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Re: Wait a sec...What about the HL7 RIM An Universal Exchange Language

From: conor dowling <conor-dowling@caregraf.com>
Date: Wed, 15 Dec 2010 10:03:26 -0800
Message-ID: <AANLkTik=crah6aP_=bgnxmmLJsgVeBLUU1MBAceeY1jG@mail.gmail.com>
To: Peter.Hendler@kp.org
Cc: markw@illuminae.com, public-semweb-lifesci@w3.org, public-semweb-lifesci-request@w3.org, twclark@nmr.mgh.harvard.edu
in Caregraf, we've been working in meaningful use (CCDs, CDA, HL7 RIM) for
the last year and use a pipeline that goes from a graph store (RDF) of
patient data into the government required CCDs. The process was recently
certified for meaningful use.

A quick compare and contrast between the CCD and its Semantic Superior (my
two pence worth anyhow):
- CCDs handle unambiguous resource identification with Object Identifiers,
naming authorities etc.. The problem in a CCD isn't unique identification
but how to alias. The same "actor"/doctor has an identifier from each
hospital. *There's no "sameas" as far as I know*
- demographics (everyone rolls their own): here the CCD relies on a few
generic classes, the ones in the RIM. This is the same, no better, no worse
than so many other demographic vocabularies out there.
- for the majority of data, clinical data, RIM also addresses the old saws
- who said something? when did they say it? who do they represent? - but in
the nitty gritty of clinical observations, it punts to *schemes of medical
coding (note I'm not saying vocabularies or ontologies)*. In other words,
it's the ye olde:
           observation type -> code
           observation value -> ...
- the code schemes have OIDs too. SNOMED, LOINC and every local schema gets
a base OID and individual "codes" are identified under that. *There's no
distinction between the flat (CVX codes) and modelled vocabularies (LOINC).
Other than "sameas", this is the key place where the Semantic Web adds

One other, more prosaic advantage of the Semantic: as an XML serialization,
RDF promotes links (rdf:resource) rather than restating the same demographic
data again and again and that brings efficiency. BTW, and you can see it in
the first post here, the government continues to see "XML" as some sort of
magic talisman, as if angled tags convey meaning by nature. Something wrong
with your current XML approach - make another! Think of the newish HData. In
most scenarios, we've had to present RDF as just an efficient XML flavor.

So I think the key upgrades brought by the Semantic Web are: models for
description, not flat codes and, for demographic data, "sameas"/identity.
Once they're in place, rule-application, entailment goes from there.

If some are interested in pursuing a semantic alternative to XML-itis and
flat code schemes, then count me in. BTW, so many semantic standards exist -
what's needed now is an implementation guide,

On Wed, Dec 15, 2010 at 8:17 AM, <Peter.Hendler@kp.org> wrote:

> The PCAST did not take into consideration (maybe they don't even know)
> there is an universal exchange language for healthcare.  It is HL7 V3.  The
> CDA is merely one of virtually infinite structures that can be constructed
> from the RIM.  The meta information as well as the clinical data is
> unambiguously represented by RIM.  There is no reason to ignore the
> thousands of man years that went into designing the RIM.  The RIM Based
> Application Architecture  (RIMBAA) work group at HL7 has had many
> demonstrations of RIM based applications.  We don't need to re invent the
> wheel.  CDA is only one particular RIM structure designed for one particular
> use case.  Those of us who have been working at HL7 for years are blown away
> by the suggestion that there needs to be a different wheel invented.
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>  Thank you.
>  *Mark <markw@illuminae.com>*
> Sent by: public-semweb-lifesci-request@w3.org
> 12/14/2010 06:44 PM
>   To
> "Tim Clark" <twclark@nmr.mgh.harvard.edu>
> cc
> public-semweb-lifesci@w3.org
> Subject
> Re: An Universal Exchange Language
> But seriously, Tim, if we were to pursue this problem, we would need some
> form of unambiguous identifier for "things"... and given the distributed
> nature of the biomedical domain, we'd want to make sure that there was
> some way of resolving that identifier to obtain metadata about it from a
> variety of disparate sources who might have very different information -
> clinical, molecular, demographic, etc...
> hmmmm....
Received on Wednesday, 15 December 2010 18:04:00 UTC

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