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Advanced EHR architectures - Promises or reality
Abstract
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.
... The aforementioned architectural paradigms are reflected in the Generic Component Model (GCM) which has been developed, combining, but not limited to, modeling theory, domain-crossing system theory, terminology and ontology modeling, knowledge engineering, process engineering and software engineering for providing a multimodel approach to any system architecture [1,6]. Following the Object Management Group's definition [7] in accordance with the biometrical grouping/classification paradigm, a domain comprises components with common properties regarding their structure, behavior and scope in distinction to other domains. ...
... 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]. ...
... Different advanced approaches for futureproof architectures, EHR specifications, and the implementation of semantically interoperable EHR systems (e.g. HL7 Version 3 Standard Set with CDA, CCD, EHR-S Functional Model, EHR-S Interoperability Model [24], GEHR [26]/openEHR [27], EN/ISO 13606 [25], and CCR [28]) have been demon-strated, discussed, and evaluated using the GCM as reference architecture for sustainable and semantically interoperable health information systems [6]. ...
... The aforementioned architectural paradigms are reflected in the Generic Component Model (GCM) which has been developed, combining, but not limited to, modeling theory, domain-crossing system theory, terminology and ontology modeling, knowledge engineering, process engineering and software engineering for providing a multimodel approach to any system architecture [1,6]. Following the Object Management Group's definition [7] in accordance with the biometrical grouping/classification paradigm, a domain comprises components with common properties regarding their structure, behavior and scope in distinction to other domains. ...
... 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]. ...
... Different advanced approaches for futureproof architectures, EHR specifications, and the implementation of semantically interoperable EHR systems (e.g. HL7 Version 3 Standard Set with CDA, CCD, EHR-S Functional Model, EHR-S Interoperability Model [24], GEHR [26]/openEHR [27], EN/ISO 13606 [25], and CCR [28]) have been demon-strated, discussed, and evaluated using the GCM as reference architecture for sustainable and semantically interoperable health information systems [6]. ...
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.
... This information is usually distributed among several independent and heterogeneous systems that may be syntactically or semantically incompatible. EHR systems, as pointed out in [4], must support life-long EHR, be technology and data format independent, facilitate sharing of EHRs via interoperability at data and knowledge levels, integrate with any/multiple terminologies, support for clinical data structures and prioritize the patient/clinician interaction. As stated in [26], not only is medicine domain big, for example, SNOMED-CT [60] contains around 350,000 atomic concepts, but also open-ended because new information, finer grained details or new relationships are always being discovered or becoming relevant. ...
... This implies that a traditional information model will never be completely adapted to the clinical requirements and its continuous evolution [2]. Given this situation, advanced standards and architectures [4,9] for representing and communicating electronic healthcare records make use of an architecture based on the dual model approach. This architecture defines two conceptual levels [2]: (1) reference model; and (2) archetype model. ...
... Nowadays, there are different advanced standards and architec- tures [4,9] for representing and communicating Electronic Healthcare Records, such as HL7 [53], OpenEHR [57] and the CEN ENV13606 [48] standard. Each one defines its own information models and manages the information in a particular way. ...
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.
... 40 Recently, EHRs have gained substantial significance, with multinational companies and governments adopting EHRs to facilitate patterns of patient care. 41 Transmission of information between healthcare facilities has notably improved due to EHRs. 42 These records are now used by primary care physicians, hospitals, insurance companies, and patients, signifying widespread acceptance among medical practitioners. ...
... The establishment of data protection agencies can oversee compliance and address data breaches swiftly. 36,37,40,41,42 Collaboration and Partnerships Effective collaboration among government agencies, healthcare institutions, technology providers, and international organizations is paramount. Private sector partnerships can drive innovation and investment in digital health solutions, fostering a thriving digital health ecosystem. ...
Abstract Objectives: This narrative review explores the transformative impact of digital healthcare tools in Nigeria's healthcare system, particularly emphasizing lessons learned from the COVID-19 pandemic. Nigeria, a country grappling with healthcare disparities and limited access, has seen digital healthcare tools play a crucial role in enhancing public health and pandemic preparedness.
Methodology and Results: This review begins by setting the stage for the relevance of digital healthcare tools in Nigeria, acknowledging the country's complex healthcare challenges. It outlines its objectives and research approach, ensuring transparency and precision in source selection, including Nigerian databases. Examining digital healthcare tools in Nigeria highlights their potential to address healthcare access issues. This review also delves into the regulatory framework governing telemedicine in Nigeria, recognizing the need for a delicate balance between regulation and innovation, given the nation's unique infrastructure challenges. This provides insights into the factors influencing telemedicine adoption among healthcare providers and patients in Nigeria. While acknowledging challenges like infrastructure limitations and regulatory complexities, this review also identifies opportunities, such as improved healthcare accessibility and cost-efficiency, brought about by digital healthcare tools in Nigeria. Concrete examples of successful digital healthcare initiatives are presented, offering actionable insights and a roadmap for future endeavors.
Conclusions: This review concludes by emphasizing the essential role of digital healthcare tools in addressing Nigeria's healthcare challenges and providing tailored recommendations for policymakers, healthcare providers, and researchers. Ultimately, this comprehensive exploration goes beyond current achievements and challenges, envisioning a future where digital healthcare tools revolutionize Nigeria's healthcare landscape , identifying promising research avenues, and anticipating innovations that can better shape the nation's healthcare.
