Architectural Approaches for HL7-based Health Information Systems Implementation

Summary

Objective: Information systems integration is hard, especially when semantic and business process interoperability requirements need to be met. To succeed, a unified methodology, approaching different aspects of systems architecture such as business, information, computational, engineering and technology viewpoints, has to be considered. The paper contributes with an analysis and demonstration on how the HL7 standard set can support health information systems integration.

Methods: Based on the Health Information Systems Development Framework (HIS-DF), common architectural models for HIS integration are analyzed. The framework is a standard-based, consistent, comprehensive, customizable, scalable methodology that supports the design of semantically interoperable health information systems and components.

Results: Three main architectural models for system integration are analyzed: the point to point interface, the messages server and the mediator models. Point to point interface and messages server models are completely supported by traditional HL7 version 2 and version 3 messaging. The HL7 v3 standard specification, combined with service-oriented, model-driven approaches provided by HIS-DF, makes the mediator model possible. The different integration scenarios are illustrated by describing a proof-of-concept implementation of an integrated public health surveil-lance system based on Enterprise Java Beans technology.

Conclusion: Selecting the appropriate integration architecture is a fundamental issue of any software development project. HIS-DF provides a unique methodological approach guiding the development of healthcare integration projects. The mediator model – offered by the HIS-DF and supported in HL7 v3 artifacts – is the more promising one promoting the development of open, reusable, flexible, semantically interoperable, platform-independent, service-oriented and standard-based health information systems.

Keywords

Systems integration - system architectures - semantic interoperability - HL7 - middleware - J2EE

