The Unified Modeling Language (UML):

A Picture IS Worth A Thousand Words

Charlie Mead, MD, MSc Director, Healthcare Information Architecture Oracle Healthcar e

Outline
T he Problem vs The Solution Syntax, Semantics, and the Semiotic T riangle T he Communication Pyramid What is a Model and what is a Modeling Language? Principles and Pitfalls of Modeling What is UML?? What is UML good for? Static structure vs Dynamic behavior in UML Static Structure: Syntax and Semantics of UML Class Diagrams Dynamic Behavior: Syntax and Semantics of UML Activity Diagrams Examples Clinical Genomics (Static Structure, Dynamic Behavior) Privileging/Credentialing (Static Structure) HL7 Reference Information Model (RIM) Backbone classes) Summary
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The Problem vs The Solution

T he Problem Implementation-independent Discovered by analysis activities One Problem Many Solutions T he Solution Implementation-specific Formulated by design activities A set of compromises related to a specific Problem Often only addressing a portion of the Problem Understand the Problem before attempting to design the Solution T his is NO an endorsement of Waterfall T Understand the Problem means Understand the essence of the Problem Key structural and behavioral aspects of the problem
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Understanding the Problem : The Communications Pyramid

Express the Problem in domain-speak rather than solution-speak SSARY GLOSSARY, GLOSSARY, GLO Express structure and behavior visually (rather than textually) whenever possible Core concepts and their relationships UML Class Diagram Core responsibilities, process flows, and interactions UML Activity Diagram Express the Problem using multiple nearly independent view s A set of layered views Structure v Behavior s T he world of sy stem architecture
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Syntax vs Semantics
T ime flies like an arrow Fruit flies like a banana T he dog eats red meat T he dog runs blue boats Administer medication for pain Administer pain medication Syntax structure Semantics meaning

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Concepts and Symbols: The Semiotic Triangle

Concept

Symbol Shark
Delicious w ith caber net.

Thing

Concept
A predator. A mem ber of the genus .. ..

Thing Symbol Shark

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The Communication Pyram id

Examples... Patient Problem List a Problem is an Observation discipline-specific observe r-specific Nursing Documentation System Care Plan charting Medication orde r processing IV administration Risk assessments Reporting an allergic reaction 1 vs 2 vs 3 observations?

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The Communication Pyram id

Standard ized Mo dels (UM L) Non-stan dard Grap hics

n n i t io e c lu c e pec ifi c So Spa tio n-S

Abstraction

Pr o Sp ble ac m en ta tio e

n-I nd ep en de nt

ad hoc Dra win gs

Im m ple

ta en

Structured Docum ents

Im

ple m

` Free-text Documents
Discussi ons

Communication

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What is a Model?
A representation of whats important Emphasizes concepts and relationships Hides unnecessary details Focuses on elucidating structure and/or function syntax semantics collaborations A human-friendly picture of complexity Encourages encapsulation Supports extensibility Facilitates layering Enables cognitive chunking 7 +- 2 concepts in hand

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What is a Modeling Language?

A language (syntax and s emantics) for building models An expression a Problem (or Sol ution) using a ML. Facilitates the visualization of c omplexity Supports the specific ation of architectur al details Enables the doc umentati on of decisions made about the s ystem, its scope, etc. Guides the constructi on of ins tances of the s ys tem represented by the model

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Why Model?
Models help define the scope of a problem and/or solution Models represent an important vehicle for reaching consensus about the architecture (structure and function) of a Problem and/or a Solution A given model of a Problem can profoundly affect the nature of the Solutions proposed and developed to solve the Problem Seeing the Problem modeled Imagining the possible Solutions

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What good is a model? What is a good model?

Models are (can be). Precise Unambiguous Complete Executable Verifiable between Problem and Solution Domain There are no right / correct models. Some models are more helpful than others. Models vs Views One Model consists of many (nearly independent) Views

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Principles of Modeling
The choice of what models to create has a profound influence on how a Problem is appr oached and thus how a Sol ution is shaped.

