ERCIM News No.29 - April 1997

An Integrated Architecture for the Provision of Health Telematic Services in a Regional Network

by Manolis Tsiknakis and Stelios Orphanoudakis

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 health care organizational structure. Thus, information and telecommuni-cations systems must primarily provide the infrastructure to permit the effective integration of distributed and heterogeneous components, ensuring overall integrity in terms of functional and information inter-working. In addition to the above, the increased mobility of citizens within a country and across country borders, make the provision of comprehensive and continuous medical care more difficult. Healthcare data for the same patient are often geographically distributed among different institutions or organizational units with little or no link between them. Furthermore, these 'patient record segments' are managed by heterogeneous auto-nomous information systems, usually implemented on different platforms with different implementation languages.

The integration of information and knowledge from different sources is increasingly becoming a key to better quality of care. Achieving this integration, however, is a challenging problem mainly because the logic, knowledge and data structures used in various systems are complex and usually incompatible. Many tasks require a large volume of data processing and communications across heterogeneous and distributed environments. Today, the problem of harnessing disparate information resources remains one of the most intensely contested information technology issue in the international research arena. A promising approach to this integration problem is to gain control of the organisation's information resources at a meta-data level while allowing autonomy of individual subsystems at the data instance level. The objective of the meta-database model is to achieve enterprise information integration over distributed and potentially heterogeneous systems while allowing these systems to operate independently and concurrently.

Topology of the Regional Healthcare Network of Crete.

Physical Computerized Patient Record (CPR) segments, distributed among several autonomous departmental information systems are integrated by means of the patient meta-record (PMR). The PMR permits the integration of CPR components, and also provides aggregation and navigation facilities (which, in turn, can be fully configured and customized) in order to assist in the appropriately personalized utilization of the CPR by the respective functional units or health care providers. The PMR manages, at a single logical point, references to all of the physical information related to a patient throughout the Integrated Hospital regardless of where such information may reside. Therefore, it is an indexing system, providing access to all stored data for a particular patient.

An Integrated Regional Health Care Network

The Center for Medical informatics and Health Telematics Applications (CMI/HTA) of the Institute of Computer Science, FORTH, is currently involved in the development of an Integrated Healthcare Network in the region of Crete, which is being developed as a model for national and transnational healthcare networks. In the course of designing the system, special efforts are being made to meet the requirements of the user groups involved and to use state-of-the-art technology and standards in every aspect of the system. Alternative patient, problem, and case oriented architectures for the CPR are being considered in an attempt to provide transparent access and secure communication of information between and within medical specialty areas, as well as in a variety of situations from community to hospital care across the region. Various strategies for HADS integration and interoperability are being considered in conjunction with the MPR to provide homogeneous access to the distributed segments of the CPR at all levels of the health care system.

Current research and development activities focus on the intelligent management of medical data in distributed multimedia databases, the real-time resource management in regional or national healthcare networks, on methodologies and architectures for the integration of heterogeneous information systems, the processing and analysis of multimedia medical data, particularly 2D and 3D images, and the indexing and retrieval of medical images based on their content, as well as on developing explicit models of the underlying workflow in the different environments (hospitals, regional healthcare networks, Internet) required for the optimization of the process of information distribution, thus improving the availability and accessibility of the electronic patient record content.

In the development of the regional healthcare network of Crete, emphasis is being given to the creation of a frame-work for integrated service provision. Advanced applications and software platforms capable of accommodating the evolving user needs and the hetero-geneous processing environments are being developed. Different service types are being designed and implemented, such as a) Services for Dynamic Content Update, ie services that enable the seamless creation of an integrated virtual electronic patient record, b) Advanced communication services (asynchronous as well as synchronous) that provide teleconsultation and remote cooperative diagnostic work between healthcare providers at different locations, and c) added-value services supporting the creation of innovative content (web based image annotation service), and added value processing of medical images (DIPE), and visualisation of information. The last is of particular importance in the medical domain, since medical care is administered by many professionals during one healthcare episode, let alone throughout a patient's lifetime. Hence the medical record has to support a wide range of users with different viewpoints. The information contained in the computerised medical record for a patient must be viewed in a variety of different ways, eg encounter-centred, problem-centred, task-centred, patient-centred, and temporal snapshots.

Please contact:
Manolis Tsiknakis or Stelios Orphanoudakis - ICS-FORTH
Tel: +30 81 391690, 391600
E-mail: {tsiknaki,orphanou}

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