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Educational Challenge of Health Information Systems’ Interoperability
Abstract
As health care develops from an organization-centered via service-centered (disease management) towards a person-centered system (favored homecare, patient monitoring, body area networks), information systems involved have to be semantically interoperable, process-related, decision-supportive, context-sensitive, user-oriented, and trustworthy.
The aforementioned paradigm shift requires highly flexible solutions based on knowledge concepts, provided by a service-oriented and model-driven approach.
Information systems' design, implementation and maintenance have to be realized based on formal grammar. This is true for all considered aspects and views of the system and its components, using metalanguages and reflecting all domains touched.
For meeting the challenge, involvement of, and close collaboration between, experts from different domains as well as knowledge and tooling regarding formal modeling and model interchange are required.
... specifying a platform-independent model), those system models can easily be transformed into different implementation platforms supported by Model Driven Development (MDD) approaches. Furthermore, when the resulting systems and components conform to the information structures and behavior described in the standard, semantic interoper-of those standards in the complete HIS architectural development cycle consisting of business modeling, requirements, analysis, design, implementation, deployment and maintenance phases [8,9]. A more formal, customizable, scalable, and shareable methodology for Health Information System (HIS) architectural development existing at the moment is the Health Information Systems Development Framework (HIS-DF) [9]. ...
... Furthermore, the proposed methodological approach opens the door towards self-organizing health information systems in the sense of autonomous computing approaches. Improvements of the formalization level of both the domain knowledge and the methodology by using, e.g., universal logics, formal languages, ontological languages need to be considered [8]. ...
Several standards applied to the healthcare domain support semantic interoperability. These standards are far from being completely adopted in health information system development, however. The objective of this paper is to provide a method and suggest the necessary tooling for reusing standard health information models, by that way supporting the development of semantically interoperable systems and components.
The approach is based on the definition of UML Profiles. UML profiling is a formal modeling mechanism to specialize reference meta-models in such a way that it is possible to adapt those meta-models to specific platforms or domains. A health information model can be considered as such a meta-model.
The first step of the introduced method identifies the standard health information models and tasks in the software development process in which healthcare information models can be reused. Then, the selected information model is formalized as a UML Profile. That Profile is finally applied to system models, annotating them with the semantics of the information model. The approach is supported on Eclipse-based UML modeling tools. The method is integrated into a comprehensive framework for health information systems development, and the feasibility of the approach is demonstrated in the analysis, design, and implementation of a public health surveillance system, reusing HL7 RIM and DIMs specifications.
The paper describes a method and the necessary tooling for reusing standard healthcare information models. UML offers several advantages such as tooling support, graphical notation, exchangeability, extensibility, semi-automatic code generation, etc. The approach presented is also applicable for harmonizing different standard specifications.
... Therefore, the following architectural paradigms have to be met: Distribution; component-orientation; modeldriven and service-oriented design, considering concepts, context and knowledge; comprehensive business modeling; separation of platform-independent and platformspecific modeling (separation of logical and technological view); agreed reference terminologies and ontologies, unified development process, advanced security and privacy services embedded in the architecture. The aforementioned architectural paradigms are reflected in the Generic Component Model (GCM) which provides a multi-model approach to any system architecture [3]. It can be used for analyzing, designing and implementing EHR architectures, but also for developing migration strategies [3], [4]. ...
... The aforementioned architectural paradigms are reflected in the Generic Component Model (GCM) which provides a multi-model approach to any system architecture [3]. It can be used for analyzing, designing and implementing EHR architectures, but also for developing migration strategies [3], [4]. ...
For meeting the requirements for high quality and safe of care as well as efficiency and productivity of health systems, latter have to move towards job sharing, communicating and cooperating structures. This paradigm change must be supported through sustainable and semantically interoperable architectures for health information systems, especially for Electronic Health Record (EHR) systems as the core application in any eHealth environment. Advanced system architectures are characterized as being highly distributed, component-oriented, model-based, service-oriented, knowledge-based, user-friendly, lawful and trustworthy, based on a unified development process, a harmonized ontology and reference terminologies. Existing and emerging approaches for EHR systems are to be compared using the Generic Component Model (GCM) as architectural reference. Any system can be assessed according to GCM dimensions: transparent domain representation, composition/decomposition behavior and reflection of the systems' viewpoints as well as their components' interoperability level. All those aspects have to be interrelated for real systems analysis, design, implementation, and deployment by that way enabling the migration of different EHR approaches on the basis of GCM.
