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Analysis and Evaluation of EHR Approaches
Bernd BLOBEL and Peter PHAROW eHealth Competence Center, Regensburg, Germany
Blobel B, Pharow P: Analysis and Evaluation of EHR Approaches MIE 2008, 26-28 May 2008, Göteborg, Sweden
EHR Projects and Standards
• ISO TC 215 TS 18308, DTR 20514
• CEN EN 12967 „Health Information System Architecture“
• CEN EN 13606 „EHR Communication“
• openEHR • GEHR • IHE RID: Retrieve Information
for Display • IHE XDS: Cross-enterprise
Clinical Document Sharing
• G-CPR • ASTM CCR • HL7 RIM & CDA, EHR-S
Functional Model, EHR-S Interoperability Model, CCD
• HARP • DICOM SR: Structured
Reporting • WADO: Web Access to
DICOM Persistent Objects • EuroRec, ProRec Centres • MML: The Medical Mark-up
Language
Blobel B, Pharow P: Analysis and Evaluation of EHR Approaches MIE 2008, 26-28 May 2008, Göteborg, Sweden
Approaches to EHR
• Currently, three streams for specifying and implementing advanced EHR architectures have been established, which partially have their roots in existing systems, in traditional thoughts and methodologies as well as in specific domain-languages and modeling languages:
Data approach (data representation) Concept approach (concept/knowledge representation) Process/service approach (business process / service
representation)
Blobel B, Pharow P: Analysis and Evaluation of EHR Approaches MIE 2008, 26-28 May 2008, Göteborg, Sweden
Approaches to EHR
• An alternative structure of current approaches with analogue methodologies and modelling languages under implementation focus is: Communication focus (message) Document focus (clinical document) Business process focus (application)
• According to the time dimension, following structure can be proposed: Episode focus (EHR extract) Life-long record focus (EHR service)
• Because of their rational roots and driving factors, all those approaches have their right to exist at least temporarily. Therefore, they exist also practically in co-existence or concurrency. The three approaches develop continuously, thereby showing some convergence.
Blobel B, Pharow P: Analysis and Evaluation of EHR Approaches MIE 2008, 26-28 May 2008, Göteborg, Sweden
Interoperability Level Instances
Technical interoperability Technical plug&play, signal- & protocol compatibility
Structural interoperability Simple EDI, envelopes
Syntactic interoperability Messages, clinical documents, agreed vocabulary
Semantic interoperability Advanced messaging, common information models and terminology
Organizations/Service interoperability Common business process
Interoperability Levels
Blobel B, Pharow P: Analysis and Evaluation of EHR Approaches MIE 2008, 26-28 May 2008, Göteborg, Sweden
Requirements for achieving interoperability and harmonisation
• Openness, scalability, flexibility, portability • Distribution at Internet level • Standard conformance • Service orientation • Semantic interoperability • Consideration of timing aspects of data and
information exchanged • Lawfulness • User acceptance • Appropriate security and privacy services
Model-Driven Architecture
Blobel B, Pharow P: Analysis and Evaluation of EHR Approaches MIE 2008, 26-28 May 2008, Göteborg, Sweden
Ent
erpr
ise
View
Info
rmat
ion
View
Com
puta
tiona
l Vie
w
Eng
inee
ring
View
Tech
nolo
gy V
iew
Business Concepts
Relations Network
Basic Services/Functions
Basic Concepts
Domain n Domain 2 Domain 1
Component View
Com
pone
nt
Com
posi
tion
System Perspective
Domain Perspective
Development Process Perspective
GCM Perspectives
Blobel B, Pharow P: Analysis and Evaluation of EHR Approaches MIE 2008, 26-28 May 2008, Göteborg, Sweden
Architecture Paradigms for Sustainable Health Information Systems
Paradigm Supported Characteristics Distribution Interoperability Component-orientation Flexibility, scalability Model-driven, service-oriented design, considering concepts, context and knowledge
User acceptance, lawfulness
Comprehensive business modeling User acceptance, lawfulness Separation of platform-independent and platform-specific modeling (separation of logical and technological view)
Portability
Specification of reference and domain models at meta-level Semantic interoperability agreed reference terminologies and ontologies Semantic interoperability Unified development process Semantic interoperability Performance, user friendliness User acceptance Embedding services in the architecture (including advanced security and privacy services)
User acceptance, lawfulness
Blobel B, Pharow P: Analysis and Evaluation of EHR Approaches MIE 2008, 26-28 May 2008, Göteborg, Sweden
GCM Characteristics HL7 Standards CCR EN/ISO 13606 openEHR IHE XDS DICOM SR
Development Process
Unified process Y N N N N N
Business modeling Y N N N P N
Service orientation P N N N P N
View separation P N N N N N
Completion of ISO 10746-2 Y N N N N N
System Architecture
Reference information model Y N Y Y Y Y
Meta model P N N N N N
Model transformation framework Y N N N N N
Concept representation Y P Y Y N Y
Consistency of components N Y Y Y Y Open concept representation language Y Y N N N N
Composition/decomposition Y N N N N N
Signature/Certificate-enabled N Y N N Y Y
Machine-processeable P P P P Y Y
Multi-Domain Suitability Domain-independent N N N N N N
Domain separation N N N N N P
Model multiplicity n 1 2 2 2 2
Ontology driven N N Y Y N N
Vocabulary Y N N N N N
Reference to terminology Y Y Y Y Y Y
Communication security services N Y N N Y Y
Application security services N Y P N N N
Inclusion of medical devices Y N F N F Y
Specialty-related N Y N N Y N
Multimedia-enabled P P N N Y Y
Feasibility
Visualization support Y Y N N N N
Blobel B, Pharow P: Analysis and Evaluation of EHR Approaches MIE 2008, 26-28 May 2008, Göteborg, Sweden
Many national and international projects and initiatives deal with design and implementation of semantically interoperable EHR systems.
No one standard currently meets all challenges for sustainable EHR solutions.
Different approaches such as HL7 v3, HL7 CDA, HL7 EHR, HL7 CCD, EN/ISO 13606 EHRcom, CEN HISA, openEHR, CCR, etc., provide a convergent pathway to component based, flexible, scaleable, business process controlled and service oriented, knowledge based, lawful, user friendly, and trustworthy EHR architectures as well as their implementation.
The Generic Component Model establishes a framework for developing and evaluating EHR systems and migration strategies for existing approaches
Interoperability requires quality assurance, testing and certification procedures.
Summary and Conclusion
Blobel B, Pharow P: Analysis and Evaluation of EHR Approaches MIE 2008, 26-28 May 2008, Göteborg, Sweden
Thank you for your attention! Bernd Blobel, PhD, Associate Professor eHealth Competence Center University of Regensburg Medical Center Franz-Josef-Strauss-Allee 11 D-93042 Regensburg, Germany Email: [email protected] Phone: +49-941-944 6769 Fax: +49-941-944 6766 http://www.ehealth-cc.de
We like to invite you to attend the EHR Workshop – National
Approaches for Sustainable, Semantically Interoperable and
Trustworthy EHR Solutions (Tuesday, 11:00-12:30, Track A) and the Joint Working Group Meeting of
EFMI WGs “EHR” and “Security, Safety and Ethics” (Tuesday,
18:00-18:40, Track C)