Carlos Cavero Barca

yourEHRM: Standard-based management of your personal healthcare information

The standardisation of the architecture of electronic healthcare records is essential for two reasons: i) the records are being used to support shared care among clinicians with different specializations; ii) the standardisation process eases the introduction of mobile technologies within and among countries between people who provide and receive healthcare. It is a common problem previously addressed in the literature that already existing EHR approaches often present interoperability issues that restrain their effective application, since the different system components do not share a common nomenclature, data types, message syntax and encoding rules. Hospitals cannot share the clinical information of the patient. yourEHRM architecture implements standards that enable the exchange of desired medical information. The solution is based on generic information models that conform to openEHR/EN13606 archetypes associated with concepts of well-known terminologies such as SNOMED-CT. Besides it offers the possibility to exchange information with other Hospital Information Systems (HIS) using Health Level 7 (HL7) Clinical Data Architecture (CDA), Continuity of Care Record (CCR), Continuity of Care Document (CCD) or virtual Medical Record (vMR) as the payload. The architecture also permits the integration of data coming from heterogeneous and fragmented healthcare information systems and devices into the EHR.

System Integration Issues for Next-Generation Remote Healthcare System

The system integration is always a terrible headache for IT technologists. Several aspects are related to a proper integration of different components and services into remote healthcare solution. Furthermore the overall integration issue cannot be regarded only from a technical point of view but it has to take into account aspects such as deployment scenario, service organization, educational and business context, resource sharing with other services. The system integration is a crucial activity and requires to be properly planned, it is based on system and service architecture design however it must be empowered taking into account use case and deployment scenario, functional and technical specification and interoperability requirements with other services. Due to the variety and complexity of system integration, in this chapter only some of the major issues related to system integration are taken into account; in particular the authors have selected the following main issues: system integration topics checklist; the interoperability and portability of data as one of the crucial aspects enabling system integration and proper deployment of solutions into the healthcare domain; structured approach for solution deployment; the user interface design as basic aspect to engage the medical professionals. Finally the critical issues are raised breaking down the lessons learnt.

Personal Health Record

This chapter focusses on the introduction of the Electronic (EHR) and Personal Health Records (PHR) as new technological approaches aimed at standardising electronic management of medical information between the patient and its physicians, as well as among medical organisations collaborating in providing integrated medical care services. It presents combined experiences in developing e-Health platforms and services with respect of supporting medical research into the causes and relationships among physiological parameters and health problems concerning different chronic diseases, cardiovascular, stroke, epilepsy, and others. The Personal Health Records (PHR) is presented as a new technological approach aimed at standardizing electronic management of medical information between the patient and its physicians, as well as among medical organizations collaborating in providing integrated medical care services. On the examples of most common commercial as well as open-source implementations of such system we aim to describe roles and aims behind electronic health recording, follow with applicable legal and standardizations frameworks and European activities in this area, leading towards introduction to most common commercial as well as open-source implementations of such systems and concluding with indication of specific adaptations enabling the use of stored personal health data for scientific research into causes and evaluation of chronic illnesses. We describe also ethical and privacy concerns that are relevant to using and exchanging electronic health information.

Patient Health Record (PHR) System

This chapter focusses on the introduction of the Electronic (EHR) and Personal Health Records (PHR) as new technological approaches aimed at standardising electronic management of medical information between the patient and its physicians, as well as among medical organisations collaborating in providing integrated medical care services. We start with the introduction of the roles and aims behind EHR, followed by the description of the applicable legal and standardisations frameworks and European activities in this area, finishing with the introduction to most common commercial as well as open-source implementations of such systems. As a conclusion we also signal ethical and privacy concerns that are relevant to using and exchanging electronic health information.

Advanced Medical Expert Support Tool (A-MEST): EHR-Based Integration of Multiple Risk Assessment Solutions for Congestive Heart Failure Patients

More and more the continuum of care is replacing the traditional way of treating the subjects of care putting people in the centre of the healthcare process. Currently clinicians start treatment after a problem occurs due to the low adoption of Clinical Decision Support Systems (CDSS) integrated with standardised Electronic Health Record (EHR) systems; The volume to value revolution in the healthcare (from stakeholder-centric to patient-centric) will allow doctors to follow the evolution of the individual before a medical episode happens, treating the patient based on statistical trends to forecast the future. The CDSS techniques applied on tele-monitoring tools permit the doctors to predict forthcoming events, improve the diagnosis and avoid continuous visits to the hospital, therefore saving costs. Advanced Medical Expert Support Tool is a step towards achieving the patient-centric approach by incorporating the health information into the EHR using European standards (ISO/EN 13606) to provide semantic interoperability by means of the dual model approach (reference model and archetypes). Three different CDSS modules have been implemented and contextualised publications are provided to the cardiologist to facilitate their daily work. A person-centric Graphical User Interface (GUI) facilitates the visualization of the health status of the patients providing meaningful information to the cardiologists. The use of archetypes allows scalability, transparency and efficiency to the hospital environment.