Models facilitate layering

type of model determines details of layer

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Principles of Modeling
Every model should be expressible at varyi ng levels of precision/granularity.

Tool for cogniti vely managing complexity

David T aylors Rule of Nines the ultimate expression of Dijkstras divide and conquer.

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The Principles of Modeling

No single model of a s ystem is sufficient. Best understood through a set of nearly independent models
different aspects of system require diffe rent visualizations

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3 Pitfalls of Modeling the Problem (Analysis)

Inconsistent or Shifting Sys tem Boundaries and Sys tem Res ponsi bilities Inconsistent levels of Abstr action within a given vi ew Premature inclusion of implementati on details

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The Unified Modeling Language (UML)

UML is a modeling language (mostly) Visual Syntax Semantics Object Constraint Language (the non-visual part) Extensible T ags Profiles Suzukis levels of learning a language Exposure, Imitation, Usage, Understanding, Composition UML is NOT A modeling process A modeling tool
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UML is.
A well-defined (mostly) visual language for describing the structure and/or function of complex systems. A language supporting well-formed models T he UML is a language that facilitates. .visualizing complex ity .specifying relationships and interactions .guiding the construction of the modeled system .documenting the decisions made about the modeled system T he de facto modeling language standard managed, maintained, and evolved by the Object Management Group (omg.org) 10-15 years in develop Convergence of multiple perspectives and agendas

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UML Building Blocks

T hings Classes Objects Activities Relationships Syntactic Semantic Diagrams Static Structure Dynamic Behavior

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UML Diagrams (aka Views of a Model)

Static Structure Class Diagrams Object Diagrams Deployment Diagrams Component Diagrams Package Diagrams Dynamic Behavior Use Case Diagrams Activity Diagrams Interaction Diagrams Sequence Diagrams/Collaboration Diagrams State Diagrams Collectively, a model is a set of (nearly independent) diagrams/views
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Is there a minimal set of diagrams needed to express dom ain knowledge?

Class Diagram Static Structure

Activity Diagram D ynamic Behavior Grounded in real-world stor yboards Glossar y NOT an UML diagram NOT fun ( or eas y) to devel op ESSENTIAL FOR SUCCESS

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UML Classes
Description/T emplate for set of things that share the same Attributes Methods/Operations/Behavior/Responsibilities Relationships syntactic semantic Named with noun phrase Classes encapsulate data (attributes) and the functions that operate on those data Cohesion == expert Classes v Instances (Objects) s T he essence of structure is the relationship between concepts
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Name

Attributes

Operations

Relationships
Structure is built by connectingclasses (concepts) using syntactic and semantic relationships Inheritance Parent/Childsemantics Aggregation/Composition Whole/Part semantics use general associations for now Vanilla associations Syntax Semantic Q ualifiers

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Relationships: Aggregation/Composition
Co mpa ny
TaxID# Name CEO KnowProfit()

NOT recommended because of semantic slipperyness

is-a-part of

Bus iness Uni t

Location Manage r

KnowProductLine ()

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Inheritance
Semantic link us ed to represent generalization / specializati on Child inherits from Parent
is-a, is-a-kind-of

Child specializes attributes and/or behavior of Parent

Parent Name PAttributes Child Name PAttributes CAttributes POperations

is-a-kind of

POperations COperations

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Relationships: Association
Unnamed syntactic link between two Concepts Real meaning is established through the further elaboration of the meaning of the association using one or more semantic qualifiers
has an association with
Co mpa ny
TaxID# Name TypeOfBusiness KnowProfit() KnowSchedule() SS# PayRate

Emp loye e

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Association Relationships: Semantic Qualifiers

Association name Usually bi-directional in Analy sis Verb phrase Multiplicity/Cardinality Instance-level business rules Role Names Additional semantic qualification Noun phrase (role names) Domain experts can read the diagram as a sentence
employer employer employs 0..* works for

