Special Topic Interoperability and EHR: Combining openEHR, SNOMED, IHE, and Continua as approaches to interoperability on national eHealth
18 January 2017
accepted in revised form: 15 May 2017
20 December 2017 (online)
Objectives: The main aims of the paper comprise the characterization and examination of the potential approaches regarding interoperability. This includes openEHR, SNOMED, IHE, and Continua as combined interoperability approaches, possibilities for their incorporation into the eHealth environment, and identification of the main success factors in the field, which are necessary for achieving required interoperability, and consequently, for the successful implementation of eHealth projects in general.
Methods: The paper represents an in-depth analysis regarding the potential application of openEHR, SNOMED, IHE and Continua approaches in the development and implementation process of eHealth in Slovenia. The research method used is both exploratory and deductive in nature. The methodological framework is grounded on information retrieval with a special focus on research and charting of existing experience in the field, and sources, both electronic and written, which include interoperability concepts and related implementation issues.
Results: The paper will try to answer the following inquiries that are complementing each other:
1. Scrutiny of the potential approaches, which could alleviate the pertinent interoperability issues in the Slovenian eHealth context.
2. Analyzing the possibilities (requirements) for their inclusion in the construction process for individual eHealth solutions.
3. Identification and charting the main success factors in the interoperability field that critically influence development and implementation of eHealth projects in an efficient manner.
Conclusions: Provided insights and identified success factors could serve as a constituent of the strategic starting points for continuous integration of interoperability principles into the healthcare domain. Moreover, the general implementation of the identified success factors could facilitate better penetration of ICT into the healthcare environment and enable the eHealth-based transformation of the health system especially in the countries which are still in an early phase of eHealth planning and development and are often confronted with differing interests, requirements, and contending strategies.
Citation: Beštek M, Stanimirovic D. Special Topic Interoperability and EHR: Combining openEHR, SNOMED, IHE, and Continua as approaches to interoperability on national eHealth. Appl Clin Inform 2017; 8: 810–825 https://doi.org/10.4338/ACI-2017-01-RA-0011
KeywordsTelemedicine - Common Data Elements - Knowledge Management - Electronic Health Records - Health information exchange
Protection of Human and Animal Subjects
The authors declare that human and/or animal subjects were not included in the project.
- 1 Pammolli F, Riccaboni M, Magazzini L. The sustainability of European health care systems: beyond income and aging. Eur J Heal Econ [Internet] 2012; 13 (05) 623-34.
- 2 Stanimirovic D. A Framework for Information and Communication Technology Induced Transformation of the Healthcare Business Model in Slovenia. J Glob Inf Technol Manag [Internet] 2015; 18 (01) 29-47.
- 3 Slovenija R. Resolucija o nacionalnem planu zdravstvenega varstva 2008–2013 “Zadovoljni uporabniki in izvajalci zdravstvenih storitev” (NPZV 08–13 ). 2013
- 4 Albreht T, Turk E, Toth M, Ceglar J, Marn S. R., Schäfer PB M, Avdeeva O, Van Ginneken E. European Observatory on Health Systems and Policies WHO. Slovenia –Health system review. Heal Care Syst Transit [Internet] 2009; 11 (03) 168.
- 5 OECD.. Health at a Glance 2013. OECD Publ [Internet]. [cited 2013 Nov 24]; Available from: http://www.oecd.org/health/health-at-a-glance.htm
- 6 Albreht T. Resolution-the national health care plan 2008–2013. Heal Policy Monit [Internet] 2008; 11: 1-6.
- 7 Ministry of Health.. Health Care System Upgrade by 2020. Gov Repub Slov Minist Heal [Internet]. 2011;1–17. Available from: http://imeinars.blogspot.co.id
- 8 European Commission.. eHealth Benchmarking III. Final Report. Smart 2009/0022. 2012; (661818) 4-7.
- 9 Wallace C. Can Information and Communications Technology Enhance Social Quality?. Int J Soc Qual [Internet] 2012; 2 (02) 98-117.
- 10 González-Sánchez VM. “Information and Communication Technologies” and entrepreneurial activity: drivers of economic growth in Europe. Serv Ind J [Internet] 2013; 33 7–8 683-93.
- 11 Qureshi S. Information and Communication Technologies in the Midst of Global Change: How do we Know When Development Takes Place?. Inf Technol Dev [Internet] 2013; 19 (03) 189-92.
- 12 Trudel M-C, Paré G, Laflamme J. Health information technology success and the art of being mindful. Health Care Manage Rev [Internet] 2012; 37 (01) 31-42.
