Patients' Medical Information

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Source: IST Results

Date: 2006-01-04

URL: http://www.sciencedaily.com/releases/2006/01/060103182421.htm

Building Interoperability Into Medical Information

Modern health information systems today are proprietary and often

only serve one department making it impossible to easily share data

across one facility, never mind across different facilities or

countries. It's a big problem. And it makes it difficult for doctors

to capture a complete clinical history of a patient. But one project

hopes to overcome this.

" The healthcare interoperability problem can be investigated in two

categories: Interoperability of the healthcare messages exchanged

and interoperability of electronic healthcare records [EHRs], " says

Professor Asuman Dogac, Director of the Software Research &

Development Center at the Middle East Technical University in

Ankara, Turkey, and coordinator of the IST-funded ARTEMIS project.

Right now messaging interfaces, or interface engines, are used to

exchange information among different healthcare information systems.

Currently, the Health Level 7 (HL7) Version 2 Messaging Standard is

the most widely implemented in healthcare.

Unfortunately, HL7 V2 compliance does not imply direct

interoperability between healthcare systems, because V2 has no

explicit information model. Instead it has rather vague definitions

for many data fields and it contains many optional fields.

It offers great flexibility, but requires detailed bilateral

agreements among healthcare systems to achieve interoperability. So

Version 3 was developed, based on an object-oriented data model but

that can't talk to V2.

EHRs suffer from similar problems. An EHR is digitally stored

healthcare information about an individual's lifetime that supports

continuity of care, education and research, while ensuring

confidentiality at all times.

A number of standardisation efforts are progressing to provide EHRs

interoperability. However, an exchange of well-structured and

machine-processable EHRs has not been achieved yet in practice.

Adding meaning

ARTEMIS provides the desperately required interoperability between

medical information systems through semantically-enriched Web

services that use defined meanings of individual pieces of input and

output parameters. The team decided not to reinvent the wheel and

used existing standards where they were relevant.

For example, an essential element in defining Semantic Web services

is domain knowledge. Medical informatics is one of the few domains

to have considerable domain knowledge developed in standards. HL7

categorises events and defines messages in healthcare based on

service functionality, which reflects the business logic. ARTEMIS

uses HL7 as a basis for defining both the service action semantics

and the message semantics.

In the ARTEMIS project, their Message Exchange Framework provides

the exchange of meaningful clinical information among healthcare

institutes through semantic mediation. The framework involves first

maps the source ontology onto the target message ontology with the

help of a tool which produces a mapping definition. This mapping

definition is then used to automatically transform the source

ontology message instances into target message instances. Through a

prototype implementation, ARTEMIS demonstrates how to mediate

between HL7 Version 2 and HL7 Version 3 messages. However, the

framework proposed is generic enough to mediate between any

incompatible healthcare standards currently in use.

For EHRs, ARTEMIS uses constraint rules for specific clinical

concepts, called `archetypes', rather than distinct entities in the

reference information model. Archetype-based interoperability

discovers existing archetypes based on their semantics. It annotates

their archetypes with ontologies, an established list of

definitions, and then composes templates from archetypes and

retrieves corresponding data from the underlying medical information

systems. ARTEMIS used electronic business XML (ebXML) registry

semantic constructs to annotate, store, discover and retrieve

archetypes.

Continuity of care with EHR

One crucial aspect in ARTEMIS is to find and retrieve clinical

information about a particular patient from different healthcare

organisations where concrete sources are unknown. To complicate

matters, in most countries there are no unique person identifiers

that would be valid for the whole lifetime of an individual and used

by all parties in healthcare and for all episodes of care. On the

contrary, in many cases several identifiers for a patient exist even

within a single organisation.

Consequently a protocol is needed that allows the identification of

patients by means of non-unique patient-related attributes. ARTEMIS

developed a `Patient Identification Process' (PIP) Protocol'. PIP

provides a solution for a common problem in the healthcare sector

that is likely to become very important with the increasing mobility

of the workforce in Europe: locating and accessing prior clinical

records for continuity of care.

Healthcare information systems operate within a strict regulatory

framework that ensures the protection of personal data and outlines

the conditions where processing is allowed. The ARTEMIS project

responded to these conditions by providing comprehensive security

and privacy protection mechanisms.

Currently, the healthcare industry's Integrating the Healthcare

Enterprise (IHE) initiative proposes the Retrieve Information for

Display (RID) integration profile to allow users to retrieve and

display patient-related documents on systems other than the document

keeping systems. Although the RID profile is well suited for use in

a single hospital or within a trust of hospitals that belong to a

single Patient Identifier Domain, it is not designed for cross-

boundary access on information stored in different hospitals.

ARTEMIS developed middleware infrastructure that extends the IHE RID

protocol for cross-enterprise search and access to patient-related

clinical information, even if no Master Patient Index is available,

and without modifications to existing information source actors.

Applied to the ARTEMIS infrastructure, the RID Information Source

and Display actors may be located in different institutions using

different Patient ID domains and different sets of demographic data.

Within the ARTEMIS network, clinical records can be located using

the Patient Identification Protocol which can also be combined with

the IHE Cross-enterprise Document Sharing (XDS) Integration Profile.

At the Healthcare Information and Management Systems Society (HIMSS)

annual conference in San Diego, February 2006, " we will run a

demonstrator that will realise a scenario where, after an accident,

a patient is admitted to the most appropriate hospital from the

ambulance, " says Dr Dogac. " The patient will be admitted before the

ambulance arrives at the hospital, via a mobile device. The hospital

admissions service will then automatically seek out any relevant

healthcare records of the patient in the ARTEMIS P2P network, and

presents them to the doctor, although the hospitals discovered may

not be using interoperable standards with each other. This is a

considerable improvement over current systems. "

Looking ahead

In the meantime, the team will continue to work on improvements in

the system, enhancing the peer-to-peer networking, security, privacy

and patient identification modules and integrating them to the

ARTEMIS architecture.

Dr Dogac emphasised that the current aim of the project is to

demonstrate the project results to the industry players on

board. " We need to show more people what we are doing and publicise

it more widely. We need to show them that it works. "

That's part of an on-going process to promote their work at

conferences like HIMMS. In the meantime, Dr Dogac will begin a new

project, SAPHIRE, in the next couple of months.

" That project will seek to extend the functionality of ARTEMIS. It

will expose medical sensor data as semantically-enriched Web

services. It will process sensor output, the patient's medical

history and clinical guidelines to help physicians with diagnoses

and treatment, " says Dr Dogac.

While ARTEMIS is focused on the hugely important step of accessing

disparate patient data through a semantic interoperability platform,

SAPHIRE uses this system to create new services that are currently

unavailable. It could mean a paradigm shift in patient care.

But even without these new services, ARTEMIS already represents a

major advance; it enables clinicians to capture the complete

clinical history of a patient that may be spread out over a number

of different institutes that do not interoperate.