Person

1..*

Organization

employee employee

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Dealing w ith One-to-Many Relationships

Finding the hidden concept that disambiguates the many-to-many rel ationship

defines responsibilities via

Co mpa ny
TaxID# Name TypeOfBusiness KnowProfit()

agrees to
Pers on

Con trac t

1 1..* employer

Position PayRate EfffectiveTime KnowSchedule()

0..*

1 employee

SS# Name DOB KnowAge()

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An Example: Credentialing and Privileging

Sorting out the c onc epts Static Structure Domain Analysis Model Glossar y Personnel Management Glossary

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Credentialing and Privileging: Dom ain Analysis Model

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Activity Diagrams
Flow charts on steroids Work flow Protocols Icons

Responsible Entity (Actor) Responsibility Partition (Swim Lane) Start/Entry point (1 per AD) End/Exit point (1-to-many per AD) Activity (verb phrase) T ransitions (directed arrow) Decision point Guard (Boolean condition) Parallelism (fork) Synchronization (join) Object/Datagram Signal (Sent vs Received)
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Activity Diagrams and Storyboards

Storyboards (text) are a good place to start BUT. Contain extraneous detail Are missing important detail start with a Storyboard, end with an Activ Diagram ity

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An Example: Clinical Genomics Testing

Clinical Laboratory (Genetics) Testing Dynamic Behavior/Process Activi ty Diagram Static Structure Class Diagram

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Clinical Laboratory Testing: Activity Diagram

P a tie n t P ro v i d e r C h a r t O rd e r E n t r y V e n d o r A sk f or B R C A t e st R ev e w Pt / Fm y H i st o r i l y P at i en t / Fa m i y h s t or y l i

[ R s k t r es ho d N O T ex ce ed ed ] i h l [ R s k Th r es ho d E x cee de d] i l

N ot i f y Pt r e B R C A t es t

E xp a n t st l i e U nd er s t nd t st a e [ Q ue st i on s] [ N o qu es t o ns ] i [ C on se nt ] O r de r BR C A t est [ N o co ns en t ]

T est E xp a na t o n l i

C on se nt O r de r BR C A t est C on f r m s am p e s r ec ei ve d i l B o od D r w I f or m a t o n l a n i O b t n bl oo d sa m p e s a i l P er f or m t e st

U nd er s t nd r esu l t a s E xp a n r su t s l i e l [ Q ue st i on s]

S am pl es r e cvd con f r m a t o n i i S en d r es ul t s

[ N o qu es t o ns ] i E xp a n car e pl an s l i [ Q ue st i on s] [ N o qu es t o ns ] i C ho os e ca r e p a n l

B R C A R e sul t s

U nd er s t nd ca r pl an s a e

D oc um en t ca r e p a n l

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Clinical Laboratory Testing: Class Diagram

H ea l t hc ar e Pr o v i e r d 1 .* M e di c al R ec or d r e vi ew s / up d at e s 1 .* 1. . * 0. . * c on t ai n s 1 . * 1 .1 E nt r y

P at i en t

0 . * I s a p at i e nt of P at i en t H i t o r y s

1 .1

0 .*

O r d er 0 .* L ab R s ul t e * I s c ol l ec t ed f ro m * - t yp e : < un sp ec f i ed > = B R C A Te st i - va u e l

1 .1 g en er a t es C o ns en t Fo r m 0 .* 0 .* L ab Te st * * 0 .* - t yp e : < un sp ec f i ed > = G e ne t c s Te st i i - na m e : < un spe ci f e d> = B R C A T es t i 1 .1

1 .1

1 .1 T s su e i - t yp e : < un sp ec f i ed > = B l oo d S am pl e i 1 .1 u t l i ze s i