Archetype-based solution to tele-monitor patients with chronic diseases.

Health tele-monitoring systems can be applied to improve chronic diseases treatment and reduce cost of care delivery. Behind this innovative and promising philosophy in the care of people with chronic diseases several benefits can be found: hospitalizations may be reduced, improvement in the patients’ quality of life and clinical evaluations more precise. The tele-monitoring includes measuring and collecting health information about individual patients, thus the evolving concept of Electronic Health Record (EHR) is crucial. Getting a shareable and universally accessible EHR is a challenge whose importance is considered by organizations that establish and manage standards. In the context of the CHIRON project, Congestive Heart Failure (CHF) patients are enrolled in an observational study to be tele-monitored by experienced doctors. Technical solutions have been designed to deal with EHR desirable features and visual requirements for remote visualization and study. An EN13606/openEHR compliant kernel is the core component dealing with multisource patient data making up a complete EHR system assuring semantic interoperability. EN13606 [1] and more concretely openEHR [2] follows the two-level modelling approach describing specifications of a reference model and archetypes to store, retrieve, exchange and manage health data in EHRs. Dynamic components to access, visualise and insert data into patients’ records are shown through a doctor-friendly user interface called Slim MEST (light-weight Medical Expert Support Tool) and combines high flexibility and adaptability as it is built upon the same archetypes defined in openEHR-kernel. Functionality is extended by means of an ECG signal viewer application, which proofs versatility of data collected by sensors used in the tele-monitoring process providing the clinicians with a practical tool for their diagnosis.

Ubiquitous tele-monitoring kit (UTK): measuring physiological signals anywhere at anytime

The Ubiquitous Tele-monitoring Kit (UTK) is aimed at helping the clinician in acquiring, managing and normalizing information coming from the patients at home and storing the data in a distributed system. This approach aims to reduce costs in the healthcare system and alleviate the inherent problems to chronic patients who usually may visit the doctors. The proposed system closes the tele-monitoring loop; wearable and ergonomic sensors integrated in the textile, automatic detection and storage of the information coming from the sensors in a common platform (XNAT) and processing and visualization of the retrieved physiological signals presenting the data treated to the clinician to optimize the continuum of care and the decision-making.

Integrating an Electronic Health Record Graphical User Interface into Nanoelectronic-Based Biosensor Technology

Lack of good and standardised Electronic Health Record (EHR) Graphical User Interfaces (GUI) can hinder the acceptance of ground-breaking medical devices devoted to healthcare professionals and / or patients. Usually, the GUIs are designed too late in the process, rather than early and iteratively throughout the development of the device. In addition, end-users should be involved at all stages, from framing the GUI to be developed, to testing and validating it in ‘real situations’. Standards permit the interoperability between systems using a common reference model. In this article we present the work done in the development of an EHR GUI for an innovative nanotelectronic-based biosensor technology for cardiovascular diseases diagnosis integrating standardised EHR information into the patient health profile. The challenge was ensuring that the Information Technology developments contributed to the effectiveness and acceptance of the device among medical community. We have achieved this goal based on: (i) a close work with the biosensors developers, in order to gain a better understanding of technology needs; (ii) development of information systems that consider the connection and communication with already widespread hospital information systems using the European standard EN13606 to guarantee the usefulness of the gathered patient data; (iii) a User-Centred Design approach, involving doctors from the very start of the development, producing a more intuitive and acceptable tool for healthcare professionals.

Adopting Rule-Based Executions in SOA-Oriented Remote Patient Monitoring Platform with an Alarm and Alert Subsystem

Monitoring and event handling are important aspects in the EU funded REACTION project and its remote patient monitoring services. The REACTION platform is designed to let any application to be able to react ubiquitously to change in a patient’s health state and environment and perform pre-defined activities such as alarm handling according to pre-programmed rules. This paper presents and discusses the platform’s alarm and alert handling system out of technical perspectives.

Medical expert support tool (MEST): a person-centric approach for healthcare management

The Medical Expert Support Tool (MEST) is aimed at helping the clinician in recognizing risk factors in the patient status by offering a multiparametric overview, and by highlighting the individual situation using meaningful colors (green, yellow and red) in order to compare the person physiological parameters with the computed profile. The medical professionals configure the conditions (relevant parameters, thresholds, rules and alerts) setting the values to the decision support modules and receiving the risk assessment results. Finally, interventions should be done depending on the evaluation of the patient. The tool has been designed along with the clinician involved in the project and it will be fully tested and evaluated during the observational study (100 patients) starting on June 2012.