Damon Berry

A CORBA-based integration of distributed electronic healthcare records using the Synapses approach

The ability to exchange in a meaningful, secure, and simple fashion relevant healthcare data about patients is seen as vital in the context of efficient and cost-effective shared or team-based care. The electronic healthcare record (EHCR) lies at the heart of this information exchange, and it follows that there is an urgent need to address the ability to share EHCRs or parts of records between carers and across distributed health information systems. This paper presents the Synapses approach to sharing based on a standardized shared record, the Federated Healthcare Record, which is implemented in an open and flexible manner using the Common Object Request Broker Architecture (CORBA). The architecture of the Federated Healthcare Record is based on the architecture proposed by the Technical Committee 251 of the European Committee for Standardization.

Sharing health-care records over the Internet

Presents a novel approach to sharing electronic health-care records that leverages the Internet and the World Wide Web, developed as part of two European Commission-funded projects, Synapses and SynEx. The approach provides an integrated view of patient data from heterogeneous, distributed information systems and presents it to users electronically. Synapses and SynEx illustrate a generic approach in applying Internet technologies for viewing shared records, integrated with existing health computing environments. Prototypes have been validated in a variety of clinical domains and health-care settings.

Interoperability issues in sharing electronic healthcare records-the Synapses approach

This paper describes the approach to information sharing being adopted by Synapses, a pan-European project funded under the EU Health Telematics Programme. The emphasis in Synapses is on developing standards to enable sharing, in whole or in part, of electronic healthcare records between distributed healthcare providers and institutions. The current technological solutions available for data sharing, including federated database systems, gateways, data warehousing, messaging and the web are insufficient on their own to meet the needs of Synapses. Thus in Synapses several different, but complementary technologies are merged in an open, distributed object-oriented environment. Furthermore, in order to safeguard the legal, ethical and clinical integrity of the record, it is essential not only to preserve the meaning of the data being transferred, but also its context and structure. Synapses solves this problem by defining a standard architecture for the federated electronic healthcare record.

An Analysis Framework for Electronic Health Record Systems

BACKGROUND The timely provision of complete and up-to-date patient data to clinicians has for decades been one of the most pressing objectives to be fulfilled by information technology in the healthcare domain. The so-called electronic health record (EHR), which provides a unified view of all relevant clinical data, has received much attention in this context from both research and industry. This situation has given rise to a large number of research projects and commercial products that aim to address this challenge. Different projects and initiatives have attempted to address this challenge from various points of view, which are not easily comparable. OBJECTIVES This paper aims to clarify the challenges, concepts, and approaches involved, which is essential in order to consistently compare existing solutions and objectively assess progress in the field. METHODS This is achieved by two different means. Firstly, the paper will identify the most significant issues that differentiate the points of view and intended scope of existing approaches. As a result, a framework for analysis of EHR systems will be produced. Secondly, the most representative EHR-related projects and initiatives will be described and compared within the context of this framework. RESULTS The main result of the present paper is an analysis framework for EHR systems. This is intended as an initial step towards an attempt to structure research on this field, clearly lacking sound principles to evaluate and compare results, and ultimately focusing its efforts and being able to objectively evaluate scientific progress. CONCLUSIONS Evaluation and comparison of results in medical informatics, and specifically EHR systems, must address technical and non-technical aspects. It is challenging to condensate in a single framework all potential views of such a field, and any chosen approach is bound to have its limitations. That being said, any well structured comparison approach, such as the framework presented here, is better than no comparison framework at all, as has been the current situation to date. This paper has presented the first attempt known to the authors to define such a framework.

Clinical coverage of an archetype repository over SNOMED-CT

Clinical archetypes provide a means for health professionals to design what should be communicated as part of an Electronic Health Record (EHR). An ever-growing number of archetype definitions follow this health information modelling approach, and this international archetype resource will eventually cover a large number of clinical concepts. On the other hand, clinical terminology systems that can be referenced by archetypes also have a wide coverage over many types of health-care information. No existing work measures the clinical content coverage of archetypes using terminology systems as a metric. Archetype authors require guidance to identify under-covered clinical areas that may need to be the focus of further modelling effort according to this paradigm. This paper develops a first map of SNOMED-CT concepts covered by archetypes in a repository by creating a so-called terminological Shadow. This is achieved by mapping appropriate SNOMED-CT concepts from all nodes that contain archetype terms, finding the top two category levels of the mapped concepts in the SNOMED-CT hierarchy, and calculating the coverage of each category. A quantitative study of the results compares the coverage of different categories to identify relatively under-covered as well as well-covered areas. The results show that the coverage of the well-known National Health Service (NHS) Connecting for Health (CfH) archetype repository on all categories of SNOMED-CT is not equally balanced. Categories worth investigating emerged at different points on the coverage spectrum, including well-covered categories such as Attributes, Qualifier value, under-covered categories such as Microorganism, Kingdom animalia, and categories that are not covered at all such as Cardiovascular drug (product).