... 40 Recently, EHRs have gained substantial significance, with multinational companies and governments adopting EHRs to facilitate patterns of patient care. 41 Transmission of information between healthcare facilities has notably improved due to EHRs. 42 These records are now used by primary care physicians, hospitals, insurance companies, and patients, signifying widespread acceptance among medical practitioners. ...
... The establishment of data protection agencies can oversee compliance and address data breaches swiftly. 36,37,40,41,42 Collaboration and Partnerships Effective collaboration among government agencies, healthcare institutions, technology providers, and international organizations is paramount. Private sector partnerships can drive innovation and investment in digital health solutions, fostering a thriving digital health ecosystem. ...
This was the first experimental holoportation transoceanic keynote address using commonly available smartphones and custom software, relayed to ConVerge2Xcelerate (#ConV2X) AI & Tech in Telehealth and Medicine, Sept 22, 2023, from Star City, Russia, t to Loyola University, New Orleans, Louisiana, by a collaborative team including, Fernando De La Pena Llaca, CEO, Aexa, and Tory Cenaj, Founder and Publisher, Partners in Digital Health. Dr. Schmid’s keynote was transcribed and provided to Telehealth and Medicine Today (THMT) to mark the momentous occasion and to share important messages across THMT’s global ecosystem. The New Orleans, LA onsite test on September 21 was conducted with success for both projection and audio. The on sit e team experienced issues with both projection and sound Sept 22, 2023. The team surmised this technology can be used successfully across borders on earth.
... Communication between different systems and their components in a complex and highly dynamic environment must fulfill several requirements [1,2]: openness, en19 scalability, flexibility, portability; distribution at Internet level; standard conformance; business process orientation; consideration of timing aspects of data and information exchanged; user acceptance; lawfulness; appropriate security and privacy services. ...
... The GCM is: "an architecture framework that enables the representation of any real or virtual system; includes the system architecture from its business prospective and the system's development process for ICT solution supporting or enabling that business" [1] which was developed by professor Bernd Blobel from University Hospital Regensburg, Regensburg, Germany. The GCM is presented in Figure 1. ...
... 1002/sres.918 design concept is limited to monolithic systems and designs appear to have been technology/ vendor driven (Kuhn and Giuse, 2001; Berg et al., 2003; Blobel, 2006). Nearly all current systems are simple relational database applications, not unlike databases found in other industries. ...
... The identification of sources of data and users is straightforward in EHR while deciphering the various participants in a federated TDHS is not always so clear. TDHS involves deeper epistemological and ontological considerations and higher levels of abstraction that require more complex designs, integrated models and implementation architectures (Blobel, 2006 ). Furthermore , development time is lengthy, cost is high, design and implementation effort is extensive, risks (e.g. ...
To date, the digitization of health care typically has focussed simply and solely on electronic records for patients. Most systems are relational databases with a finite number of intra-enterprise applications and are limited to in-house use by health care facilities. Very few of these systems have realized fully functional, scalable, distribution capabilities, not to mention interoperability with external systems. This short-sighted tendency to build large-scale but restrictive automated systems that ignore the interactive nature of health care has resulted in limited operational success and acceptance. That said, this trend is not irreversible. Given the right circumstances, distributed, interoperable, digital health systems could emerge rapidly, offering both intra- and inter-enterprise benefits. To succeed, the design of these so-called total digital health systems (TDHSs) must be approached holistically, incorporating such properties of health care delivery systems as softness, openness, complexity, flexibility and generality. Because of the procedural nature of most electronic health record (EHR) applications now in use, traditional system approaches—such as the relational database model to application design—would be adequate for EHRs. This paper discusses the systemic nature of health care information systems and compares and contrasts the traditional EHR with TDHS. A soft systems methodology (SSM) is proposed for TDHS design. Copyright © 2008 John Wiley & Sons, Ltd.
... Services based on standardized electronic health record architectures (EHRAs) [3] are intended not only to improve treatment of individual patients but also to give a fresh impetus for research, quality management and health politics. Data analysis may concern the EHRs of individual patients or may be conducted across patients. ...
... Implementing this important project is going to influence documentation, communication and analysis of patient-related data. Services based on standardized electronic health record architectures (EHRAs) [3] are intended not only to improve treatment of individual patients but also to give a fresh impetus for research, quality management and health politics. Data analysis may concern the EHRs of individual patients or may be conducted across patients. ...
Lifelong electronic health records can supply valuable information for research, quality management and health politics in addition to supporting treatment of patients. Based on experiences with scientific data analysis in a university hospital environment, requirements on cross-institutional analysis of electronic health records in a healthcare system are discussed. The concept of archetypes can play a key role in this context. Archetypes can be utilized in data analysis for visualization, semantic linkage and finally for standardized data transfer.
... Details on structure and content of the structured body of the CDA document "SAE report" This section describes several requirements to be met for communication between dierent systems and presents the interoperability levels dened to meet the objectives and requirements of the actors involved in communication and cooperation.2.1 Interop erability requirem entsCommunication between dierent systems and their components in a complex and highly dynamic environment must fulll several requirements[1,2]: openness, scalability, exibility, portability ...
... Since traditional information models do not meet the requirements of MIS and their continuing evolution, advanced standards for representation and communication of EMRs [7,8] propose to use an architecture based on the dual model approach. This architecture defines two conceptual levels: ...
