Transformation of Health and Social Care Systems—An Interdisciplinary Approach Toward a Foundational Architecture

Objective: For realizing pervasive and ubiquitous health and social care services in a safe and high quality as well as efficient and effective way, health and social care systems have to meet new organizational, methodological, and technological paradigms. The resulting ecosystems are highly complex, highly distributed, and highly dynamic, following inter-organizational and even international approaches. Even though based on international, but domain-specific models and standards, achieving interoperability between such systems integrating multiple domains managed by multiple disciplines and their individually skilled actors is cumbersome. Methods: Using the abstract presentation of any system by the universal type theory as well as universal logics and combining the resulting Barendregt Cube with parameters and the engineering approach of cognitive theories, systems theory, and good modeling best practices, this study argues for a generic reference architecture model moderating between the different perspectives and disciplines involved provide on that system. To represent architectural elements consistently, an aligned system of ontologies is used. Results: The system-oriented, architecture-centric, and ontology-based generic reference model allows for re-engineering the existing and emerging knowledge representations, models, and standards, also considering the real-world business processes and the related development process of supporting IT systems for the sake of comprehensive systems integration and interoperability. The solution enables the analysis, design, and implementation of dynamic, interoperable multi-domain systems without requesting continuous revision of existing specifications.publishedVersionPeer reviewe

Transformation of Health and Social Care Systems—An Interdisciplinary Approach Toward a Foundational Architecture

Objective: For realizing pervasive and ubiquitous health and social care services in a safe and high quality as well as efficient and effective way, health and social care systems have to meet new organizational, methodological, and technological paradigms. The resulting ecosystems are highly complex, highly distributed, and highly dynamic, following inter-organizational and even international approaches. Even though based on international, but domain-specific models and standards, achieving interoperability between such systems integrating multiple domains managed by multiple disciplines and their individually skilled actors is cumbersome. Methods: Using the abstract presentation of any system by the universal type theory as well as universal logics and combining the resulting Barendregt Cube with parameters and the engineering approach of cognitive theories, systems theory, and good modeling best practices, this study argues for a generic reference architecture model moderating between the different perspectives and disciplines involved provide on that system. To represent architectural elements consistently, an aligned system of ontologies is used. Results: The system-oriented, architecture-centric, and ontology-based generic reference model allows for re-engineering the existing and emerging knowledge representations, models, and standards, also considering the real-world business processes and the related development process of supporting IT systems for the sake of comprehensive systems integration and interoperability. The solution enables the analysis, design, and implementation of dynamic, interoperable multi-domain systems without requesting continuous revision of existing specifications