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The RIM Backbone

i l t r dC t C cssc: Sdy a n Ent de_i r _: S em ec ngaeo o S< agagegC unci s dy o ut _ t d: C >> l nLaud_cm i at nue b c m a s i i : ETI Q d SEP m i cy_vl c: E d c : ou _C E _ c i ne whcyEA N qt B < :T pr cn: l e_dC f ee E o_dce . 0n 1 nm c<E>C de: G ETS> c: E S pr eee_dB f er nci : L n t s_d: m sseD i <: u t as ext net eI L<> ei c: B <T> t l cc_A VLTS i kd E r eom G E _i : sd C . nl n_: E 1 hat gcdC x e v m r ncsast : D s r n i poae_t u_t E s e ly pa s .p 01 . c. se .o 01s R e 1 l a_dC l cssc: So st gf r _r t _ i aeo d S<> i : ETI 1 spydy c: C G D _l b net A A L i ae_ dgEni <B i ond: a _ ssu_r _i r f i t asi oco e r . sdom S<T> aci e_ 0. ad: B E>SL pr pt n sspdynef cc_A VLT> 1 _o b. . ef t di G C i ce_0nt l cet e: E<S t e_vB T > u t : as : < eei T_xED cr i aet : I t cO m qt f t n: LTI T> yi _ poR br I S<N i: son t .. 0n a_gt yeceR l k<S hsr et p_d_o_nLT> t 0nef cvC : V a ei i l i :e . . ft tS I e m a_uc hsor e t o r cpi yet Pai D t p_dcSat n : uni _C l d C f cct c: oc: S ouecdt : T cqo_en_N nt n nC eext _b st _xor r I en not VED i o_d<S t e: cLT> m : m eI : E d C a__apnaw e_dC hsspcat ar ns_: S a r t sneucc: E i i gt r d C ae . i gar t t : 0snt u_xED n e . o fr .. 0n

Participation
M gdpr t i t n n aae_ai pi o c a da_T>S<S> i : EcI ETC t usd st S<:

t l o_cC c cssc: SA a m _d: S _ t n d dT> i : EdI C S< ssu_r _ co i or f e a_uc yer deSosi hsor t p_cr l i Lp e vA C B ct : a h a dgD n : L hs c: C i dB _n ao 1 . . neet ed: d: C 0ni qsi cnocTS ont nor _I cuxoi t l N n 1 net c: ETC x: Ed t t i n_S<S> eot cbr N si i __b: t t D t mG sace_e: TS pr ent : T ry : r n ef uyt eG e_ m f svi S s_ I act _i : T ii ti t v s_r t r i t g_ aef o a_gt cukqn_: C hsr epae_yPQ t a hecoi c S p td avi ydSE<S at i yt m T a : llii 1 . . pt cdC 0nsi _dC l_ pr i ba_T: SE od_t t e : r et ogt : i d: L j nc: SSB ia _ oi i ni i cC T<E> cpat cl _dE>C nf _r yLI T> nei nncdC e l eV r t upbI d N b o uoo cnj t i _ : S ncn nnt ni : n<B i ext c_i : L oer ndni : L cept l ki : B nsecot ndE i ao_d_nC de_e_TdB L ega _SEE r nngedC > r nt __nef ogasnot o i ei c x_ a l u c: : < .. 1* Fi ni l c a a nca_t A hi neat M cer t m : O _ t _ .. 0* i A ct et _nxf copxdct t o _ nvs t r oeoe_r ee_dC l vl c: E

i n_ c adi sLi _sbj t : E m t r vgu ed bi esdi gndec C h_i t e t t mv B _ r ni ai e r : deesdt eTS c eTS d n deae_i : L cae_m : m i e_t i d: L l er ut l i h_n bi pdbr nI B h o t r or n_n_i : B a_r onb: N godr _r dTL

Enyhi it t _er

O nzt n g io r aai ad: A <>r l a_ : E dr B ut _ t nddi A y c saar G D cssdC nds _

t a oM el E f m dC r _r : ci a M f at em ei n r aucud_at a rl opm _m TS l _n: Ti e: t ai S exi yi eI V<S i on t br _m sal t t t : LT> t

