Comparison of openEHR and HL7 FHIR standards

Health informatics is characterized by the need tosecurely store, process and transmit large amounts of sensitivemedical data while ensuring interoperability with other systems.Among many standards used in such systems there are two whichhave gained interest in recent years and cover most of thoseneeds: openEHR and HL7 FHIR. In this paper, both standardsare discussed and compared with each other. The architecture ofboth systems, the similarities and differences, methods of datamodeling and ensuring interoperability were presented

Modeling healthcare authorization and claim submissions using the openEHR dual-model approach

<p>Abstract</p> <p>Background</p> <p>The TISS standard is a set of mandatory forms and electronic messages for healthcare authorization and claim submissions among healthcare plans and providers in Brazil. It is not based on formal models as the new generation of health informatics standards suggests. The objective of this paper is to model the TISS in terms of the openEHR archetype-based approach and integrate it into a patient-centered EHR architecture.</p> <p>Methods</p> <p>Three approaches were adopted to model TISS. In the first approach, a set of archetypes was designed using ENTRY subclasses. In the second one, a set of archetypes was designed using exclusively ADMIN_ENTRY and CLUSTERs as their root classes. In the third approach, the openEHR ADMIN_ENTRY is extended with classes designed for authorization and claim submissions, and an ISM_TRANSITION attribute is added to the COMPOSITION class. Another set of archetypes was designed based on this model. For all three approaches, templates were designed to represent the TISS forms.</p> <p>Results</p> <p>The archetypes based on the openEHR RM (Reference Model) can represent all TISS data structures. The extended model adds subclasses and an attribute to the COMPOSITION class to represent information on authorization and claim submissions. The archetypes based on all three approaches have similar structures, although rooted in different classes. The extended openEHR RM model is more semantically aligned with the concepts involved in a claim submission, but may disrupt interoperability with other systems and the current tools must be adapted to deal with it.</p> <p>Conclusions</p> <p>Modeling the TISS standard by means of the openEHR approach makes it aligned with ISO recommendations and provides a solid foundation on which the TISS can evolve. Although there are few administrative archetypes available, the openEHR RM is expressive enough to represent the TISS standard. This paper focuses on the TISS but its results may be extended to other billing processes. A complete communication architecture to simulate the exchange of TISS data between systems according to the openEHR approach still needs to be designed and implemented.</p

The emergence of openness in open source projects : the case of openEHR

The meaning of openness in open source is both intrinsically unstable and dynamic, and tends to fluctuate with time and context. We draw on a very particular open-source project primarily concerned with building rigorous clinical concepts to be used in electronic health records called openEHR. openEHR explains how openness is a concept that is purposely engaged with, and how, in this process of engagement, the very meaning of open matures and evolves within the project. Drawing on rich longitudinal data related to openEHR we theorise the evolving nature of openness and how this idea emerges through two intertwined processes of maturation and metamorphosis. While metamorphosis allows us to trace and interrogate the mutational evolution in openness, maturation analyses the small, careful changes crafted to build a very particular understanding of openness. Metamorphosis is less managed and controlled, whereas maturation is representative of highly precise work carried out in controlled form. Both processes work together in open-source projects and reinforce each other. Our study reveals that openness emerges and evolves in open-source projects where it can be understood to mean rigour; ability to participate; open implementation; and an open process. Our work contributes to a deepening in the theorisation of what it means to be an open-source project. The multiple and co-existing meanings of ‘open’ imply that open-source projects evolve in nonlinear ways where each critical meaning of openness causes a reflective questioning by the community of its continued status and existence

Comparative study of healthcare messaging standards for interoperability in ehealth systems