The meta-modeling of medical records helps standardize and capitalize the expert's knowledge domain. It promotes the interoperability knowledge and the reuse of clinical concepts, i.e., archetypes. It also promotes high quality electronic medical record system (EMRS) design, which helps provide better care service delivery. As a result, different standards of medical informatics use the dual model to support interoperability between Medical Information Systems. We particularly quote ISO/EN 13606 and OpenEHR. However, the use of these standards still presents challenges. Apart from political reasons, the main obstacles to the adoption of these standards include: (1) a lack of guides and methodological tools to facilitate the construction of EMRS using two conceptual levels. Designers must have languages, approaches and tools to assist them in the modeling of archetypal EMRS; (2) a lack of methodologies for semantic activities on the content of electronic health records in the semantic web environment; (3) and a lack of management of uncertainties and inaccuracies that may exist in the medical field. The construction of an approach to modeling EMRS according to the dual model approach, considering the uncertainties, inaccuracies and semantics of these systems, is a difficult task, given the challenges to emancipate. In literature, we don't find such an approach. We, therefore, defined one in this paper. Our goal is to guide the designer in all stages of developing a new generation of EMRS, from analysis and specification of requirements to implementation. To achieve this goal, we have created an approach to support the following activities: (1) clinical concepts and information management and meta-modeling in accordance with the openEHR standard, (2) integration of the semantic dimension into EMRS considered to enable the execution of semantic activities in the semantic web environment; and (3) integration of the fuzzy dimension into electronic medical record data structures. As a contribution, we defined an approach called Fuzzy SemanticOpenEHR allowing the integration of semantic and fuzzy dimensions into EMRS modeled using the openEHR standard. Fuzzy SemanticOpenEHR intends to help and equip the designer during the different phases of creating a fuzzy ontology. Thanks to the mechanisms offered by this approach, we have been able to obtain a fuzzy ontological basis that can serve as a knowledge base that can support the semantic interoperability between EMRS, the deduction of new knowledge and the taking of knowledge's clinical decision. To test our contribution, we proceeded to the realization of a prototype of tools realized for the pediatric neurology service of the university hospital "Hédi Chaker Sfax-Tunisia" and the association of the handicapped persons safeguard of Sfax. This prototype is a framework called "XML 2 FuzzyOWL". Then, we tested this framework using a case of a disease which is "Cerebral Palsy".
... To ensure the sustainability and efficiency of EMR systems, several research studies focused on models storage and the structuring of information and medical knowledge. Therefore, the advanced standards for EMR representation and communication [4,5], such as ISO/EN 13606 ''Health Informatics -EHR communication" [6] and OpenEHR [7], propose the use of an architecture based on the dual model approach, carried out the metamodeling of healthcare records with two conceptual levels: reference model, and archetype model. The first level models the semantics of data in terms of generic data types and structures in a stable form. ...
Purpose:
Integrating semantic dimension into clinical archetypes is necessary once modeling medical records. First, it enables semantic interoperability and, it offers applying semantic activities on clinical data and provides a higher design quality of Electronic Medical Record (EMR) systems. However, to obtain these advantages, designers need to use archetypes that cover semantic features of clinical concepts involved in their specific applications. In fact, most of archetypes filed within open repositories are expressed in the Archetype Definition Language (ALD) which allows defining only the syntactic structure of clinical concepts weakening semantic activities on the EMR content in the semantic web environment. This paper focuses on the modeling of an EMR prototype for infants affected by Cerebral Palsy (CP), using the dual model approach and integrating semantic web technologies. Such a modeling provides a better delivery of quality of care and ensures semantic interoperability between all involved therapies' information systems.
Methods:
First, data to be documented are identified and collected from the involved therapies. Subsequently, data are analyzed and arranged into archetypes expressed in accordance of ADL. During this step, open archetype repositories are explored, in order to find the suitable archetypes. Then, ADL archetypes are transformed into archetypes expressed in OWL-DL (Ontology Web Language - Description Language). Finally, we construct an ontological source related to these archetypes enabling hence their annotation to facilitate data extraction and providing possibility to exercise semantic activities on such archetypes.
Results:
Semantic dimension integration into EMR modeled in accordance to the archetype approach. The feasibility of our solution is shown through the development of a prototype, baptized "CP-SMS", which ensures semantic exploitation of CP EMR. This prototype provides the following features: (i) creation of CP EMR instances and their checking by using a knowledge base which we have constructed by interviews with domain experts, (ii) translation of initially CP ADL archetypes into CP OWL-DL archetypes, (iii) creation of an ontological source which we can use to annotate obtained archetypes and (vi) enrichment and supply of the ontological source and integration of semantic relations by providing hence fueling the ontology with new concepts, ensuring consistency and eliminating ambiguity between concepts.
Conclusions:
The degree of semantic interoperability that could be reached between EMR systems depends strongly on the quality of the used archetypes. Thus, the integration of semantic dimension in archetypes modeling process is crucial. By creating an ontological source and annotating archetypes, we create a supportive platform ensuring semantic interoperability between archetypes-based EMR-systems.
... Since traditional information models do not meet the requirements of MIS and their continuing evolution, advanced standards for representation and communication of EMRs [7,8] propose to use an architecture based on the dual model approach. This architecture defines two conceptual levels: ...
