A semantically enriched clinical guideline model enabling deployment in heterogeneous healthcare environments.

Clinical guidelines are developed to assist healthcare practitioners to make decisions on patient's medical problems, and as such they communicate with external applications to retrieve patient data to initiate medical actions through clinical workflows, and transmit information to alert/reminder systems. The interoperability problems in the healthcare information technology domain prevent wider deployment of clinical guidelines because each deployment requires a tedious custom adaptation phase. In this paper, we provide machine-processable mechanisms that express the semantics of clinical guideline interfaces so that automated processes can be used to access the clinical resources for guideline deployment and execution. To be able to deploy the semantically extended guidelines to healthcare settings semiautomatically, the underlying application's semantics must also be available. We describe how this can be achieved based on two prominent implementation technologies in use in the eHealth domain: integrating healthcare enterprise cross-enterprise document sharing integration profile for discovering and exchanging electronic healthcare records and Web service technology for interacting with the clinical workflows and wireless medical sensor devices. The system described in this paper is realized within the scope of the SAPHIRE Project.

Enhancing IHE XDS for federated clinical affinity domain support.

One of the key problems in healthcare informatics is the inability to share patient records across enterprises. To address this problem, an important industry initiative called "integrating the healthcare enterprise (IHE)" specified the "cross enterprise document sharing (XDS)" profile. In the IHE XDS, healthcare enterprises that agree to work together form a "clinical affinity domain" and store healthcare documents in an ebXML registry/repository architecture to facilitate their sharing. The affinity domains also agree on a common set of policies such as coding lists to be used to annotate clinical documents in the registry/repository and the common schemes for patient identification. However, since patients expect their records to follow them as they move from one clinical affinity domain to another, there is a need for affinity domains to be federated to enable information exchange. In this paper, we describe how IHE XDS can be enhanced to support federated clinical affinity domains. We demonstrate that federation of affinity domains are facilitated when ontologies, rather than coding term lists, are used to annotate clinical documents. Furthermore, we describe a patient identification protocol that eliminates the need to keep a master patient index file for the federation.