RESUMO
INTRODUCTION: The Medical Informatics Initiative (MII) in Germany has pioneered platforms such as the National Portal for Medical Research Data (FDPG) to enhance the accessibility of data from clinical routine care for research across both university and non-university healthcare settings. This study explores the efficacy of the Medical Informatics Hub in Saxony (MiHUBx) services by integrating Klinikum Chemnitz gGmbH (KC) with the FDPG, leveraging the Fast Healthcare Interoperability Resources Core Data Set of the MII to standardize and harmonize data from disparate source systems. METHODS: The employed procedures include deploying installation packages to convert data into FHIR format and utilizing the Research Data Repository for structured data storage and exchange within the clinical infrastructure of KC. RESULT: Our results demonstrate successful integration, the development of a comprehensive deployment diagram, additionally, it was demonstrated that the non-university site can report clinical data to the FDPG. DISCUSSION: The discussion reflects on the practical application of this integration, highlighting its potential scalability to even smaller healthcare facilities and to pave the way to access to more medical data for research. This exemplary demonstration of the interplay of different tools provides valuable insights into technical and operational challenges, setting a precedent for future expansions and contributing to the democratization of medical data access.
Assuntos
Registros Eletrônicos de Saúde , Alemanha , Humanos , Informática Médica , Armazenamento e Recuperação da Informação/métodos , Integração de Sistemas , Interoperabilidade da Informação em SaúdeRESUMO
INTRODUCTION: 16 million German-language free-text laboratory test results are the basis of the daily diagnostic routine of 17 laboratories within the University Hospital Erlangen. As part of the Medical Informatics Initiative, the local data integration centre is responsible for the accessibility of routine care data for medical research. Following the core data set, international interoperability standards such as FHIR and the English-language medical terminology SNOMED CT are used to create harmonised data. To represent each non-numeric laboratory test result within the base module profile ObservationLab, the need for a map and supporting tooling arose. STATE OF THE ART: Due to the requirement of a n:n map and a data safety-compliant local instance, publicly available tools (e.g., SNAP2SNOMED) were insufficient. Concept and Implementation: Therefore, we developed (1) an incremental mapping-validation process with different iteration cycles and (2) a customised mapping tool via Microsoft Access. Time, labour, and cost efficiency played a decisive role. First iterations were used to define requirements (e.g., multiple user access). LESSONS LEARNED: The successful process and tool implementation and the described lessons learned (e.g., cheat sheet) will assist other German hospitals in creating local maps for inter-consortia data exchange and research. In the future, qualitative and quantitative analysis results will be published.
Assuntos
Systematized Nomenclature of Medicine , Alemanha , Humanos , Registros Eletrônicos de Saúde , Integração de SistemasRESUMO
INTRODUCTION: Medical research studies which involve electronic data capture of sensitive data about human subjects need to manage medical and identifying participant data in a secure manner. To protect the identity of data subjects, an independent trusted third party should be responsible for pseudonymization and management of the identifying data. METHODS: We have developed a web-based integrated solution that combines REDCap as an electronic data capture system with the trusted third party software tools of the University Medicine Greifswald, which provides study personnel with a single user interface for both clinical data entry and management of identities, pseudonyms and informed consents. RESULTS: Integration of the two platforms enables a seamless workflow of registering new participants, entering identifying and consent information, and generating pseudonyms in the trusted third party system, with subsequent capturing of medical data in the electronic data capture system, while maintaining strict separation of medical and identifying data in the two independently managed systems. CONCLUSION: Our solution enables a time-efficient data entry workflow, provides a high level of data protection by minimizing visibility of identifying information and pseudonym lists, and avoids errors introduced by manual transfer of pseudonyms between separate systems.
Assuntos
Pesquisa Biomédica , Segurança Computacional , Confidencialidade , Software , Consentimento Livre e Esclarecido , Anônimos e Pseudônimos , Humanos , Registros Eletrônicos de Saúde , Integração de Sistemas , Interface Usuário-ComputadorRESUMO
INTRODUCTION: The reuse of clinical data from clinical routine is a topic of research within the field of medical informatics under the term secondary use. In order to ensure the correct use and interpretation of data, there is a need for context information of data collection and a general understanding of the data. The use of metadata as an effective method of defining and maintaining context is well-established, particularly in the field of clinical trials. The objectives of this paper is to examine a method for integrating routine clinical data using metadata. METHODS: To this end, clinical forms extracted from a hospital information system will be converted into the FHIR format. A particular focus is placed on the consistent use of a metadata repository (MDR). RESULTS: A metadata-based approach using an MDR system was developed to simplify data integration and mapping of structured forms into FHIR resources, while offering many advantages in terms of flexibility and data quality. This facilitated the management and configuration of logic and definitions in one place, enabling the reusability and secondary use of data. DISCUSSION: This work allows the transfer of data elements without loss of detail and simplifies integration with target formats. The approach is adaptable for other ETL processes and eliminates the need for formatting concerns in the target profile.
