Archetype development and governance methodologies for the electronic health record

[ES] La interoperabilidad semántica de la información sanitaria es un requisito imprescindible para la sostenibilidad de la atención sanitaria, y es fundamental para afrontar los nuevos retos sanitarios de un mundo globalizado. Esta tesis aporta nuevas metodologías para abordar algunos de los aspectos fundamentales de la interoperabilidad semántica, específicamente aquellos relacionados con la definición y gobernanza de modelos de información clínica expresados en forma de arquetipo. Las aportaciones de la tesis son: - Estudio de las metodologías de modelado existentes de componentes de interoperabilidad semántica que influirán en la definición de una metodología de modelado de arquetipos. - Análisis comparativo de los sistemas e iniciativas existentes para la gobernanza de modelos de información clínica. - Una propuesta de Metodología de Modelado de Arquetipos unificada que formalice las fases de desarrollo del arquetipo, los participantes requeridos y las buenas prácticas a seguir. - Identificación y definición de principios y características de gobernanza de arquetipos. - Diseño y desarrollo de herramientas que brinden soporte al modelado y la gobernanza de arquetipos. Las aportaciones de esta tesis se han puesto en práctica en múltiples proyectos y experiencias de desarrollo. Estas experiencias varían desde un proyecto local dentro de una sola organización que requirió la reutilización de datos clínicos basados en principios de interoperabilidad semántica, hasta el desarrollo de proyectos de historia clínica electrónica de alcance nacional.[CA] La interoperabilitat semàntica de la informació sanitària és un requisit imprescindible per a la sostenibilitat de l'atenció sanitària, i és fonamental per a afrontar els nous reptes sanitaris d'un món globalitzat. Aquesta tesi aporta noves metodologies per a abordar alguns dels aspectes fonamentals de la interoperabilitat semàntica, específicament aquells relacionats amb la definició i govern de models d'informació clínica expressats en forma d'arquetip. Les aportacions de la tesi són: - Estudi de les metodologies de modelatge existents de components d'interoperabilitat semàntica que influiran en la definició d'una metodologia de modelatge d'arquetips. - Anàlisi comparativa dels sistemes i iniciatives existents per al govern de models d'informació clínica. - Una proposta de Metodologia de Modelatge d'Arquetips unificada que formalitza les fases de desenvolupament de l'arquetip, els participants requerits i les bones pràctiques a seguir. - Identificació i definició de principis i característiques de govern d'arquetips. - Disseny i desenvolupament d'eines que brinden suport al modelatge i al govern d'arquetips. Les aportacions d'aquesta tesi s'han posat en pràctica en múltiples projectes i experiències de desenvolupament. Aquestes experiències varien des d'un projecte local dins d'una sola organització que va requerir la reutilització de dades clíniques basades en principis d'interoperabilitat semàntica, fins al desenvolupament de projectes d'història clínica electrònica d'abast nacional.[EN] Semantic interoperability of health information is an essential requirement for the sustainability of healthcare, and it is essential to face the new health challenges of a globalized world. This thesis provides new methodologies to tackle some of the fundamental aspects of semantic interoperability, specifically those aspects related to the definition and governance of clinical information models expressed in the form of archetypes. The contributions of the thesis are: - Study of existing modeling methodologies of semantic interoperability components that will influence in the definition of an archetype modeling methodology. - Comparative analysis of existing clinical information model governance systems and initiatives. - A proposal of a unified Archetype Modeling Methodology that formalizes the phases of archetype development, the required participants, and the good practices to be followed. - Identification and definition of archetype governance principles and characteristics. - Design and development of tools that provide support to archetype modeling and governance. The contributions of this thesis have been put into practice in multiple projects and development experiences. These experiences vary from a local project inside a single organization that required a reuse on clinical data based on semantic interoperability principles, to the development of national electronic health record projects.This thesis was partially funded by the Ministerio de Economía y Competitividad, ayudas para contratos para la formación de doctores en empresas “Doctorados Industriales”, grant DI-14-06564 and by the Agencia Valenciana de la Innovación, ayudas del Programa de Promoción del Talento – Doctorados empresariales (INNODOCTO), grant INNTA3/2020/12.Moner Cano, D. (2021). Archetype development and governance methodologies for the electronic health record [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/16491

