Ontolog Forum Panel Discussion

Healthcare Informatics Landscapes, Roadmaps, and Blueprints: Towards a Business Case Strategy for Large Scale Ontology Projects

Moderated by: RexBrooks,

• Panel Members:
  • MarkMusen, Director Stanford Medical Informatics—confirmed;
  • BobSmith, Professor Emeritus, California State University--confirmed,
  • MarcWine, GSA Office of Intergovernmental Solutions-confirmed;
  • DavidWhitten, WorldVistA, Co-founder; Public Domain Knowledge Bank--confirmed,
  • Brett Trusko, OASIS Healthcare Industry Consultant—pending;
  • ChristopherChute, OMG-HL7 —pending;
  • Brand Nieman, EPA, chair of the federal Semantic Interoperability Community of Practice, CIO Council -pending
  • Esther Dyson —pending.

1. Objectives This Panel Discussion seeks to:

• identify the outlines and key landmarks of the current healthcare informatics landscape;
• clarify semantic interoperability issues between and amongst existing and planned standards, particularly between OMG-HL7 and OASIS initiatives;
• identify an appropriate Ontology Strategy and committment to business valuation;
• express key issues for Health Services(Sciences?) Domain Ontology organizational maturity and technology readiness levels;
• describe the Time dimension opportunities between remote organizational units.

2. Background: Prior Ontolog Discussion Forums have focused upon topics such as Services Sciences and Ontologies and Tagging for an increasingly focused audience of interdisciplinary experts and cross-disciplinary practitioners, while recent Ontolog Speaker Forums have examined topics of :

• WorldVistA entitled: "The Importance of Dynamism in the OpenVistA Model" for an audience of communities seeking interoperability in Electronic Healthcare issues;
• "Enhancing Business Processes Using Semantic Reasoning" for an audience of communities seeking interoperability in Business Processing;
• "The Maturity of Business Ontologies and Rate of Adoption - examples and challenges from the domain of eCommerce and electronic business collaborations" for an audience of communities interested in examining the issues of Semantic Web development in the business domain.
• We wish to engage thought leaders on healthcare informatic frontiers because there are many converging efforts heading in similar directions for standardizing the range of business functions that support healthcare delivery.
  • In other words, the timing is ripe and right for the development of a new ontological viewpoint to guide this committment and inform a strategy to harmonize these converging efforts seamlessly and without a wasteful conflict of competing organizations trying to achieve the same goal.

3. Key assumptions and start of a framework for discussing large scale Healthcare ontology implementation strategies

• This topic concerns stategies to share ontologies ( vocabulary/datamodel standards ) for medicine regardless of context [Contexts range along at least 4 dimensions:
• Place (geo-spatial zones ranging from a single ER episode thru Lab Tests and treatments on 3 or more continents);
• Threat Level ( Benign friendly zone to potential risk to catastrophic mass casualties ); *Personal Anonymity -- Security (A single individual to a family to a genetic type);
• Time ( See Patrick Cassidy’s presentation)]

3.1 Ontolog Health Informatics foundations

• Prior presentations, for example Dr. Musen’s Grass Roots presentation, illustrated the problems between the major Health Informatic groups (Philosophers, Knowledge Representation Specialists, and Life Science Specialists);
• The Ontolog Forum at the 7th Protege Conference at Bethesda included presentations examining the 25 years of promising IT solutions to health care data requirements [ Bob Smith’s timeline from 1980 initiatives with PROMIS and Alan Rector’s analysis of past trends ]

3.2 Ontolog Health Informatics participation in USA’s SICoP and ONC RFI-summary (The Prelude to the 4 RFPs and the AHIC Charter) Today, as a cumulative result of trends and events, Canada, the UK, New Zealand, and the United States have launched significant HIT projects.

These individual projects involve implicit ontology strategies impacting many different domains. More specifically, these domains include the financial, geopolitical governmental (legal, law enforcement, military, overlapping municipal, county-borough, regional, state-province jurisdictional) and related business/commerical information networks and matrices. Not surprisingly, the apparent complexity of programs and resource dependencies requires “increasingly sophisticated” tools such as Protege and other alternatives to simple spreadsheets or word processing tools, and training-indoctrination and education of new skills.

