An Adaptive Semantic based Mediation System for Data Interoperability among Health Information Systems

Heterogeneity in the management of the complex medical data, obstructs the attainment of data level interoperability among Health Information Systems (HIS). This diversity is dependent on the compliance of HISs with different healthcare standards. Its solution demands a mediation system for the accurate interpretation of data in different heterogeneous formats for achieving data interoperability. We propose an adaptive AdapteR Interoperability ENgine mediation system called ARIEN, that arbitrates between HISs compliant to different healthcare standards for accurate and seamless information exchange to achieve data interoperability. ARIEN stores the semantic mapping information between different standards in the Mediation Bridge Ontology (MBO) using ontology matching techniques. These mappings are provided by our System for Parallel Heterogeneity (SPHeRe) matching system and Personalized-Detailed Clinical Model (P-DCM) approach to guarantee accuracy of mappings. The realization of the effectiveness of the mappings stored in the MBO is evaluation of the accuracy in transformation process among different standard formats. We evaluated our proposed system with the transformation process of medical records between Clinical Document Architecture (CDA) and Virtual Medical Record (vMR) standards. The transformation process achieved over 90 % of accuracy level in conversion process between CDA and vMR standards using pattern oriented approach from the MBO. The proposed mediation system improves the overall communication process between HISs. It provides an accurate and seamless medical information exchange to ensure data interoperability and timely healthcare services to patients.     

临床信息系统间基于语义的数据交换方案设计与实现

随着信息技术的不断发展和医疗服务需求的日益增加,医院信息化建设已成为医疗卫生事业发展的重要趋势。目前医院中使用的各种信息系统,如电子病历系统、放射科信息管理系统等,所用的系统平台、技术接口和标准规范各不相同,使这些异构临床信息系统产生的信息资源在格式、语法、术语的含义等很多方面存在差异,从而难以实现系统间的数据交换。针对这一问题,引入语义互操作的概念,设计并提出了异构临床信息系统间的语义互操作三层架构模型。并以眼科信息系统与其他异构系统之间的数据交换为例,验证临床信息系统间的语义互操作模型,部分解决了系统间的语义异构问题,为异构临床信息系统间的整合模式提供了新的思路和方法。     

Electronic case reporting (eCR) of COVID-19 to public health: implementation perspectives from the Minnesota Department of Health

Electronic case reporting (eCR) is the automated generation and transmission of case reports from electronic health records to public health for review and action. These reports (electronic initial case reports: eICRs) adhere to recommended exchange and terminology standards. eCR is a partnership of the Centers for Disease Control and Prevention (CDC), Association of Public Health Laboratories (APHL) and Council of State and Territorial Epidemiologists (CSTE). The Minnesota Department of Health (MDH) received eICRs for COVID-19 from April 2020 (3 sites, manual process), automated eCR implementation in August 2020 (7 sites), and on-boarded ∼1780 clinical units in 460 sites across 6 integrated healthcare systems (through March 2022). Approximately 20 000 eICRs/month were reported to MDH during high-volume timeframes. With increasing provider/health system implementation, the proportion of COVID-19 cases with an eICR increased to 30% (March 2022). Evaluation of data quality for select demographic variables (gender, race, ethnicity, email, phone, language) across the 6 reporting health systems revealed a high proportion of completeness (>80%) for half of variables and less complete data for rest (ethnicity, email, language) along with low ethnicity data (<50%) for one health system. Presently eCR implementation at MDH includes only one EHR vendor. Next steps will focus on onboarding other EHRs, additional eICR data extraction/utilization, detailed analysis, outreach to address data quality issues, and expanding to other reportable conditions.     

语义环境下电子期刊出版标准探讨

定义语义出版的概念,对语义环境下数字出版相关标准进行分类,列举适用于电子图书和多媒体等载体的相关标准,从互操作、数据交换、字体编码、标识注册以及终端应用等方面详细分析语义环境下电子期刊内容加工、发布与有效利用等相关的各种标准,概述了语义环境下电子期刊出版标准在生物医学领域中的应用现状。     

