Experimental Platform for Model-Integrated Clinical Information Systems
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1 Experimental Platform for Model-Integrated Clinical Information Systems Janos Mathe, Jan Werner, Yonghwan Lee, Akos Ledeczi, Bradley Malin #, Janos Sztipanovits Department of Electrical Engineering and Computer Science # Department of Biomedical Informatics Vanderbilt University TRUST Review, April 2, 2008
2 Context Electronic Medical Records (EMR) is an integrative project with three main goals: Build a credible testbed for EMR research Contribute to solving privacy and security challenges of EMR systems applications Use EMR application testbeds for the integration, testing, and evaluation of new technologies on core TRUST research areas, including: o Model-based design for security and privacy o o o o Formal modeling, verification, enforcement of privacy & security policies Data mining & representation of real clinical workflows Security & privacy technologies for sensor networks Public policy to technology interactions 2
3 Summary 1. Experimental platform for Model-Integrated Clinical Information Systems (MICIS) Provide a common integration testbed for security and privacy aware Clinical Information Systems (CIS). 2. Component integration platform Based on a standard -Oriented Architecture framework (SOA) Extended Prolog-based Policy Evaluation Point & Policy Enforcement Point components (MICIS-PROPER) Reusable Platform-Independent Integrated with the Apache Orchestration Director Engine (ODE)
4 Summary 3. Model integration platform Built on Vanderbilt's metaprogrammable Model-Integrated Computing (MIC) tool suite System models capture environment Workflows s Deployment Messages Message Attributes Organizations Roles Access control policies Security policies Privacy modeling language based on Stanford's work on contextual integrity Enables formal representation of permitted communications Considers past, as well as future, communication instances
5 Summary 3. Model integration platform Experimental platform has several components: Set of domain-specific modeling languages Captures relevant architectural components Captures policy modeling aspects of selected CIS applications Model transformations Map domain-specific models on the MICIS component integration platform Example application models Running experiments for analytic analysis
6 Policy Execution Environment Execution Env. Orchestration Logic Execution Engine Application A Application B Application C Architecture (Big Picture) Modeling Integration Platform (MICIS-MIP) User Interface Layer Modeling Environment Metamodel Editor Model Transformation Layer Front End (page) Enterprise BUS Front End (page) Front End (GUI) Metamodels Workflows s Container Metamodel Workflows Model Editor User Models Enterprise BUS Execution Engine Policy Enforcement Point (PEP) Policy Engine Verification Tool Orchestration Logic Workflow Workflow Workflow Policy Set (Prolog Rules) Verification Tool CIS Orchestrator (CIS-O) Execution Environment CIS-DB Policy Decision Point (PDP) Component Integration Platform (MICIS-CIP) MICIS-PROPER
7 Policy Execution Environment Execution Env. Orchestration Logic Execution Engine Application A Application B Application C Architecture: Applications Modeling Integration Platform (MICIS-MIP) User Interface Layer Modeling Environment Metamodel Editor Model Transformation Layer Front End (page) Enterprise BUS Front End (page) Front End (GUI) Metamodels Workflows s Container Metamodel Workflows Model Editor User Models Enterprise BUS Execution Engine Policy Enforcement Point (PEP) Policy Engine Verification Tool Orchestration Logic Workflow Workflow Workflow Policy Set (Prolog Rules) Verification Tool CIS Orchestrator (CIS-O) Execution Environment CIS-DB Policy Decision Point (PDP) Component Integration Platform (MICIS-CIP) MICIS-PROPER
8 Architecture: Execution / Control Execution Env. Policy Orchestration Logic Execution Engine Application A Execution Environment Application B Application C Modeling Integration Platform (MICIS-MIP) User Interface Layer Modeling Environment Metamodel Editor Model Transformation Layer Front End (page) Enterprise BUS Front End (page) Front End (GUI) Metamodels Workflows s Container Metamodel Workflows Model Editor User Models Enterprise BUS Execution Engine Policy Enforcement Point (PEP) Policy Engine Verification Tool Orchestration Logic Workflow Workflow Workflow Policy Set (Prolog Rules) Verification Tool CIS Orchestrator (CIS-O) Execution Environment CIS-DB Policy Decision Point (PDP) Component Integration Platform (MICIS-CIP) MICIS-PROPER