Assuntos
Metadados , Projetos Piloto , Reino Unido , Registros Eletrônicos de Saúde , Humanos , Sistemas de Informação Hospitalar , Integração de SistemasRESUMO
Supportive robotic solutions take over mundane, but essential tasks from human workforce in biomedical research and development laboratories. The newest technologies in collaborative and mobile robotics enable the utilization in the human-centered and low-structured environment. Their adaptability, however, is hindered by the additional complexity that they introduce. In our paper we aim to entangle the convoluted laboratory robot integration architectures. We begin by hierarchically decomposing the laboratory workflows, and mapping the activity representations to layers and components of the automation control architecture. We elaborate the framework in detail on the example of pick-and-place labware transportation - a crucial supportive step, which we identified as the number one area of interest among experts of the field. Our concept proposal serves as a reference architecture model, the key principles of which were used in reference implementations, and are in line with international standardization efforts.
Assuntos
Automação Laboratorial , Robótica , Robótica/instrumentação , Automação Laboratorial/métodos , Humanos , Laboratórios , Integração de SistemasRESUMO
Patient-generated health data (PGHD) is the person's health-related data collected outside the clinical environment. Integrating this data into the electronic health record (EHR) supports better patient-provider communication and shared decision-making, empowering patients to actively manage their health conditions. In this study, we investigated the essential features needed for patients and healthcare providers to effectively integrate PGHD functionality into the EHR system. Through our collaborative design approach involving healthcare professionals (HCPs) and patients, we developed a prototype and suggestion, using Estonia as a model, which is the ideal approach for collecting and integrating PGHD into the EHR.
Assuntos
Registros Eletrônicos de Saúde , Estônia , Humanos , Participação do Paciente , Dados de Saúde Gerados pelo Paciente , Pessoal de Saúde , Integração de SistemasRESUMO
Our novel Intelligent Tutoring System (ITS) architecture integrates HL7 Fast Healthcare Interoperability Resources (FHIR) for data exchange and Unified Medical Language System (UMLS) codes for content mapping.
Assuntos
Nível Sete de Saúde , Unified Medical Language System , Interoperabilidade da Informação em Saúde , Integração de Sistemas , HumanosRESUMO
The emergence of new collaborative systems, coupled with uncontrolled data accumulation in traditional systems, poses sustainability challenges. This poster advocates the adoption of the MACH architecture as a potential framework to enhance sustainability and credibility within healthcare systems by offering robust system designs and management controls.
Assuntos
Informática Médica , Humanos , Integração de Sistemas , Atenção à SaúdeRESUMO
Effective management of diabetes necessitates efficient data handling, insightful analytics, and personalized interventions. In this study, we present a comprehensive system that automates the extraction, transformation, and loading of continuous glucose monitoring data. Data is integrated into an interactive dashboard with dual access levels: one for healthcare management professionals and another for patients for clinical management. The dashboard provides real-time updates and customizable visualization options, empowering users with actionable insights into their glucose levels. Furthermore, a clustering model to categorize patients into distinct groups based on their glucose profiles was developed. Through this model, three clusters representing different patterns of glucose control are identified. Healthcare professionals can utilize these insights to tailor treatment strategies, allocate resources effectively, and identify high-risk patients.
Assuntos
Automonitorização da Glicemia , Diabetes Mellitus , Interface Usuário-Computador , Humanos , Diabetes Mellitus/terapia , Aprendizado de Máquina não Supervisionado , Integração de Sistemas , Glicemia/análiseRESUMO
An important paradigm shift within healthcare is the shift toward patient-centered care (PCC). Multidisciplinary team meetings (MDTM) are considered essential for PCC, despite being considered time-consuming and expensive. Patient-centered information (PCI) is known to improve the quality of care. This study investigated where and how the PCI of multidisciplinary professionals' health records exists, and to explore the possibility of a sustainable PCC-supporting healthcare system. We performed an exploratory pilot study of the patient records of three patients with breast cancer. We observed that PCI was documented throughout the care pathway in the cases examined. However, we also found that these data were fragmented and scattered across various medical records, and they were also from different point of views and patient care perspectives. PCI was founded to be less accessible than traditional medical records and was even hard to find using a manual search. We therefore propose that preparing PCI for MDTM may be one of the obvious burdens for healthcare professionals (HPs). We do however believe that integrating PCI from multiple professionals' records likely plays an important function in a shift towards PCC and serves to improve not only the quality of care but also the HPs' experiences without additional burden and could contribute to a more sustainable health care system.