... At the center of this transformation are PCKGs, which significantly advance personalized, data-driven care. PCKGs facilitate the integration of diverse data types, including medical history, genetics, lifestyle choices, and real-time data from health technology devices, fostering a comprehensive view of patient health essential for customizing treatments to individual needs (Mesko, 2022;Blobel, 2007). ...
Patient-Centric Knowledge Graphs (PCKGs) represent an important shift in healthcare that focuses on individualized patient care by mapping the patient’s health information holistically and multi-dimensionally. PCKGs integrate various types of health data to provide healthcare professionals with a comprehensive understanding of a patient’s health, enabling more personalized and effective care. This literature review explores the methodologies, challenges, and opportunities associated with PCKGs, focusing on their role in integrating disparate healthcare data and enhancing patient care through a unified health perspective. In addition, this review also discusses the complexities of PCKG development, including ontology design, data integration techniques, knowledge extraction, and structured representation of knowledge. It highlights advanced techniques such as reasoning, semantic search, and inference mechanisms essential in constructing and evaluating PCKGs for actionable healthcare insights. We further explore the practical applications of PCKGs in personalized medicine, emphasizing their significance in improving disease prediction and formulating effective treatment plans. Overall, this review provides a foundational perspective on the current state-of-the-art and best practices of PCKGs, guiding future research and applications in this dynamic field.
... The situation becomes more complex when those individuals do not live in the same country, for example; licensure, certification, and protection must be standardised in terms of laws inside the European Communities [205]. -Interoperability: As health care develops from an organisationcentred via service-centred towards an individual-centred system, information systems involved must be semantically interoperable, process-related, decision-supportive, contextsensitive, user-oriented, and trustworthy [206]. -Services: Integrating sustainable and beneficial telehomecare services require key internal and external stakeholders involved in the beginning of the project of the delivery of services to the elderly [207]. ...
Objective:
Extensive efforts have been made in both academia and industry in the research and development of smart wearable systems (SWS) for health monitoring (HM). Primarily influenced by skyrocketing healthcare costs and supported by recent technological advances in micro- and nanotechnologies, miniaturisation of sensors, and smart fabrics, the continuous advances in SWS will progressively change the landscape of healthcare by allowing individual management and continuous monitoring of a patient's health status. Consisting of various components and devices, ranging from sensors and actuators to multimedia devices, these systems support complex healthcare applications and enable low-cost wearable, non-invasive alternatives for continuous 24-h monitoring of health, activity, mobility, and mental status, both indoors and outdoors. Our objective has been to examine the current research in wearable to serve as references for researchers and provide perspectives for future research.
Methods:
Herein, we review the current research and development of and the challenges facing SWS for HM, focusing on multi-parameter physiological sensor systems and activity and mobility measurement system designs that reliably measure mobility or vital signs and integrate real-time decision support processing for disease prevention, symptom detection, and diagnosis. For this literature review, we have chosen specific selection criteria to include papers in which wearable systems or devices are covered.
Results:
We describe the state of the art in SWS and provide a survey of recent implementations of wearable health-care systems. We describe current issues, challenges, and prospects of SWS.
Conclusion:
We conclude by identifying the future challenges facing SWS for HM.
... While software engineering deals with the ICT stuff of systems, the whole bunch of the aforementioned disciplines is urgently required for the problem of business integration as the major challenge of system integration. Initiated by the German CORBA Chapter and matured at the Magdeburg Medical Informatics Department in the early nineties, the GCM can be used as architectural reference model • for analyzing, designing, and implementing EHR systems and underlying architectural models characterized by their components, functionalities, and relationships, • for defining migration strategies, but also • for evaluation, gap analysis and roadmap definition in standards development [6,8]. ...