Archetype Modeling Methodology

[EN] Clinical Information Models (CIMs) expressed as archetypes play an essential role in the design and development of current Electronic Health Record (EHR) information structures. Although there exist many experiences about using archetypes in the literature, a comprehensive and formal methodology for archetype modeling does not exist. Having a modeling methodology is essential to develop quality archetypes, in order to guide the development of EHR systems and to allow the semantic interoperability of health data. In this work, an archetype modeling methodology is proposed. This paper describes its phases, the inputs and outputs of each phase, and the involved participants and tools. It also includes the description of the possible strategies to organize the modeling process. The proposed methodology is inspired by existing best practices of CIMs, software and ontology development. The methodology has been applied and evaluated in regional and national EHR projects. The application of the methodology provided useful feedback and improvements, and confirmed its advantages. The conclusion of this work is that having a formal methodology for archetype development facilitates the definition and adoption of interoperable archetypes, improves their quality, and facilitates their reuse among different information systems and EHR projects. Moreover, the proposed methodology can be also a reference for CIMs development using any other formalism.This work was partially funded by grant DI-14-06564 (Doctorados Industriales) of the Ministerio de Economia y Competitividad of Spain. The authors would also thank the participants of all R&D projects that have served to evaluate and improve the presented methodology.Moner Cano, D.; Maldonado Segura, JA.; Robles Viejo, M. (2018). Archetype Modeling Methodology. Journal of Biomedical Informatics. 79:71-81. https://doi.org/10.1016/j.jbi.2018.02.003S71817

Detailed Clinical Models Governance System in a Regional EHR Project

The final publication is available at Springer via http://dx.doi.org/ 10.1007/978-3-319-00846-2_313In this work we present the Concept Oriented Repository (ROC), a system developed for the management of clinical information models, also known as detailed clinical models (DCM). It has been developed to be used in the Electronic Health Record project of the Valencia regional health agency (AVS). The system uses DCMs as a way to define clinical models independently of the healthcare standard chosen by the organization. These definitions create a framework where different actors can come to agreements on which information has to be represented and managed in the project. These concepts can be used later for the definition of technical artifacts (archetypes, templates, forms or message definitions) to be used by AVS information systemsThis work has been funded by Electronic Health History project from Valencia Health Agency (HSEAVS).Boscá Tomás, D.; Marco Ruiz, L.; Moner Cano, D.; Maldonado Segura, JA.; Insa, L.; Robles Viejo, M. (2013). Detailed Clinical Models Governance System in a Regional EHR Project. En XIII Mediterranean Conference on Medical and Biological Engineering and Computing 2013. Springer. 1266-1269. doi:10.1007/978-3-319-00846-2_313S1266126

Clinical information modeling processes for semantic interoperability of electronic health records: systematic review and inductive analysis