Terveydenhuollon tietojärjestelmien arkkitehtuurit ja standardit

Tutkielmassa tarkastellaan terveydenhuollon tietojärjestelmien järjestelmäarkkitehtuureja ja terveydenhuollon tietotekniikan standardeja. Tavoitteena on luoda kokonaiskuva alalla käytetyistä käsitteistä ja niiden välisistä yhteyksistä, terveydenhuollon tietojärjestelmien arkkitehtuureista sekä selvittää, miten niissä noudatetaan erilaisia standardeja. Arkkitehtuurikuvausten lähteinä on käytetty verkosta löytyvää järjestelmien toimittajien ylläpitämää dokumentaatiota ja niihin liittyviä tieteellisiä julkaisuja. Tietojärjestelmien toteutuksissa voidaan erottaa karkeasti kolme erilaista arkkitehtuurimallia: federoitu malli, palvelukeskeinen malli ja keskitetty malli. Federoidussa arkkitehtuurimallissa tiedot koostetaan yhdeksi kokonaisuudeksi useasta eri lähteestä. Palvelukeskeisessä mallissa erilaiset järjestelmät viestivät keskenään yhteisen palvelurajapinnan välityksellä. Keskitetyssä mallissa järjestelmä muodostaa yhden kokonaisuuden, joten integraatiota muihin järjestelmiin ei juuri tarvita. Näistä palvelukeskeinen malli on kaikkein modernein ja soveltuu tarkastelun perusteella hyvin terveydenhuollon tietojärjestelmien toteutukseen, sillä heterogeenisten järjestelmien integrointi on siinä keskeisellä sijalla. Käytössä olevien tietojärjestelmäratkaisujen perusteella tarkastellaan lähemmin standardeja neljästä eri kategoriasta. Arkkitehtuuriin liittyviä standardeja ovat RM-ODP-viitemalli, potilastietojärjestelmien standardi ISO 18308 ja kokonaisarkkitehtuuri HISA. Potilaskertomuksiin liittyviä standardeja ovat CEN/ISO 13606, OpenEHR ja ISO 20514. Sanomanvälitykseen kehitettyjä standardeja ovat HL7 versiot 2 ja 3 sekä CDA R2. Näiden yhteydessä käsitellään lisäksi HL7 RIM -viitetietomallia, joka on kaikkien HL7 versioon 3 liittyvien standardien perusta. Luokitusstandardeista käsitellään SNOMED CT -terminologiaa ja ICD-10-tautiluokitusta. Tarkastellut standardit ovat pääosin yhteensopivia, sillä niiden kehityksessä on huomioitu mahdollinen yhteiskäyttö ja niillä on paljon keskinäisiä viittauksia. Ainoastaan HL7 versio 2 on ristiriidassa uudempien HL7-standardien kanssa. Standardien joustavuuden haittapuoleksi osoittautuu erilaisten tulkintojen ristiriitaisuus standardien toteutuksessa. Terveydenhuollon tietojärjestelmien yhteentoimivuuden ongelmia ei voida ratkaista ilman arkkitehtuurista kokonaiskuvaa standardien ja järjestelmien kehityksessä

Contribuciones al diseño de arquitecturas de sistemas distribuidos abiertos para la provisión de servicios del cuidado de la salud y de soporte a la autonomía del ciudadano