- 13 Iveroth E, Fryk P, Rapp B. Information technology strategy and alignment issues in health care organizations. Health Care Manage Rev [Internet] 2013; 38 (03) 188-200.
- 14 Black AD, Car J, Pagliari C, Anandan C, Cresswell K, Bokun T, McKinstry B, Procter R, Majeed A, Sheikh A. The impact of eHealth on the quality and safety of health care: a systematic overview. Djulbegovic B. editor. PLoS Med [Internet] 2011; 8 (01) e1000387.
- 15 Rosenkötter N, Achterberg PW, Van Bon-Martens MJH, Michelsen K, Van Oers HAM, Brand H. Key features of an EU health information system: A concept mapping study. Eur J Public Health 2016; 26 (01) 65-70.
- 16 Haux R. Medical informatics: Past, present, future. Int J Med Inform [Internet] 2010; 79 (09) 599-610.
- 17 Stanimirovi[cacute] D.. Modelling the Health Information System in Slovenia –Operative, Construction and Implementation Aspects. Int J Eng Bus Manag [Internet]. 2015: 1. Available from: http://www.intechopen.com/journals/international_journal_of_engineering_business_management/modelling-the-health-information-system-in-slovenia-ndash-operative-construction-and-implementation
- 18 Leung RC. Health information technology and dynamic capabilities. Health Care Manage Rev [Internet] 2012; 37 (01) 43-53.
- 19 Bardhan IR, Thouin MF. Health information technology and its impact on the quality and cost of healthcare delivery. Decis Support Syst [Internet] 2013; 55 (02) 438-49.
- 20 Gibson CJ, Dixon BE, Abrams K. Convergent evolution of health information management and health informatics. A perspective on the future of information professionals in health care. Appl Clin Inform [Internet] 2015; 6 (01) 163-84.
- 21 Office of the National Coordinator for Health IT.. Connecting Health and Care for the Nation : A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure. 2012: 1-13.
- 22 Commission E. European Interoperability Framework (EIF) for European public services. Brussels. 2010
- 23 Commission European, Langenhove P van, Decreus K, Rogala A, Olyslaegers T, Whitehouse D. eHealth European Interoperability Framework –Vision on eHealth EIF. 2013: 64.
- 24 Roadmap D, Europe FOR. Semantic Interoperability for Better Health and Safer Healthcare [Internet] Journal of Magnetism and Magnetic Materials. 2009 240. 508-510.
- 25 European Comission.. Bringing cross-border interoperability to health care [Internet]. 2011 Available from: http://ec.europa.eu/isa/actions/02-interoperability-architecture/2–12action_en.htm
- 26 Semantic Interoperability for Health Network [Internet]. 2011 Available from: http://www.semantichealthnet.eu
- 27 Expanding Health Data Interoperability Services [Internet]. 2014 Available from: https://ec.europa.eu/digital-single-market/en/news/expand-deploying-sustainable-cross-border-ehealth-services-eu
- 28 Cross border patient registries initiative (PARENT) [Internet]. 2012 Available from: http://patientregistries.eu
- 29 Security And InteroperabiLity in Next Generation PPDR CommUnication InfrastructureS [Internet]. 2013 Available from: https://www.sec-salus.eu
- 30 Trillium Bridge Bridging Patient Summaries across the Atlantic [Internet]. 2013 Available from: http://www.trilliumbridge.eu
- 31 Trillium-II EU/US Cooperation for Global Interoperability in Digital Health [Internet]. 2017 Available from: http://www.i-hd.eu/index.cfm/services/research/trillium-ii
- 32 Electronic Health Records for Clinical Research [Internet]. 2011 Available from: http://www.ehr4cr.eu
- 33 Advancing eHealth Interoperability [Internet]. 2013 Available from: https://www.antilope-project.eu
- 34 TRANSFoRm [Internet]. 2010 Available from: http://www.i-hd.eu/index.cfm/resources/ec-projects-results/transform/
- 35 eHealth standards and Profiles in Action for Europe and Beyond [Internet]. 2015 Available from: http://www.estandards-project.eu
- 36 Valdez RS, Holden RJ, Novak LL, Veinot TC. Transforming consumer health informatics through a patient work framework: connecting patients to context. J Am Med Informatics Assoc [Internet] 2014; 1-7.
- 37 Marceglia S, Fontelo P, Ackerman MJ. Transforming consumer health informatics: connecting CHI applications to the health-IT ecosystem. J Am Med Informatics Assoc [Internet] 2015; 22 e1 e210-2.
