Ics-forth 1996 an Architectural Framework for the Integration of Geographically Distributed Heterogeneous Autonomous Medical Information Systems an Architectural Framework for the Integration of Geographically Distributed Heterogeneous Autonomous Medical Information Systems

In this paper, a medical domain-specific framework is presented, by which integration in terms of access to information resources, and in terms of content, structure, and visualization of patient record segments can be achieved. After introducing four different types of integration, an appropriate architecture is described that comprises a ‘Universal Medical Client’ and a number of server-based components, by which geographically distributed heterogeneous autonomous medical information systems can be accessed in a uniform manner. E. Leisch , M. Tsiknakis , and S. Orphanoudakis 1,2 An Architectural Framework for Integration EuroPACS'96,pp.73-77,October3-5,1996 page 1 An Architectural Framework for the Integration of Geographically Distributed Heterogeneous Autonomous Medical Information Systems E. Leisch , M. Tsiknakis , and S. Orphanoudakis 1,2 1 Institute of Computer Science, FORTH, P.O. Box 1385, 711 10 Heraklion, Greece 2 Dept. of Computer Science, University of Crete, 714 09 Heraklion, Greece ABSTRACT In this paper, a medical domain-specific framework is presented, by which integration in terms of access to information resources, and in terms of content, structure, and visualization of patient record segments can be achieved. After introducing four different types of integration, an appropriate architecture is described that comprises a ‘Universal Medical Client’ and a number of server-based components, by which geographically distributed heterogeneous autonomous medical information systems can be accessed in a uniform manner.In this paper, a medical domain-specific framework is presented, by which integration in terms of access to information resources, and in terms of content, structure, and visualization of patient record segments can be achieved. After introducing four different types of integration, an appropriate architecture is described that comprises a ‘Universal Medical Client’ and a number of server-based components, by which geographically distributed heterogeneous autonomous medical information systems can be accessed in a uniform manner. INTRODUCTION Increased mobility is an important phenomenon concerning the citizens living in European Community countries. In the healthcare sector, this makes the provision of comprehensive medical care, with continuity across different countries and different healthcare providers, more difficult. Patient-related healthcare data for a single person are usually not only managed by different institutions or organizational units, but they are also quite often geographically distributed, a significant percentage of them across country boundaries. Furthermore, those ‘patient record segments’ are being kept in heterogeneous autonomous information systems, usually implemented on different platforms with different implementation languages. The diversity of hospital organizations, the complexity of clinical protocols and procedures, as well as the different preferences of various user groups make it extremely difficult for a single monolithic information system to effectively serve the needs of an entire healthcare organizational structure. As a consequence, users must be allowed to select the applications most suitable for their needs and requirements. In addition, a number of applications are already available on the market that address specific aspects of the healthcare structure. Thus, information and telecommunications systems must primarily provide the infrastructure to permit the effective integration of distributed and heterogeneous components. [[1]] Following the architecture presented in this paper it will be possible to provide users with an integrated view of all accessible patient record segments concerning, for instance, a single person. This can be achieved by means of a common medical domain-specific framework [[2]] for the integration in terms of access to information resources, and in terms of content, structure, and visualization of patient record segments. TYPES OF INTEGRATION Before describing the architecture, a closer look at the different types of integration [[2]] that are to be achieved will be helpful in positioning conceptually the individual parts of the framework. Presentation Integration Presentation Integration refers to the user interface(s), by which heterogeneous information systems communicate with the medical or non-medical personnel that may be involved in the process of healthcare service provision. Our approach is to develop a ‘Universal Medical Client’, that is based on the notion of a ‘Graphical Patient Record’. E. Leisch , M. Tsiknakis , and S. Orphanoudakis 1,2 An Architectural Framework for Integration EuroPACS'96,pp.73-77,October3-5,1996 page 2 Control Integration Control Integration deals with the problem of sending service requests from a client to a server and receiving the