The meta-modeling of medical records helps standardize and capitalize the expert’s knowledge domain. It promotes the interoperability knowledge and the reuse of clinical concepts, i.e., archetypes. It also promotes high quality electronic medical record system (EMRS) design, which helps provide better care service delivery. As a result, different standards of medical informatics use the dual model to support interoperability between Medical Information Systems. We particularly quote ISO/EN 13606 and OpenEHR. However, the use of these standards still presents challenges. Apart from political reasons, the main obstacles to the adoption of these standards include: (1) a lack of guides and methodological tools to facilitate the construction of EMRS using two conceptual levels. Designers must have languages, approaches and tools to assist them in the modeling of archetypal EMRS; (2) a lack of methodologies for semantic activities on the content of electronic health records in the semantic web environment; (3) and a lack of management of uncertainties and inaccuracies that may exist in the medical field. Theconstruction of an approach to modeling EMRS according to the dual model approach, considering the uncertainties, inaccuracies and semantics of these systems, is a difficult task, given the challenges to emancipate. In literature, we don’t find such an approach. We, therefore, defined one in this paper. Our goal is to guide the designer in all stages of developing a new generation of EMRS, from analysis and specification of requirements to implementation. To achieve this goal, we have created an approach to support the following activities: (1) clinical concepts and information management and meta-modeling in accordance with the openEHR standard, (2) integration of the semantic dimension into EMRS considered to enable the execution of semantic activities in the semantic web environment; and (3) integration of the fuzzy dimension into electronic medical record data structures. As a contribution, we defined an approach called Fuzzy SemanticOpenEHR allowing the integration of semantic and fuzzy dimensions into EMRS modeled using the openEHR standard. Fuzzy SemanticOpenEHR intends to help and equip the designer during the different phases of creating a fuzzy ontology. Thanks to the mechanisms offered by this approach, we have been able to obtain a fuzzy ontological basis that can serve as a knowledge base that can support the semantic interoperability between EMRS, the deduction of new knowledge and the taking of knowledge’s clinical decision. To test our contribution, we proceeded to the realization of a prototype of tools realized for the pediatric neurology service of the university hospital “Hédi Chaker Sfax - Tunisia” and the association of the handicapped persons safeguard of Sfax. This prototype is a framework called “XML 2 FuzzyOWL”. Then, we tested this framework using a case of a disease which is “Cerebral Palsy”.
... To ensure the sustainability and efficiency of EHR systems, several research studies have focused on providing models for the storage and structuring of information and medical knowledge. Proposed solutions are based [2,3] on the principle that it is appropriate to have a meta-modelling of EHR systems [4,5]. Thus, the advanced EHR representation and communication standards proposed using an architecture based on the dual model approach. ...
Purpose: Different medical computer science standards, such as ISO\EN 13606, openEHR and HL7 CDA, use the dual model approach to support interoperability between medical information systems. However, use of these standards encounters some obstacles: (i) lack methodological tools to facilitate design of Electronic Health Record (EHR) systems in accordance to two conceptual levels, (ii) Lack of methodologies to perform semantic activities on EHR content in the semantic web environment, and (iii) Absence of models to adapt medical knowledge, modelled by means of archetypes, in different contexts of use. This paper presents a model-driven based methodology for the generation of context-aware medical interfaces. This methodology, entitled OpenEHR modelling Methodology: OpenEHR-MM includes concepts, models, rules, processes and tools aimed to assist EHR designer in the generation process of context-aware medical interfaces.
Methods: OpenEHR-MM is based on the use of the model driven architecture technological space, and it includes the following four steps:
1. Analysis and specification of requirements: This first step aims to guide EHR interface designer in the definition of users’ needs.
2. Conceptualization: This step aims to define tools, concepts and approaches that assist EHR designer in the two conceptual levels modelling process. At this step, we define an approach to provide the context information modelling.
3. Ontologization: This step aims to assist the designer to integrate the semantic dimension in the EHR systems modeled in accordance to the dual model approach.
4. Implementation: Finally, OpenEHR-MM provides an adaptive approach to enable medical interface configuration with respect to contexts settings.
Results: A model driven-based methodology for context-aware medical interfaces generation process. The experimentation of this methodology is performed on the EHR related to patients affected by cerebral palsy.
... The existence of such a wide variety of requirements implies the definition of specialized standards, classified according to the specific area to which they are related. Table 2 details the actual status of standardization of EHR grouped into the main specification areas: identification, architecture, infrastructure, communication models and security policies, among others [5,6]. The incorporation of such standards and models into new EHR system designs would allow a further step to be taken in the utilization of future eHealth systems, preventing the proliferation of non-reusable prototypes. ...
The standardization of Electronic Health Records (EHR) is a crucial factor for ensuring interoperable sharing of health data. During recent decades, a plethora of initiatives - driven by international organizations - has emerged to define the required models describing the exchange of information between EHRs. These models cover different essential characteristics for building interoperable EHRs, such as architecture, methodology, communication, safety or terminology, among others. In this context, the European reference frame for the standardized exchange of EHR is the recently approved ISO/EN 13606 standard. This multi-part standard provides the syntactic and semantic capabilities (through a dual model approach) as well as terminology, security and interface considerations for the standardized exchange of EHR. This paper provides (a) an introduction to the different standardization efforts related to the interoperable exchange of EHR around the world, and (b) a description of how the ISO/EN 13606 standard provides interoperable sharing of clinical information.