Entity

Pl e c a m l _d: L bi oei nB adcn_t : dr di t D t ED e: A r i os pot t t xD i xnT so: S gpi _x: E _ st Di ec ve

obi _m poy j _ceEEm ee bd C l o_c: _: T j _t l ndSE oal sccC E j l r _p_dC ba : aayyy: : sl yt eM a r qt oO E szaepsr _x D har _xeuet : t : _ pr dt eqi m _xED t cv u n oei _ p et

ago r d_G acr C cet r t r n: E i au_t n i d

R _i r ohe e l Pant i te onf m aceC cyi ni l _dsE_: E d oi tt y e i eant : n vr _pr t _pr ocdC

tn e eet i ef t i t T r cr C i deny i cai em S f r o__i t t :

Role

Pan_ncnt i t ur t ee o e act _vl deE: E usl e_uC C i : adysosr _cB m encend bi i n_oc_d: L h_g s s t aoei ot r ei _t r i n di hcua_i oPd c st _f nqt egaosdpyi _cC l nhr _t yi : Q : E pr r l st t n: L _ tu e_a_i si d B r edcuesd: E > e m r _e C pcnyc: esc: T<E sf i l ot ec_dSEC e oc_ ur a_sdsED e g rC al bedeEo_e : vl c_sl ai dscED aual _ct : vube_ocn al R ra e l f aur i d_i sy: EA h e i sq L t oz vt _t R

Sul py p c O r t on sv qt PQ e_i eI LT> m hcci _eEeC > vl r eN beai C y: e_ : t d : o<C er __Pr dur SE > exct ust m V<S aposdcTdSE>D aupA ncdSE<E ped neot Y: _<ET t e: t o apai ee: S<C t r ohst cETT< i r hscc: : C >> gt _d : D _ t e m t _aSETT> di at ai edr : D t e_t depE<C gvo_ S deei _x ST i n r t t enr _D egqyi y te PQ : rn i nr W kel t : E ehoi g_s _e _ i c aboyr eqt : cr hdat _yPQ ow spl vl dC

Clinical Acts

s n n i st o ot Su_nea: Tt D r pochi _dSEC > uebt c_dm r ai _da C ap_qsEcQ < a: I do_c: t PQ er y: e< asqt VVy: T> r t _cI _P>><R e yeL dods_t : E< TO e s t L< m _yeqySTR > x ok a hcqt SET pon_qydC O uect i cQ st t ut : P E si o_: b n

ad: A <D Pes dr B A r o G> n m i l t t _ddEE r as sl : aa_nuc_C edt t al ec_dC ucoye u : am i __t E: C bi ocv s a di l t agaecdE a t : sui r se l i i _r _dC _cC l l bar nm _c: E v y io egi s l t i r nga i ant dnE pi o_am odoC scal _f m ni : c e u d aei _SEC aT_ESETE> r c_dcocEEt C : <C et cgoTd>S< > ni : p hc u_<: r

n f co aooN Pr sl v_sbEt t xdcoces_t gcuec nm _aoni n_ j _ c iC br i t t l si ai nd: C t r nx: E : se_d: t c C ad t D E ge__i i dB n as eunr s__dLE ha au t easn :

m f at e_ol nm onar uem osa: d C sal r _r cdr _t t c: E w enm n t _cr _: t e_ ST f u ot or _el dST _ l et vec: E l e a m C c al cl _t ot e: S at abr onm l sl i ai _i T _ e mn d i I i g oay pi l i r oag_m l t dC pel pet _ei yPQ sxi l di yr t nhpc: E c_nnuql : osi _ a t s ta pi a_el i nqQ e g_o P x_asnt y_t : i 0*

nt ai ct C i n cpai _oaer t heet _yPQ g yqyPQ q: di t eqPQ m _t : ahr yt : apt ec: _EC cp_p_dC : E eaydt _e: sr e__at y aor y d p bar t l _qcPQ boi r l aqyPQ t o_et t : m et d M saeC r o s e g ot l n C m canuct n o ui t of ni mn i o

apocA edC st sScdebl r sr e p_h_cs : r _e o zhel eeeoc nut u i can_t : Q auassccC t r e_yi _D D l _i e_r m _qyP ggi t t : e td gat qePQ :