This is a pre-copyedited, author-produced PDF of an article accepted for publication in Journal of the American Medical Informatics Association following peer review. The version of record is available online at: http://dx.doi.org/10.1093/jamia/ocv008[EN] [Objective] This systematic review aims to identify and compare the existing processes and methodologies that have been published in the literature for defining clinical information models (CIMs) that support the semantic interoperability of electronic health record (EHR) systems. [Material and Methods] Following the preferred reporting items for systematic reviews and meta-analyses systematic review methodology, the authors reviewed published papers between 2000 and 2013 that covered that semantic interoperability of EHRs, found by searching the PubMed, IEEE Xplore, and ScienceDirect databases. Additionally, after selection of a final group of articles, an inductive content analysis was done to summarize the steps and methodologies followed in order to build CIMs described in those articles. [Results] Three hundred and seventy-eight articles were screened and thirty six were selected for full review. The articles selected for full review were analyzed to extract relevant information for the analysis and characterized according to the steps the authors had followed for clinical information modeling. [Discussion] Most of the reviewed papers lack a detailed description of the modeling methodologies used to create CIMs. A representative example is the lack of description related to the definition of terminology bindings and the publication of the generated models. However, this systematic review confirms that most clinical information modeling activities follow very similar steps for the definition of CIMs. Having a robust and shared methodology could improve their correctness, reliability, and quality. [Conclusion] Independently of implementation technologies and standards, it is possible to find common patterns in methods for developing CIMs, suggesting the viability of defining a unified good practice methodology to be used by any clinical information modeler.This research has been partially funded by the Instituto de Salud Carlos III (Platform for Innovation in Medical Technologies and Health), grant PT13/0006/0036 and the Spanish Ministry of Economy and Competitiveness, grants TIN2010-21388-C02-01 and PTQ-12-05620.Moreno-Conde, A.; Moner Cano, D.; Da Cruz, WD.; Santos, MR.; Maldonado Segura, JA.; Robles Viejo, M.; Kalra, D. (2015). Clinical information modeling processes for semantic interoperability of electronic health records: systematic review and inductive analysis. Journal of the American Medical Informatics Association. 22(4):925-934. https://doi.org/10.1093/jamia/ocv008S925934224Goossen W Goossen-Baremans A van der Zel M . Detailed clinical models: a review. Healthc Inform Res. 2010;16:201.Beeler, G. W. (1998). HL7 Version 3—An object-oriented methodology for collaborative standards development1Presented at the International Medical Informatics Association Working Group 16 Conference on Standardisation in Medical Informatics—Towards International Consensus and Cooperation, Bermuda, 12 September, 1997.1. International Journal of Medical Informatics, 48(1-3), 151-161. doi:10.1016/s1386-5056(97)00121-4Dolin, R. H., Alschuler, L., Boyer, S., Beebe, C., Behlen, F. M., Biron, P. V., & Shabo (Shvo), A. (2006). HL7 Clinical Document Architecture, Release 2. Journal of the American Medical Informatics Association, 13(1), 30-39. doi:10.1197/jamia.m1888Fast Health Interoperability Resources (FHIR). http://www.hl7.org/fhir/. Accessed July 18, 2014.Beale T . Archetypes: constraint-based domain models for futureproof information systems. OOPSLA 2002 Workshop Behav Semant. 2002.ISO 13606:2008 - Health informatics - Electronic health record communication. 2008. www.iso.org/iso/catalogue_detail.htm?csnumber=40784.OpenEHR. http://www.openehr.org/. Accessed July 18, 2014.Clinical Information Modeling Initiative (CIMI). http://www.opencimi.org/. Accessed July 18, 2014.Goossen WT . Using detailed clinical models to bridge the gap between clinicians and HIT. Stud Health Technol Inf. 2008;141:3–10.Oniki TA Coyle JF Parker CG . Lessons learned in detailed clinical modeling at Intermountain Healthcare. J Am Med Inform Assoc. 2014. Advance access published; doi:10.1136/amiajnl-2014-002875.Jacobson I Booch G Rumbaugh J . The Unified Software Development Process. Massachusetts, USA: Addison-Wesley Reading; 1999.Ahn, S., Huff, S. M., Kim, Y., & Kalra, D. (2013). Quality metrics for detailed clinical models. International Journal of Medical Informatics, 82(5), 408-417. doi:10.1016/j.ijmedinf.2012.09.006Kalra D . Editorial principles for the development of standards for the structure and content of health records. 