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

From: Parsa Mirhaji <pmirhaji@knomed.com>
Date: Thu, 16 Dec 2010 15:28:29 -0600
Cc: Peter.Hendler@kp.org, markw@illuminae.com, W3C HCLSIG hcls <public-semweb-lifesci@w3.org>, "S. Ward Casscells" <ward.casscells@gmail.com>, public-semweb-lifesci-request@w3.org, twclark@nmr.mgh.harvard.edu
Message-Id: <EEAE5163-35C7-4678-BF01-7BF2D069D5D0@knomed.com>
To: conor dowling <conor-dowling@caregraf.com>
My concern/opinion is that in the past many years the technical community has invested so much on XML and HL7 in the name of interoperability (Ironically calling it Semantic Interoperability) that now it is very difficult for someone to come out and say that we should be doing Semantic modeling instead! The immediate response followed by some rolling of eyes being 'Well we already have that! look at RIM, use XML, etc'. My response is "Is that right? then why is that we are having this discussion now and after almost 30 years of XML and HL7 experience?" . So appears that collectively we have erected a mountain of technical frameworks for interoperability in front of us and the only way to get there is to get past it!  

It is maybe that most of us still think of 'Semantic Interoperability' as how we human beings come to agree about meaning and context of our 'codes'. We are somehow thinking of that process of consensus making about use of terms and codes as 'Semantic'. But from my perspective it is not about us humans anymore. RIM and XML did that and we are where we are. We need to redefine Semantic Interoperability as how machines and artifacts make an agreement about the meaning and context of 'codes'. Now this new focus will point in a direction other than XML and indefinite code=value pairs that we should somehow come up with for the data, metadata, and metadata of the metadata... Then constructs such as same-as, constraint based subsumptions and relationship making between URIs will start adding value to the enterprises that need to grow and adapt to changing environments much faster than we human beings can agree on the times that we can meet to discuss change... 

Parsa Mirhaji, MD, PhD
Scientific Officer
KnowMED Inc.
Phone: 832 378-8385

On Dec 15, 2010, at 12:03 PM, conor dowling wrote:

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 value.

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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Mark <markw@illuminae.com> 
Sent by: public-semweb-lifesci-request@w3.org
12/14/2010 06:44 PM

"Tim Clark" <twclark@nmr.mgh.harvard.edu>
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...

Received on Thursday, 16 December 2010 22:03:25 UTC

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