9 Policy Execution Environment Execution Env. Orchestration Logic Execution Engine Application A Application B Application C Architecture: Modeling Modeling Integration Platform (MICIS-MIP) User Interface Layer Modeling Environment Metamodel Editor Model Transformation Layer Front End (page) Enterprise BUS Front End (page) Front End (GUI) Metamodels Workflows s Container Metamodel Workflows Model Editor User Models Enterprise BUS Execution Engine Policy Enforcement Point (PEP) Policy Engine Verification Tool Orchestration Logic Workflow Workflow Workflow Policy Set (Prolog Rules) Verification Tool CIS Orchestrator (CIS-O) Execution Environment CIS-DB Policy Decision Point (PDP) Component Integration Platform (MICIS-CIP) MICIS-PROPER
10 Architecture: Model Transforms Execution Env. Policy Orchestration Logic Execution Engine Application A Execution Environment Application B Application C Modeling Integration Platform (MICIS-MIP) User Interface Layer Modeling Environment Metamodel Editor Model Transformation Layer Front End (page) Enterprise BUS Front End (page) Front End (GUI) Metamodels Workflows s Container Metamodel Workflows Model Editor User Models Enterprise BUS Execution Engine Policy Enforcement Point (PEP) Policy Engine Verification Tool Orchestration Logic Workflow Workflow Workflow Policy Set (Prolog Rules) Verification Tool CIS Orchestrator (CIS-O) Execution Environment CIS-DB Policy Decision Point (PDP) Component Integration Platform (MICIS-CIP) MICIS-PROPER
11 Architecture: Model Transforms Execution Env. Policy Orchestration Logic Execution Engine Application A Execution Environment Application B Application C Modeling Integration Platform (MICIS-MIP) User Interface Layer Modeling Environment Metamodel Editor Metamodels Model Transformation Layer Front End (page) Front End (page) MICIS-PROPER Enterprise BUS Front End (GUI) Metamodel Model Editor a.k.a. Specification s & Workflows Container Workflows Enforcement Enterprise BUS User Models Execution Engine Policy Enforcement Point (PEP) Policy Engine Verification Tool Orchestration Logic Workflow Workflow Workflow Policy Set (Prolog Rules) Verification Tool CIS Orchestrator (CIS-O) Execution Environment CIS-DB Policy Decision Point (PDP) Component Integration Platform (MICIS-CIP) MICIS-PROPER
12 Policy MICIS-PROPER architecture Modeling Integration Platform (MICIS-MIP) Modeling Environment Model Editor Model Transformation Layer Workflow Models Data Models Policy Models Prolog-based Policy Evaluation Point and Policy Enforcement Point (MICIS-PROPER)
13 Policy Set Policy Enforcement Point (PEP) Context Handler MICIS-PROPER architecture Container (Axis2 running on Tomcat) Policy Engine Policy Store Policy Description Policy Decision Point (PDP) Prolog-based Policy Evaluation Point and Policy Enforcement Point (MICIS-PROPER)
14 Policy Policy Set Policy Enforcement Point (PEP) Context Handler MICIS-PROPER architecture Modeling Integration Platform (MICIS-MIP) Modeling Environment Model Editor Model Transformation Layer Container (Axis2 running on Tomcat) Policy Engine Workflow Models Data Models Policy Store Policy Description Policy Models Policy Decision Point (PDP)
15 Policy Policy Set Policy Enforcement Point (PEP) Context Handler MICIS-PROPER architecture Modeling Integration Platform (MICIS-MIP) Modeling Environment Model Editor Workflow Models Data Models Policy Models Model Transformation Layer Policy Store Container (Axis2 running on Tomcat) Policy Engine Policy Description Policy Decision Point (PDP) Integrated with Apache Orchestration Director Engine (ODE) Enabler - construct rigorous specification via privacy & security languages - experimental analysis of specification in complex system - description of security and privacy constraints with temporal aspects - rich user-defined contextual dependence
16 Tying it Together: An Example Scenario Outpatient monitoring system Wearable sensors, video capture, wireless networking Outpatient TRUST Project: Berkeley Cornell Vanderbilt
17 Tying it Together: An Example Scenario Outpatient Outpatient monitoring system 1. send AlertMessage CIS Orchestrator (CIS-O) Clinical Information System
18 Tying it Together: An Example Scenario Outpatient Outpatient monitoring system 2. Log AlertMessage CIS DB EMR System CIS Orchestrator (CIS-O) Clinical Information System
19 Tying it Together: An Example Scenario Outpatient Outpatient monitoring system CIS DB EMR System 3. Pull PatientRecord CIS Orchestrator (CIS-O) Clinical Information System