- 38 Marceglia S, Fontelo P, Rossi E, Ackerman MJ. A Standards-Based Architecture Proposal for Integrating Patient mHealth Apps to Electronic Health Record Systems. Appl Clin Inf [Internet] 2015; 6 (03) 488-505.
- 39 Stanimirovi[cacute] D.. Evaluation of Information Systems and Enterprise Architecture Models in Healthcare. University of Ljubljana 2014.
- 40 Beštek M, Brodnik A. Interoperability and mHealth –precondition for successful eCare. In: Adibi S. editor. Mobile Health (mHeath) The Technology Road Map [Internet]. New York:: Springer; 2014
- 41 Beštek M, Umer R, Jeras I. Vzpostavitev interoperabilne hrbtenice IS e-Zdravje Konceptualna zasnova [Internet]. 2011 Available from: http://www.mz.gov.si/fileadmin/mz.gov.si/pageuploads/eZdravje/2011/eZdravje_-_Vzpostavitev_interoperabilne_hrbtenice.pdf
- 42 Integrating the Healthcare Enterprise [Internet] Available from: https://www.ihe.net
- 43 OpenEHR.org [Internet] Available from: http://www.openehr.org
- 44 SNOMED [Internet] Available from: http://www.snomed.org
- 45 Personal Connected Health Alliance [Internet Available from: http://www.pchalliance.org
- 46 Yin K R. Case study research: design and methods. 4th ed. Thousand Oaks, CA:: Sage Publications; 2009
- 47 Quinn Patton M. Qualitative Evaluation and Research Methods. 2nd ed. Thousand Oaks, CA:: Sage Publications; 1990
- 48 Blobel B, Goossen W, Brochhausen M. Clinical modeling—A critical analysis. Int J Med Inform [Internet] 2014; 83 (01) 57-69.
- 49 Maldonado JA, Valencia S. Detailed Clinical Models and their relation with Electronic Health Records. Polytechnic University of Valencia; 2015
- 50 Rector AL, Johnson PD, Tu S, Wroe C, Rogers J. Interface of Inference Models with Concept and Medical Record Models. 2001: 1-8.
- 51 HL7. HL7 Fast Healthcare Interoperability Resources [Internet]. [cited 2017 Mar 7]. Available from: http://wiki.hl7.org/index.php?title=FHIR
- 52 Kalra D, Vander Stichele R, Schulz S, Karlsson D, Rosenbeck Gøeg K, Cornet R, Cangioli G, Chronaki C, Thun S, Jaulent M-C, Hämäläinen P, Kronstein Kufrin V, Fathollah-Nejad R, Dewenter H, Volkert P, Melgara M, Stroetmann V. Assessing SNOMED CT for Large Scale eHealth –D4.4 Policy and strategy recommendations –final report. 2015
- 53 Urbauer P, Sauermann S, Frohner M, Forjan M, Pohn B, Mense A. Applicability of IHE/Continua components for PHR systems: Learning from experiences. Comput Biol Med 2015; 59: 186-93.
- 54 Smith B, Ceusters W. HL7 RIM: an incoherent standard. Stud Health Technol Inform 2006; 124 August 133-8.
- 55 Browne E. Shortcomings of HL7 Reference Information Model ( RIM ) [Internet]. 2008 Available from: http://docplayer.net/22512528-Shortcomings-of-hl7-reference-information-model-rim.html
- 56 Summary P, Version D. Smart Open Services for European Patients Open eHealth initiative for a European large-scale pilot of epSOS Interoperability Framework. 2009
- 57 Beale T. Archetypes: Constraint-based Domain Models for Future-proof Information Systems. In: Workshop on Behavioural Semantics. OOPSLA 2002.
- 58 Martinez-Costa C, Menarguez-Tortosa M, Fernandez-Breis JT, Martínez-Costa C, Menárguez-Tortosa M, Fernández-Breis JT. An approach for the semantic interoperability of ISO EN 13606 and OpenEHR archetypes. J Biomed Inform [Internet] 2010; 43 (05) 736-46.
- 59 EkoSMART Smart Cities and Communities [Internet]. 2016 Available from: http://ekosmart.net/en/ekosmart-2/
- 60 Kodele D, Košir F, Marušič D, Sušelj M, RUSZV P. eZdravje 2010, Strategija informatizacije slovenskega zdravstvenega sistema 2005–2010. 2010