corresponding responses, in a heterogeneous multi-platform environment. In our opinion, the most appropriate solution for that problem is the use of a commercially available CORBAcompliant (standard) Object Request Broker [[3]] [[4]]. Data Integration Data Integration is probably the most difficult part of the job. Data Integration leads to a semantically consistent view of the integrated patient record segments (virtual patient record). In order to achieve it, ‘Mediation Services’ [[5]] have to be developed, that are able to bridge the syntactic and semantic gap between heterogeneous healthcare-related information systems. Another aspect of data integration is the ability for structured input of semantically consistent data during insert, update, or query operations on patient record segments and other healthcare-related data. A prerequisite for that is the existence of an Authority Service or a Terminology Server [[6]], which checks or suggests the medical terms used in data-entry or query forms. Functional Integration Functional Integration has to do with the modeling of healthcare-related processes, and with Workflow Management [[7]] in the healthcare sector. Functional integration is enabled by active information systems; it is achievable through workflow management techniques. Based on the other types of integration, it offers the ability to define, schedule, initiate, monitor, and control healthcare-related procedures or processes, e.g. the performing of a diagnostic service request according to given administrative and clinical procedures. ARCHITECTURE According to the approach described in this paper, medical workstations provide the means to access patient record segments, that may be distributed on the servers of medical Intranets. For that purpose, those workstations are equipped with a Universal Medical Client, which enables them to send requests to server-based components and to attached healthcare-related information systems by means of a CORBA-compliant Object Request Broker (ORB) [[3]]. The ORB adds platform-independence to client/server relationships and provides transparency of service object location, activation, and communication. For the formulation of client/server requests, an SGML-based platform-neutral data exchange format is used. Universal Medical Client The Universal Medical Client provides an integrated view of all patient record segments, that reside somewhere in a medical Intranet. It incorporates medical domain-specific viewing and processing tools for different types of multimedia patient record segments (e.g. images, bio-signals, etc.), as well as mechanisms for initiating and controlling healthcare-related processes. Its user interface is partly based on the notion of a Graphical Patient Record; the latter can be seen as a structured workspace that is populated by means of queries or by inserting new patient record segments. The Graphical Patient Record provides a global view of the information available about a given patient or patient group. The Universal Medical Client supports ‘Bookmarks’ for patients, patient groups (populations), and (sets of) patient record segments. Bookmarks are typed hypertext links. They may have post-search or pre-search character, i.e. they consist of sets of patient record segment references or of the criteria specifying them, respectively. The Universal Medical Client has also an integrated e-mail client, and there is an extensible set of optional plug-ins, e.g. for specialized processing of patient record segments. Confidentiality issues are not in the scope of the current work; later, they will be handled by an Authentication Service that restricts the amount of accessible or visible information depending on the identity and the access rights of the requester. E. Leisch , M. Tsiknakis , and S. Orphanoudakis 1,2 An Architectural Framework for Integration EuroPACS'96,pp.73-77,October3-5,1996 page 3 Server-Based Components of the Medical Domain-Specific Framework The server-based components to be discussed in this paper comprise an ‘Electronic Patient Record Broker’ (EPR Broker), an ‘Patient Record Segment Search Engine’ (PRS Search Engine), and depending on the variety of attached information systems a set of Mediation Services; those components are based on a ‘Patient Meta-Record’ (PMR) and/or its extensions. Patient Meta-Record & Extensions EPR Broker PRS Search Engine Mediation Service(s) Outgoing Requests to EPR components or to other attached information systems Incoming Requests from EPR components or Universal Medical Clients Figure 1 : Server-based components of the medical domain-specific framework The Patient Meta-Record (PMR) The Patient Meta-Record (PMR) [[8]] comprises the Global Data Model (GDM) for patient-centered healthcare information as presented through the Universal Medical Client, as well as (mapping) information concerning the attached information systems, their interfaces, locations, data models, schemata, contents, meanings, concepts, semantics, etc. The PMR can be easily modified to satisfy the needs resulting from the integration of new or other informati