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}@ics.forth.gr
