analysis and evaluation of ehr approaches

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


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)


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.


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


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


Ent

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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


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


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


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


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)

analysis and evaluation of ehr approaches

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