Oy, Microsoft Oy, Oracle Finland Oy, Hospital District of Satakunta, Bea Systems Oy, Hospital District of Helsinki and Uusimaa, City of Kuopio, Kustannus Oy Duodecim, Mawell Oy

Juha.Mykkanen@uku.fi

www.uku.fi/tike/his/serapi/www.plugit.fi/