... These systems will serve as new and powerful sources of health information about the residents of a country. The electronic health record (EHR) is the informational basis of such eHealth systems [3]. Flexible exchange of data between different distributed EHR systems as well as secure and confidential storage of patient records to facilitate communication between health professionals about the status of an individual, have been given significant attention. ...
Background: While data based on health statistics (S-data) provide a summarized view of the health of a general population, data based on electronic health records (EHR-data) provide information about individual patients. Serving fairly different purposes, the two approaches to health information have evolved more or less independently. However, various benefits of using EHR-data in connection with public health issues have been identified and discussed. Objectives: The conceptual differences between these two approaches and the potential benefits of integration are discussed. A schematic illustration of the integration of EHR-data and S-data is outlined to analyze an integration scenario. Methods: As a test case we used reimbursement data of the Main Association of Austrian Social Security Institutions (EHR-data) and Austrian data of the European Community Health Survey (S-data). The time frame considered was restricted to the period from 2006 to 2007, and the prevalence of diabetes mellitus in Austria was selected as the exemplary subject of interest. Results: With respect to specific medical concepts, comparisons between EHR-data and S-data are clearly feasible. EHR-data are potentially valid substitutes of S-data and can provide detailed evidence for health reporting. For diabetes the difference of the prevalence between EHR-data and S-Data was only 1% for whole Austria. Conclusions: The pilot study yielded encouraging results. With respect to specific medical concepts, comparisons between EHR-data and S-data are clearly feasible. EHR-data are potentially valid to substitute or supplement surveys and can provide detailed evidence for health reporting.
... Communication between different systems and their components in a complex and highly dynamic environment must fulfill several requirements [1], [2]: openness, scalability, flexibility, portability; distribution at Internet level; standard conformance; business process orientation; consideration of timing aspects of data and information exchanged; user acceptance; lawfulness; appropriate security and privacy services ...
The paper presents the steps and metrics for evaluating the interoperability of an Obstetrics-Gynecology Department Information System applied on Bega Clinic Timisoara regarding its readiness for interoperability in relation with similar systems. The developed OGD IS was modeled starting from the Generic Component Model and sends information to other medical units using the HL7 Clinical Document Architecture and Continuity of Care Document standards. The data for evaluation are real, collected between 2009 and 2010 from Bega Clinic Timisoara. The results were relatively good for the investigated data and structure.
... The lifelong clinical information of any person supported by electronic means congures his Electronic Healthcare Record (EHR). Nowadays there are dier- ent advanced standards and architectures [1] for representing and communicating EHRs, such as HL7 [2], OpenEHR [3] and UNE-EN 13606 [4]. Some of these ad- vanced EHR standards, such as OpenEHR and UNE-EN 13606 make use of the dual model architecture approach [5]. ...
Semantic interoperability of clinical standards is a major challenge in the eHealth across Europe, because this would allow health-care professionals to manage the complete EHR of patient. Archetypes are considered a cornerstone to deliver fully interoperable EHRs. Our work is focused on the development of ontology-based methods and tech-niques for providing semantic interoperability between dierent EHR standards at archetype level. Hence, solutions for the semantic repre-sentation, transformation and management of clinical archetypes are de-scribed in this work.
... Electronic Health Record (EHR) systems are software systems that manage patient information that typically arises within a single health care institution. Such systems exist in various flavors and can be built up out of several different types of components and rely on different types of standards such as HL7 [16] or openEHR [3]. One particular component of a modern EHR deals with the access to terminologies and to coding and classification systems such as ICD-9-CM [39] or SNOMED-CT [35]. ...
Traditional database resources and Semantic Web technology face problems when there is a need to keep track of individuals in reality as these individuals undergo changes of various sorts. We describe an application which implements the Referent Tracking paradigm in which each real world entity has its own unique ID. The application is designed to be able to store relationships between tracked instances and also to be extendable to very high orders of magnitude (in principle to accept numbers of entries in the billions). Our approach is based on ontologies grounded in realism, but it can be extended also to information that is captured using the terminologies or concept-based ontologies used in traditional knowledge representation systems. The repository uses RDF as representation format, and it can thus be queried with query languages such as SPARQL, SeRQL and RQL, thereby providing support for reasoning over multiple ontologies.
... The electronic health record (EHR) is defined as a repository of information regarding to the health of a subject of care in computer-processable form, stored and transmitted securely and accessible by multiple authorized users [1]. Its main goal is to support continuous, efficient and high-quality integrated healthcare by using structured data entries [2,3], interoperability [4] and standards [5], real-time and point-of-care usage [6], privacy enhancing techniques improving security aspects [7,8], semantic interoperability by ontology-based ap-proaches [9] or decision support systems [10]. A comprehensive and suitable EHR system has not been internationally implemented by any software company or other vendor till now, that is why the evaluation of different EHR systems is important [11]. ...
To identify support of structured data entry for an electronic health record application in temporomandibular joint disorders.
The methods of structuring information in dentistry are described and the interactive DentCross component is introduced. A system of structured voice-supported data entry in electronic health record on several real cases in the field of dentistry is performed. The connection of this component to the MUDRLite electronic health record is described.
The use of DentVoice, an application which consists of the electronic health record MUDRLite and the voice-controlled interactive component DentCross, to collect dental information required by temporomandibular joint disorders is shown.
The DentVoice application with the DentCross component showed the practical ability of the temporomandibular joint disorder treatment support.