2012. https://www.rcplondon.ac.uk/sites/default/files/documents/editorial-principles-for-the-development-of-record-standards.pdf. Accessed July 16, 2014.Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ, 339(jul21 1), b2535-b2535. doi:10.1136/bmj.b2535Transparent reporting of systematic reviews and meta-analyses (PRISMA). http://www.prisma-statement.org/. Accessed July 18, 2014.US National Library of Medicine. http://www.pubmed.gov. Accessed July 18, 2014.IEEE Xplore Digital Library. http://ieeexplore.ieee.org/. Accessed July 18, 2014.ScienceDirect. http://www.sciencedirect.com/. Accessed July 18, 2014.Elo, S., & Kyngäs, H. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62(1), 107-115. doi:10.1111/j.1365-2648.2007.04569.xRinner C Kohler M Hübner-Bloder G . Creating ISO/EN 13606 archetypes based on clinical information needs. In: Proceedings of EFMI Special Topic Conference, 14–15 April 2011, Lǎsko, Slovenia e-Health Across Borders Without Boundaries. 2011:14–15.Muñoz Carrero A Romero Gutiérrez A Marco Cuenca G . Manual práctico de interoperabilidad semántica para entornos sanitarios basada en arquetipos. Unidad de investigación en Telemedicina y e-Salud. Instituto de Salud Carlos III - Ministerio de Economía y Competitividad. 2013.Kalra D . Editorial principles for the development of standards for the structure and content of health records. 2012. https://www.rcplondon.ac.uk/sites/default/files/documents/editorial-principles-for-the-development-of-record-standards.pdf . Accessed July 18, 2015.Yuksel, M., & Dogac, A. (2011). Interoperability of Medical Device Information and the Clinical Applications: An HL7 RMIM based on the ISO/IEEE 11073 DIM. IEEE Transactions on Information Technology in Biomedicine, 15(4), 557-566. doi:10.1109/titb.2011.2151868Nagy M Hanzlicek P Precková P . Semantic interoperability in Czech healthcare environment supported by HL7 version 3. Methods Inf Med. 2010;49:186.LOPEZ, D., & BLOBEL, B. (2009). A development framework for semantically interoperable health information systems. International Journal of Medical Informatics, 78(2), 83-103. doi:10.1016/j.ijmedinf.2008.05.009Lopez DM Blobel B . Enhanced semantic interoperability by profiling health informatics standards. Methods Inf Med. 2009;48:170–177.Lopez DM Blobel B . Enhanced semantic interpretability by healthcare standards profiling. Stud Health Technol Inform. 2008;136:735.Knaup, P., Garde, S., & Haux, R. (2007). Systematic planning of patient records for cooperative care and multicenter research. International Journal of Medical Informatics, 76(2-3), 109-117. doi:10.1016/j.ijmedinf.2006.08.002Goossen, W. T. F., Ozbolt, J. G., Coenen, A., Park, H.-A., Mead, C., Ehnfors, M., & Marin, H. F. (2004). Development of a Provisional Domain Model for the Nursing Process for Use within the Health Level 7 Reference Information Model. Journal of the American Medical Informatics Association, 11(3), 186-194. doi:10.1197/jamia.m1085Anderson, H. V., Weintraub, W. S., Radford, M. J., Kremers, M. S., Roe, M. T., Shaw, R. E., … Tcheng, J. E. (2013). Standardized Cardiovascular Data for Clinical Research, Registries, and Patient Care. Journal of the American College of Cardiology, 61(18), 1835-1846. doi:10.1016/j.jacc.2012.12.047Jian, W.-S., Hsu, C.-Y., Hao, T.-H., Wen, H.-C., Hsu, M.-H., Lee, Y.-L., … Chang, P. (2007). Building a portable data and information interoperability infrastructure—framework for a standard Taiwan Electronic Medical Record Template. Computer Methods and Programs in Biomedicine, 88(2), 102-111. doi:10.1016/j.cmpb.2007.07.014Spigolon, D. N., & Moro, C. M. C. (2012). Arquétipos do conjunto de dados essenciais de enfermagem para atendimento de portadoras de endometriose. Revista Gaúcha de Enfermagem, 33(4), 22-32. doi:10.1590/s1983-14472012000400003Späth, M. B., & Grimson, J. (2011). Applying the archetype approach to the database of a biobank information management system. International Journal of Medical Informatics, 80(3), 205-226. doi:10.1016/j.ijmedinf.2010.11.002Smith, K., & Kalra, D. (2008). Electronic health records in complementary and alternative medicine. International Journal of Medical Informatics, 77(9), 576-588. doi:10.1016/j.ijmedinf.2007.11.005Bax, M. P., Kalra, D., & Santos, M. R. (2012). Dealing with the Archetypes Development Process for a Regional EHR System. Applied Clinical Informatics, 03(03), 258-275. doi:10.4338/aci-2011-12-ra-0074Moner D Moreno A Maldonado JA . Using archetypes for defining CDA templates. Stud Health Technol Inform. 