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Using the dual-level modeling approach to develop applications for pervasive healthcare
Abstract
Health information technology is the area of IT involving the design, development, creation, use and maintenance of information systems for the healthcare industry. Automated and interoperable healthcare information systems are expected to lower costs, improve efficiency and reduce error, while also providing better consumer care and service. Pervasive Healthcare focuses on the use of new technologies, tools, and services, to help patients play a more active role in the treatment of their conditions. Pervasive Healthcare environments demand a huge amount of information exchange, and specific technologies have been proposed to provide interoperability between the systems that comprise such environments. However, the complexity of these technologies makes it difficult to fully adopt them and to migrate Centered Healthcare Environments to Pervasive Healthcare Environments. Therefore, this paper proposes an approach to develop applications in the Pervasive Healthcare environment, through the use of dual-level modeling based on Archetypes. This approach was demonstrated and evaluated in a controlled experiment that we conducted in the cardiology department of a hospital located in the city of Marilia (São Paulo, Brazil). An application was developed to evaluate this approach, and the results showed that the approach is suitable for facilitating the development of healthcare systems by offering generic and powerful capabilities.
... Consequently, more time and effort can be invested in developing the clinical content of the archetype. 15,16 The openEHR Clinical Knowledge Manager (CKM) is an online collaborative e-health knowledge asset-management application and repository of clinical knowledge resources such as archetypes, templates, and clinical terminology subsets. 17 It allows domain experts with different backgrounds and levels of experience to collaborate, cooperate, and contribute to the development, review, and maintenance of DCMs. ...
Background Data modeling for electronic health records (EHRs) is complex, requiring technological and cognitive sophistication. The openEHR approach leverages the tacit knowledge of domain experts made explicit in a model development process aiming at interoperability and data reuse.
Objective The purpose of our research was to explore the process that enabled the aggregation of the tacit knowledge of domain experts in an explicit form using the Clinical Knowledge Manager (CKM) platform and associated assets. The Tobacco Smoking Summary archetype is used to illustrate this.
Methods Three methods were used to triangulate findings: (1) observation of CKM discussions by crowdsourced domain experts in two reviews, (2) observation of editor discussions and decision-making, and (3) interviews with eight domain experts. CKM discussions were analyzed for content and editor discussions for decision-making, and interviews were thematically analyzed to explore in depth the explication of tacit knowledge.
Results The Detailed Clinical Model (DCM) process consists of a set of reviews by domain experts, with each review followed by editorial discussions and decision-making until an agreement is reached among reviewers and editors that the DCM is publishable. Interviews revealed three themes: (1) data interoperability and reusability, (2) accurate capture of patient data, and (3) challenges of sharing tacit knowledge.
Discussion The openEHR approach to developing an open standard revealed a complex set of conditions for a successful interoperable archetype, such as leadership, maximal dataset, crowdsourced domain expertise and tacit knowledge made explicit, editorial vision, and model-driven software. Aggregated tacit knowledge that is explicated into a DCM enables the ability to collect accurate data and plan for the future.
Conclusion The process based on the CKM platform enables domain experts and stakeholders to be heard and to contribute to mutually designed standards that align local protocols and agendas to international interoperability requirements.
... the questionnaires randomly intermixed items across constructs (PU, PEU, IU), and we conducted a group pre-test to ensure that the scales were appropriate [9,69,70]. About 80% and 73% of the distributed questionnaires were duly completed by the healthcare professionals and patients, respectively. ...
Background and objective:
In Pervasive Healthcare, novel information and communication technologies are applied to support the provision of health services anywhere, at anytime and to anyone. Since health systems may offer their health records in different electronic formats, the openEHR Foundation prescribes the use of archetypes for describing clinical knowledge in order to achieve semantic interoperability between these systems. Software agents have been applied to simulate human skills in some healthcare procedures. This paper presents a methodology, based on the use of openEHR archetypes and agent technology, which aims to overcome the weaknesses typically found in legacy healthcare systems, thereby adding value to the systems.
Methods:
This methodology was applied in the design of an agent-based system, which was used in a realistic healthcare scenario in which a medical staff meeting to prepare a cardiac surgery has been supported. We conducted experiments with this system in a distributed environment composed by three cardiology clinics and a center of cardiac surgery, all located in the city of Marília (São Paulo, Brazil). We evaluated this system according to the Technology Acceptance Model.