... Recently, new structural standards by CEN, HL7 (v3 RIM), openEHR, etc. have appeared [2][3][4], and they are being applied in pilot research and industrial projects to implement new information systems e.g. [5,6]. However, the question of today is how to interconnect heterogeneous legacy systems, based on huge relational databases. ...
The research presented deals with the problem of how information technology can support the interconnection of medical information systems in practice. We apply a two-part structural standard that consists of a fixed Information Reference (IR) Model, and an Archetype Reference (AR) Model that uses the structures of the IR model. A very important problem with the real-world application of such a two-level model is that the high level (abstract) entities, structures and their connections must be somehow translated into lower level equivalents that legacy database information systems can actually use to program their standardised interface. Our choice for the lower level medium is XML, such that the standard appears as an XSD schema that can be used, in the usual way, to validate a message document. To test the viability of the above paradigm, we developed an archetype-XSD translator tool in the form of Protégé/OWL plugins and tested it on an industrial interface for exchanging medical episodes (MedQuery), using an implementation of openEHR. We found that the most important features: Containment, Cardinality, Named references to other instances, and References to external terminologies, could all be mapped to standard XSD constructs. We also developed a validator plugin to check external references. We plan to put the system at work in a heterogeneous medical messaging system (a descendant of the Budapest based MediNet system) in the near future.
... Also, the model exchange between specificationsb ased on different meta-lan-guagessuchasUML and XML mustbesupported,w hich can easily be done using the OMGXMI specification [9]and/or by deploying appropriatet ools such as, e.g., Rational Rose ® [10]. Figure 2r oughly characterizes the development strategy for model-drivens elf-organizing health information systems [11]. ...
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.
... Extended by social, prevention or lifestyle information, the Electronic Health Record (EHR) is becoming established. The EHR enhances to become the core application of any eHealth platform and service [1]. ...
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.
... The Generic Component Model[7] ...
For improving quality and efficiency of health delivery under the wellknown burdens, the health service paradigm has to change from organization-centered over process-controlled to personal health. Established in connection to the already existing International Center for Telemedicine, the eHealth Competence Center in Regensburg has been dedicated to advance research, development, education and administration of comprehensive eHealth. In cooperation with internal and external partners, the Personal Health paradigm comprising of health telematics, telemedicine, biomedical engineering, bioinformatics and genomics is pushed ahead. The paper introduces the underlying paradigms, requirements, architectural framework and development processes for comprehensive service-oriented Personal Health interoperability chains.
... On the one hand, the card can bear the vital information subset of a health record. In case of a Patient Data Cards (PDC) designed and used mainly as a storage card, e.g., relevant medical data can be stored there as parts (sub-sets, extracts) of an Electronic Health Record [20], [21]. On the other hand, the card may solely be used as a pointer providing references and links to information stored in shared-care networked systems. ...
All types of advanced communication, collaboration, and cooperation in healthcare require a strong involvement of all addressed parties including health professionals and patients. Modern healthcare aims at involving patients having them take over responsibility for their own health status. Allowing them to take on their changed roles as emancipated partners in advanced care management, health professionals need to be educated and patients need to be empowered. From a security viewpoint, health issues have to be communicated via trusted health networks. To provide communication and cooperation between professionals and patients as well as to guarantee the required level of involvement of patients in shared care management environments, cards are widely used as person identifiers, on the one hand, and as security tokens, on the other. Being introduced as storage media and portable personalized application system, cards enable a patient controlled access to personalized health services as well as proper use and exchange of personal health data for specific purposes such as emergency. Furthermore, cards allow access to the wider electronic patient record via pointers or tickets. Cards can empower patients. The German Electronic Health Card (eGK) shall thus support care management and specific workflow processes e.g. for prescription and disease management. Regardless whether designed as data or pointer card - international standardization is a prerequisite also for national solutions. The more information patients have regarding different procedures and processes in healthcare, the more are they able to play their dedicated role within care management. Cards can and will contribute by allowing patients to get controlled access to administrative and medical data stored either on cards or in networks. Card holders determine who has access to their health information.
The revolution in information technology and in information and knowledge management contributed to the generation of actionable information and actionable knowledge required to address critical problems of national and global health care. Yet, despite expectations, e-based approaches are far from fulfilling the dream of equitable and universal access to health across the globe. A dramatically new approach is needed if health care is to be brought “among the people.” Based on maximum integration of computer technology (CT), information technology (IT), information management (IM), and knowledge management (KM), and multidimensional human expertise, the concept of “Teams of Leaders” (ToL) provides a foundation for such an approach. Utilizing the entire spectrum of IT/IM/KM, irrespective of specific platforms, and harnessing globally distributed human expertise, Teams of Leaders transcend bureaucracies and politics, create “bottom-up” flows of ideas and knowledge, and generate horizontal and vertical collaboration among hitherto isolated actors. By empowering people rather than concentrating on technology-facilitated improvements of processes, ToL may prove to be one of the pivotal concepts behind the desperately needed healthcare revolution.
Information and communications technology (ICT) can support the achievement of health outcomes. ICT can transform the manner in which health services are delivered. This chapter discusses some trends in pervasive e-health with the hope that this endeavor will assist e-health scholars channel their research efforts to new directions. Having extensively reviewed extant research, we focus on health education, electronic health records (EHR), blockchain technology, standardization, and m-health.