Advances in the information and communication technology have created the field of "health informatics," which amalgamates healthcare, information technology and business. The use of information systems in healthcare organisations dates back to 1960s, however the use of technology for healthcare records, referred to as Electronic Medical Records (EMR), management has surged since 1990’s (Net-Health, 2017) due to advancements the internet and web technologies. Electronic Medical Records (EMR) and sometimes referred to as Personal Health Record (PHR) contains the patient’s medical history, allergy information, immunisation status, medication, radiology images and other medically related billing information that is relevant. There are a number of benefits for healthcare industry when sharing these data recorded in EMR and PHR systems between medical institutions (AbuKhousa et al., 2012). These benefits include convenience for patients and clinicians, cost-effective healthcare solutions, high quality of care, resolving the resource shortage and collecting a large volume of data for research and educational needs. My Health Record (MyHR) is a major project funded by the Australian government, which aims to have all data relating to health of the Australian population stored in digital format, allowing clinicians to have access to patient data at the point of care. Prior to 2015, MyHR was known as Personally Controlled Electronic Health Record (PCEHR). Though the Australian government took consistent initiatives there is a significant delay (Pearce and Haikerwal, 2010) in implementing eHealth projects and related services. While this delay is caused by many factors, interoperability is identified as the main problem (Benson and Grieve, 2016c) which is resisting this project delivery. To discover the current interoperability challenges in the Australian healthcare industry, this comparative study is conducted on Health Level 7 (HL7) messaging models such as HL7 V2, V3 and FHIR (Fast Healthcare Interoperability Resources). In this study, interoperability, security and privacy are main elements compared. In addition, a case study conducted in the NSW Hospitals to understand the popularity in usage of health messaging standards was utilised to understand the extent of use of messaging standards in healthcare sector. Predominantly, the project used the comparative study method on different HL7 (Health Level Seven) messages and derived the right messaging standard which is suitable to cover the interoperability, security and privacy requirements of electronic health record. The issues related to practical implementations, change over and training requirements for healthcare professionals are also discussed

Quality framework for semantic interoperability in health informatics: definition and implementation

Aligned with the increased adoption of Electronic Health Record (EHR) systems, it is recognized that semantic interoperability provides benefits for promoting patient safety and continuity of care. This thesis proposes a framework of quality metrics and recommendations for developing semantic interoperability resources specially focused on clinical information models, which are defined as formal specifications of structure and semantics for representing EHR information for a specific domain or use case. This research started with an exploratory stage that performed a systematic literature review with an international survey about the clinical information modelling best practice and barriers. The results obtained were used to define a set of quality models that were validated through Delphi study methodologies and end user survey, and also compared with related quality standards in those areas that standardization bodies had a related work programme. According to the obtained research results, the defined framework is based in the following models: Development process quality model: evaluates the alignment with the best practice in clinical information modelling and defines metrics for evaluating the tools applied as part of this process. Product quality model: evaluates the semantic interoperability capabilities of clinical information models based on the defined meta-data, data elements and terminology bindings. Quality in use model: evaluates the suitability of adopting semantic interoperability resources by end users in their local projects and organisations. Finally, the quality in use model was implemented within the European Interoperability Asset register developed by the EXPAND project with the aim of applying this quality model in a broader scope to contain any relevant material for guiding the definition, development and implementation of interoperable eHealth systems in our continent. Several European projects already expressed interest in using the register, which will now be sustained by the European Institute for Innovation through Health Data

Registros eletrônicos de saúde e pesquisa clínica : ferramentas para permitir um uso adequado e descentralizado de informações