2012;180:53–57.Moner D Maldonado JA Boscá D . CEN EN13606 normalisation framework implementation experiences. In: Seamless Care, Safe Care: The Challenges of Interoperability and Patient Safety in Health Care: Proceedings of the EFMI Special Topic Conference, June 2–4, 2010; Reykjavik, Iceland. IOS Press; 2010: 136.Marcos, M., Maldonado, J. A., Martínez-Salvador, B., Boscá, D., & Robles, M. (2013). Interoperability of clinical decision-support systems and electronic health records using archetypes: A case study in clinical trial eligibility. Journal of Biomedical Informatics, 46(4), 676-689. doi:10.1016/j.jbi.2013.05.004Leslie H . International developments in openEHR archetypes and templates. Health Inf Manag J. 2008;37:38.Kohl CD Garde S Knaup P . Facilitating secondary use of medical data by using openEHR archetypes. Stud Health Technol Inform. 2009;160:1117–1121.Garde, S., Hovenga, E., Buck, J., & Knaup, P. (2007). Expressing clinical data sets with openEHR archetypes: A solid basis for ubiquitous computing. International Journal of Medical Informatics, 76, S334-S341. doi:10.1016/j.ijmedinf.2007.02.004Garcia D Moro CM Cicogna PE . Method to integrate clinical guidelines into the electronic health record (EHR) by applying the archetypes approach. Stud Health Technol Inform. 2012;192:871–875.Duftschmid, G., Rinner, C., Kohler, M., Huebner-Bloder, G., Saboor, S., & Ammenwerth, E. (2013). The EHR-ARCHE project: Satisfying clinical information needs in a Shared Electronic Health Record System based on IHE XDS and Archetypes. International Journal of Medical Informatics, 82(12), 1195-1207. doi:10.1016/j.ijmedinf.2013.08.002Dias, R. D., Cook, T. W., & Freire, S. M. (2011). Modeling healthcare authorization and claim submissions using the openEHR dual-model approach. BMC Medical Informatics and Decision Making, 11(1). doi:10.1186/1472-6947-11-60Buck, J., Garde, S., Kohl, C. D., & Knaup-Gregori, P. (2009). Towards a comprehensive electronic patient record to support an innovative individual care concept for premature infants using the openEHR approach. International Journal of Medical Informatics, 78(8), 521-531. doi:10.1016/j.ijmedinf.2009.03.001Puentes, J., Roux, M., Montagner, J., & Lecornu, L. (2012). Development framework for a patient-centered record. Computer Methods and Programs in Biomedicine, 108(3), 1036-1051. doi:10.1016/j.cmpb.2012.06.007Liu, D., Wang, X., Pan, F., Yang, P., Xu, Y., Tang, X., … Rao, K. (2010). Harmonization of health data at national level: A pilot study in China. International Journal of Medical Informatics, 79(6), 450-458. doi:10.1016/j.ijmedinf.2010.03.002Liu, D., Wang, X., Pan, F., Xu, Y., Yang, P., & Rao, K. (2008). Web-based infectious disease reporting using XML forms. International Journal of Medical Informatics, 77(9), 630-640. doi:10.1016/j.ijmedinf.2007.10.011Kim, Y., & Park, H.-A. (2011). Development and Validation of Detailed Clinical Models for Nursing Problems in Perinatal care. Applied Clinical Informatics, 02(02), 225-239. doi:10.4338/aci-2011-01-ra-0007Khan, W. A., Hussain, M., Afzal, M., Amin, M. B., Saleem, M. A., & Lee, S. (2013). Personalized-Detailed Clinical Model for Data Interoperability Among Clinical Standards. Telemedicine and e-Health, 19(8), 632-642. doi:10.1089/tmj.2012.0189Jing, X., Kay, S., Marley, T., Hardiker, N. R., & Cimino, J. J. (2012). Incorporating personalized gene sequence variants, molecular genetics knowledge, and health knowledge into an EHR prototype based on the Continuity of Care Record standard. Journal of Biomedical Informatics, 45(1), 82-92. doi:10.1016/j.jbi.2011.09.001Hsu, W., Taira, R. K., El-Saden, S., Kangarloo, H., & Bui, A. A. T. (2012). Context-Based Electronic Health Record: Toward Patient Specific Healthcare. IEEE Transactions on Information Technology in Biomedicine, 16(2), 228-234. doi:10.1109/titb.2012.2186149Hoy D Hardiker NR McNicoll IT . Collaborative development of clinical templates as a national resource. Int J Med Inf. 2009;78:S3–S8.Buyl, R., & Nyssen, M. (2009). Structured electronic physiotherapy records. International Journal of Medical Informatics, 78(7), 473-481. doi:10.1016/j.ijmedinf.2009.02.007D’Amore JD Mandel JC Kreda DA . Are Meaningful Use Stage 2 certified EHRs ready for interoperability? Findings from the SMART C-CDA Collaborative. J Am Med Inform Assoc. 2014. Advance access published; doi:10.1136/amiajnl-2014-002883.Kalra D Tapuria A Austin T . Quality requirements for EHR archetypes. In: MIE; 2012: 48–52.Garde S Hovenga EJ Gränz J . Managing archetypes for sustainable and semantically interoperable electronic health records. Electron J Health Inform. 2007;2:e9.Madsen M Leslie H Hovenga EJS . Sustainable clinical knowledge management: an archetype development life cycle. Stud Health Technol Inform. 2010;151:115–132.Kohl CD Garde S Knaup P . Facilitating the openEHR approach-organizational structures for defining high-quality archetypes. Stud Health Technol Inform. 2008;136:437.Stroetmann VN Kalra D Lewalle P . Semantic interoperability for better health and safer healthcare. European Commission, Directorate-General Information Society and Media; 2009. http://dx.doi.org/10.2759/38514