20 Tying it Together: An Example Scenario Outpatient Outpatient monitoring system 3. Show AlertMessage CIS Orchestrator (CIS-O) Alert Monitor System Clinical Information System
21 Tying it Together: An Example Scenario Outpatient Outpatient monitoring system I need to see this patient s vitals! CIS Orchestrator (CIS-O) Alert Monitor System Clinical Information System Nurse Monitors & verifies alerts
22 Tying it Together: An Example Scenario Outpatient Outpatient monitoring system CIS Orchestrator (CIS-O) Alert Monitor System Clinical Information System Nurse Monitors & verifies alerts
23 Tying it Together: An Example Scenario Outpatient Outpatient monitoring system 4. Request PatientRecord CIS Orchestrator (CIS-O) Alert Monitor System Clinical Information System
24 Tying it Together: An Example Scenario Outpatient Outpatient monitoring system CIS DB EMR System 5. Request Patient Record CIS Orchestrator (CIS-O) Clinical Information System
25 Tying it Together: An Example Scenario Outpatient Outpatient monitoring system CIS DB EMR System 6. Pull Patient Record CIS Orchestrator (CIS-O) Clinical Information System
26 Tying it Together: An Example Scenario Outpatient Outpatient monitoring system 7. Send Patient Record CIS Orchestrator (CIS-O) Alert Monitor System Clinical Information System
27 Tying it Together: An Example Scenario Outpatient Outpatient monitoring system Bob (the patient) needs help! CIS Orchestrator (CIS-O) Alert Monitor System Clinical Information System Nurse Monitors & verifies alerts
28 Tying it Together: An Example Scenario Outpatient Outpatient monitoring system Validate Alert CIS Orchestrator (CIS-O) Alert Monitor System Clinical Information System Nurse Monitors & verifies alerts
29 Tying it Together: An Example Scenario Outpatient Outpatient monitoring system CIS Orchestrator (CIS-O) Alert Monitor System Clinical Information System Nurse Monitors & verifies alerts
30 Tying it Together: An Example Scenario Outpatient Outpatient monitoring system CIS Orchestrator (CIS-O) Alert Monitor System Clinical Information System Nurse Monitors & verifies alerts
31 Tying it Together: An Example Scenario Outpatient Outpatient monitoring system 8. Relay Message CIS Orchestrator (CIS-O) Message Delivery System Clinical Information System
32 Tying it Together: An Example Scenario Outpatient Outpatient monitoring system 9. Transform & Notify Message Delivery System Pager Clinical Information System
33 Tying it Together: An Example Scenario Outpatient monitoring system Outpatient Many options: e.g., Call provide directions to patient e.g., Alert EMS bring patient to hospital e.g., Message Delivery System Pager Doctor Clinical Information System Verified alert indicates a serious condition
34 Tying it Together: An Example Scenario Clinical information Outpatient system 1. send AlertMessage services, workflows, policies, roles 2. log AlertMessage 5. pull PatientRecord 3. show AlertMessage 8. Insert AlertMessage are all captured 6. send in PatientRecord the models CIS DB 4. request PatientRecord 7. store AlertMessage EMR System CIS Orchestrator (CIS-O) Outpatient monitoring system Wearable sensors, video capture, wireless networking TRUST project (Berkeley, Cornell, Vanderbilt) Alert Monitor System Nurse Nurse monitors and verifies alerts 9. Send message The system is automatically generated and deployed Message Delivery System Pager Doctor Doctor is notified when a verified alert indicates a serious condition Clinical Information System
35 Example: A Little Deeper OPMAlertMain Receive OPMAlert Invoke Log Invoke AlertMessage Reply EMR WS Synchronous Message exchange Asynchronous Message exchange Access Control Policy Execution Point OPMAlertMonitor Receive AlertMessage Invoke MessageRender Receive EMRRequest Invoke EMR Alert Message Render WS Reply EMR Invoke EMRStore Receive EMRStore Message Sender WS Invoke MessageSender Reply
36 Example Scenario OPMAlertMain Receive OPMAlert Invoke Log Invoke AlertMessage Reply EMR WS OPMAlertMonitor Receive AlertMessage Invoke MessageRender Receive EMRRequest Invoke EMR Reply EMR Invoke EMRStore Receive EMRStore Synchronous Message exchange Asynchronous Message exchange Access Control Policy Execution Point Alert Message Render WS Message Sender WS Invoke MessageSender Reply When an anomaly is detected, the outpatient monitoring service issues an alert The clinical information system orchestrator (CIS-O) receives the alert message After logging alarm status in the EMR system, CIS-O sends the message to Alert Monitor System to render it on a monitoring station When the nurse checks the message requests the patient s medical record to evaluate the situation