Publication History

Received: 10 August 2009

Accepted: 08 December 2009

Article published online:
17 January 2018

• References

• 1 Spahni S, Lovis C, Mercille R, Verdel H, Cotten M, Geissbühler A. Implementing a new ADT based on the HL7 version 3 RIM. Int J Med Inform 2007; 76 2–3 190-194.
• 2 Makki SK. The Integration and Interoperability Issues of Legacy and Distributed Systems. In: Seventh International Conference on Web-Age Information Management Workshops; 2006 Jun 17-19; Hong Kong, China: Washington DC: IEEE Press; 2006: 21.
• 3 Mykkanen J, Porrasmaa J, Korpela M. A process for specifying integration for multi-tier applications in healthcare. Int J Med Inform 2003; 70 2–3 173-182.
• 4 López DM, Blobel B. A Development Framework for Semantically Interoperable Health Information Systems. Int J Med Inform 2009; 78 (02) 83-103.
• 5 Andersson J, Johnson P. Architectural integration styles for large-scale enterprise software systems. In: Proceedings of the Fifth IEEE International Conference on Enterprise Distributed Object Computing; 2001 Sept 1-4; Seattle, USA. Washington DC: IEEE Press; 2001: 224-236
• 6 Vetere G, Lenzerini M. Models for semantic inter-operability in service-oriented architectures. IBM Syst J 2005; 44 (04) 887-903.
• 7 Bernstein K, Bruun-Rasmussen M, Vingtoft S, Andersen SK, Nohr C. Modelling and implementing electronic health records in Denmark. Int J Med Inform 2005; 74 2–4 213-220.
• 8 IEEE Computer Society.. IEEE Standard Glossary of Software Engineering Terminology, IEEE Std 610.12-1990. The Institute of Electronical and Electronics Engineers, Inc, 1990
• 9 Bernstein PA. Middleware: a model for distributed system services. Commun ACM 1996; 39 (02) 86-98.
• 10 Mykkänen J, Korpela M, Ripatti S, Rannanheimo J, Sorri J. Local, regional and national interoperability in hospital-level systems architecture. Methods Inf Med 2007; 46 (04) 470-475.
• 11 Blobel B. Analysis, Design and Implementation of Secure and Interoperable Distributed Health Information Systems. Amsterdam: IOS Press; 2002
• 12 ISO/IEC IS 10746-2.. Information technology – Open Distributed Processing – Reference Model: Foundations. International Organization for Standardization; 1996
• 13 Lopez DM, Blobel B. Enhanced Semantic Inter-operability by Profiling Health Informatics Standards. Methods Inf Med 2009; 48 (02) 170-177.
• 14 Lopez DM, Blobel B. Connecting public health and clinical information systems by using a standardized methodology. Medinfo 2007; 12 (01) 132-136
• 15 Blobel B, Holena M. Comparing middleware concepts for advanced healthcare system architectures. Int J Med Inform 1997; 46 (02) 69-85.
• 16 Blobel BGME, Engel K, Pharow P. Semantic inter-operability – HL7 Version 3 compared to advanced architecture standards. Methods Inf Med. 2006; 45 (04) 343-353.
• 17 Blobel B, Pharow P. Analysis and evaluation of EHR approaches. Methods Inf Med 2009; 48 (02) 162-169.
• 18 Transport Specification – Web Services Profile, Release 2 (standard on the Internet). Ann Arbor: Health Level Seven, Inc;; 2008. (Cited 2008 May 18) Available from: http://www.hl7.org/v3ballot/html/infrastructure/transport/transport-wsprofiles.htm
• 19 The HSSP Service Oriented Reference Architecture (homepage on the Internet). Ann Arbor: Health Level Seven, Inc.; 2008. (Cited 2008 May 18) Available from: http://hssp.wikispaces.com.
• 20 Resolución 2542 de 1998. Sistema Integral de Información para el Sistema General de Seguridad Social en Salud – SIIS (monograph on the Internet), Bogotá: Ministerio de la Protección Social, República de Colombia. 1998 (Online). (Cited 2008 May 15). Available from: http://www.minproteccionsocial.gov.co.
• 21 Decreto 3518 de 2006.. Sistema de Vigilancia en Salud Pública. (Monograph on the Internet). Bogotá: Ministerio de la Protección Social, República de Colombia; 1998. (Online). (Cited 2008 May 15). Available from: http://www.minproteccionsocial.gov.co.
• 22 HL7 Inc.. HL7 Java SIG Project (homepage on the Internet). 2009 (Cited 2009 Oct 22). Available from: http://www.hl7.org/Special/committees/java/overview.cfm
• 23 Mirth Project (homepage on the Internet).. Irvine: WebReach Inc;. 2008 (Cited 2008 May 22). Open Source Cross-Platform HL7 Interface Engine. Available from: http://www.mirthproject.org.
• 24 SDO.. Service Data Objects Home (homepage on the Internet). 2009 (Cited 2009 Nov 01) Available from: http://www.osoa.org/display/Main/Service+Data+Objects+Home.
• 25 HL7 Inc.. SAEAF Project (homepage on the Internet). 2009 (Cited 2009 Oct 28). Available from: http://gforge.hl7.org/gf/project/saeaf.
• 26 HL7 Inc.. RIM Based Application Architecture Work Group (homepage on the Internet). 2009 (Cited 2009 Nov 01). Available from: http://www.hl7.org/Special/committees/java/overview.cfm
• 27 (B)MW – (Bio-)Med WorkX Project (homepage on the Internet). 2009 (Cited 2009 Nov 01). Available from: http://aurora.regenstrief.org/mw.
• 28 NHS National Programme for Information Technology (IT) (homepage on the Internet). 2009 (Cited 2009 Nov 04) Available from: http://www.connectingforhealth.nhs.uk.
• 29 Bernstein K, Bruun-Rasmussen M, Vingtoft S, Andersen SK, Nøhr C. Modelling and Implementing Electronic Health Records in Denmark. Int J Med Inf 2005; 74 2–4 213-220.
• 30 Saranummi N, Ensio A, Laine M, Nykänen P, Itkonen P. National health IT services in Finland. Methods Inf Med 2007; 46 (04) 463-469.
• 31 de Graaf JC, Vlug AE, van Boven GJ. Dutch virtual integration of healthcare information. Methods Inf Med 2007; 46 (04) 458-462.
• 32 Canada Health Infoway Inc.: EHRS Blueprint (homepage on the Internet). 2009 (Cited 2009 Nov 04) Available from: http://www.Infoway-Inforoute.ca.
• 33 Ryan A, Eklund P. A framework for semantic inter-operability in healthcare: a service oriented architecture based on health informatics standards. Stud Health Technol Inform 2008; 136: 759-764.
• 34 Mykkänen J, Paakkanen E, Toivanen M. Four-level process modeling in healthcare SOA analysis and design. Stud Health Technol Inform 2009; 146: 276-280.
• 35 Van Hoecke S. et al. Service-oriented subscription management of medical decision data in the intensive care unit. Methods Inf Med 2008; 47 (04) 364-380.
• 36 Lopez DM, Blobel B. Quality Evaluation of Health Information System’s Architectures Developed Using the HIS-DF Methodology. 13th World Congress on Medical Informatics – Medinfo 2010 (submitted)
• 37 HL7 Inc., Fundación HL7 Colombia. (Homepage on the Internet). 2009 (Cited 2009 Nov 01). Available from: http://www.hl7.org.co.