Texto completo de TeseoEl dominio sanitario se ha visto enormemente influenciado por las Tecnologías de la Información y la Comunicación (TICs) en las últimas décadas. Consecuencia de esto son los avances en dispositivos, gestión de información y procesos asistenciales. En parte debido a la heterogeneidad tecnológica de las soluciones y a la ausencia de una metodología formal de aplicación de las TICs, en la actualidad el escenario sanitario está fragmentado en sistemas separados que rara vez cooperan entre sí para proveer capacidades avanzadas. Esto dificulta la mejora en la eficiencia de los procesos, la evolución del sistema sanitario y la reducción de costes al existir soluciones redundantes que en ocasiones coexisten en las organizaciones sanitarias. La práctica clínica también está evolucionando hacia escenarios descentralizados donde la asistencia a un individuo es compartida entre diferentes organizaciones sanitarias (en ocasiones incluso distribuidas geográficamente) y en los que la coherencia de la información así como su privacidad son requisitos indispensables para una mejora de la eficiencia. En este escenario descentralizado los individuos y no las organizaciones deben ser el centro de los procesos, sustituyendo el actual rol pasivo por uno activo en el mantenimiento y mejora de su salud. Garantizar la interoperatividad en un sistema distribuido es una de las necesidades fundamentales para facilitar el entendimiento entre las partes implicadas. La normalización en los distintos niveles de comunicación (sintáctico, semántico, organizativo, etc.) es la clave para la interoperatividad pero adoptar los esfuerzos normativos en ocasiones resulta una tarea ardua debido principalmente a la variedad de iniciativas normativas y el solapamiento entre ellas. Todos los aspectos relevantes de los sistemas distribuidos tanto de propósito general como específicos del dominio sanitario están cubiertos por esfuerzos normativos pero a menudo es necesario realizar una armonización entre iniciativas antes de aplicarlas al desarrollo de sistemas para no perder interoperatividad. En esta Tesis Doctoral se investiga, diseña y desarrolla un paradigma de sistema distribuido orientado al sujeto de la asistencia que permite la colaboración de sistemas, usuarios, organizaciones y dispositivos con el objetivo común de mejorar y mantener la salud del sujeto de la asistencia concreto. Este paradigma hereda los fundamentos del concepto de organización virtual (Virtual Organization) y se ha denominado Person-Oriented Virtual Organization (POVO). El principal requisito de diseño de este paradigma es la adopción de normas y estándares que potencien la interoperatividad de los sistemas desplegados y garantice una larga vida útil de los mismos a través de la reutilización ulterior de sus capacidades. Siguiendo este principio de diseño la arquitectura de POVO está basada en las especificaciones del estándar ISO/EN 12967 (HISA) específico del dominio sanitario y el marco de trabajo RM-ODP. Para establecer una adecuada base arquitectural, en esta Tesis Doctoral se analiza la norma HISA y se reestructura para que sea más fiel a los principios de diseño del marco de trabajo RM-ODP y siga la formalización determinada por el estándar ISO 19793 (UML4ODP). La especificación del estándar HISA se extiende con capacidades de seguridad y de gestión de semántica. Dichas extensiones están basadas en el análisis y armonización de la normativa aplicable buscando optimizar y facilitar la aplicación de la solución final. Al margen de la especificación de los principios arquitecturales y funciones básicas de la POVO, se particulariza dicho paradigma para el estilo arquitectural SOA y la tecnología de computación en Grid y se diseña y desarrolla un mecanismo de control de acceso orientado a la administración por parte del sujeto de la asistencia y basado en capacidades semánticas. El mecanismo de autorización sigue un esquema de control de acceso basado en atributos que, utilizando ontologías y reglas de inferencia, permite automatizar el proceso de toma de decisiones. Así cualquier sujeto de la asistencia puede determinar de forma sencilla sus preferencias de acceso sobre los recursos e información directamente relacionados con su salud. Estas preferencias son traducidas e integradas en la base de conocimiento y un motor de inferencia será el que autorice o deniegue los intentos de acceso en base a las políticas definidas por el sujeto de la asistencia. Las aportaciones de esta Tesis Doctoral, en líneas generales, ponen de manifiesto tres aspectos fundamentales en el ámbito de las TICs aplicadas al dominio sanitario. En primer lugar, el potencial que la normalización tiene para construir soluciones interoperables, reutilizables y con amplios horizontes temporales. Como consecuencia de ello es necesario potenciar las iniciativas normativas actuales y armonizar los solapamientos que existan entre ellas. Ejemplo de esto es la norma HISA cuya amplia adopción está ligada a la correcta integración con otras normas del mismo ámbito y su adecuada puesta en valor. En segundo lugar, los escenarios distribuidos con foco en el sujeto de la asistencia son el paso evolutivo natural de la asistencia sanitaria dadas las actuales (y futuras) coyunturas económicas y sociales. La tecnología está alcanzando una gran madurez en lo que a sistemas distribuidos se refiere pero aún queda camino por recorrer para poder construir soluciones fiables y eficientes que cubran los requisitos específicos de un escenario distribuido tan complejo como el que se presenta en esta Tesis Doctoral. Por último, el mecanismo de control de acceso diseñado y desarrollado sirve de prueba de concepto de cómo la tecnología actual puede otorgar a los individuos un papel activo en el mantenimiento de su salud y procesos relacionados sin necesidad de que tengan conocimientos tecnológicos avanzados

An analysis of approaches for developing national health information systems : a case study of two sub-Saharan African countries.

Master of Science in Mathematics, Statistics and Computer Science. University of KwaZulu-Natal, Durban, 2016.Health information systems in sub-Saharan African countries are currently characterized by significant fragmentation, duplication and limited interoperability. Incorporating these disparate systems into a coherent national health information system has the potential to improve operational efficiencies, decision-making and planning across the health sector. In a recent study, Coiera analysed several mature national health information systems in high income countries and categorised a topology of the approaches for building them as: top-down, bottom-up or middle-out. Coeria gave compelling arguments for countries to adopt a middle-out approach. Building national health information systems in sub-Saharan African countries pose unique and complex challenges due to the substantial difference between the socio-economic, political and health landscapes of these countries and high income countries. Coiera’s analysis did not consider the unique challenges faced by sub-Saharan African countries in building their systems. Furthermore, there is currently no framework for analysing high-level approaches for building NHIS. This makes it difficult to establish the benefits and applicability of Coiera’s analysis for building NHIS in sub-Saharan African countries. The aim of this research was to develop and apply such a framework to determine which approach in Coiera’s topology, if any, showed signs of being the most sustainable approach for building effective national health information systems in sub-Saharan African countries. The framework was developed through a literature analysis and validated by applying it in case studies of the development of national health information systems in South Africa and Rwanda. The result of applying the framework to the case studies was a synthesis of the current evolution of these systems, and an assessment of how well each approach in Coiera’s topology supports key considerations for building them in typical sub-Saharan African countries. The study highlights the value of the framework for analysing sub-Saharan African countries in terms of Coiera’s topology, and concludes that, given the peculiar nature and evolution of national health information systems in sub-Saharan African countries, a middle-out approach can contribute significantly to building effective and sustainable systems in these countries, but its application in sub-Saharan African countries will differ significantly from its application in high income countries

