The document discusses the challenges of healthcare informatics and proposes multilevel modeling (MLM) and open source software as solutions. It argues that MLM separates reference and knowledge models, allowing knowledge to adapt over time without replacing the whole system. Open specifications and tools support sharing knowledge artifacts and ensuring interoperability. MLM and open source align with principles of beneficence, non-maleficence, and efficiency in healthcare informatics. The approach has potential to address issues like information chaos, system failures, and costs that traditional approaches have faced.

1. Health Informatics: the Relevance of Open Source and Multilevel Modeling Luciana T. Cavalini, MD, PhD Timothy W. Cook, MSc “ Multilevel Healthcare Information Modeling“ (MLHIM) Laboratory (UFF/UERJ) Associated to the National Institute of Science and Technology – Medicine Assisted by Scientific Computing

3. The time changes are fast

6. Integration projects that were successful in other businesses have been attempted in healthcare over the last 46 years, spending trillions of dollars, with a 100% failure rate

7. The result: healthcare is the less computerized business in economy

9. ↓ waste of staff time in search of critical information

10. ↓ duplication of tests, medications and procedures

11. ↑ early detection and prevention

12. ↑ adherence to therapeutic protocols

13. ↓ risk of adverse events and medical errors

14. ↓ avoidable hospitalization and mortality

15. Total loss: £ 12 billion in 10 years

16. Total loss: not published (6 years)

17. Total loss: US$200 million (13 years)

20. The electronic records already implemented seldom follow any of the ISO TC 215 recommendations or any other standardization

21. The mixture of incompatible systems runs across the entire system: from inside the hospitals up to the local, regional, national and international levels

22. The reality of British NHS = The reality of American Medicare = The reality of Brazilian SUS etc.

23. Hardware is not the problem anymore

24. What about software?

25. What software???

26. Interoperability

27. Interoperability!

28. Interoperability?

29. Where is the context?

30. Here is the context!

32. Traditional Modeling

34. Adding new concepts and “customizing” a legate system for another facility demands the total re-make of the system (re-modelling, re-implementation, re-test, re-deployment)

35. Unaffordable costs, frustrated users, abandonment of the systems (average time = 2 years)

36. Multilevel Modeling This approach is compliant to the ISO 20514 standard

38. The Reference Model is a necessary and sufficient set of generic classes for the persistence of all types of health information

39. The Knowledge Modeling is the combination of the Reference Model classes and the definition of constraints to those very classes, enough to define a given healthcare concept

40. Multilevel Modeling Reference Model Knowledge Modeling Your Application (GUI, BI etc)

41. Multilevel Modeling Specification Compliance to Standards Open Implemented open EHR Inspired ISO 20514, 18308 and 13606 “ Yes“ “ Yes“ (RM and KM tools = Yes) MLHIM Inspired by ISO 21090, 20514, 18308 and 13606 and W3C specs YES RM and KM tools

43. open EHR Reference Model (Low level structure)

44. “ Nanos gigantium humeris insidentes” Bernard of Chartres

45. “ Make things as simple as possible, but no simpler” Albert Einstein

46. MLHIM Reference Model CCD CareEntry or AdminEntry Cluster Cluster ...and its child classes ...and its child classes

47. Knowledge Modeling in MLM Name (Spec) Architecture Open # of KM artifacts / concept Solution for Cavalini's conjecture Combination of KM artifacts Open Archetype ( open EHR) Archetype Definition Language “ Yes“ One Specialisation Templates “ Yes” Concept Constraint Definition – CCD (MLHIM) XSD Yes Undefined No restriction for the # of CCDs / concept Master CCD Yes

48. open EHR archetypes and MLHIM CCDs Analogy: Lego ®

49. open EHR archetypes and MLHIM CCDs Archetype / CCD Concept

51. Principle 2: The Knowledge Modeling artifacts should be valid against the Reference Model Principles 1 an 2 require open specifications and strongly support open source implementations of the RM and open source KM tools

53. Principle 4: The Knowledge Modeling artifacts are shareable among applications Principles 3 and 4 strongly support open instances of KM repositories

55. Principle of Efficiency (or cost-effectiveness): IT adoption in healthcare is a healthcare intervention such as drugs, lab tests etc and it should be submitted to the same scrutiny The principles of Beneficence / Non-Maleficence and Efficiency strongly support the adoption of OS MLM-based applications in healthcare

56. Thank you! Join us: Visit us: http://macc.lncc.br http://www.mlhim.org My e-mail: lutricav@vm.uff.br Special acknowledgements: Sergio Freire Mike Bainbridge