Sufficiently Advanced

“Moving from a paper to a digital record brings issues of interoperability and distinguishability. In a paper world, form, presentation and content have been understood for thousands of year. Paper is paper, interoperability is a physical act: obtaining a chart, faxing a record or making a duplicate. And, paper being paper, dispenses with distinguishability as well—recognition and ability to use is mastered in childhood.”
Article
Symtym, 16 November 2008

OpenEHR: The World’s Record

“In a world where connectivity reigns, our health information is largely still caught up in silos and, in the main, is not shareable by clinicians. Shared electronic health records (SEHRs) are increasingly needed to provide timely, comprehensive and coordinated healthcare. Over many years there have been ongoing and thorough attempts to achieve the sharing of health information in order to support the improvement of health outcomes, but this incremental approach, gradually building on previous experience, has not been wholly successful. Progress has been made; however despite enormous investment and resources, the solution has been more difficult than most ever anticipated. Healthcare provision does not seem to fit into the same kind of data sharing model that has been successful in other domains, such as banking or financial services.”
Article
Trend of IT, 23 October 2008

Standards near for intelligent EHRs

“Intelligent electronic health records (iEHRS) will be the core of future e-health programs, something that standards bodies and government agencies are increasingly recognizing, according to one of the main proponents of the technology.
iEHRs take advantage of advances in computer semantics in ways that enable pertinent clinical data to be collected for physicians, researchers, and even public safety officials in real time.”
Article
Brian Robinson, GHIT Notebook, 22 October 2008

Semantic Web Sparks Evolution of Health 2.0 – A Road Map to Consumer-Centric Healthcare

“Delivery strategy in a consumer-centric healthcare system focuses on identifying, facilitating, and integrating online and offline communication and care delivery channels needed to reach and coordinate end goals (value) as defined by disparate customer segments (patient, provider, payor, policymaker, caretaker, etcetera).
Services are location independent, time independent, provider de-linked, and value-generating. Rising healthcare costs, increasing chronic conditions, and barriers to access drive the search for a new route to safer, cost-effective quality care.
Health 2.0 is content and community: patients trusting patients. The semantic web sparks Health 2.0 evolution towards more consumer-centric care by enabling viral network growth and increasing personal-usage value of patient-created, “human-to-human” centric networks.
Semantic web technology and open source API development provide opportunities to build consumer-centric services.  But the roadmap for true consumer-centric care does not end with semantic web growth – rather it begins there.
The authors present a conceptual roadmap for reaching consumer-centric care at the intersection of two rapidly-evolving developmental axes: joining patients and professionals in the healthcare conversation and combining brick-and-mortar real world systems with virtual online services. Future evolutionary phases Health 3.0 and 4.0 are defined using examples.
The authors provide a model, termed “neXthealth,” which gives stakeholders concrete tools to define their position (using existing service lines and development initiatives) and focus on four critical factors needed to realize complete consumer-centric care: content, community, commerce and coherence.”
Article
Jen McCabe Gorman and Maarten den Braber, September 2008

My motivations

“I am a physician and researcher passionate on the “new” patient-health care provider relationship, specifically on topics of patient engagement and empowerment , virtual communities and support groups, new models of care for patients, remote patient monitoring, shared decision making, and equity in health through technology.
I am a ’survivor’ of three near-death experiences in early 2006 (an accident, a medical error, and a complicated surgery). My body shows the scars of lessons learned and my mind is filled with ideas and solutions on how to improve the patient experience and outcomes.”
Article
Carlosrizo.com, 9 September 2008

Version 3 of HL7 released

“Developer of global healthcare standards, Health Level Seven, has announced the release of Version 3 Normative Edition 2008, a globally-defined suite of specifications based on HL7’s Reference Information Model.
Article
e-Health Europe, 18 August 2008

La interoperabilidad semántica se fijará en el coste-beneficio para avanzar

“Ingenieros y clínicos deben caminar de la mano para que la interoperabilidad semántica avance, ya que es un campo imprescindible para la actual sanidad que sólo en los dos o tres últimos años ha avanzado realmente. Para que esta progresión siga, e incluso aumente, habrá que fijarse en el coste-beneficio y ver dónde aporta un valor añadido.”
Article (Spanish)
David Rodríguez Carenas, Diario Medico, 30 July 2008

A development framework for semantically interoperable health information systems