面向医学信息交换的语义查询系统设计

医疗信息工作者通过制定医学数据交换标准，实现各种纷杂独立的异构医疗信息系统间的数据共享。但由于现实医疗环境的复杂性，存在如HIs、PACS、LIS和OS等异构系统，在这些异构系统中对相同含义的对象可能存在各种不同的语言表达方式，如何识别利用这些信息以提高医疗服务质量，成为备受关注且亟需解决的问题。提出面向医学信息交换的语义查询系统，引入本体的方法来解决语义信息缺乏问题，以更好地实现医疗系统的信息交换和共享。     

The Clinical Document Architecture and the Continuity of Care Record: A Critical Analysis

Health care provides many opportunities in which the sharing of data between independent sites is highly desirable. Several standards are required to produce the functional and semantic interoperability necessary to support the exchange of such data: a common reference information model, a common set of data elements, a common terminology, common data structures, and a common transport standard. This paper addresses one component of that set of standards: the ability to create a document that supports the exchange of structured data components. Unfortunately, two different standards development organizations have produced similar standards for that purpose based on different information models: Health Level 7 (HL7)'s Clinical Document Architecture (CDA) and The American Society for Testing and Materials (ASTM International) Continuity of Care Record (CCR). The coexistence of both standards might require mapping from one standard to the other, which could be accompanied by a loss of information and functionality. This paper examines and compares the two standards, emphasizes the strengths and weaknesses of each, and proposes a strategy of harmonization to enhance future progress. While some of the authors are members of HL7 and/or ASTM International, the authors stress that the viewpoints represented in this paper are those of the authors and do not represent the official viewpoints of either HL7 or of ASTM International.     

Ubiquitous Healthcare Computing with Sensor Grid Enhancement with Data Management System (SEGEDMA)

Wireless Sensor Network (WSN) can be deployed to monitor the health of patients suffering from critical diseases. Also a wireless network consisting of biomedical sensors can be implanted into the patient’s body and can monitor the patients’ conditions. These sensor devices, apart from having an enormous capability of collecting data from their physical surroundings, are also resource constraint in nature with a limited processing and communication ability. Therefore we have to integrate them with the Grid technology in order to process and store the collected data by the sensor nodes. In this paper, we proposed the SEnsor Grid Enhancement Data Management system, called SEGEDMA ensuring the integration of different network technologies and the continuous data access to system users. The main contribution of this work is to achieve the interoperability of both technologies through a novel network architecture ensuring also the interoperability of Open Geospatial Consortium (OGC) and HL7 standards. According to the results, SEGEDMA can be applied successfully in a decentralized healthcare environment.     

Integrating Hospital Information Systems in Healthcare Institutions: A Mediation Architecture

Many studies have examined the integration of information systems into healthcare institutions, leading to several standards in the healthcare domain (CORBAmed: Common Object Request Broker Architecture in Medicine; HL7: Health Level Seven International; DICOM: Digital Imaging and Communications in Medicine; and IHE: Integrating the Healthcare Enterprise). Due to the existence of a wide diversity of heterogeneous systems, three essential factors are necessary to fully integrate a system: data, functions and workflow. However, most of the previous studies have dealt with only one or two of these factors and this makes the system integration unsatisfactory. In this paper, we propose a flexible, scalable architecture for Hospital Information Systems (HIS). Our main purpose is to provide a practical solution to insure HIS interoperability so that healthcare institutions can communicate without being obliged to change their local information systems and without altering the tasks of the healthcare professionals. Our architecture is a mediation architecture with 3 levels: 1) a database level, 2) a middleware level and 3) a user interface level. The mediation is based on two central components: the Mediator and the Adapter. Using the XML format allows us to establish a structured, secured exchange of healthcare data. The notion of medical ontology is introduced to solve semantic conflicts and to unify the language used for the exchange. Our mediation architecture provides an effective, promising model that promotes the integration of hospital information systems that are autonomous, heterogeneous, semantically interoperable and platform-independent.     

医疗卫生信息技术标准概述(一)

信息技术(IT)已经在医疗卫生领域中广泛应用于临床信息的收集、处理、管理和使用。IT技术的重要应用之一是建立病人不同来源的临床数据的长期记录,并在任何需要的时候和地点以安全的方式向医生提供这些信息。病人数据无缝集成将极大地改善医疗质量及减少医疗错误。为了在不同系统之间交换临床信息及实现互操作性,开放标准起着非常关键的作用。本文提供医疗卫生领域一些主要信息技术标准及其应用的一个概述。     

Improving newborn screening laboratory test ordering and result reporting using health information exchange