A mobile ECG monitoring system with context collection

Preventative health management represents a shift from the traditional approach of reactive treatment-based healthcare towards a proactive wellness-management approach where patients are encouraged to stay healthy with expert support when they need it, at any location and any time. This work represents a step along the road towards proactive, preventative healthcare for cardiac patients. It seeks to develop a smart mobile ECG monitoring system that requests and records context information about what is happening around the subject when an arrhythmia event occurs. Context information about the subject’s activities of daily living will, it is hoped, provide an enriched data set for clinicians and so improve clinical decision making. As a first step towards a mobile cardiac wellness guideline system, the authors present a system which can receive bio-signals that are wirelessly streamed across a body area network from Bluetooth enabled electrocardiographs. The system can store signals as they arrive while also responding to significant changes in Electrocardiogram activity. The authors have developed a prototype on a handheld computer that detects and responds to changes in the calculated heart rate as detected in an ECG signal. Although the general approach taken in this work could be applied to a wide range of bio-signals, the work focuses on ECG signals. The components of the system are, A Bluetooth receiver, data collection and storage module A real-time ECG beat detection algorithm. An Event-Condition-Action (E-CA) rule base which decides when to request context information from the user. – A simple user interface which can request additional information from the user. A selection of real-time ECG detection algorithms were investigated for this work and one algorithm was tested in MATLAB and then implemented in Java. In order to collect ECG signals (and in principle any signals), the generalised data collection architecture has also been developed using Java and Bluetooth technology. An Event-Condition-Action (ECA) rule based expert system evaluates the changes in heart beat interval to decide when to interact with the user to request context information. Keywords— ECG, PDA, Holter and ECA.

Identity Management to Support Access Control in E-Health Systems

The related and often challenging topics of identity management and access control form an essential foundation for e-health infrastructure. Several approaches and supporting specifications for electronic healthcare record system (EHR-S) communication have been proposed by research projects and standards development organizations in recent years. For instance, part four of the CEN TC251 EN13606 EHRcom standard and the HL7 Role Based Access Control Draft Standard for Trial Use have helped to specify the nature of access control behaviour in relation to EHR communication within and between healthcare organisations. Access control services are a core component not only of the integrated care EHR-S but also for other information systems in the e-health domain. To underpin functionality of this type in a distributed environment, it is necessary to provide access to scalable, secure and uniform ID domains for users and patients.

An Investigation of the use of a High Resolution ADC as a “Digital Biopotential Amplifier”

Sigma delta analogue to digital converters have been used in many signal processing applications including some commercially available systems for sampling of bio-signals

Using structured P2P overlay networks to build content sensitive communities

This paper details a proposed peer-to-peer system, which allows a user to join communities of other like-minded users in order to exchange files. Utilising the routing capabilities of Pastry, the proposed system includes an indexing service, which facilitates the creation of virtual rendezvous points for users with similar interests (manifested by shared keywords). Users are described by the content they store. By using vector space modelling techniques users can be grouped together to form content sensitive communities. The system is built to serve as the basis for a distributed archive of research papers. The system is designed to improve the efficiency of file searches over current P2P file sharing applications. Search requests result in a comprehensive set of relevant documents being returned as searching are based on semantic meaning rather than literal matching.

Towards a Digital Earth: using archetypes to enable knowledge interoperability within geo-observational sensor systems design

Earth System Science (ESS) observational data are often inadequately semantically enriched by geo-observational information systems to capture the true meaning of the associated data sets. Data models underpinning these information systems are often too rigid in their data representation to allow for the ever-changing and evolving nature of ESS domain concepts. This impoverished approach to observational data representation reduces the ability of multi-disciplinary practitioners to share information in a computable way. Object oriented techniques that are typically employed to model data in a complex domain (with evolving domain concepts) can unnecessarily exclude domain specialists from the design process, invariably leading to a mismatch between the needs of the domain specialists, and how the concepts are modelled. In many cases, an over simplification of the domain concept is captured by the computer scientist. This paper proposes that two-level modelling methodologies developed by health informaticians to tackle problems of domain specific use-case knowledge modelling can be re-used within ESS informatics. A translational approach to enable a two-level modelling process within geo-observational sensor systems design is described. We show how the Open Geospatial Consortium’s (OGC) Observations & Measurements (O&M) standard can act as a pragmatic solution for a stable reference-model (necessary for two-level modelling), and upon which more volatile domain specific concepts can be defined and managed using archetypes. A rudimentary use-case is presented, followed by a worked example showing the implementation methodology and considerations leading to an O&M based, two-level modelling design approach, to realise semantically rich and interoperable Earth System Science based geo-observational sensor systems.