“Background
Semantic interoperability is a basic challenge to be met for new generations of distributed, communicating and co-operating health information systems (HIS) enabling shared care and e-Health. Analysis, design, implementation and maintenance of such systems and intrinsic architectures have to follow a unified development methodology.
Methods
The Generic Component Model (GCM) is used as a framework for modeling any system to evaluate and harmonize state of the art architecture development approaches and standards for health information systems as well as to derive a coherent architecture development framework for sustainable, semantically interoperable HIS and their components. The proposed methodology is based on the Rational Unified Process (RUP), taking advantage of its flexibility to be configured for integrating other architectural approaches such as Service-Oriented Architecture (SOA), Model-Driven Architecture (MDA), ISO 10746, and HL7 Development Framework (HDF).
Results
Existing architectural approaches have been analyzed, compared and finally harmonized towards an architecture development framework for advanced health information systems.
Conclusion
Starting with the requirements for semantic interoperability derived from paradigm changes for health information systems, and supported in formal software process engineering methods, an appropriate development framework for semantically interoperable HIS has been provided. The usability of the framework has been exemplified in a public health scenario.”
Abstract
Diego M. Lopez and Bernd G.M.E. Blobel, International Journal of Medical Informatics, In Press, Corrected Proof, Available online 14 July 2008, doi:10.1016/j.ijmedinf.2008.05.009

E-Health 3.0: How Can The Semantic Web Change The World Of Internet Health Information?

“Access to online health information is something most individuals take for granted these days. Whether sifting through a million Google hits or a laborious visit to WebMD, most people with access to a computer have utilized the current online health tools. Just ten years ago, few would give credence to reputable health information posted on the Web. Even fewer of us would rely on it as a primary or secondary source of medical information. Yet, recent Pew research suggests that 8 in 10 Internet users go online for health information totaling eight million health searches on a typical day. While the depth of information on the Web has increased dramatically, the ability to access the right information has floundered in comparison. Contextual data retrieval is particularly critical with health information and by most accounts the Internet is a mess in this regard. The ground breaking idea of a new search paradigm known as Semantic Web may hold the promise of a cure.”
Article
Alex Trzebucki, Medical News Today, 13 June 2008

Web 2.0 and the Semantic Web – The Healthcare Viewpoint.

“The following really interesting article came to my attention a few days ago.
Healthcare and Emerging Rich Web Technologies – The WEB 2.0/Semantic Web Challenge and Opportunity
Article
David More, Australian Health Information Technology, 5 June 2008

Semantic search vs Google: In Medicine

“I’ve been playing with Powerset for a while. It seems to be a service that can take us to the world of semantic web or web 3.0. It uses Wikipedia and Freebase as resources. The main idea is to ask questions instead of search for terms. Let’s give it a try.”
Article
Bertalan Meskó, ScienceRoll, 26 May 2008

Call for semantic health interoperability

“A leading UK academic has called for a new push on the development of semantic electronic health records based on ‘clinical archetypes’ as the only viable route to deliver fully interoperable electronic health care records, writes Jon Hoeksma in Slovenia.
Dr Dipak Kalra of University College London said clinical archetypes, or “clinical shapes” need to be used in tandem with the advanced clinical standards terminology of SNOMED CT to develop fully interoperable EHRs. He described archetypes as a tool “for building clinical consensus in a consistent ways”.”
Article
e-Health Europe, 6 May 2008

Semantic Interoperability for Electronic Health Records

“Semantic interoperability - the ability to send human readable and computable records from place to place. An electronic health record with vocabulary controlled, structured problem lists, medications, labs, and radiology studies sending this data into structured lists within a personal health record is an example of semantic interoperability. Semantic interoperability ensures that decision support software can interpret the transmitted data and perform quality and safety checks such as drug/drug or drug/allergy checking. Google Health supports semantic interoperability for problems, medications, allergies and laboratories. The Continuity of Care Document, the clinical summary which has been recognized by Secretary Leavitt and the American Health Information Community (AHIC) is semantically interoperable, as detailed below.”
Article
John Halamka, Life as a Healthcare CIO, 5 May 2008