Capture, coding and communication of newborn screening (NBS) information represent a challenge for public health laboratories, health departments, hospitals, and ambulatory care practices. An increasing number of conditions targeted for screening and the complexity of interpretation contribute to a growing need for integrated information-management strategies. This makes NBS an important test of tools and architecture for electronic health information exchange (HIE) in this convergence of individual patient care and population health activities. For this reason, the American Health Information Community undertook three tasks described in this paper. First, a newborn screening use case was established to facilitate standards harmonization for common terminology and interoperability specifications guiding HIE. Second, newborn screening coding and terminology were developed for integration into electronic HIE activities. Finally, clarification of privacy, security, and clinical laboratory regulatory requirements governing information exchange was provided, serving as a framework to establish pathways for improving screening program timeliness, effectiveness, and efficiency of quality patient care services.     

A unified structural/terminological interoperability framework based on LexEVS: application to TRANSFoRm

Objective

Biomedical research increasingly relies on the integration of information from multiple heterogeneous data sources. Despite the fact that structural and terminological aspects of interoperability are interdependent and rely on a common set of requirements, current efforts typically address them in isolation. We propose a unified ontology-based knowledge framework to facilitate interoperability between heterogeneous sources, and investigate if using the LexEVS terminology server is a viable implementation method.

Materials and methods

We developed a framework based on an ontology, the general information model (GIM), to unify structural models and terminologies, together with relevant mapping sets. This allowed a uniform access to these resources within LexEVS to facilitate interoperability by various components and data sources from implementing architectures.

Results

Our unified framework has been tested in the context of the EU Framework Program 7 TRANSFoRm project, where it was used to achieve data integration in a retrospective diabetes cohort study. The GIM was successfully instantiated in TRANSFoRm as the clinical data integration model, and necessary mappings were created to support effective information retrieval for software tools in the project.

Conclusions

We present a novel, unifying approach to address interoperability challenges in heterogeneous data sources, by representing structural and semantic models in one framework. Systems using this architecture can rely solely on the GIM that abstracts over both the structure and coding. Information models, terminologies and mappings are all stored in LexEVS and can be accessed in a uniform manner (implementing the HL7 CTS2 service functional model). The system is flexible and should reduce the effort needed from data sources personnel for implementing and managing the integration.     

基于本体的医院医学术语管理系统设计研究

介绍基于本体的医学术语管理优势,阐述基于本体的医院医学术语管理系统设计及应用场景,分析不足之处并提出建议,为提高医院信息系统语义互操作性、医疗数据质量管理与应用水平提供参考。     

Barriers to the Widespread Adoption of Health Data Standards: An Exploratory Qualitative Study in Tertiary Healthcare Organizations in Saudi Arabia

Although health data standards are perceived to be the essential solution for interoperability barriers within medical IT systems, the level of adoption of those standards still remains frustratingly low. Little is known about the barriers facing their adoption within the healthcare organizations context. In addressing this gap in the literature, based on IT related standards adoption theories such as Diffusion of Innovation Theory and the theories surrounding the Economics of Standards, a qualitative multiple-case study was undertaken in Saudi Arabia to investigate those barriers. The results exposed that few standards were adopted because of four broad reasons, managerial, technical, educational and governmental. While some of the findings can be rooted to those related standards theories, others can be underpinned through the normative literature. Core barriers are the lack of a national regulator and a data exchange plan, and the lack of an adequate policy regarding medical IT systems and information management and national healthcare system; also important are technical barriers and the switching costs to the standards. The outcome of this study can be used in forming effective interventions when planning to use health data standards and, in particular those in developing countries.     

A Generative Tool for Building Health Applications Driven by ISO 13606 Archetypes

The use of Electronic Healthcare Records (EHR) standards in the development of healthcare applications is crucial for achieving the semantic interoperability of clinical information. Advanced EHR standards make use of the dual model architecture, which provides a solution for clinical interoperability based on the separation of the information and knowledge. However, the impact of such standards is biased by the limited availability of tools that facilitate their usage and practical implementation. In this paper, we present an approach for the automatic generation of clinical applications for the ISO 13606 EHR standard, which is based on the dual model architecture. This generator has been generically designed, so it can be easily adapted to other dual model standards and can generate applications for multiple technological platforms. Such good properties are based on the combination of standards for the representation of generic user interfaces and model-driven engineering techniques.     