... Taking the lead in development and deployment of advanced pHealth requires broad and at the same time deep knowledge and proficiency about all involved domains, their concepts, methodologies, terminologies and ontologies, as well as appropriate means for formalizing and presenting them. Current educational programs do not meet these challenges [72]. For overcoming this deficiency, the eHealth Competence Center at the University of Regensburg Medical Center offers specialized courses and programs in collaboration with renowned international partners in several countries such as Czech Republic, Germany, Finland, Malaysia, Romania, but also in North and South America -partially running a while already and partially being in preparation. ...
For improving safety and quality of care as well as efficiency of health delivery under the well-known burdens, health services become specialized, distributed, and therefore collaborative, thereby changing the health service paradigm from organization-centered over process-controlled to personal health (pHealth).
Personalized eHealth services provided independent of time and location have to be based on advanced technical paradigms of mobile, pervasive and autonomous computing, enabling ubiquitous health services. Personalized eHealth systems require a multidisciplinary approach including medicine, informatics, biomedical engineering, bioinformatics and the omics disciplines but also legal and regulatory affairs, administration, security, privacy and ethics, etc. Interoperability between different components of the intended system must be provided through an architecture-centric, model-driven, formalized process.
In order to analyze, design, specify, implement and maintain such an interactive environment impacted by so many different domains, a formal and unified methodology for system analysis and design has been developed and deployed, based on an overall architectural framework. The paper introduces the underlying paradigms, requirements, architectural reference models, modeling and formalization principles as well as development processes for comprehensive service-oriented personalized eHealth interoperability chains, thereby exploiting all interoperability levels up to service interoperability. A special focus is put on ontologies and knowledge representation in the context of eHealth and pHealth solutions. Furthermore, EHR solutions, security requirements, existing and emerging standards, and educational challenges for realizing personalized pHealth are briefly discussed.
For personal health, bridging between disciplines including ontology coordination is the crucial demand. All aspects of the design and development process have to be considered from an architectural viewpoint.
... While software engineering deals with the ICT stuff of systems, the whole bunch of the aforementioned disciplines is urgently required for the problem of business integration as the major challenge of system integration. Initiated by the German CORBA Chapter and matured at the Magdeburg Medical Informatics Department in the early nineties, the GCM can be used as architectural reference model • for analyzing, designing, and implementing EHR systems and underlying architectural models characterized by their components, functionalities, and relationships, • for defining migration strategies, but also • for evaluation, gap analysis and roadmap definition in standards development [6,8]. ...
EHR systems are core applications in any eHealth/pHealth environment and represent basic services for health telematics platforms. Standards Developing Organizations as well as national programs define EHR architectures as well as related design, implementation, and deployment processes. Claiming to meet the challenge for semantic interoperability and to offer a sustainable pathway, the resulting documents and specifications are sometimes controversial and even inconsistent.
Based on long-term experiences from national and international EHR projects, inputs from related academic groups, and active involvement at CEN, ISO, HL7, an analysis and evaluation study has been performed. Using the Generic Component Model (GCM) reference architecture, the characteristics for advanced and sustainable EHR architectures have been investigated. The dimensions of such an architectural reference model have been described, including basic principles of the underlying formal logical framework.
Strengths and weaknesses of the different standards, specifications, and approaches have been studied and summarized. Migration pathways for re-using and harmonizing the available materials as well as for formally defining standards development roadmaps can be derived.
For providing interoperable and sustainable EHR systems, an EHR architecture reflecting all paradigms of the GCM is absolutely necessary. The resulting EHR solution represents a services architecture of distributed components. The development process shall be completely model-driven and tool-based with formalized specifications of all domains' aspects.
... Therei sc urrentlyashift towards cooperative, shared carea sw ella st owards increased patiente mpowermenta nd selfmanagement of care [ 81]. Health-enabling technologies have the potentialt os upport both [3]. ...
To analyze utilization of sensor technology in telemonitoring and home care and to discuss concepts and challenges of sensor-enhanced regional health information systems (rHIS).
The study is based upon experience in sensor-based telemedicine and rHIS projects, and on an analysis of HIS-related journal publications from 2003 to 2005 conducted in the context of publishing the IMIA Yearbook of Medical Informatics.