Leveraging electronic healthcare record standards and semantic web technologies for the identification of patient cohorts

Introduction The secondary use of Electronic Healthcare Records (EHRs) often requires the identification of patient cohorts. In this context, an important problem is the heterogeneity of clinical data sources, which can be overcome with the combined use of standardized information models, Virtual Health Records, and semantic technologies, since each of them contributes to solving aspects related to the semantic interoperability of EHR data. Our main objective is to develop methods allowing for a direct use of EHR data for the identification of patient cohorts leveraging current EHR standards and semantic web technologies. Materials and Methods We propose to take advantage of the best features of working with EHR standards and ontologies. Our proposal is based on our previous results and experience working with both technological infrastructures. Our main principle is to perform each activity at the abstraction level with the most appropriate technology available. This means that part of the processing will be performed using archetypes (i.e., data level) and the rest using ontologies (i.e., knowledge level). Our approach will start working with EHR data in proprietary format, which will be first normalized and elaborated using EHR standards and then transformed into a semantic representation, which will be exploited by automated reasoning. Results We have applied our approach to protocols for colorectal cancer screening. The results comprise the archetypes, ontologies and datasets developed for the standardization and semantic analysis of EHR data. Anonymized real data has been used and the patients have been successfully classified by the risk of developing colorectal cancer. Conclusion This work provides new insights in how archetypes and ontologies can be effectively combined for EHR-driven phenotyping. The methodological approach can be applied to other problems provided that suitable archetypes, ontologies and classification rules can be designed.This work was supported by the Ministerio de Economia y Competitividad and the FEDER program through grants TIN2010-21388-C01 and TIN2010-21388-C02. MCLG was supported by the Fundacion Seneca through grant 15555/FPI/2010.Fernández-Breis, JT.; Maldonado Segura, JA.; Marcos, M.; Legaz-García, MDC.; Moner Cano, D.; Torres-Sospedra, J.; Esteban-Gil, A.... (2013). Leveraging electronic healthcare record standards and semantic web technologies for the identification of patient cohorts. Journal of the American Medical Informatics Association. 20(E2):288-296. https://doi.org/10.1136/amiajnl-2013-001923S28829620E2Cuggia, M., Besana, P., & Glasspool, D. (2011). Comparing semi-automatic systems for recruitment of patients to clinical trials. International Journal of Medical Informatics, 80(6), 371-388. doi:10.1016/j.ijmedinf.2011.02.003Sujansky, W. (2001). Heterogeneous Database Integration in Biomedicine. Journal of Biomedical Informatics, 34(4), 285-298. doi:10.1006/jbin.2001.1024Schadow G Russler DC Mead CN . Integrating medical information and knowledge in the HL7 RIM. Proceedings of the AMIA Symposium, 2000:764–8.Johnson PD Tu SW Musen MA . A virtual medical record for guideline-based decision support. Proceedings of the AMIA 2001 Annual Symposium, 294–8.German, E., Leibowitz, A., & Shahar, Y. (2009). An architecture for linking medical decision-support applications to clinical databases and its evaluation. Journal of Biomedical Informatics, 42(2), 203-218. doi:10.1016/j.jbi.2008.10.007Peleg, M., Keren, S., & Denekamp, Y. (2008). Mapping computerized clinical guidelines to electronic medical records: Knowledge-data ontological mapper (KDOM). Journal of Biomedical Informatics, 41(1), 180-201. doi:10.1016/j.jbi.2007.05.003Maldonado, J. A., Costa, C. M., Moner, D., Menárguez-Tortosa, M., Boscá, D., Miñarro Giménez, J. A., … Robles, M. (2012). Using the ResearchEHR platform to facilitate the practical application of the EHR standards. Journal of Biomedical Informatics, 45(4), 746-762. doi:10.1016/j.jbi.2011.11.004Parker CG Rocha RA Campbell JR . Detailed clinical models for sharable, executable guidelines. Stud Health Technol Inform 2004;107:145–8.Clinical Information Modeling Initiative. http://informatics.mayo.edu/CIMI/index.php/Main_Page (accessed Jun 2013).W3C, OWL2 Web Ontology Language. http://www.w3.org/TR/owl2-overview/ (accessed Jun 2013).European Commission. Semantic interoperability for better health and safer healthcare. Deployment and research roadmap for Europe. ISBN-13: 978-92-79-11139-6, 2009.SemanticHealthNet. http://www.semantichealthnet.eu/ (accessed Jun 2013).Martínez-Costa, C., Menárguez-Tortosa, M., Fernández-Breis, J. T., & Maldonado, J. A. (2009). A model-driven approach for representing clinical archetypes for Semantic Web environments. Journal of Biomedical Informatics, 42(1), 150-164. doi:10.1016/j.jbi.2008.05.005Iqbal AM . An OWL-DL ontology for the HL7 reference information model. Toward useful services for elderly and people with disabilities Berlin: Springer, 2011:168–75.Tao, C., Jiang, G., Oniki, T. A., Freimuth, R. R., Zhu, Q., Sharma, D., … Chute, C. G. (2012). A semantic-web oriented representation of the clinical element model for secondary use of electronic health records data. Journal of the American Medical Informatics Association, 20(3), 554-562. doi:10.1136/amiajnl-2012-001326Heymans, S., McKennirey, M., & Phillips, J. (2011). Semantic validation of the use of SNOMED CT in HL7 clinical documents. Journal of Biomedical Semantics, 2(1), 2. doi:10.1186/2041-1480-2-2Menárguez-Tortosa, M., & Fernández-Breis, J. T. (2013). OWL-based reasoning methods for validating archetypes. Journal of Biomedical Informatics, 46(2), 304-317. doi:10.1016/j.jbi.2012.11.009Lezcano, L., Sicilia, M.-A., & Rodríguez-Solano, C. (2011). Integrating reasoning and clinical archetypes using OWL ontologies and SWRL rules. Journal of Biomedical Informatics, 44(2), 343-353. doi:10.1016/j.jbi.2010.11.005Tao C Wongsuphasawat K Clark K . Towards event sequence representation, reasoning and visualization for EHR data. Proceedings of the 2nd ACM SIGHIT International Health Informatics Symposium (IHI'12). New York, NY, USA: ACM:801–6.Bodenreider O . Biomedical ontologies in action: role in knowledge management, data integration and decision support. IMIA Yearbook of Medical Informatics 2008;67–79.Beale T . Archetypes. Constraint-based domain models for future-proof information systems. http://www.openehr.org/files/publications/archetypes/archetypes_beale_web_2000.pdfSNOMED-CT. http://www.ihtsdo.org/snomed-ct/ (accessed Jun 2013).UMLS Terminology Services. https://uts.nlm.nih.gov/home.html (accessed Jun 2013).The openEHR Foundation, openEHR Clinical Knowledge Manager. http://www.openehr.org/knowledge/ (accessed Jun 2013).Maldonado, J. A., Moner, D., Boscá, D., Fernández-Breis, J. T., Angulo, C., & Robles, M. (2009). LinkEHR-Ed: A multi-reference model archetype editor based on formal semantics. International Journal of Medical Informatics, 78(8), 559-570. doi:10.1016/j.ijmedinf.2009.03.006SAXON XSLT and XQuery processor. http://saxon.sourceforge.net/ (accessed Jun 2013).NCBO Bioportal. http://bioportal.bioontology.org/ (accessed Jun 2013).The Protégé Ontology Editor and Knowledge Acquisition System. http://protege.stanford.edu/ (accessed Jun 2013).Semantic Web Integration Tool. http://sele.inf.um.es/swit (accessed Jun 2013).Hermit Reasoner. http://www.hermit-reasoner.com/ (accessed Jun 2013).The OWLAPI. http://owlapi.sourceforge.net/ (accessed Jun 2013).Institute for Health Metrics and Evaluation. Global Burden of Disease. http://www.healthmetricsandevaluation.org/gbd (accessed Jun 2013).Segnan N Patnick J von Karsa L . European guidelines for quality assurance in colorectal cancer screening and diagnosis 2010. First Edition. European Union. ISBN 978-92-79-16435-4.W3C. XQuery 1.0: An XML Query Language. http://www.w3.org/TR/xquery/ (accessed Jun 2013).DL Query. http://protegewiki.stanford.edu/wiki/DL_Query (accessed Jun 2013).SPARQL Query Language for RDF. http://www.w3.org/TR/rdf-sparql-query/ (accessed Jun 2013).Semantic Web Rule Language. http://www.w3.org/Submission/SWRL/ (accessed Jun 2013).Marcos, M., Maldonado, J. A., Martínez-Salvador, B., Boscá, D., & Robles, M. (2013). Interoperability of clinical decision-support systems and electronic health records using archetypes: A case study in clinical trial eligibility. Journal of Biomedical Informatics, 46(4), 676-689. doi:10.1016/j.jbi.2013.05.004Marcos, M., Maldonado, J. A., Martínez-Salvador, B., Moner, D., Boscá, D., & Robles, M. (2011). An Archetype-Based Solution for the Interoperability of Computerised Guidelines and Electronic Health Records. Lecture Notes in Computer Science, 276-285. doi:10.1007/978-3-642-22218-4_35MobiGuide: Guiding patients anytime everywhere. http://www.mobiguide-project.eu/ (accessed Jun 2013).EURECA: Enabling information re-Use by linking clinical RE search and Care. http://eurecaproject.eu/ (accessed Jun 2013).Rea, S., Pathak, J., Savova, G., Oniki, T. A., Westberg, L., Beebe, C. E., … Chute, C. G. (2012). Building a robust, scalable and standards-driven infrastructure for secondary use of EHR data: The SHARPn project. Journal of Biomedical Informatics, 45(4), 763-771. doi:10.1016/j.jbi.2012.01.009Clinical Element Models. http://informatics.mayo.edu/sharp/index.php/CEMS (accessed Jun 2013)

