An Architecture for CDS and Quality Measurement

1
An Architecture for CDS and Quality Measurement

• September 2013

2
Architecture

• The manner in which the components of a computer
  or computer system are organized and integrated
• -- Merriam-Webster Online Dictionary

3
Building Architectural Components
4
HL7 (SAIF) Architectural Components
5
SAIF in Simple Terms
Viewpoints Viewpoints Business Requirements Information Models Behavioral Models Engineering Technology
Specifications Conceptual Scope, Problem Statement, Story Boards, Use Cases Domain Analysis Model, Clinical Statement Pattern Functional Specs, Service Roles Relationships, Application Roles Interactions Compatibility, Existing Platforms, Design Patterns
Specifications Platform Independent Authorities and Alignments, Core Principles, Priorities, Methodology Logical Models Collaboration Patterns, Interface / Service Specifications (e.g., WSDL) Existing Models, Libraries, Intended Transparencies
Specifications Platform Specific Rules, Procedures Physical Models, Schemas Scripts, Orchestrations, Interface Implementations APIs, Protocols, Transforms, ITS, Deployment Models
6
Transparent Invisible
Transparency What it Makes Invisible
access differences in data representation and procedure calling mechanism
location physical addresses, including the distinction between local versus remote
migration relocation relocation of an object
persistence deactivation and reactivation of an object
failure failure and possible recovery of objects
replication maintenance of consistency between replicas
transaction coordination of transactions
7
What is a Template

• A set of constraints on a model.
• Further refines existing models to narrow scope.
• Represented by a formal definition.
• Used to validate instances.
• Summarized from HL7 Templates DSTU and Ballot
  Draft

8
What is Metadata

• Used to Find Manage Things Governance
• Subject
• Provenance
• Security Privacy
• Descriptive
• Exchange
• Object Lifecycle
• Relationships
• -- See Healthcare Metadata

9
HL7 Specifications Related to Quality Improvement

• VMR for CDS Logical Model
• VMR for CDS Templates
• VMR for CDS XML Implementation Guide
• HED Knowledge Artifact Implementation Guide
• Decision Support Service Implementation Guide
• HQMF Specification
• HQMF QDM-Based Implementation Guide
• CCDA Specification
• QRDA Specification
• Arden Syntax
• GELLO
• InfoButton
• QDM
• XML ITS (1 2)
• Data Types
• RIM
• Clinical Statement Pattern

10
Reverse Engineering a Product Architecture

• Specification Teardown
• Overlaps and Gaps
• Similarities and Differences
• Identify Opportunities
• Agree to disagree, or to work it out
• Plan the Journey Ahead

11
Specification Teardown

• Using your PSS and Specification
• Write down the Spec Name on several Post-it Notes
• Identify SAIF Components in your Spec/PSS
• Put it up on the chart
• Repeat until Done
• Dont Sweat the Small Stuff

12
Overlaps Gaps, Similarities and Differences

• Identify Overlaps
• If two components are similar, put them closer
  together.
• If different, farther apart.
• Is anything missing? Are you sure?
• Look for hidden assumptions

13
Opportunities and Variations

• Whats the low hanging fruit?
• Successes? Failures?
• What Variations are OK? Not?
• How long will it take to fix?

14
Plan and Prioritize

• What can be delivered by November for Ballot, or
  January for Publication
• What needs more time?
• Where will the puck be
• In 6 months?
• In 12 months?
• How do we get there? What is the path of least
  regret?

15
Questions?

• ?