O Hospital de Clínicas de Porto Alegre (HCPA) tem sua história muito ligada à Tecnologia da Informação. Referência na área de saúde e em modelo de gestão, tornou-se em 2009, a pedido do Ministério da Educação (MEC), protagonista na condução do projeto Aplicativos de Gestão para Hospitais Universitários (AGHU), com o objetivo de transferir para os hospitais vinculados àquele ministério o conhecimento e suas práticas de gestão assistencial e administrativa. Passados vários anos desde o início do projeto AGHU e considerando o crescimento contínuo, o aplicativo passou a ser denominado Aplicativos para Gestão Hospitalar (AGHUse) e tornou-se uma solução consolidada e adotada por dezenas de Instituições de Saúde em todas as regiões do Brasil. Apesar de estimarmos um potencial de 20 milhões de pacientes sendo registrados nas inúmeras instâncias do sistema AGHUse, as informações daí decorrentes ainda não oferecem todo seu potencial visto que as inúmeras instalações não conversam entre si e também não conversam com outros sistemas. Assim, se um mesmo paciente é atendido em vários estabelecimentos de saúde, mesmo que utilizem o mesmo sistema, ainda tem seu cadastro individual em cada instituição e não podem ter suas informações de saúde consolidadas e intercambiadas. Com o avanço das tecnologias de rede e de consolidação de informações em âmbito global, entendemos que não existem mais barreiras técnicas para a integração de dados e para a possibilidade do paciente tornar-se efetivamente possuidor de suas informações de saúde, podendo inclusive dispor delas individualmente em aplicativos de prontuário pessoal. O presente trabalho visa buscar um modelo padronizado e tecnologias que permitam a troca de informações entre diferentes instâncias do AGHUse e também outros sistemas, possibilitando sua interoperabilidade e disponibilidade de forma segura e confiável.The Hospital de Clínicas de Porto Alegre (HCPA) has its history closely linked to Information Technology. Reference in the area of health and management model, became in 2009, at the request of the Ministry of Education (MEC), protagonist in conducting the project Aplicativos para Gestão de Hospitais Universitários (AGHU), with the objective of transferring to the linked hospitals to that ministry the knowledge and its practices of healthcare and administration management. After several years since the beginning of the AGHU project and considering the continuous growth, the application has been renamed Aplicativos para Gestão Hospitalar (AGHUse) and has become a consolidated solution adopted by dozens of health institutions in all regions of Brazil. Although we estimate about 20 million patients enrolled in the numerous instances of the AGHUse, the information that follows does not yet offer its full potential since the many facilities do not talk to each other and also do not talk to other systems. Thus, if the same patient is treated in several health facilities, even if they use the same system, they still have their individual records in each institution and can not have their health information consolidated and exchanged. With the advancement of network technologies and information consolidation at the global level, we understand that there are no more technical barriers to data integration and the possibility of the patient becoming effectively in possession of their health information, and may even dispose of them individually in personal medical record applications. The present work aims to search for a standardized model and technologies that allow the information exchange between different instances of AGHUse and other systems, enabling its interoperability and availability in a safe and reliable way

Front-Line Physicians' Satisfaction with Information Systems in Hospitals

Day-to-day operations management in hospital units is difficult due to continuously varying situations, several actors involved and a vast number of information systems in use. The aim of this study was to describe front-line physicians' satisfaction with existing information systems needed to support the day-to-day operations management in hospitals. A cross-sectional survey was used and data chosen with stratified random sampling were collected in nine hospitals. Data were analyzed with descriptive and inferential statistical methods. The response rate was 65 % (n = 111). The physicians reported that information systems support their decision making to some extent, but they do not improve access to information nor are they tailored for physicians. The respondents also reported that they need to use several information systems to support decision making and that they would prefer one information system to access important information. Improved information access would better support physicians' decision making and has the potential to improve the quality of decisions and speed up the decision making process.Peer reviewe

pHealth 2021. Proc. of the 18th Internat. Conf. on Wearable Micro and Nano Technologies for Personalised Health, 8-10 November 2021, Genoa, Italy

Smart mobile systems – microsystems, smart textiles, smart implants, sensor-controlled medical devices – together with related body, local and wide-area networks up to cloud services, have become important enablers for telemedicine and the next generation of healthcare services. The multilateral benefits of pHealth technologies offer enormous potential for all stakeholder communities, not only in terms of improvements in medical quality and industrial competitiveness, but also for the management of healthcare costs and, last but not least, the improvement of patient experience. This book presents the proceedings of pHealth 2021, the 18th in a series of conferences on wearable micro and nano technologies for personalized health with personal health management systems, hosted by the University of Genoa, Italy, and held as an online event from 8 – 10 November 2021. The conference focused on digital health ecosystems in the transformation of healthcare towards personalized, participative, preventive, predictive precision medicine (5P medicine). The book contains 46 peer-reviewed papers (1 keynote, 5 invited papers, 33 full papers, and 7 poster papers). Subjects covered include the deployment of mobile technologies, micro-nano-bio smart systems, bio-data management and analytics, autonomous and intelligent systems, the Health Internet of Things (HIoT), as well as potential risks for security and privacy, and the motivation and empowerment of patients in care processes. Providing an overview of current advances in personalized health and health management, the book will be of interest to all those working in the field of healthcare today