3. 3 Expansion of AHIC’s impacts upon standards bodies and opportunity for the business case arguments/committments [ Layers, Levels, Points of View / Viewpoints, Goals-Means Chains; Rules, and Rules for Rulemaking Policies; Domain ecology ]

3.4 Service Domain Systems and Service-Oriented Architectures provide means for maintaining EHR-States (Updates and Acknowledgements of State Change)

• Dr. Brailer's extensive and public discussion of required Health IT System changes and value propositions have elicited partial cost and/or benefit scenarios for debate.
  • (A recent study describes a $200 Billion "price tag" scenario)
  • Figure 1. HIMSS CCHIT model indicating important “Relationships” within the US Healthcare Systems

4.Panel Discussion: General Initial orienting questions around the proposition: "We have reached a “tipping point” because of the change in the focus of large organizations' attention now achieved by Dr. Brailer’s ONCHIT initiatives." (Keep in mind the primary vectors/axes of Time, Place, Threat Level, Personal / Group Privacy-Security)

• 1.Is it now important to proseletyze the business value of ontology strategies more effectively?
• 2.If so, what agenda items need to be identified and addressed?
• 3.And what viewpoints and strategic assumptions need to be considered and honed?
• 4.What models and “meta-models” are available to guide policy level debates in appropriate forums?
• 5.Which turf battles should be considered or avoided?
• 6.Can and should we seek a set of primary policy concerns to develop a coordinated [ choreographed ] global system for sharing interoperable “Frameworks” in a specified timeframe that produces results with minimal disruptive conflict among interdependent communities.
• 7.What constitutes appropriate maturity level for standards to be considered qualified for inclusion in these interoperable "Frameworks"?
• 8.Can modeling and appropriate simplification of complicated relationships improve this short list of concerns?
• 9.Should Enterprise Business Models be considered at this point, given that Enterprise Architecture and Service-Oriented Architecture are gaining greater traction and it is of the utmost importance to simplify physical workflows, financial flows and associated knowledge flows within an enterprise and between levels?

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5. Panel Discussion: Domain specific questions and answers...

Government: GSA Office of Intergovernmental Solutions /VA (David Whitten-MarcWine) would be ideally suited to address this area, but Department of Homeland Security (Mike Daconta-DRM/NIEM) and/or Department of Justice (GJXDM-JIEM) would also be well suited for some aspects, so perhaps a team would be in order;

Standards Bodies such as OASIS Healthcare Industry Consultant Brett Trusko, with perhaps a team as well, including International Health Continuum, Emergency Management, Business Centric Methodology, and, perhaps XML-Legal Technical Committees;

OMG/HL7, Dr. Christopher Chute perhaps with a team of his choosing, as well;

Ontological Community: Mark Musen, Bob Smith to represent this community.

6. A few Domain specific considerations:

• 1.credential equivalence for physicians, physicians' assistants, emergency medical technicians/paramedics, nurses, military paramedics;
• 2.standards for common testing protocols and terminologies;
• 3.sensor standards; public warning/alerting instruction services;
• 4.individual electronic health records;
• 5.information access security permissions by organization and role;
• 6.medical vocabularies/datamodels for emergency types (chemical, biological, radiological, nuclear, as well as natural disasters/accidents such as storms-drowning, lacerations, blunt force trauma, structure/wild fires-burns, etc);
• 7.medical equipment/supplies vocabularies/datamodels
• 8.emergency equipment/supplies vocabularies/datamodels
• 9.financial/insurance/governmental program vocabularies/datamodels
• 10.geospatial vocabularies/datamodels—both governmental (chain of command-geopolitcal-jurisdictional police-fire-rescue/recovery) and private sector (logistical-locational drug, equipment, asset allocation points)
• 11.emergency management vocabularies/datamodels
• 12.transportation management vocabularies/datamodels (related to geospatial/geopolitical)

We would like 5-7 slides summarizing the panelist's position in relation to the topic, with a short biographical sketch. We will compile the slides into a combined presentation, and each panelist will have 5-7 minutes to make a short presentation to accompany their slides, then we will proceed with the discussion. There will be a page on the Ontolog website for the slides to be posted so that all panelists can review them, and make such adjustments as they require.

We would like the panelists to select three main questions from those presented, or suggest their own, and we will post the consensus questions on the webiste. We will start the discussion with those question and will proceed from there.