The CEN healthcare information systems architecture standard and the DHE middleware. A practical support to the integration and evolution of healthcare systems.

The integration and evolution of existing systems represents one of the most urgent priorities of health care information systems in order to allow the whole organisation to meet the increasing clinical organisational and managerial needs. This paper discusses how an open architecture, based on the introduction of a middleware of common health care-specific services, not only reduces the effort necessary for allowing existing systems to interwork, but also automatically establishes a functional and informational basis common to the whole organisation. New applications can be also be rapidly developed and natively integrated with the rest of the system. Such architecture has already been formalised through the proposed European Prestandard, defined by the CEN/TC251/PT1013 Standard Architecture for Health care Information Systems [1]. Thanks to the availability of industrial products conforming to the standard, the effectiveness and validity of this approach has already been demonstrated in practice. For example, through the Hansa collaboration, hospitals and industries from 15 European countries use the same industrial middleware (i.e. the DHE—Distributed Healthcare Environment) for integrating existing systems as well as for developing new applications.