Managing healthcare transformation towards P5 medicine (Published in Frontiers in Medicine)

Health and social care systems around the world are facing radical organizational, methodological and technological paradigm changes to meet the requirements for improving quality and safety of care as well as efficiency and efficacy of care processes. In this they’re trying to manage the challenges of ongoing demographic changes towards aging, multi-diseased societies, development of human resources, a health and social services consumerism, medical and biomedical progress, and exploding costs for health-related R&D as well as health services delivery. Furthermore, they intend to achieve sustainability of global health systems by transforming them towards intelligent, adaptive and proactive systems focusing on health and wellness with optimized quality and safety outcomes. The outcome is a transformed health and wellness ecosystem combining the approaches of translational medicine, 5P medicine (personalized, preventive, predictive, participative precision medicine) and digital health towards ubiquitous personalized health services realized independent of time and location. It considers individual health status, conditions, genetic and genomic dispositions in personal social, occupational, environmental and behavioural context, thus turning health and social care from reactive to proactive. This requires the advancement communication and cooperation among the business actors from different domains (disciplines) with different methodologies, terminologies/ontologies, education, skills and experiences from data level (data sharing) to concept/knowledge level (knowledge sharing). The challenge here is the understanding and the formal as well as consistent representation of the world of sciences and practices, i.e. of multidisciplinary and dynamic systems in variable context, for enabling mapping between the different disciplines, methodologies, perspectives, intentions, languages, etc. Based on a framework for dynamically, use-case-specifically and context aware representing multi-domain ecosystems including their development process, systems, models and artefacts can be consistently represented, harmonized and integrated. The response to that problem is the formal representation of health and social care ecosystems through an system-oriented, architecture-centric, ontology-based and policy-driven model and framework, addressing all domains and development process views contributing to the system and context in question. Accordingly, this Research Topic would like to address this change towards 5P medicine. Specifically, areas of interest include, but are not limited: • A multidisciplinary approach to the transformation of health and social systems • Success factors for sustainable P5 ecosystems • AI and robotics in transformed health ecosystems • Transformed health ecosystems challenges for security, privacy and trust • Modelling digital health systems • Ethical challenges of personalized digital health • Knowledge representation and management of transformed health ecosystems Table of Contents: 04 Editorial: Managing healthcare transformation towards P5 medicine Bernd Blobel and Dipak Kalra 06 Transformation of Health and Social Care Systems—An Interdisciplinary Approach Toward a Foundational Architecture Bernd Blobel, Frank Oemig, Pekka Ruotsalainen and Diego M. Lopez 26 Transformed Health Ecosystems—Challenges for Security, Privacy, and Trust Pekka Ruotsalainen and Bernd Blobel 36 Success Factors for Scaling Up the Adoption of Digital Therapeutics Towards the Realization of P5 Medicine Alexandra Prodan, Lucas Deimel, Johannes Ahlqvist, Strahil Birov, Rainer Thiel, Meeri Toivanen, Zoi Kolitsi and Dipak Kalra 49 EU-Funded Telemedicine Projects – Assessment of, and Lessons Learned From, in the Light of the SARS-CoV-2 Pandemic Laura Paleari, Virginia Malini, Gabriella Paoli, Stefano Scillieri, Claudia Bighin, Bernd Blobel and Mauro Giacomini 60 A Review of Artificial Intelligence and Robotics in Transformed Health Ecosystems Kerstin Denecke and Claude R. Baudoin 73 Modeling digital health systems to foster interoperability Frank Oemig and Bernd Blobel 89 Challenges and solutions for transforming health ecosystems in low- and middle-income countries through artificial intelligence Diego M. López, Carolina Rico-Olarte, Bernd Blobel and Carol Hullin 111 Linguistic and ontological challenges of multiple domains contributing to transformed health ecosystems Markus Kreuzthaler, Mathias Brochhausen, Cilia Zayas, Bernd Blobel and Stefan Schulz 126 The ethical challenges of personalized digital health Els Maeckelberghe, Kinga Zdunek, Sara Marceglia, Bobbie Farsides and Michael Rigb