国外长期照护机构和医院之间卫生信息交换状况分析

目的:对国外长期照护机构与医院之间卫生信息交换文献进行系统综述分析。方法:检索2009年1月1日至2020年10月31日期间PubMed、Embase和Web of Science数据库中收录的相关英文文献,进行筛选、审核和纳入。结果:42篇文献被纳入分析,结果显示长期照护机构与医院之间卫生信息交换主要包括电子照护传输系统(28.6%)、电子消息系统(14.3%)、信息交换系统(26.2%)和远程医疗系统(30.9%)四种类型。61.9%文献中卫生信息交换系统与患者电子健康档案系统有交互接口,只有19.0%文献在信息交换期间使用HL7相关标准,属于语义互操作文献仅有11.9%。结论:国外长期照护机构与医院之间数据交换的信息化程度较弱,实现两类机构之间有效信息共享与交换,面临很多问题和挑战。     

语义互操作标准在临床决策支持系统中的应用

介绍临床决策支持系统互操作研究基本情况,基于语义互操作标准类别、临床决策支持系统开发与部署的功能需求,对临床决策支持系统中的标准进行分类,探讨各类标准在临床决策支持系统中的应用。     

Health-information exchange: why are we doing it,and what are we doing?

Health-information exchange, that is, enabling the interoperability of automated health data, can facilitate important improvements in healthcare quality and efficiency. A vision of interoperability and its benefits was articulated more than a decade ago. Since then, important advances toward the goal have been made. The advent of the Health Information Technology for Economic and Clinical Health Act and the meaningful use program is already having a significant impact on the direction that health-information exchange will take. This paper describes how interoperability activities have unfolded over the last decade and explores how recent initiatives are likely to affect the directions and benefits of health-information exchange.     

中医药优势病种文献数据结构解析与网络模型构建思路

目的：提出中医药优势病种文献数据语义网络模型构建的思路,以实现中医药优势病种文献数据集成共享,进一步揭示中医药优势病种信息内涵。方法：顶层本体的设计基于中医临床术语系统及中医药学语言系统,抽取中医药概念及关系,利用获取的中医药优势病种文献全信息数据,确定其核心概念和非核心概念。基于基础数据抽取规范,利用顶层本体与基础数据结合的方法构建语义网络模型。结果：通过分析中医药优势病种文献数据特点,成功构建了体现中医药优势病种特色的语义网络模型。结论：构建规范的中医药优势病种文献语义网络模型有利于中医药优势病种信息的集成与应用,可以为中医药数据的统一规范提供指导。     

Approaching semantic interoperability in Health Level Seven

‘Semantic Interoperability’ is a driving objective behind many of Health Level Seven''s standards. The objective in this paper is to take a step back, and consider what semantic interoperability means, assess whether or not it has been achieved, and, if not, determine what concrete next steps can be taken to get closer. A framework for measuring semantic interoperability is proposed, using a technique called the ‘Single Logical Information Model’ framework, which relies on an operational definition of semantic interoperability and an understanding that interoperability improves incrementally. Whether semantic interoperability tomorrow will enable one computer to talk to another, much as one person can talk to another person, is a matter for speculation. It is assumed, however, that what gets measured gets improved, and in that spirit this framework is offered as a means to improvement.     

Standardizing Nursing Information in Canada for Inclusion in Electronic Health Records: C-HOBIC

The Canadian Health Outcomes for Better Information and Care (C-HOBIC) project introduced systematic use of standardized clinical nursing terminology for patient assessments. Implemented so far in three Canadian provinces, C-HOBIC comprises an innovative model for large-scale capture of standardized nursing-sensitive clinical outcomes data within electronic health records (EHRs). To support this activity, nursing assessment and outcomes concepts were mapped to the International Classification for Nursing Practice (ICNP®). By comparing serial data on a patient across multiple time points, the C-HOBIC model can generate nursing-sensitive patient outcome reports. A principle benefit of the C-HOBIC model is that it provides nurses with information critical to planning for and evaluating patient care. Inclusion of nursing information in either provincial databases or EHRs in three Canadian provinces promotes continuity of patient care across sectors of the healthcare systems in those provinces and also facilitates aggregation and analysis by administrators and policy makers. The C-HOBIC model provides standardized, consistent, interoperable clinical information that reflects nursing practice throughout the Canadian healthcare System.