Assuntos
Neoplasias da Mama , Registros Eletrônicos de Saúde , Equipe de Assistência ao Paciente , Assistência Centrada no Paciente , Humanos , Neoplasias da Mama/terapia , Feminino , Projetos Piloto , Integração de SistemasRESUMO
The realization of benefits from health information technology (HIT) implementation takes place in the long tail of implementation that must integrate technology, work practices and contextual factors. While formal health informatics education programs exist, they tend to be focused at the strategic management or specialized implementation level. HIT support at the local level often falls to clinical care staff that have little or no formal training in HIT implementation. This paper will expand on the term context-sensitive digital integrators (CSDI) as a role that could support local implementation. We discuss the CSDI role, including terminology, competencies and the role context sensitivity plays in implementation, and how CSDIs could be better supported and trained in different contexts.
Assuntos
Informática Médica , Humanos , Integração de SistemasRESUMO
In recent years, there has been a rapid growth in the use of AI in the clinical domain. In order to keep pace with this development, a framework should be created in which clinical AI models can be easily trained, managed and applied. In our study, we propose a clinical AI platform that supports the development cycle and application of clinical AI models. We consider not only the development of an isolated clinical AI platform, but also its integration into clinical IT. This includes the consideration of so-called medical data integration centers. We evaluate our approach with the aid of a clinical AI use case to demonstrate the functionality of our clinical AI platform.
Assuntos
Inteligência Artificial , Registros Eletrônicos de Saúde , Integração de Sistemas , Humanos , Informática MédicaRESUMO
This paper explores the challenges and lessons learned during the mapping of HL7 v2 messages structured using custom schema to openEHR for the Medical Data Integration Center (MeDIC) of the University Hospital, Schleswig-Holstein (UKSH). Missing timestamps in observations, missing units of measurement, inconsistencies in decimal separators and unexpected datatypes were identified as critical inconsistencies in this process. These anomalies highlight the difficulty of automating the transformation of HL7 v2 data to any standard, particularly openEHR, using off-the-shelf tools. Addressing these anomalies is crucial for enhancing data interoperability, supporting evidence-based research, and optimizing clinical decision-making. Implementing proper data quality measures and governance will unlock the potential of integrated clinical data, empowering clinicians and researchers and fostering a robust healthcare ecosystem.
Assuntos
Nível Sete de Saúde , Registros Eletrônicos de Saúde , Interoperabilidade da Informação em Saúde , Alemanha , Integração de Sistemas , Humanos , Registro Médico Coordenado/métodosRESUMO
The interoperability of healthcare data across various systems remains a big challenge, largely attributable to the disparate data schemas and APIs in use. This study showcases the integration of a FHIR layer into GameBus, a gamified health platform, aiming to enhance its interoperability. Traditionally, GameBus has relied on proprietary data schemas and REST APIs, which restricted data exchange with other platforms. The incorporation of the FHIR standard significantly mitigates these constraints. The FHIR layer, constructed with open-source technologies - including the Google HCLS Data Harmonization tool for data transformation and the HAPI FHIR framework for RESTful services - allows GameBus to engage in data sharing using standardized FHIR formats and APIs. Implemented as a standalone microservice, this layer requires no alterations to the pre-existing architecture of GameBus. Furthermore, the design and implementation of the FHIR layer illustrate a generic method for achieving interoperability across diverse healthcare platforms.
Assuntos
Registros Eletrônicos de Saúde , Humanos , Interoperabilidade da Informação em Saúde , Integração de SistemasRESUMO
The efficient direct integration of real-time medical device data is a promising approach to improve patient care enabling a direct and eminent intervention. This study presents a comprehensive approach for integrating real-time medical device data into clinical environments using the HL7® FHIR® standards and IEEE 11073 Service-Oriented Device Connectivity (SDC). The study proposes a conceptual framework and an opensource proof-of-concept implementation for real-time data integration within the Medical Data Integration Center (MeDIC) at UKSH. Key components include a selective recording mechanism to mitigate storage issues and ensure accurate data capture. Our robust network architecture utilizes Kafka brokers for seamless data transfer in isolated networks. The study demonstrates the selective capturing of real-time data within a clinical setting to enable medical device data for a down-stream processing and analysis.