Consumer Health Information Seeking as Hypothesis Testing

Objective Despite the proliferation of consumer health sites, lay individuals often experience difficulty finding health information online. The present study attempts to understand users’ information seeking difficulties by drawing on a hypothesis testing explanatory framework. It also addresses the role of user competencies and their interaction with internet resources.
Design Twenty participants were interviewed about their understanding of a hypothetical scenario about a family member suffering from stable angina and then searched MedlinePlus® consumer health information portal for information on the problem presented in the scenario. Participants’ understanding of heart disease was analyzed via semantic analysis. Thematic coding was used to describe information seeking trajectories in terms of three key strategies: verification of the primary hypothesis, narrowing search within the general hypothesis area and bottom-up search.
Results Compared to an expert model, participants’ understanding of heart disease involved different key concepts, which were also differently grouped and defined. This understanding provided the framework for search-guiding hypotheses and results interpretation. Incorrect or imprecise domain knowledge led individuals to search for information on irrelevant sites, often seeking out data to confirm their incorrect initial hypotheses. Online search skills enhanced search efficiency, but did not eliminate these difficulties.
Conclusions Regardless of their web experience and general search skills, lay individuals may experience difficulty with health information searches. These difficulties may be related to formulating and evaluating hypotheses that are rooted in their domain knowledge. Informatics can provide support at the levels of health information portals, individual websites, and consumer education tools.
Article
Alla Keselman, Allen C. Browne, and David R. Kaufman, Journal of the American Medical Informatics Association, April 24, 2008 as JAMIA PrePrint; doi:10.1197/jamia.M2449

Consumer Health Concepts that do not Map to the UMLS: Where Do They Fit?

Objective This study has two objectives: first, to identify and characterize consumer health terms not found in the Unified Medical Language System (UMLS) Metathesaurus (2007 AB); second, to describe the procedure for creating new concepts in the process of building a consumer health vocabulary. How do the unmapped consumer health concepts relate to the existing UMLS concepts? What is the place of these new concepts in professional medical discourse?
Design The consumer health terms were extracted from two large corpora derived in the process of Open Access Collaboratory Consumer Health Vocabulary (OAC CHV) building. Terms that could not be mapped to existing UMLS concepts via machine and manual methods prompted creation of new concepts, which were then ascribed semantic types, related to existing UMLS concepts, and coded according to specified criteria.
Results This approach identified 64 unmapped concepts, 17 of which were labeled as uniquely “lay” and not feasible for inclusion in professional health terminologies. The remaining terms constituted potential candidates for inclusion in professional vocabularies, or could be constructed by post-coordinating existing UMLS terms. The relationship between new and existing concepts differed depending on the corpora from which they were extracted.
Conclusion Non-mapping concepts constitute a small proportion of consumer health terms, but a proportion that is likely to affect the process of consumer health vocabulary building. We have identified a novel approach for identifying such concepts.
Article
Alla Keselman, Catherine Arnott Smith, Guy Divita, Hyeoneui Kim, Allen C. Browne, Gondy Leroy, and Qing Zeng-Treitler, Journal of the American Medical Informatics Association, April 24, 2008 as JAMIA PrePrint; doi:10.1197/jamia.M2599

Improving Healthcare Middleware Standards with Semantic methods and technologies

Abstract:
A critical issue in healthcare informatics is to facilitate the integration and interoperability of applications. This goal can be achieved through an open architecture based on a middleware independent from specific applications; useful for working with existing systems, as well as for the integration of new systems. Several standard organizations are making efforts toward this target. This work is based on the EN 12967-1,2,3, developed by CEN, that follows the ODP (Open Distributed Processing) methodology, providing a specification of distributed systems based on the definition of five viewpoints. However, only the three upper viewpoints are used to produce EN 12967, the two lower viewpoints should be considered in the implementation context. We are using Semantic Grid for lower views and Semantic Web and Web Services for the definition of the upper views. We analyze benefits of using these methods and technologies and expose methodology for the development of this semantic healthcare middleware observing European Standards.

Isabel Román^a,b, Jorge Calvillo^b,a, Laura M. Roa^a,b and Germán Madinabeitia^a
a University of Seville, Spain
^b CIBER-BBN, Seville, Spain

To be published in “Medical and Care Compunetics 5″, IOSPress, 2008.
To be presented at the ICMCC Event 2008.