The article discuss important development in medical informatics from the past and in the present by way of examples. The word ’informatics’ is discussed as well as the relationship of the disciplines like biomedical informatics, health informatics and healthcare informatics to medical informatics. These cross-sectional disciplines form one of the bases for biomedicine and healthcare. They play the significant role in the new presented concept of the holistic information-based healthcare.
The increased availability and use of information and communications technologies (ICTs) including mobile devices has created many new opportunities for supporting the achievement of healthcare outcomes. That is, e-health offers tremendous potential to transform the manner in which health services are delivered and interventions are carried out in the healthcare industry. A plethora of e-health applications are emerging though many are also quickly disappearing, and users are still unsure of the true e-health benefits. In this chapter, we discuss some key developments in e-health. We argue that leveraging their inherent power can create opportunities for achieving tangible outcomes in healthcare. Additionally, this chapter will assist e-health researchers and practitioners channel and focus their research efforts to developing areas. Having extensively reviewed extant research, we focus on health awareness and education, personal health information management, standardization, m-health, and security and privacy.
This paper presents a solution for improving communication between medical information systems using Web Services. A Web Service is used as a supporting technology to improve the interoperability between different medical informatics systems and CDS (Clinical Decision Support) systems. A demonstration is made for the communication between an Obstetrics-Gynecology Department Information System, a Pediatrics Department Information System, a General Practitioner Information System and a Clinical Decision Support System. All the applications are web-based and can be accessed using a browser. HL7 CDA (Clinical Document Architecture) and CCD (Continuity of Care Document) standards are used in order to support the entire system's interoperability. Flexibility and ubiquity in accessing vital information are the main benefits of the presented solution.
The use of Information and Communications Technologies (ICT) to support the achievement of health outcomes has the potential to transform the manner in which health services are delivered. Although there is an increasing number of contributions in e-health research, knowledge in this area remains limited. In this chapter, we discuss current trends in pervasive e-health with the hope that this endeavor will assist e-health scholars channel their research efforts. Having extensively reviewed extant research, we focus on health education, electronic health records (EHR), standardization, and m-health.
Monitoring the patient is an important issue in healthcare for taking critical decision based on evidence. The paper presents a model of the monitoring activities in cardiology departments using Business Process Modeling and Notation and Bizagy software and the consequently developed application for monitoring in cardiology departments. The application is developed in Visual Studio.NET 2012 using ASP.NET pages and C# language. The database of the application is uploaded in the cloud using the Windows Azure platform. The communication between different cardiology departments situated in different locations based on an Application for monitoring in cardiology is using HL7 Clinical Document Architecture, leading to a complete medical history of the patient related mainly on the heart disease. The data collected from different cardiology departments resides in the cloud. Having the possibility to collect big amounts of data from different cardiology departments offers the opportunity to access and process huge amounts of data important for diagnosis and prevention that help increasing the life expectancy, reduce the medical errors and provide more better care of the patient.
As XML data is being widely adopted as a data and object exchange format for both structured and semi structured data, the need for quality control and measurement is only to be expected. This can be attributed to the increase in the need for data quality metrics in traditional databases over the past decade. The traditional model provide constraints mechanisms and features to control quality defects but unfortunately these methods are not foolproof. This report reviews work on data quality in both database and management research areas. The review includes (i) the exploration into the notion of data quality, its definitions, metrics, control and improvement in data and information sets and (ii) investigation of the techniques which used in traditional databases like relational and object databases where most focus and resource has been directed. In spite of the wide adoption of XML data since its inception, the exploration does not only show a huge gap between research works of data quality in relational databases and XML databases but also show how very little support database systems provide in giving a measure of the quality of the data they hold. This inducts the need to formularize mechanisms and techniques for embedding data quality control and metrics into XML data sets. It also presents the viability of a process based approach to data quality measurement with suitable techniques, applicable in a dynamic decision environments with multidimensional data and heterogeneous sources. This will involve modelling the interdependencies and categories of the attributes of data quality generally referred to as data quality dimensions and the adoption of a formal means like process algebra, fuzzy logic and any other appropriate approaches. The attempt is contextualised using the healthcare domain as it bears all the required characteristics.
Archetypes facilitate the sharing of clinical knowledge and therefore are a basic tool for achieving interoperability between healthcare information systems. In this paper, a Semantic Web System for Managing Archetypes is presented. This system allows for the semantic annotation of archetypes, as well for performing semantic searches. The current system is capable of working with both ISO13606 and OpenEHR archetypes.
The formalization and analysis of medical guidelines play an essential role in clinical practice nowadays. Due to their inexorably generic nature such guidelines leave room for different interpretation and implementation. Hence, it is desirable to understand this variability and its implications for patient treatment in practice. In this paper we propose an approach for comparing guideline-based treatment processes with empirical treatment processes. The methodology combines ideas from workflow modeling, process simulation, process mining, and statistical methods of evidence-based medicine. The applicability of the approach is illustrated based on the Cutaneous Melanoma use case.
Since the first concepts for electronic health records (EHRs) in the 1990s, the content, structure, and technology of such records were frequently changed and adapted. The basic idea to support and enhance health care stayed the same over time. To reach these goals, it is crucial that EHRs themselves adhere to rigid quality requirements. The present review aims at describing the currently available, mainly non-functional, quality requirements with regard to electronic health records.
