Cloud architecture for electronic health record systems interoperability.

BACKGROUND: Current Electronic Health Record (EHR) systems are built using different data representation and information models, which makes difficult achieving information exchange. OBJECTIVE: Our aim was to propose a scalable architecture that allows the integration of information from different EHR systems. METHODS: A cloud-based EHR interoperable architecture is proposed through the standardization and integration of patient electronic health records. The data is stored in a cloud repository with high availability features. Stakeholders can retrieve the patient EHR by requesting only to the integrated data repository. The OpenEHR two-level approach is applied according to the HL7-FHIR standards. We validated our architecture by comparing it with 5 different works (CHISTAR, ARIEN, DIRAYA, LLPHR and INEHRIS) using a set of selected axes and a scoring method. RESULTS: The problem was reduced to a single point of communication between each EHR system and the integrated data repository. By combining cloud computing paradigm with selected health informatics standards, we obtained a generic and scalable architecture that complies 100% with interoperability requisites according to the evaluation framework applied. CONCLUSIONS: The architecture allowed the integration of several EHR systems, adapting them with the use of standards and ensuring the availability thanks to cloud computing features.

Modelagem do padrão TISS por meio do enfoque dual da Fundação openEHR / Modeling TISS standard using the openEHR dual-model approach

Em 2005, a Agência Nacional de Saúde Suplementar (ANS) estabelece o padrão TISS (Troca de Informação na Saúde Suplementar), intercâmbio eletrônico obrigatório entre as operadoras de planos de saúde (cerca de 1500 registradas na ANS) e prestadores de serviços (cerca de 200 mil) sobre os eventos de assistência prestados aos beneficiários. O padrão TISS foi desenvolvido seguindo a estrutura do Comitê ISO/TC215 de padrões para informática em saúde e se divide em quatro partes: conteúdo e estrutura, que compreende a estrutura das guias em papel; representação de conceitos em saúde, que se refere às tabelas de domínio e vocabulários em saúde; comunicação, que contempla as mensagens eletrônicas; e segurança e privacidade, seguindo recomendação do Conselho Federal de Medicina (CFM). Para aprimorar sua metodologia de evolução, essa presente tese analisou o grau de interoperabilidade do padrão TISS segundo a norma ISO 20514 (ISO 20514, 2005) e a luz do modelo dual da Fundação openEHR, que propõe padrões abertos para arquitetura e estrutura do Registro Eletrônico de Saúde (RES). O modelo dual da Fundação openEHR é composto, no primeiro nível, por um modelo de referência genérico e, no segundo, por um modelo de arquétipos, onde se detalham os conceitos e atributos. Dois estudos foram realizados: o primeiro se refere a um conjunto de arquétipos demográficos elaborados como proposta de representação da informação demográfica em saúde, baseado no modelo de referência da Fundação openEHR. O segundo estudo propõe um modelo de referência genérico, como aprimoramento das especificações da Fundação openEHR, para representar o conceito de submissão de autorização e contas na saúde, assim como um conjunto de arquétipos. Por fim, uma nova arquitetura para construção do padrão TISS é proposta, tendo como base o modelo dual da Fundação openEHR e como horizonte a evolução para o RES centrado no paciente.

In 2005 the Brazilian National Healthcare Agency (Agência Nacional de Saúde Suplementar (ANS), in Portuguese) published the TISS standard, a mandatory electronic exchange claims between the health insurance (approximately 1500 registered at ANS) and healthcare providers (approximately 200 000) about the healthcare events provided to the beneficiaries. The TISS standard was developed following the structure of the ISO/TC215 Committee for Health Informatics and is divided into four parts: data structure that encompasses the forms; semantic content that refers to the vocabularies and terminologies; data interchange that includes the electronic messages; and security issues in healthcare information following a recommendation of the Federal Council of Medicine (Conselho Federal de Medicina (CFM), in Portuguese). To improve the TISS standard’s evolution, this study analyses the levels of interoperability in accordance with ISO 20514 (ISO 20514, 2005) and the dual model of the openEHR Foundation, which proposes open standards for Electronic Health Records (EHR) architecture and healthcare information. The dual model of the openEHR Foundation specifications is composed, on the first level, by a generic reference model and on the second by an archetype model that details the concepts and attributes. Two studies were conducted in this thesis: the first one refers to a set of demographic archetypes developed as a proposal representation of the demographic information, based on the reference model of the openEHR Foundation. The second study proposes a generic reference model, as an improvement of the openEHR specifications, to represent the concept of submission of claims, as well as a set of archetypes. Finally, a new architecture for building the TISS standard is proposed based on the dual model of the openEHR Foundation and envisioning a patient-centered EHR.

The implications of electronic health records for personalized medicine.

The emerging concept of an electronic health record (EHR) targeted at a patient centric, cross-institutional and longitudinal information entity (possibly spanning the individuals lifetime) has great promise for personalized medicine. In fact, it is probably the only vehicle through which we may truly realize the personalization of medicine beyond population-based genetic profiles that are expected to become part of medication and treatment indications in the near future. The new EHR standards include mechanisms that integrate clinical data with genomic testing results obtained through applying research-type procedures, such as full DNA sequencing, to an individual patient. Although the most optimal process for the utilization of integrated clinical-genomic data in the EHR framework is still unclear, the new Health Level Seven (HL7) Clinical Genomics Draft Standard for Trial Use suggests using the 'encapsulate & bubble-up' approach, which includes two main phases: the encapsulation of raw genomic data and bubbling-up the most clinically significant portions of that data, while associating it with clinical phenotypes residing in the individual's EHR.