A Model for Managing Information Flow on the World Wide Web

Metadata merged with duplicate record (http://hdl.handle.net/10026.1/330) on 20.12.2016 by CS (TIS).This is a digitised version of a thesis that was deposited in the University Library. If you are the author please contact PEARL Admin ([email protected]) to discuss options.This thesis considers the nature of information management on the World Wide Web. The web has evolved into a global information system that is completely unregulated, permitting anyone to publish whatever information they wish. However, this information is almost entirely unmanaged, which, together with the enormous number of users who access it, places enormous strain on the web's architecture. This has led to the exposure of inherent flaws, which reduce its effectiveness as an information system. The thesis presents a thorough analysis of the state of this architecture, and identifies three flaws that could render the web unusable: link rot; a shrinking namespace; and the inevitable increase of noise in the system. A critical examination of existing solutions to these flaws is provided, together with a discussion on why the solutions have not been deployed or adopted. The thesis determines that they have failed to take into account the nature of the information flow between information provider and consumer, or the open philosophy of the web. The overall aim of the research has therefore been to design a new solution to these flaws in the web, based on a greater understanding of the nature of the information that flows upon it. The realization of this objective has included the development of a new model for managing information flow on the web, which is used to develop a solution to the flaws. The solution comprises three new additions to the web's architecture: a temporal referencing scheme; an Oracle Server Network for more effective web browsing; and a Resource Locator Service, which provides automatic transparent resource migration. The thesis describes their design and operation, and presents the concept of the Request Router, which provides a new way of integrating such distributed systems into the web's existing architecture without breaking it. The design of the Resource Locator Service, including the development of new protocols for resource migration, is covered in great detail, and a prototype system that has been developed to prove the effectiveness of the design is presented. The design is further validated by comprehensive performance measurements of the prototype, which show that it will scale to manage a web whose size is orders of magnitude greater than it is today

Easing the development of healthcare architectures following RM-ODP principles and healthcare standards

RM-ODP has been widely accepted and used in the field of system and software model engineering and of enterprise computing within different environments. One of these specific domains is healthcare, in which the international standard Health Information Services Architecture (HISA) is applied under the directives of RM-ODP. HISA presents a flexible architecture identifying common use cases, actors, information, and services and easing its extension with specific services, systems and information. The HISA standard follows system specification through the RM-ODP viewpoints but it does not consider other features of the reference model, such as the Enterprise language or the UML4ODP specification. In this paper, we introduce the rationale and specification of the three technology-independent viewpoints of an HISA-based architecture conforming to RM-ODP and UML4ODP. Moreover, we evaluate how easy it is to extend this architecture to introduce specific services and elements. As proof of concept we explore security and privacy issues (i.e., requirements, actors, information objects, etc.) and enrich the architecture with suitable objects and services, mainly from access control standardization efforts. In addition, a detailed discussion about the divergences between RM-ODP and HISA is presented. The main contribution of our work is to develop (guided by RM-ODP, HISA, and other standards) a methodology and tools allowing healthcare service developers and designers to build solutions conforming to standards and leveraging the benefits of distribution and interoperability. These tools consist of the specification of three technology-independent viewpoints according to the guidelines of HISA, RM-ODP and UML4ODP for the healthcare domain, and they will be freely available. In parallel, these viewpoints are extended with access control issues, and the adequacy of the HISA extension mechanism is evaluated