37 Example Scenario OPMAlertMain Receive OPMAlert Invoke Log Invoke AlertMessage Reply EMR WS OPMAlertMonitor Receive AlertMessage Invoke MessageRender Receive EMRRequest Synchronous Message exchange Asynchronous Message exchange Access Control Policy Execution Point Alert Message Render WS Patient information includes medical history & contact information which can be used by the nurse to validate the alert If the alert is deemed important, she writes the status to the patient medical record Invoke EMR Reply EMR Invoke EMRStore Receive EMRStore Message Sender WS Invoke MessageSender Reply Finally, CIS-O forwards the alert message to the designated doctors by using the Message Delivery System Otherwise, the alert message is stored in the EMR system and the process is terminated
38 Example: Sample Workflow Model Step 1 Step 2 Step 3 Step 4 6 Step 5 Workflow: OPMAlertStore process
39 Example: Sample Workflow Model OPMAlertStore Process Goal: store the result of nurse s alert validation Workflow: OPMAlertStore process Steps: 1. Alert status is assigned to the OPMAlert data type 2. Invoke EMRStore activity invokes the PatientInformation web service a) Store the validation results in the EMR System b) Privacy policies applied when invokeemrstore activity invokes Patient Information web service
40 Example: Sample Workflow Model OPMAlertStore Process Goal: store the result of nurse s alert validation Workflow: OPMAlertStore process Steps: 3. After the receive activity receives the acknowledge message from the web service, it assigns it to the AlertMessage variable 4. The InvokeMessageSender activity invokes the MessageSender web service to forward the alert message to the designated doctors via the Message Delivery System
41 Example: Sample Workflow Model OPMAlertStore Process Goal: store the result of nurse s alert validation 1 2 Steps: 3 5. After the MessageSender web service is completed, The OPMAlertstore process returns. Workflow: OPMAlertStore process
42 Example: Policy Models
43 Example: Policy Models Policies Defined for Scenario Only medical staff is allowed to access alert messages Only primary care physicians are allowed to access patient s medical record The nurse is allowed to access the records of patients monitored by the OPM system Medical staff is allowed to access patient s record in emergency situation triggering the Break Glass policy
44 Example: Policy Models Policy description includes Definition of incoming & outgoing data Evaluation point Obligations Additional datasets for policy evaluation Model contains information required to generate the policy: Query evaluated to determine access rights Attribute relations used for policy evaluation Textual policy description
45 Example: Policy Models Example query: retrievedata(patientid, staffid) after the service has been executed Use a redefined set of predicates and attribute relations (is_critical(), treats(staffid,mrn)) These are generated from incoming data outgoing data by the Policy Enforcement Point (PEP)
46 Magic: Transform Code Execution Env. Policy Orchestration Logic Execution Engine Application A Execution Environment Application B Application C Modeling Integration Platform (MICIS-MIP) User Interface Layer Modeling Environment Metamodel Editor Model Transformation Layer Front End (page) Enterprise BUS Front End (page) Front End (GUI) Metamodels Workflows s Container Metamodel Workflows Model Editor User Models Enterprise BUS Execution Engine Policy Enforcement Point (PEP) Policy Engine Verification Tool Orchestration Logic Workflow Workflow Workflow Policy Set (Prolog Rules) Verification Tool CIS Orchestrator (CIS-O) Execution Environment CIS-DB Policy Decision Point (PDP) Component Integration Platform (MICIS-CIP) MICIS-PROPER
47 Code Generation Policy Description Policy Document Policy
48 Code Generation Execution Environment Deploy.xml BPELDocument (OPMAlertMain Process)
49 Code Generation Execution Environment WSDL for OPMAlertMain Process WSDL for Patient Information
50 Conclusions Experimental Platform for EMR research Helping to solve privacy and security challenges of EMR systems applications Usable for the integration, testing and evaluation of new technologies Ongoing technology transition: Experimental Sepsis Management System for ICUs: Sepsis management protocol is formally defined: evidence-based medicine Sepsis Management System is mapped on SOA platform Model-Integrated systems approach
51 Acknowledgements NSF TRUST (CCF ) Research Team Yonghwan Lee Akos Ledeczi, Ph.D. Janos Mathe Brad Malin, Ph.D. Jan Werner Janos Sztipanovits, Ph.D.
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