A ndeni sge_t t i y poaycr _dB it so C pr r _ceE : L m nd n i i _a: i

v: I S pam evei _akN a t _al eLT< > r er D ct sA Y ue Pui het _s c h l ubeD nacm eE t t obet d_cC sj ct i ot i i dC deci m _al : ae ogesi _g _ant _ca: i o r n _ d r em i phdcd: t aaes_m ccEE nsnonode E di si i oo__: C e s e s _m t d C r

A ot cun nm cc: C ST : uer yr et R <, Q cr et _dq: TO O > noe_aac_t M O i l ndbl neq: VLM te t E al s_a_y y I <P> w

Fi t m dat a c nc _ a a_ns n t pam nr l c: c cet ecnni l r qci A yen_i sor E r d_xFi c_aaat oL t ea_nt C i haer t ey E g _ R der ecnq_a_t : EA i ne_xhet : eO R i bt t r ner t qy: L t e_a_y T t s t ag R

Admin/ Finance Acts

nvi _l e I oceem t n m _r _: E d o : unqyeat R <O Q ti td C i f ec : un_nPQ LTM , > t _b : E r ai ocr R f cpi _m O P t snb: A por er R _ C nt A oi a_sucLd: cer g_oEecLE v r noysj c_d: i f en t _ubt i B

nol t t uuor _vn sr C cdeet 01st e_p_SI e cr y: C r pnet ei : os d

nat uur Sr cr dc e) ox_t cu I r sr t e( t t udoum s C et sut e f c ue nt nt r r oc d: l al i ST

5 44 192 7 39

Pr im ar y Subject Ar eas Classes Attr ibut es Associa tio ns Gener aliza tio ns

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The RIM Backbone

Direct Authority Indirect Authority Part of Repl ces a Role Link 0..* 1 0..* Entity Organi ation z Place Person Living Subj ct e Materi l a Healt Chart h 1 Role 1 Patient Member Guardian Healt care facility h Practitioner Location Specim en 0..* 1 0..* Subject Benefici ry a Author Consultant Referrer Informant Witness Participation 0..* Referral Transport tion a Suppl y Procedure Consent Observati n o Medi ation c Act com plex Financialact 1 Fulfills Com ponent Supported by Docum ents Repl ces a Act Relati nship o 0..* 1 Act 0..* 1

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Healthcare Transactions
I need a Chest X-ray for Mr. Smith

Report Result

Order Chest X-r ay

Interpre t Study

Set of Class and Activity Diagrams (plus Glossary)

Schedule Chest X-r ay

Place Image in Radiologist Queue

Check Technician Availability Perform Procedure Check Equipment Availability

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Summ ary
Healthcare domain knowledge is an instance of a complex system Complex, inter-related concepts (static structure) Complex, inter-related behavior (partitioning of responsibilities) Sy stems built to support healthcare will therefore be complex Experience in multiple disciplines has shown that the most efficient way to communicate, encapsulate, and manage complex systems is to represent them using a visual modeling language T he UML is the de facto visual modeling language in the world of software engineering Application to non-software sy stems as well Every practicing Informaticist should at a minimum -- have a reading knowledge of UML Class and Activ Diagrams (and be able to author ity the associated G lossary)

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References
www.omg.org The cor e UML site www.ectoset.com Affordable (<$100) UML modeling tool www.rational.c om White papers on tools and the use of the UML in building real-world s ystems

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