Health-related parameters that are subject to sensor-based measurement in home care and telemonitoring are identified. Publications related to telemonitoring, home care and smart houses are analyzed concerning scope and utilization of sensor technology. Current approaches for integrating sensor technology in rHIS based on a corresponding eHealth infrastructure are identified. Based on a coarse architecture of home care and telemonitoring systems ten challenges for sensor-enhanced rHIS are identified and discussed: integration of home and health telematic platforms towards a sensor-enhanced telematic platform, transmission rate guarantees, ad hoc connectivity, cascading data analysis, remote configuration, message and alert logistic, sophisticated user interfaces, unobtrusiveness, data safety and security, and electronic health record integration.
Utilization of sensor technology in health care is an active field of research. Currently few research projects and standardization initiatives focus on general architectural considerations towards suitable telematic platforms for establishing sensor-enhanced rHIS. Further research finalized by corresponding standardization is needed. Part 2 of this paper will present experiences with a research prototype for a sensor-enhanced rHIS telematic platform.
Remote Health monitoring is encouraged to keep an eye on the patient's health status outside the zone of the clinic. These smart wearable gadgets are now integrated with mobile apps to work efficiently as telemedicine and telehealth to incorporate into the Internet of Medical Things. This chapter introduces WIoMT (Wearable Internet of Medical Things) and reviews smart wearable healthcare devices' scientific terms as well as commercial pains. Internet of Medical Things is displayed through a refined background, wearable computing, wearable technology, cloud frameworks, and architecture design. Included are required hardware and software, body sensors, smartphones, the smart medical application, medical location analyzers for data storage, and finally, a diagnosis. Wearable devices are tested under strict observation fitness, vital signs, and smart environment. Wearable devices are now used for a wide scale of monitoring healthcare.
Remote Health monitoring is encouraged to keep an eye on the patient's health status outside the zone of the clinic. These smart wearable gadgets are now integrated with mobile apps to work efficiently as telemedicine and telehealth to incorporate into the Internet of Medical Things. This chapter introduces WIoMT (Wearable Internet of Medical Things) and reviews smart wearable healthcare devices' scientific terms as well as commercial pains. Internet of Medical Things is displayed through a refined background, wearable computing, wearable technology, cloud frameworks, and architecture design. Included are required hardware and software, body sensors, smartphones, the smart medical application, medical location analyzers for data storage, and finally, a diagnosis. Wearable devices are tested under strict observation fitness, vital signs, and smart environment. Wearable devices are now used for a wide scale of monitoring healthcare.
Perhaps the biggest impediment to achieving reliable and interoperable healthcare information systems is the absence of widespread standards adoption; and not just standards, but standards that are clear and unambiguous. These standards must provide precise specifications in a language that can be universally understood and interpreted—the language of conformance. This conformance language provides the means and constructs for defining requirements and solutions exactly and consistently so that systems, products, etc. can achieve conformance that ultimately leads to interoperability. These means and constructs are embodied in the principles of conformance, the subject and focus of this book.
One of the key points to maintain and boost research and development in the area of smart wearable systems (SWS) is the development of integrated architectures for intelligent services, as well as wearable systems and devices for health and wellness management. This paper presents such a generic architecture for multiparametric, intelligent and ubiquitous wireless sensing platforms. It is a transparent, smartphone-based sensing framework with customizable wireless interfaces and plug‘n’play capability to easily interconnect third party sensor devices. It caters to wireless body, personal, and near-me area networks. A pivotal part of the platform is the integrated inference engine/runtime environment that allows the mobile device to serve as a user-adaptable personal health assistant. The novelty of this system lays in a rapid visual development and remote deployment model. The complementary visual Inference Engine Editor that comes with the package enables artificial intelligence specialists, alongside with medical experts, to build data processing models by assembling different components and instantly deploying them (remotely) on patient mobile devices. In this paper, the new logic-centered software architecture for ubiquitous health monitoring applications is described, followed by a discussion as to how it helps to shift focus from software and hardware development, to medical and health process-centered design of new SWS applications.
