Modeling digital health systems to foster interoperability

Information systems are a complex thing, and they are mostly not used stand-alone anymore. In that context, many different issues must be considered. It starts with defining the system's purpose, includes the use cases and scenarios in combination with the necessary data ideally separated into distinct domains. Furthermore, it requires the selection of an appropriate set of supporting components/tools and a development environment including some technology to enable continuous integration. And the endeavor does not come to an end with the development of the system itself. To manage those challenges, thinking about design and architectural principles becomes a mandatory element. The situation gets more complicated with growing expectations regarding communication and cooperation between the more and more complex and dynamic ecosystem's actors. The resulting information system has to adhere to different, sometimes contradictory principles and requirements, frequently controlled by different authorities. This paper focuses less on developing information systems in general but concentrates on the aspects that must be considered when multiple requirements from different stakeholders for data exchange and knowledge sharing for advanced interoperability must be met. The latter is commonly underspecified due to missing proper verification of the correct interpretation of data. One intent of the paper is to promote the deployment of information models as a common basis to derive data exchange specifications establishing advanced interoperability. However, it also addresses the necessity to guarantee that the information models and implementable artifacts correctly represent the intended functions and objectives as well as the underlying concepts of the business system in its prevailing context. Therefore, we cannot limit our considerations on the data and information viewpoints

Standardizing Medical Quality Assurance and Control in Germany : Based on HL7® FHIR®

n Germany, vendors in cooperation with the responsible organizations have developed a powerful mechanism to supply data for medical quality assurance and control to public health agencies. However, this mechanism is proprietary and limited in some regards. On the other hand, by the current means it comprehensively documents the necessary requirements worth being analyzed in detail so that the shortcomings of the specification may be overcome by facilitating international standards. This paper provides the foundation for this approach and suggests a possible transition by introducing different possible options that can be facilitated independently

Solving the Modeling Dilemma as a Foundation for Interoperability

Introduction: Progressive health paradigms, involving many different disciplines and combining multiple policy domains, requires advanced interoperability solutions. This results in special challenges for modeling health systems. Methods: The paper discusses classification systems for data models and enterprise business architectures and compares them with the ISO Reference Architecture. Results and Conclusions: Existing definitions, specifications and standards for data models enabling interoperability are analyzed, and their limitations are evaluated. Amendments to correctly use those models and to better meet the aforementioned challenges are offered

How to Work with Vocabulary Correctly, Exemplified with Gender Coding?

Popular data exchange standards facilitate the use of vocabulary in different ways. Quite often, the usage is based on, and in favor of, simple implementations not considering reality. In most cases the vocabulary is assembled in form of simple code lists. Well-known bad practice is neither to define proper concept descriptions for the individual codes leaving their interpretation to the developer nor to identify the underlying vocabulary domain resulting in a mixture of something. This paper takes the gender use case and analyses the use of codes within some data exchange standards and makes recommendations for improvements in handling and managing code systems correctly

Data Modeling Challenges of Advanced Interoperability

Progressive health paradigms, involving many different disciplines and combining multiple policy domains, requires advanced interoperability solutions. This results in special challenges for modeling health systems. The paper discusses classification systems for data models and enterprise business architectures and compares them with the ISO Reference Architecture. On that basis, existing definitions, specifications and standards of data models for interoperability are evaluated and their limitations are discussed. Amendments to correctly use those models and to better meet the aforementioned challenges are offered

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

Principles and Standards for Designing and Managing Integrable and Interoperable Transformed Health Ecosystems

The advancement of sciences and technologies, economic challenges, increasing expectations, and consumerism result in a radical transformation of health and social care around the globe, characterized by foundational organizational, methodological, and technological paradigm changes. The transformation of the health and social care ecosystems aims at ubiquitously providing personalized, preventive, predictive, participative precision (5P) medicine, considering and understanding the individual’s health status in a comprehensive context from the elementary particle up to society. For designing and implementing such advanced ecosystems, an understanding and correct representation of the structure, function, and relations of their components is inevitable, thereby including the perspectives, principles, and methodologies of all included disciplines. To guarantee consistent and conformant processes and outcomes, the specifications and principles must be based on international standards. A core standard for representing transformed health ecosystems and managing the integration and interoperability of systems, components, specifications, and artifacts is ISO 23903:2021, therefore playing a central role in this publication. Consequently, ISO/TC 215 and CEN/TC 251, both representing the international standardization on health informatics, declared the deployment of ISO 23903:2021 mandatory for all their projects and standards addressing more than one domain. The paper summarizes and concludes the first author’s leading engagement in the evolution of pHealth in Europe and beyond over the last 15 years, discussing the concepts, principles, and standards for designing, implementing, and managing 5P medicine ecosystems. It not only introduces the theoretical foundations of the approach but also exemplifies its deployment in practical projects and solutions regarding interoperability and integration in multi-domain ecosystems. The presented approach enables comprehensive and consistent integration of and interoperability between domains, systems, related actors, specifications, standards, and solutions. That way, it should help overcome the problems and limitations of data-centric approaches, which still dominate projects and products nowadays, and replace them with knowledge-centric, comprehensive, and consistent ones