Exchange of Computable Patient Data between the Department of Veterans Affairs (VA) and the Department of Defense (DoD): Terminology Mediation Strategy

“Complete patient health information that is available where and when it is needed is essential to providers and patients and improves healthcare quality and patient safety. VA and DoD have built on their previous experience in patient data exchange to establish data standards and terminology services to enable real-time bi-directional computable (i.e., encoded) data exchange and achieve semantic interoperability in compliance with recommended national standards and the eGov initiative. The project uses RxNorm, UMLS, and SNOMED CT terminology standards to mediate codified pharmacy and allergy data with greater than 92 and 60 percent success rates respectively. Implementation of the project has been well received by users and is being expanded to multiple joint care sites. Stable and mature standards, mediation strategies, and a close relationship between healthcare institutions and Standards Development Organizations are recommended to achieve and maintain semantic interoperability in a clinical setting.”
Abstract
Omar Bouhaddou, Pradnya Warnekar, Fola Parrish, Nhan Do, Jack Mandel, John Kilbourne and Michael J. Lincoln, Journal of the American Medical Informatics Association, Volume 15, Issue 2, March-April 2008, Pages 174-183, doi:10.1197/jamia.M2498

Web 3.0 for healthcare at SWWS’08 - The 2008 International Conference on Semantic Web and Web Services

Modern Healthcare Systems that have embraced Internet technologies are evolving towards self management from a clinical knowledge perspective. In contrast, patients are using Web 2.0 technologies and developing social networking communities for healthcare which are evolving towards becoming user-generated online medical portals or Health 2.0. Semantic Web or Web 3.0 is now being developed by adding Artificial Intelligence to internet services to deliver the next generation of personalised services. A grand challenge is to define Web 3.0 solutions for healthcare. A pioneering session at SWWS 08 focuses on these research developments in a seamlessly connected health community which brings together Web, Web 2.0 and Web 3.0 technologies for personalised healthcare.

We are at a pioneering stage to combine forces and bring together the research community to focus future activities and align developments towards community generated healthcare solutions (or Web 3.0 for healthcare). Become actively involved and submit a paper with unpublished original work associated with user-generated healthcare solutions (web 2.0, health 2.0), web 3.0 services for healthcare and visionary papers on community generated healthcare solutions. All accepted papers will be published in the conference proceedings/book.

Call for papers

A method to map heterogeneity between near but non-equivalent semantic attributes in multiple health data registries

“Health registries from multiple jurisdictions often include terms that are assumed to be semantically equivalent (e.g. fetal death and stillbirth). Closer examination reveals that such attributes have near — but non-equivalent — semantics. Thus their degree of semantic heterogeneity is an important indicator of uncertainty associated with data integration between registries. We build an OWL-encoded ontology which formalizes the relationships between similar perinatal concepts found in different databases. We also introduce the concept of ontology-based metadata as a means of contextualizing such terms and linking context to the attribute data. This extended metadata are exported as XML from the health registries, and it — along with the OWL ontology — is interfaced via a web-based GUI accessible to health researchers. The GUI mapping serves as the basis for making ad hoc comparison and integration decisions. Uncertainty is addressed by precisely mapping semantic heterogeneity between fields.”
Abstract
Nadine Schuurman and Agnieszka Leszczynski, Health Informatics Journal, Vol. 14, No. 1, 39-57 (2008), DOI: 10.1177/1460458207086333

UPMC Prepares Clinical Data Interoperability Project

“Soon doctors and other clinicians at the University of Pittsburgh Medical Center’s many hospitals and outpatient offices will be able to access key patient data, such as drug information, in a single view.
On Feb. 3, UPMC will begin to go live with the fruits of a multimillion-dollar interoperability project that’s been more than a year in the making.”
Article
Marianne Kolbasuk McGee, InformationWeek, 3 January 2008

Web 3.0 and medicine

“Make way for the semantic web
This time last Christmas, medical blogs and RSS feeds were the hot technology topics, and we were debating the merits of newer models of scholarly publishing in web 2.0, such as open access and medical wikis. Can web 3.0 be here already?
Article
Editorial, BMJ  2007;335:1273-1274 (22 December), doi:10.1136/bmj.39428.494236.BE

Semantic interoperability of EHR systems

Dipak Kalra a & Bernd Blobel b
a CHIME – Centre for Health Informatics and Multiprofessional Education, University College London, United Kingdom
b eHealth Competence Center, University of Regensburg Medical Center, Regensburg, Germany

Abstract.

This paper describes the challenges that are being tackled and those that remain to be addressed if we are to enable electronic health record information to be shared seamlessly and meaningfully. This goal is known as semantic interoperability, and is needed if computational services are to be able to interpret safely clinical data that has been integrated from diverse sources. Based on sustainable architectural approaches, the paper describes the clinical case for consistently expressed clinical meaning within electronic health records, in particular where computers rather than humans need to be able to process EHR data safely. It outlines the main kinds of information and knowledge artefact that are used to represent meaning within EHRs, and considers for each its role and limitations. The problems that arise with trying to use terminology consistently with EHR reference models is explored, together with the implications for designing EHR archetypes. Examples are given of situations where a diversity of options exists for how to represent compound (multi-part) clinical expressions. Recommendations are made for the kinds of change that are needed both in record structures and in terminology systems to minimise this diversity and thereby aid semantic interoperability.

