RESUMEN
OBJECTIVES: This paper reflects on the role of open source in health information system interoperability. Open source is a driving force in computer science research and the development of information systems. It facilitates the sharing of information and ideas, enables evolutionary development and open collaborative testing of code, and broadens the adoption of interoperability standards. In health care, information systems have been developed largely ad hoc following proprietary specifications and customized design. However, the wide deployment of integrated services such as Electronic Health Records (EHRs) over regional health information networks (RHINs) relies on interoperability of the underlying information systems and medical devices. METHODS: This reflection is built on the experiences of the PICNIC project that developed shared software infrastructure components in open source for RHINs and the OpenECG network that offers open source components to lower the implementation cost of interoperability standards such as SCP-ECG, in electrocardiography. RESULTS: Open source components implementing standards and a community providing feedback from real-world use are key enablers of health care information system interoperability. CONCLUSIONS: Investing in open source is investing in interoperability and a vital aspect of a long term strategy towards comprehensive health services and clinical research.
Asunto(s)
Informática Médica/organización & administración , Integración de Sistemas , Sistemas de Registros Médicos Computarizados , Programas InformáticosRESUMEN
BACKGROUND: The sharing of information resources is generally accepted as the key to substantial improvements in productivity and better quality of care. In addition, due to the greater mobility of the population, national and international healthcare networks are increasingly used to facilitate the sharing of healthcare-related information among the various actors of the field. In the context of HYGEIAnet, the regional health telematics network of Crete, an Integrated Electronic Health Record environment has been developed to provide integrated access to online clinical information, accessible throughout the island. OBJECTIVES: To make available comprehensive medical information about a patient by means of incorporating all the distributed and heterogeneous health record segments into an Integrated Electronic Health Record that can be viewed on-line through a unified user interface and visualization environment. METHODS: The technological approach for implementing this Integrated Electronic Health Record environment is based on the HYGEIAnet Reference Architecture, which provides the necessary framework for the reuse of services, components, and interfaces. Seamless presentation of information is achieved by means of the Extensible Markup Language (XML), while its underlying capabilities allow for dynamic navigation according to personalized end-user preferences and authorities. RESULTS: The Integrated Electronic Health Record environment developed in HYGEIAnet provides the basis for consistent and authenticated access to primary information over the Internet in order to support decision-making. Primary information is always kept at the place where it has been produced, and is maintained by the most appropriate clinical information system, contrasting traditional store and forward techniques, or centralized clinical data repositories. CONCLUSIONS: Since documents are much more easily accessible rather than data inside a database, Extensible Markup Language has the potential of becoming a very cheap technology provided, of course, that the underlying Healthcare Information Infrastructure exists. XML can be introduced incrementally and its implementation is completely transparent to the end user.
Asunto(s)
Internet , Registro Médico Coordinado/métodos , Sistemas de Registros Médicos Computarizados/organización & administración , Lenguajes de Programación , Integración de Sistemas , Bases de Datos como Asunto/organización & administración , Humanos , Programas Médicos Regionales/organización & administraciónRESUMEN
A fundamental requirement for achieving continuity of care is the seamless sharing of multi-clinical information. Several different technological approaches can be followed to enable the sharing of health record segments. In all cases interoperability between systems is a prerequisite and this requires presently a major technological challenge. Inter-operability can be achieved either through messages or through a more advanced approach based on a federation of autonomous systems. Message based integration is centered mainly on the exchange of HL7 and DICOM messages for achieving the functional integration of clinical information systems (CIS) at institutional or regional level. The federated approach is principally used for facilitating the virtual view of the Integrated Electronic Health Record (I-EHR), without having to replicate unnecessary information. Within the context of HYGEIAnet, which is the regional health telematics network of Crete, both approaches have been utilized for providing end users with seamless access to clinical information. Both are based on an open architecture, which provides the framework for the reuse of standardized common components and public interfaces. This work presents the experiences related to the implementation of "messaging" and "federating" in HYGEIAnet, which are used complementary to each other. A comparison of the two parallel approaches, together with their strengths and weaknesses is described, and evaluation is given from the technological as well as the end users' perspective. Emphasis is given on the technological challenges in developing open, component-based information infra-structure to support integrated service delivery.
Asunto(s)
Redes de Comunicación de Computadores/organización & administración , Sistemas de Información/organización & administración , Programas Médicos Regionales/organización & administración , Integración de Sistemas , Redes de Comunicación de Computadores/normas , Sistemas de Computación , Grecia , Sistemas de Información/normas , Sistemas de Registros Médicos ComputarizadosRESUMEN
The basics of a particular Integrated Electronic Health Record (I-EHR) implementation are presented, as realised by the Patient Clinical Data Directory (PCDD) system. PCDD operates within the context of HYGEIAnet, the Integrated Healthcare Telematics Network of Crete. PCDD is based on a federation of autonomous information systems and provides to its authorized users alternative views of the health record as well as access and retrieval services to its geographically distributed segments. The data model of the PCDD is based on the Subjective Objective Assessment Plan (SOAP) model that originates from the primary healthcare domain. Access to detailed information on particular patients healthcare encounters is delivered via role-based authorization privileges and controls. The administration of the national healthcare organizations' business rules, for different user-groups, is made via a specially tailored and developed rule-editor.
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Seguridad Computacional , Sistemas Integrados y Avanzados de Gestión de la Información , Sistemas de Registros Médicos Computarizados , Grecia , HumanosRESUMEN
This paper presents WebOnCOLL, a web-based medical collaboration environment, which has been designed in the context of the regional healthcare network of Crete. WebOnCOLL employs the infrastructure of regional healthcare networks to provide integrated services for virtual workspaces, annotations, e-mail, and on-line collaboration. Virtual workspaces support collaborative concepts like personal web pages, bulletin boards, discussion lists, shared workspaces, and medical case folders. Annotations provide a natural way for people to interact with multimedia content, while e-mail is one of the most popular forms of communication today. On-line collaboration satisfies the need for a more direct form of communication.
Asunto(s)
Tecnología Biomédica , Internet , Conducta Cooperativa , Grecia , Humanos , Programas Médicos RegionalesRESUMEN
The need for collaboration and data sharing among systems dedicated to individual functional areas and user groups has initiated major efforts towards the development of an integrated hospital information system. Major issues in the development of any integrated architecture that incorporates autonomous departmental systems include the development of commonly accepted interaction mechanisms, standardisation, the structure of the computerised patient record, its extensibility, as well as limitations multimedia data impose. This paper presents work done within project IHIS, a nationally funded project for the development of an integrated hospital information system that provides ICU staff with access to both the ICU assisting laboratory information system's data as well as radiological multimedia data.