Josef Ingenerf

Standardized terminological services enabling semantic interoperability between distributed and heterogeneous systems

The interconnection of heterogeneous computer applications in medicine raises the issue of semantic interoperability, going beyond traditional approaches of terminological standardization in basically three aspects. First, the variety of medical vocabularies that currently coexist in different domains is a major barrier for the integration of autonomously developed applications. Fortunately, with the Unified Medical Language System (UMLS) there are machine-readable terminological sources that cover and integrate most of the existing medical vocabularies. Second, the exchanged data need to be processed by a machine for different purposes like patient data integration, access to literature and knowledge bases as well as clinical audit and research. Medical vocabularies provided as passive dictionaries are no longer sufficient. Software system developers should take advantage of terminological services for refining user queries, for mapping the users terms to appropriate medical vocabularies etc. Third, the services should be accessible uniformly and transparently. In the CORBAmed initiative a proposal for a standardized interface for querying and accessing computerized medical terminology resources was created. Based on the mentioned principles the MUSTANG system (Medical UMLS based Terminology Server for Authoring, Navigating and Guiding the Retrieval to Heterogeneous Knowledge Sources) has been developed. It is implemented on a Windows NT platform using the ORACLE database management and development software. The terminological services are accessible via multiple interfaces. The MUSTANG-System and the experiences with using terminological services in practice are described. Opposed to other levels of standardization like syntactical message standards there is much more a hesitation in the use of standardized terminology.

Telemedicine and terminology: different needs of context information

Traditionally, communication between healthcare providers, including the provision of physicians with information and knowledge, works quite well because there are implicitly common conventions and assumptions in the collaboration of all involved actors. The basic prerequisite of the communication process between humans is a mutual agreement on syntax and semantics of oral and written language, i.e., of the medical sublanguage. With telemedicine, i.e., the use of telecommunication and informatics in medicine, this prerequisite is no longer sufficient. First, various professionals from different clinical communities, characterized by specialty, nationality, school, etc., share the management of the patients health. Second, electronically communicated information is more and more intended for processing by computer applications rather than for direct interpretation by human users. Third, the interconnection of distributed heterogeneous software systems in medicine raises the issue of semantic interoperability, especially the problem of data integration. A faithful communication in such a scenario must be based on explicit assumptions behind a message. Interpreting an usually highly context-dependent utterance demands for mechanisms on a pragmatic level in natural language processing. The need for additional processing and integration of the transferred data by the receiving system demands for standardization and mediation, taking into consideration contextual knowledge that cannot entirely be explained and processed with linguistic and terminological approaches. This paper describes different categories of contexts and also different needs of applications concerning context awareness.

Reporting Device Observations for semantic interoperability of surgical devices and clinical information systems.

Service-oriented medical device architectures make the progress from interdisciplinary research projects to international standardisation: A new set of IEEE 11073 proposals shall pave the way to industry acceptance. This expected availability of device observations in a standardised representation enables secondary usage if interoperability with clinical information systems can be achieved. The Device Observation Reporter (DOR) described in this work is a gateway that connects these realms. After a user chooses a selection of signals from different devices in the digital operating room, the DOR records these semantically described values for a specified duration. Upon completion, the signals descriptions and values are transformed to Health Level Seven version 2 messages and sent to a hospital information system/electronic health record system within the clinical IT network. The successful integration of device data for documentation and usage in clinical information systems can further leverage the novel device communication standard proposals. Complementing these, an Integrating the Healthcare Enterprise profile will aid commercial implementers in achieving interoperability. Their solutions could incorporate clinical knowledge to autonomously select signal combinations and generate reports of diagnostic and interventional procedures, thus saving time and effort for surgical documentation.

Semantic interoperability in the OR.NET project on networking of medical devices and information systems — A requirements analysis

OR.NET is the German national flagship project on networking of medical devices and information systems. Its objective is to define, implement and validate a standard-based integration solution for safe and dynamic networking of devices and systems in the operating room and its clinical surroundings. An important part of this project is to ensure semantic interoperability. Besides standardized inter-device communication, this task needs an engine for semantic mediation between heterogeneous communication partners. This work analyses the requirements that need to be satisfied by such an engine. It will have to transform messages between different forms of standardized representation in the operational environment of an open communication framework. Especially the information exchange between devices and information systems will be dependent on the engines reliable and verifiable semantic mediation. Being deployed on an embedded device in a service-oriented architecture based on web services, the component will have to comply not only with international healthcare standards and medical device directives but also with W3C specifications to provide and describe its capabilities. In the future, the semantic interoperability engine could be extended to a general ontology-based framework, further promoting and supporting device integration based on standards in the surgery domain.