Assuntos
Nível Sete de Saúde , Integração de Sistemas , Pesquisa sobre Serviços de Saúde , Humanos , Registros Eletrônicos de SaúdeRESUMO
Established cardiovascular risk scores are typically based on items from structured clinical data such as age, sex, or smoking status. Cardiovascular risk is also assessed from physiological measurements such as electrocardiography (ECG). Although ECGs are standard diagnostic tools in clinical care, they are scarcely integrated into clinical information systems. To overcome this roadblock, we propose the integration of an automatic workflow for ECG processing using the DICOMweb interface to transfer ECGs in a standardised way. We implemented the workflow using non-commercial software and tested it with about 150,000 resting ECGs acquired in a maximum-care hospital. We employed Orthanc as DICOM server and AcuWave as signal processing application and implemented a fully-automated workflow which reads the ECG data and computes heart rate-related parameters. The workflow is evaluated on off-the-shelf hardware and results in an average run time of approximately 40 ms for processing a single ECG.
Assuntos
Eletrocardiografia , Software , Humanos , Processamento de Sinais Assistido por Computador , Fluxo de Trabalho , Integração de Sistemas , Registros Eletrônicos de SaúdeRESUMO
According to the regulation "Decreto del Presidente del Consiglio dei Ministri" (DPCM) of September 29, 2015, n.178, the Logical Observation Identifiers Names and Codes (LOINC) system is included among the coding systems adopted in the Italian Electronic Health Record (EHR). As part of the Digital Health Solutions in Community Medicine (DHEAL-COM) project, one key goal is to categorize parameters using international classification systems. This enables the identification of appropriate Information and Communication Technology (ICT) solutions tailored to support people's health needs. Our objective is to incorporate LOINC codes for parameter categorization, thus anticipating the future use of EHR.
Assuntos
Registros Eletrônicos de Saúde , Logical Observation Identifiers Names and Codes , Itália , Integração de Sistemas , Humanos , Registro Médico CoordenadoRESUMO
This paper presents an implementation of an architecture based on open-source solutions using ELK Stack - Elasticsearch, Logstash, and Kibana - for real-time data analysis and visualizations in the Medical Data Integration Center, University Hospital Cologne, Germany. The architecture addresses challenges in handling diverse data sources, ensuring standardized access, and facilitating seamless analysis in real-time, ultimately enhancing the precision, speed, and quality of monitoring processes within the medical informatics domain.
Assuntos
Hospitais Universitários , Alemanha , Integração de Sistemas , Registros Eletrônicos de Saúde , Sistemas Computacionais , SoftwareRESUMO
While the importance of Electronic Health Records (EHR) interoperability is widely recognised in the healthcare digitalisation context, its optimal governance structure remains controversial, requiring further research. Through the rapid literature review of 32 articles retrieved from PubMed and EBSCO, 47 distinct factors under ten categories were established. The three most cited factors in the reviewed 32 articles were "Robust inter-institutional connections, trust, and the technologies to ensure security", "Legal adaptations to the evolving digitalisation needs", and "Standardisation of terminologies and codes, and harmonised data structure". This review contributes preliminary results for the ongoing research to optimise EHR interoperability governance.
Assuntos
Registros Eletrônicos de Saúde , Registros Eletrônicos de Saúde/organização & administração , Interoperabilidade da Informação em Saúde , Integração de Sistemas , Registro Médico CoordenadoRESUMO
Healthcare faces significant challenges in exchanging and utilizing health information across diverse providers, necessitating innovative solutions for improved interoperability. This study presents a comprehensive exploration of scalable technical and semantic solutions for patient care integration, emphasizing the implementation of these solutions within the framework of the Fast Healthcare Interoperability Resources (FHIR) standard. Our approach revolves around the development and deployment of Technical Interoperability Suite (TIS) and Semantic Interoperability Suite (SIS) technology solutions to disparate health information systems, predominantly Electronic Health Records (EHRs) into a unified Patient Care Platform, fostering comprehensive data exchange and utilization. The integration process involves importing data from various EHR systems and transforming imported patient data into FHIR-standardized formats. The provided solution supports various functionalities, including automatic and manual importation of patient data, through standard computer-readable templates. The integration of TIS and SIS solutions is underpinned by a robust technological framework, incorporating technologies such as Typescript, Deno, and document-oriented databases such as MongoDB. The effectiveness of our interoperability solutions was validated through deployment in multinational EU projects: ADLIFE and CAREPATH. The scalability and generalizability of our approach underscore its potential for diverse healthcare settings.