Utilidad de los arquetipos ISO 13606 para representar modelos clínicos detallados

Objetivo: Evaluar la utilidad de los Arquetipos ISO/CEN 13606 y openEHR en la representación de modelos clínicos detallados. Metodología: como editores de arquetipos se utilizaron LinkERH para ISO/CEN 13606 y los editores de Ocean Informatics y LiU para openEHR. Como caso de uso se representaron los conjuntos de datos identificados en los modelos locales de tres sistemas (hospital, UCI y atención primaria) en el dominio de la úlcera por decúbito, abarcando la observación, evaluación, instrucción y acción. Los conceptos fueron enlazados con terminologías SNOMED CT y MedDRA. Se buscaron arquetipos relacionados con el dominio en los repositorios internacionales para ser reutilizados. Resultados: Se realizó un conjunto de arquetipos equivalentes ISO/CEN 13606 y openEHR, en español e inglés. Los arquetipos proporcionan un formalismo útil para especificar datos de un modelo detallado. Los modelos producidos por las herramientas de edición de arquetipos son comprensibles para los clínicos. Los arquetipos proporcionan un marco para la implementación de las terminologías en la HCE. Se requiere el desarrollo de técnicas para el diseño de arquetipos que garanticen su calidad.Serrano, P.; Moner Cano, D.; Sebastian, T.; Maldonado Segura, JA.; Navalón, R.; Robles Viejo, M.; Gómez, Á. (2009). Utilidad de los arquetipos ISO 13606 para representar modelos clínicos detallados. RevistaeSalud.com. 5(18):100-110. http://hdl.handle.net/10251/61364S10011051