Due to the increased adoption of Electronic Health Records (EHR) and its integrated clinical decision support (CDS) tools, health information technology (HIT) is a key influence in Medicine. The main challenges in healthcare are to integrate the information across care units and to increase the quality of continuity of patient care. There are three types of knowledge sources in medicine: (1) Evidence Based Practice (EBP), (2) Practice Based Evidence, and (3) Medical Textbooks. Information in these sources is presented and organized in different formats. Ontology may allow us to integrate knowledge discovered from two separate data sources without platform restrictions. The knowledge can be reusable and sharable without the need of technology. Further, this paper also combines the strengths from both EBP and PBE on knee treatment. The hybrid knowledge model will derived from real practices while integrating existing external knowledge discovered and reported in published literatures.
eHealth and pHealth solutions have to meet the semantic interoperability challenge. Enabling pervasive computing and even
autonomic computing, pHealth system architectures cover many domains, scientifically managed by specialized disciplines using
their specific ontologies. Therefore, semantic interoperability has to advance from a communication protocol to an ontology
bridging challenge.
KeywordsSemantic interoperability-ontology-pHealth-Generic Component Model
The paradigm shift from organization-centered to managed care and on to personal health settings increases specialization and distribution of actors and services related to the health of patients or even citizens before becoming patients. As a consequence, extended communication and cooperation is required between all principals involved in health services such as persons, organizations, devices, systems, applications, and components. Personal health (pHealth) environments range over many disciplines, where domain experts present their knowledge by using domain-specific terminologies and ontologies. Therefore, the mapping of domain ontologies is inevitable for ensuring interoperability. The paper introduces the care paradigms and the related requirements as well as an architectural approach for meeting the business objectives. Furthermore, it discusses some theoretical challenges and practical examples of ontologies, concept and knowledge representations, starting general and then focusing on security and privacy related services. The requirements and solutions for empowering the patient or the citizen before becoming a patient are especially emphasized.
To examine the architectural differences and similarities of a Japanese and German hospital information system (HIS) in a case study. This cross-cultural comparison, which focuses on structural quality characteristics, offers the chance to get new insights into different HIS architectures, which possibly cannot be obtained by inner-country comparisons.
A reference model for the domain layer of hospital information systems containing the typical enterprise functions of a hospital provides the basis of comparison for the two different hospital information systems. 3LGM(2) models, which describe the two HISs and which are based on that reference model, are used to assess several structural quality criteria. Four of these criteria are introduced in detail.
The two examined HISs are different in terms of the four structural quality criteria examined. Whereas the centralized architecture of the hospital information system at Chiba University Hospital causes only few functional redundancies and leads to a low implementation of communication standards, the hospital information system at the University Hospital of Leipzig, having a decentralized architecture, exhibits more functional redundancies and a higher use of communication standards.
Using a model-based comparison, it was possible to detect remarkable differences between the observed hospital information systems of completely different cultural areas. However, the usability of 3LGM(2) models for comparisons has to be improved in order to apply key figures and to assess or benchmark the structural quality of health information systems architectures more thoroughly.
Objectives: EHR systems are core applications in any eHealth/pHealth environment and represent basic services for health tele-matics platforms. Standards Developing Organizations as well as national programs define EHR architectures as well as related design , implementation, and deployment processes. Claiming to meet the challenge for semantic interoperability and to offer a sustainable pathway, the resulting documents and specifications are sometimes controversial and even inconsistent. Methods: Based on long-term experiences from national and international EHR projects, inputs from related academic groups, and active involvement at CEN, ISO, HL7, an analysis and evaluation study has been performed. Using the Generic Component Model (GCM) reference architecture, the characteristics for advanced and sustainable EHR architectures have been investigated. The dimensions of such an architectural reference model have been described, including basic principles of the underlying formal logical framework. Results: Strengths and weaknesses of the different standards, specifications, and approaches have been studied and summarized. Migration pathways for re-using and harmonizing the available materials as well as for formally defining standards development roadmaps can be derived. Conclusions: For providing interoperable and sustainable EHR systems, an EHR architecture reflecting all paradigms of the GCM is absolutely necessary. The resulting EHR solution represents a services architecture of distributed components. The development process shall be completely model-driven and tool-based with formalized specifications of all domains' aspects.