A combined approach - systematic literature analysis and expert interviews - was used. The literature analysis as well as the expert interviews included sources/experts from different domains such as standards and norms, scientific literature and guidelines, and best practice. The expert interviews were performed by using problem-centric qualitative computer-assisted telephone interviews (CATIs) or face-to-face interviews. All of the data that was obtained was analyzed using qualitative content analysis techniques.
In total, more than 1200 requirements were identified of which 203 requirements were also mentioned during the expert interviews. The requirements are organized according to the ISO 9126 and the eEurope 2002 criteria. Categories with the highest number of requirements found include global requirements, (general) functional requirements and data security. The number of non-functional requirements found is by contrast lower.
The manuscript gives comprehensive insight into the currently available, primarily non-functional, EHR requirements. To our knowledge, there are no other publications that have holistically reported on this topic. The requirements identified can be used in different ways, e.g. the conceptual design, the development of EHR systems, as a starting point for further refinement or as a basis for the development of specific sets of requirements.
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.
Zusammenfassung Die elektronische Patientenakte ist die Kernapplikation jeder Gesundheitstelematik-Plattform. Was haben wir — was brauchen
wir für e-Health Europe?
Semantically interoperable health information systems have to be based on shared knowledge and harmonised terminologies/ontologies. Therefore, knowledge representation regarding domain concepts, terms, and relationships used must be harmonised. Starting with the Generic Component Model, different approaches for representing concepts in the healthcare area are discussed, demonstrating common principles and transformation ways.
to describe the key concepts and elements used to implement a comprehensive access management system to a distributed, component-based healthcare information system.
the a priori access is based on an institution-wide policy for access rights coupled to proximity process for the granting of such rights. Access rights are explicit and externalized from the information systems components. A posteriori control is based on a centralized, exhaustive journal of accesses to all components coupled to a decentralized verification process for suspicious accesses.
the system has been operational for three years, initially used for the access to the computerized patient record components, and now extending to all the components of the hospital information system. The same architecture will be used for the development of the trans-institutional community health information network.
In addition to the meaning as Health Informatics Society of Australia, HISA is the acronym used for the new European Standard: Health Informatics - Service Architecture. This EN 12967 standard has been developed by CEN - the federation of 29 national standards bodies in Europe. This standard defines the essential elements of a Service Oriented Architecture and a methodology for localization particularly useful for large healthcare organizations. It is based on the Open Distributed Processing (ODP) framework from ISO 10746 and contains the following parts: Part 1: Enterprise viewpoint. Part 2: Information viewpoint. Part 3: Computational viewpoint. This standard is now also the starting point for the consideration for an International standard in ISO/TC 215. The basic principles with a set of health specific middleware services as a common platform for various applications for regional health information systems, or large integrated hospital information systems, are well established following a previous prestandard. Examples of large scale deployments in Sweden, Denmark and Italy are described.
For improving quality and efficiency of health delivery under the well-known burdens, the health service paradigm has to change from organization-centered over process-controlled to personal health. The growing complexity of highly distributed and fully integrated healthcare settings can only be managed through an advanced architectural approach, which has to include all dimensions of personal health. Here, ICT, medicine, biomedical engineering, bioinformatics and genomics, legal and administrative aspects, terminology and ontology have to be mentioned. The Generic Component Model allows for different domains' concept representation and aggregation. Framework, requirements, methodology and process design possibilities for such a future-proof and meanwhile practically demonstrated approach are discussed in detail. The deployment of the Generic Component Model and the concept representation to biomedical engineering aspects of eHealth are touched upon as essential issues.
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.
Semantic interoperability is a basic challenge to be met for new generations of distributed, communicating and co-operating health information systems (HIS) enabling shared care and e-Health. Analysis, design, implementation and maintenance of such systems and intrinsic architectures have to follow a unified development methodology.
The Generic Component Model (GCM) is used as a framework for modeling any system to evaluate and harmonize state of the art architecture development approaches and standards for health information systems as well as to derive a coherent architecture development framework for sustainable, semantically interoperable HIS and their components. The proposed methodology is based on the Rational Unified Process (RUP), taking advantage of its flexibility to be configured for integrating other architectural approaches such as Service-Oriented Architecture (SOA), Model-Driven Architecture (MDA), ISO 10746, and HL7 Development Framework (HDF).
Existing architectural approaches have been analyzed, compared and finally harmonized towards an architecture development framework for advanced health information systems.
Starting with the requirements for semantic interoperability derived from paradigm changes for health information systems, and supported in formal software process engineering methods, an appropriate development framework for semantically interoperable HIS has been provided. The usability of the framework has been exemplified in a public health scenario.
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.
This paper presents a totally generic client-server model for accessing legacy and new databases according to the three tier architecture principles. It is based on an integrated environment that eases the dynamic creation and instantiation of secure web applications that access multiple database management systems. Emphasis is placed on the ability to query almost any type of relational database and queries can simultaneously address a multitude of data sources. The information is collected, assembled and presented to users depending on a possible set of user profiles. These profiles originate from work on securing the conduct of clinical studies. This has been achieved in the context of the EU funded project HARP (Harmonisation for the Security of Web Technologies and Applications). The generic character of the model is exploited through an accompanying set of development tools. This permits efficient and effective creation and maintenance of applications in several domains of health telematics and beyond. Main merit is the lightweight character of the resulting platform, whereby all necessary instantiations are accomplished through a set of related XML documents.