LinkEHR-Ed: A multi-reference model archetype editor based on formal semantics

Purpose To develop a powerful archetype editing framework capable of handling multiple reference models and oriented towards the semantic description and standardization of legacy data. Methods The main prerequisite for implementing tools providing enhanced support for archetypes is the clear specification of archetype semantics. We propose a formalization of the definition section of archetypes based on types over tree-structured data. It covers the specialization of archetypes, the relationship between reference models and archetypes and conformance of data instances to archetypes. Results LinkEHR-Ed, a visual archetype editor based on the former formalization with advanced processing capabilities that supports multiple reference models, the editing and semantic validation of archetypes, the specification of mappings to data sources, and the automatic generation of data transformation scripts, is developed. Conclusions LinkEHR-Ed is a useful tool for building, processing and validating archetypes based on any reference model.This work was supported in part by the Spanish Ministry of Education and Science under grant TS12007-66S7S-C02; by the Generalitat Valenciana under grant APOSTD/2007/055 and by the program PAID-06-07 de la Universidad Politecnica de Valencia.Maldonado Segura, JA.; Moner Cano, D.; Boscá Tomás, D.; Fernandez Breis, JT.; Angulo Fernández, C.; Robles Viejo, M. (2009). LinkEHR-Ed: A multi-reference model archetype editor based on formal semantics. International Journal of Medical Informatics. 78(8):559-570. https://doi.org/10.1016/j.ijmedinf.2009.03.006S55957078

Non-invasive lightweight integration engine for building EHR from autonomous distributed systems

[EN] In this paper we describe Pangea-LE, a message-oriented lightweight data integration engine that allows homogeneous and concurrent access to clinical information from disperse and heterogeneous data sources. The engine extracts the information and passes it to the requesting client applications in a flexible XML format. The XML response message can be formatted on demand by appropriate Extensible Stylesheet Language (XSL) transformations in order to meet the needs of client applications. We also present a real deployment in a hospital where Pangea-LE collects and generates an XML view of all the available patient clinical information. The information is presented to healthcare professionals in an Electronic Health Record (EHR) viewer Web application with patient search and EHR browsing capabilities. Implantation in a real setting has been a success due to the non-invasive nature of Pangea-LE which respects the existing information systems.This work was partially funded by the Spanish Ministry of Science and Technology (MEC-TSI2004-06475-102-01) and the Spanish Ministry of Health (PI052245)Angulo Fernández, C.; Crespo Molina, PM.; Maldonado Segura, JA.; Moner Cano, D.; Perez Cuesta, D.; Abad, I.; Mandingorra Gimenez, J.... (2007). Non-invasive lightweight integration engine for building EHR from autonomous distributed systems. International Journal of Medical Informatics. 76(Supplement 3):417-424. https://doi.org/10.1016/j.ijmedinf.2007.05.002S41742476Supplement

Using the ResearchEHR platform to facilitate the practical application of the EHR standards

Possibly the most important requirement to support co-operative work among health professionals and institutions is the ability of sharing EHRs in a meaningful way, and it is widely acknowledged that standardization of data and concepts is a prerequisite to achieve semantic interoperability in any domain. Different international organizations are working on the definition of EHR architectures but the lack of tools that implement them hinders their broad adoption. In this paper we present ResearchEHR, a software platform whose objective is to facilitate the practical application of EHR standards as a way of reaching the desired semantic interoperability. This platform is not only suitable for developing new systems but also for increasing the standardization of existing ones. The work reported here describes how the platform allows for the edition, validation, and search of archetypes, converts legacy data into normalized, archetypes extracts, is able to generate applications from archetypes and finally, transforms archetypes and data extracts into other EHR standards. We also include in this paper how ResearchEHR has made possible the application of the CEN/ISO 13606 standard in a real environment and the lessons learnt with this experience. © 2011 Elsevier Inc..This work has been partially supported by the Spanish Ministry of Science and Innovation under Grants TIN2010-21388-C02-01 and TIN2010-21388-C02-02, and by the Health Institute Carlos in through the RETICS Combiomed, RD07/0067/2001. Our most sincere thanks to the Hospital of Fuenlabrada in Madrid, including its Medical Director Pablo Serrano together with Marta Terron and Luis Lechuga for their support and work during the development of the medications reconciliation project.Maldonado Segura, JA.; Martínez Costa, C.; Moner Cano, D.; Menárguez-Tortosa, M.; Boscá Tomás, D.; Miñarro Giménez, JA.; Fernández-Breis, JT.... (2012). Using the ResearchEHR platform to facilitate the practical application of the EHR standards. Journal of Biomedical Informatics. 45(4):746-762. doi:10.1016/j.jbi.2011.11.004S74676245