Connecting the clinical IT infrastructure to a service-oriented architecture of medical devices

Abstract The new medical device communication protocol known as IEEE 11073 SDC is well-suited for the integration of (surgical) point-of-care devices, so are the established Health Level Seven (HL7) V2 and Digital Imaging and Communications in Medicine (DICOM) standards for the communication of systems in the clinical IT infrastructure (CITI). An integrated operating room (OR) and other integrated clinical environments, however, need interoperability between both domains to fully unfold their potential for improving the quality of care as well as clinical workflows. This work thus presents concepts for the propagation of clinical and administrative data to medical devices, physiologic measurements and device parameters to clinical IT systems, as well as image and multimedia content in both directions. Prototypical implementations of the derived components have proven to integrate well with systems of networked medical devices and with the CITI, effectively connecting these heterogeneous domains. Our qualitative evaluation indicates that the interoperability concepts are suitable to be integrated into clinical workflows and are expected to benefit patients and clinicians alike. The upcoming HL7 Fast Healthcare Interoperability Resources (FHIR) communication standard will likely change the domain of clinical IT significantly. A straightforward mapping to its resource model thus ensures the tenability of these concepts despite a foreseeable change in demand and requirements.

Design, implementation, and evaluation of a mobile application for patient empowerment and management of long-term follow-up after childhood cancer.

In Germany, about 1,800 new cases of childhood cancer are diagnosed every year. The chances of survival have increased significantly over the last 40 years due to the continuous improvement of treatment strategies. The number of childhood cancer survivors in Germany thus ranges around 30,000 nowadays. But their treatment with surgery, chemotherapy, and radiation has certain side-effects. In addition to the acute effects during the treatment phase, the disease- and treatment-related late effects can occur even decades after the end of therapy. These late effects draw attention as the survival rate constantly increases. Two-thirds of the former patients retain long-term consequences, nearly a fifth with a resulting diminished quality of life. Early detection of these late effects can help to reduce or even to prevent serious health damage. Therefore, the study group LESS supplies long-term follow-up recommendations for former patients. The project described in this paper was to design and implement a mobile application to increase the compliance for this aftercare program. This application provides information about the patients individual aftercare plan and supports appointment management as well as a reminding functionality. A prototype for former osteosarcoma patients was tested and evaluated in two university hospitals. First results show the applications very high potential for patient empowerment.

Extending the IEEE 11073-1010X nomenclature for the modelling of surgical devices

The current lack of medical device interoperability can only be overcome by the usage of structural and semantic standards. Therefore, a modern service-oriented architecture for systems of networked medical devices has been developed within the IEEE 11073 series. Its application to new domains such as surgery also demands an extension of the IEEE 11073-1010X Nomenclature, which was initially designed for only a limited set of device types. We thus propose new terms for surgical devices and component interactions, options for the (limited) post-coordination of terms, and term mapping to SNOMED CT and LOINC. In addition, we discuss the development of device specialisation standards.

Point-of-care medical devices and systems interoperability: A mapping of ICE and FHIR

Medical devices at the point-of-care can be interconnected through standardised communication protocols to build an Integrated Clinical Environment (ICE), but in order to interoperate with clinical information systems, different data exchange standards need to be conformed to. The emerging HL7 Fast Healthcare Interoperability Resources (FHIR) framework appeals to developers and clinicians alike and is a promising candidate to modernise this domain. Novel IEEE 11073 standard proposals that specify a service-oriented architecture of networked medical devices are one example for an ICE architecture. They are based on expressing a devices capabilities and state in a machine-readable way in order to be safely accessed and manipulated by other participants in the networked device system. In this work, the domain information and service model of this ICE architecture was mapped to FHIR resources that were constrained and extended to support the modelling of this device architecture. Through the definition of a FHIR profile, the data structures were aligned, effectively allowing for the transformation of medical device observation data from ICE to FHIR representation without the need for any proprietary interface. The implementation of this transformation, e. g. as a gateway, bridges the structural interoperability gap between two contemporary communication architectures for medical devices and clinical information systems and thus lays the foundation for semantic interoperability that can be achieved through the combined use with controlled vocabularies. The consequent availability of device data enables secondary usage such as large-scale data analytics. Future sub-profiles for specific device types further simplify the transformation.

Der Impact der Medizinischen Informatik

ZusammenfassungMedizin ist ein wichtiges Anwendungsgebiet der Informatik. Medizinische Informatik bietet anwendungsorientierte Lösungen durch den Einsatz oder die Anpassung bestehender Ideen, Methoden und Ergebnisse der Informatik. Umgekehrt gibt es in der Medizinischen Informatik auch eigenständige Entwicklungen, die die Informatik im Allgemeinen mit wesentlichen grundlegenden Lösungen beeinflussen und bereichern. Solche Bereiche sind vor allem Bildverarbeitung, Informationssysteme, Prozessunterstützung, Klassifikationen und Terminologien (Ontologien) sowie datenschutzfördernde Techniken und Beweis- und IT-Sicherheit.