EHR systems are core applications in any eHealth/pHealth environment and represent basic services for health telematics platforms. Many projects are performed at the level of Standards Developing Organizations or national programs, respectively, for defining EHR architectures as well as related design, implementation, and deployment processes. Claiming to meet the challenge for semantic interoperability and offering the right pathway, the resulting documents and specifications are sometimes controversial and even inconsistent. Based on a long tradition in the EHR domain, on the collective experience of academic groups such as the EFMI EHR Working Group, and on an active involvement at CEN, ISO, HL7 and several national projects around the globe, an analysis and evaluation study has been performed using the Generic Component Model reference architecture. Strengths and weaknesses of the different approaches as well as migration pathways for re-using and harmonizing the available materials are offered.
The personal health paradigm puts the citizen in the health services business process center. This enhances the subject of care's opportunities, rights and duties regarding his/her health status and the process for maintaining and improving it. First, the citizen and his/her direct environment have to become part of the health information systems network. This implies diagnostic and therapeutic processes performed to the subject of care independent of time, location and local resources by closing the gap through appropriate mobile and miniaturized medical devices up to an implantable level. The individualization of care delivery services requires individualized diagnostic and therapeutic means based on bioinformatics and genomics methodologies. As the individual needs of a subject of care are not predictable, the system architecture must adaptively and autonomously, integrating all domains defining eHealth. Second, the architecture must be policy-controlled for empowering the subject of care, offering all privacy and security services needed. Third, embedded in the system architecture, the subject needs the knowledge presented in the right way using the right terminology to enable the intended empowerment.
Based on the component paradigm for software engineering as well as on a consideration of common middleware approaches for health information systems, a generic component model has been developed supporting analysis, design, implementation and harmonisation of such complex systems. Using methods like abstract automatons and the Unified Modelling Language (UML), it could be shown that such components enable the modelling of real-world systems at different levels of abstractions and granularity, so reflecting different views on the same system in a generic and consistent way. Therefore, not only programs and technologies could be modelled, but also business processes, organisational frameworks or security issues as done successfully within the framework of several European projects.
Enabling the shared care paradigm, centralised or even decentralised electronic health record (EHR) systems increasingly become core applications in hospital information systems and health networks. For realising multipurpose use and reuse as well as inter-operability at knowledge level, EHR have to meet special architectural requirements. The component-oriented and model-based architecture should meet international standards. Especially in extended health networks realising inter-organisational communication and co-operation, authorisation cannot be organised at user level anymore. Therefore, models, methods and tools must be established to allow formal and structured policy definition, policy agreements, role definition, authorisation and access control. Based on the author's international engagement in EHR architecture and security standards referring to the revision of CEN ENV 13606, the GEHR/open EHR approach, HL7 and CORBA, models for health-specific and EHR-related roles, for authorisation management and access control have been developed. The basic concept is the separation of structural roles defining organisational entity-to-entity relationships and enabling specific acts on the one hand, and functional roles bound to specific activities and realising rights and duties on the other hand. Aggregation of organisational, functional, informational and technological components follows specific rules. Using UML and XML, the principles as well as some examples for analysis, design, implementation and maintenance of policy and authorisation management as well as access control have been practically implemented.
Forming the informational reflection of the patients and their care, the Electronic Health Record (EHR) is the core application of any complex health information system or health network. Such an ideally lifelong history file must be reliable, flexible, adaptable to new concepts and technologies, and robust, to allow for sharing knowledge over its lifetime. A sophisticated architecture must be chosen for meeting this challenge.
An advanced EHR architecture for designing and implementing future-proof EHR systems must be a model of generic properties required for any Electronic Patient Record to provide communicable, comprehensive, useful, effective, and legally binding records that preserve their integrity over the time, independent of platforms and systems as well as of national specialties. the resulting approach is based on the ISO Reference Model-Open Distributed Processing.
Based on advanced architectural principles introduced in the paper, a new generation of HER systems has been designed and implemented for demonstrating the feasibility of the approach. This result is presented and evaluated regarding the achievements and problems using the component-based paradigm of model-driven health information system architectures.
The future-proof EHR approach that has been established has been shortly evaluated. Advantages regarding flexibility, reliability, and portability of policy-driven, highly secure, role-dependent applications have to be considered in the light of performance as well as of the availability of network and application services.
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