Results:
The case study confirmed the acceptance of our agent-based system by healthcare professionals and patients, who reacted positively with respect to the usefulness of this system in particular, and with respect to task delegation to software agents in general. The case study also showed that a software agent-based interface and a tools-based alternative must be provided to the end users, which should allow them to perform the tasks themselves or to delegate these tasks to other people.
Conclusions:
A Pervasive Healthcare model requires efficient and secure information exchange between healthcare providers. The proposed methodology allows designers to build communication systems for the message exchange among heterogeneous healthcare systems, and to shift from systems that rely on informal communication of actors to a more automated and less error-prone agent-based system. Our methodology preserves significant investment of many years in the legacy systems and allows developers to extend them adding new features to these systems, by providing proactive assistance to the end-users and increasing the user mobility with an appropriate support.
Privacy risks associated with the Internet of Things and big data
Domain-specific languages (DSLs) are languages tailored to a specific
application domain. They offer substantial gains in expressiveness
and ease of use compared with general-purpose programming languages
in their domain of application. DSL development is hard, requiring
both domain knowledge and language development expertise. Few people
have both. Not surprisingly, the decision to develop a DSL is often
postponed indefinitely, if considered at all, and most DSLs never
get beyond the application library stage.Although many articles have
been written on the development of particular DSLs, there is very
limited literature on DSL development methodologies and many questions
remain regarding when and how to develop a DSL. To aid the DSL developer,
we identify patterns in the decision, analysis, design, and implementation
phases of DSL development. Our patterns improve and extend earlier
work on DSL design patterns. We also discuss domain analysis tools
and language development systems that may help to speed up DSL development.
Finally, we present a number of open problems.
The TISS standard is a set of mandatory forms and electronic messages for healthcare authorization and claim submissions among healthcare plans and providers in Brazil. It is not based on formal models as the new generation of health informatics standards suggests. The objective of this paper is to model the TISS in terms of the openEHR archetype-based approach and integrate it into a patient-centered EHR architecture.
Three approaches were adopted to model TISS. In the first approach, a set of archetypes was designed using ENTRY subclasses. In the second one, a set of archetypes was designed using exclusively ADMIN_ENTRY and CLUSTERs as their root classes. In the third approach, the openEHR ADMIN_ENTRY is extended with classes designed for authorization and claim submissions, and an ISM_TRANSITION attribute is added to the COMPOSITION class. Another set of archetypes was designed based on this model. For all three approaches, templates were designed to represent the TISS forms.
The archetypes based on the openEHR RM (Reference Model) can represent all TISS data structures. The extended model adds subclasses and an attribute to the COMPOSITION class to represent information on authorization and claim submissions. The archetypes based on all three approaches have similar structures, although rooted in different classes. The extended openEHR RM model is more semantically aligned with the concepts involved in a claim submission, but may disrupt interoperability with other systems and the current tools must be adapted to deal with it.
Modeling the TISS standard by means of the openEHR approach makes it aligned with ISO recommendations and provides a solid foundation on which the TISS can evolve. Although there are few administrative archetypes available, the openEHR RM is expressive enough to represent the TISS standard. This paper focuses on the TISS but its results may be extended to other billing processes. A complete communication architecture to simulate the exchange of TISS data between systems according to the openEHR approach still needs to be designed and implemented.
MedView is a suit of clinical applications for recording, retrieving and visualizing patient records, which has been developed and in use for more than ten years. By the introduction of the openEHR architecture, the MedView project started an investigation to migrate from its locally developed framework to openEHR. Issues related to this process, have been discussed in this paper.
The life-long clinical information of any person supported by electronic means configures his Electronic Health Record (EHR). This information is usually distributed among several independent and heterogeneous systems that may be syntactically or semantically incompatible. There are currently different standards for representing and exchanging EHR information among different systems. In advanced EHR approaches, clinical information is represented by means of archetypes. Most of these approaches use the Archetype Definition Language (ADL) to specify archetypes. However, ADL has some drawbacks when attempting to perform semantic activities in Semantic Web environments. In this work, Semantic Web technologies are used to specify clinical archetypes for advanced EHR architectures. The advantages of using the Ontology Web Language (OWL) instead of ADL are described and discussed in this work. Moreover, a solution combining Semantic Web and Model-driven Engineering technologies is proposed to transform ADL into OWL for the CEN EN13606 EHR architecture.