Use of XML Schema Definition for the Development of Semantically Interoperable Healthcare Applications

Multilevel modeling has been proven in software as a viable solution for semantic interoperability, without imposing any specific programming languages or persistence models. The Multilevel Healthcare Information Modeling MLHIM specifications have adopted the XML Schema Definition 1.1 as the basis for its reference implementation, since XML technologies are consistent across all platforms and operating systems, with tools available for all mainstream programming languages. In MLHIM, the healthcare knowledge representation is defined by the Domain Model, expressed as Concept Constraint Definitions CCDs, which provide the semantic interpretation of the objects persisted according to the generic Reference Model classes. This paper reports the implementation of the MLHIM Reference Model in XML Schema Definition language version 1.1 as well as a set of examples of CCDs generated from the National Cancer Institute --- Common Data Elements NCI CDE repository. The set of CCDs was the base for the simulation of semantically coherent data instances, according to independent XML validators, persisted on an eXistDB database. This paper shows the feasibility of adopting XML technologies for the achievement of semantic interoperability in real healthcare scenarios, by providing application developers with a significant amount of industry experience and a wide array of tools through XML technologies.

[1]  Fabio Kon,et al.  Open Source Systems: Grounding Research - 7th IFIP WG 2.13 International Conference, OSS 2011, Salvador, Brazil, October 6-7, 2011. Proceedings , 2011, OSS.

[2]  Philip Achimugu,et al.  Record Linkage System in a Complex Relational Database - MINPHIS Example , 2010, MedInfo.

[3]  Karen Adams,et al.  Review Paper: Three Decades of Research on Computer Applications in Health Care: Medical Informatics Support at the Agency for Healthcare Research and Quality , 2002, J. Am. Medical Informatics Assoc..

[4]  Peter F. Patel-Schneider,et al.  OWL 2 Web Ontology Language Primer (Second Edition) , 2012 .

[5]  Olof Torgersson,et al.  A Migration to an openEHR-Based Clinical Application , 2009, MIE.

[6]  Dean F Sittig,et al.  A new sociotechnical model for studying health information technology in complex adaptive healthcare systems , 2010, Quality and Safety in Health Care.

[7]  Crystal Kallem,et al.  Data standards, data quality, and interoperability. , 2007, Journal of AHIMA.

[8]  Antônio Francisco do Prado,et al.  Using archetypes and Domain Specific Languages on development of ubiquitous applications to pervasive healthcare , 2010, 2010 IEEE 23rd International Symposium on Computer-Based Medical Systems (CBMS).

[9]  Kostas S. Metaxiotis,et al.  E-health in the new millennium: a research and practice agenda , 2004, Int. J. Electron. Heal..

[10]  Bernd Blobel,et al.  Analysis and Evaluation of EHR Approaches , 2008, MIE.

[11]  Farzad Mostashari,et al.  The business end of health information technology. Can a fully integrated electronic health record increase provider productivity in a large community practice? , 2010, The Journal of medical practice management : MPM.

[12]  Bernd Blobel.  Ontologies, Knowledge Representation, Artificial Intelligence - Hype or Prerequisites for International pHealth Interoperability? , 2011, EFMI-STC.

[13]  Arnon Rosenthal,et al.  XML's Impact on Databases and Data Sharing , 2001, Computer.

[14]  Thomas Y. Lee,et al.  XML schema design and management for e-Government data interoperability , 2009 .

[15]  J. Javitt,et al.  How to succeed in health information technology. , 2004, Health affairs.

[16]  David Raths.  Shifting away from silos. The interoperability challenges that hospitals face pale in comparison to the headaches plaguing state departments. , 2010, Healthcare informatics : the business magazine for information and communication systems.

[17]  Luciana Tricai Cavalini,et al.  Knowledge engineering of healthcare applications based on minimalist multilevel models , 2012, 2012 IEEE 14th International Conference on e-Health Networking, Applications and Services (Healthcom).

[18]  Edie E Zusman.  Form facilitates function: innovations in architecture and design drive quality and efficiency in healthcare. , 2010, Neurosurgery.

[19]  Mankyu Choi,et al.  A Mechanism of Institutional Isomorphism in Referral Networks Among Hospitals in Seoul, South Korea , 2010, The health care manager.

[20]  William A Hyman.  When medical devices talk to each other: the promise and challenges of interoperability. , 2010, Biomedical instrumentation & technology.

[21]  Ann S O'Malley,et al.  Primary Care Physicians' Links to Other Physicians Through Medicare Patients: The Scope of Care Coordination , 2009, Annals of Internal Medicine.

[22]  Hao Wang,et al.  A metamodelling approach to behavioural modelling , 2012, BM-FA '12.

[23]  Marco Eichelberg,et al.  A survey and analysis of Electronic Healthcare Record standards , 2005, CSUR.

[24]  Catalina Martínez-Costa,et al.  Towards ISO 13606 and openEHR Archetype-Based Semantic Interoperability , 2009, MIE.

[25]  V Maojo,et al.  Medical Informatics and Bioinformatics: Integration or Evolution through Scientific Crises? , 2006, Methods of Information in Medicine.

[26]  Donald Bruce Sanderson.  Loss of data semantics in syntax directed translation , 1994 .

[27]  Sérgio Miranda Freire,et al.  Modeling healthcare authorization and claim submissions using the openEHR dual-model approach , 2011, BMC Medical Informatics Decis. Mak..

[28]  Luciana Tricai Cavalini,et al.  Implementing a specification for exceptional data in multilevel modeling of healthcare applications , 2012, SIGH.

[29]  Luciana Tricai Cavalini,et al.  Health Informatics: The Relevance of Open Source and Multilevel Modeling , 2011, OSS.

[30]  N. Harris,et al.  Hospital and after: experience of patients and carers in rural and remote north Queensland, Australia. , 2004, Rural and remote health.

[31]  Sheng Yu,et al.  Clinical coverage of an archetype repository over SNOMED-CT , 2012, J. Biomed. Informatics.

[32]  Kathleen Charters.  Home Telehealth Electronic Health Information Lessons Learned , 2009, Nursing Informatics.

[33]  Cédric Bousquet,et al.  Using the CEN/ISO Standard for Categorial Structure to Harmonise the , 2009, MIE.

[34]  Marcia M Ward,et al.  Nurses' Perceptions of How Clinical Information System Implementation Affects Workflow and Patient Care , 2011, Computers, informatics, nursing : CIN.

[35]  Alex Macario,et al.  Challenges that limit meaningful use of health information technology , 2010, Current opinion in anaesthesiology.