Semantic Interoperability between Clinical and Public Health Information Systems for Improving Public Health Services

Diego M. Lopez & Bernd G.M.E. Blobel
eHealth Competence Center Regensburg, University of Regensburg Medical Center, Germany

Abstract.

Improving public health services requires comprehensively integrating all services including medical, social, community, and public health ones. Therefore, developing integrated health information services has to start considering business process, rules and information semantics of involved domains. The paper proposes a business and information architecture for the specification of a future-proof national integrated system, concretely the requirements for semantic integration between public health surveillance and clinical information systems. The architecture is a semantically interoperable approach because it describes business process, rules and information semantics based on national policy documents and expressed in a standard language such us the Unified Modeling Language UML. Having the enterprise and information models formalized, semantically interoperable Health IT components/services development is supported.

HL7 Conformance: How to do Proper Messaging

Frank Oemig a and Bernd G.M.E. Blobel b
a Agfa HealthCare / GWI Medica GmbH, Bonn, Germany,br /> b eHealth Competence Center, University of Regensburg Medical Center, Germany

Abstract.

Communication and cooperation between different applications is mediated by interfaces following corresponding standards. The interpretation of standards, the understanding of requirements and specification of solutions is very different within the vendor community. In a shared care environment based on extended inter-organizational inter-relationships, this interoperability has to be provided at semantic and service-oriented level. For that purpose, harmonized reference models, agreed terminologies, ontologies and concept representations as well as a unified development and deployment process have to be standardized. The latter also includes testing and certification procedures. The paper shortly introduces in the semantic interoperability approach provided by HL7.

A Standard Ontology for the Semantic Integration of Components in Healthcare Organizations

I. Román, L.M. Roa, G. Madinabeitia and L.J. Reina
Group of Telematic Engineering; Biomedical Engineering Group; Dept. of Signal Theory and Communications, University of Seville, Spain

Abtract

In this paper we introduce an ontology that covers all the terminology involved in the ODP standard. This ontology has been extended with concepts taken from the prEN12967 in order to apply it in the healthcare domain. Describing components formally and using this ontology, their semantic integration can be eased together with the benefits derived from the assistance to the automatic discovery, selection, invocation and composition of components facilities.

Personal Health – the Future Care Paradigm

Thomas Norgall, Bernd Blobel and Peter Pharow
Image Processing and Medical Engineering, Fraunhofer Institute for Integrated Circuits IIS, Erlangen;
eHealth Competence Center, University of Regensburg Medical Center, Germany

Abstract

Demographic, economic and social conditions developed countries are faced with require a paradigm change for delivering high quality and efficient health services. In that context healthcare systems have to turn towards individualized of patient’s care, also called personal care. Interoperability requirements for ubiquitous personalized health services reach beyond current concepts of health information integration among professional stakeholders and related Electronic Patient Records (”e-Health”): Future personal health platforms have particularly to maintain semantic interoperability among systems using different modalities and technologies, different knowledge representation and domain experts’ languages as well as different coding schemes and terminologies to include home, personal and mobile systems. The paper introduces the evolving paradigm related to personal health information systems.

Standardization of demographic service for a federated healthcare environment

I. Román*, L. Roa** and G. Madinabeitia*
*Group of Telematic Engineering, University of Seville, Spain
**Biomedical Engineering Group, University of Seville, Spain

Abstract:

Throughout everybody’s lifetime any person may have episodes of care provided by many health-care providers. This is mainly due to the increasingly specialisation of medicine practice and to the growth of population mobility, among other factors. On the other hand, new information and communication technologies (ICT) are being used in the healthcare tasks making these easier and more efficient. The aid of ICT is having a clear impact in the transition to the digital hospital being the management of multimedia clinical information systems an essential issue.

In this new scenario patient’s clinical information is distributed among several information systems, geographically dispersed. These are usually autonomous and heterogeneous systems, that were developed with different objectives and, consequently with different data models, platforms, standards and semantics. The interest is that they work in a collaborative environment so we can see this as a federated environment.

In order to collect the patient’s healthcare information distributed in all the federation (the Electronic Healthcare Record, EHR) a resolution of incompatibilities between the systems of the federation must be accomplished. These incompatibilities can be classified into three levels: semantic, functional and instance incompatibilities.