Interoperability as a Property of Ubiquitous Healthcare Systems

One of the key problems in healthcare informatics is the lack of interoperability among different healthcare information systems. Interoperability can be investigated in different categories in the eHealth domain, such as the interoperability of the messages exchanged between healthcare applications, interoperability of Electronic Healthcare Records (EHRs), interoperability of patient identifiers, coding terms, clinical guidelines and healthcare business processes. Furthermore, all these categories can be investigated in two major layers: syntactic interoperability layer and the semantic interoperability layer. Syntactic interoperability (which we term as messaging layer), involves the ability of two or more systems to exchange information. Syntactic interoperability involves several layers: network and transport layer (such as Internet), application protocol layer (such as HTTP or email), messaging protocol and message format layer (such as ebXML messaging or SOAP), and the sequencing of the messages.

2014

The healthcare model currently being used in most countries will soon be inadequate, due to the increasing care costs of a growing population of elderly people, the rapid increase of chronic diseases, the growing demand for new treatments and technologies, and the relative decrease in the number of healthcare professionals with respect to the population increase. This healthcare model, which is centered on highly specialized people, located in large hospitals, needs to change into a distributed model, in order to produce faster responses and to allow patients to manage their own health. This centralized healthcare model also implies that patients and healthcare professionals have to move to the same place (a hospital or clinic) for the healthcare services to be delivered, and it is often expensive and inefficient. A distributed healthcare model that pervades the daily lives of the citizens is more appropriate to provide less expensive and more effective and timely healthcare, and characterizes Pervasive Healthcare. In Pervasive Healthcare, novel information and communication technologies are applied to support the provision of health services anywhere, at anytime and to anyone. This thesis aims at demonstrating the feasibility of using healthcare standards, ubiquitous computing technologies, service-oriented architecture principles, and software agents, to develop interoperable applications for exchanging messages in Pervasive Healthcare environments. This thesis presents a Reusable Architecture and a Message Generator that employ these technologies for achieving its aim. Our Reusable Architecture and Message Generator also meet the requirements of interoperability between heterogeneous healthcare information systems that are usually found in Pervasive Healthcare environments. In this work, a case study was performed in a realistic distributed healthcare environment, where three usage scenarios were defined in the cardiology domain: delivery of laboratory analysis results, schedule of an appointment for pacemaker evaluation, and support of a medical staff Completing a PhD thesis is truly like running a marathon. They are both endurance events, they last a long time and they require a consistent and carefully calculated amount of effort to complete them and not burn out. One of the joys of completion is to look over the journey past and remember all the friends and family who have helped and supported me along this long but fulfilling road. This thesis project started five years ago at Computer Science Department at Federal University of São Carlos in the context of Ubiquitous Computer Group. During the first three years of my PhD research, I have experienced one of the memorable times in my life. After that, I was invited to continue my research project at University of Twente. During the last two years working in the warm and friendly environment of SCS group, I felt at home living with the SCS members. It would not have been possible to write this doctoral thesis without the help and support of the kind people around me, to only some of whom it is possible to give particular mention here. First and above all, I praise God, the almighty for providing me this opportunity and granting me the capability to proceed successfully. I wish to praise and thank for the gift of our Mother Thrice Admirable, Queen and Victress of Schoenstatt. Thank you for the wisdom and perseverance that He has been bestowed upon me during this research project, and indeed, throughout my life: 'I can do everything through Him who gives me strength.' (Philippians 4: 13). This thesis appears in its current form due to the assistance and guidance of important people. I would therefore like to offer my sincere thanks to all of them. I will never forget the help and support of our secretaries Suse and Bertine. You have been always supportive to me indeed like old friends. I never forgot your time and effort to contact different companies and agencies in order to help me solve many personal problems in the Netherlands. Bertine, thank you for your support and kind words. Suse, thank you for all your help, and the arrangements for my defense would not have been possible without you. Geert Jan, my appreciation for the technical assistance you have provided for our office. I Last but not the least, I must acknowledge my beloved wife and best friend, Elaine, without whose love, encouragement and editing assistance, I would not have finished this thesis. You spent sleepless nights with me and was always my support in the moments when there was no one to answer my queries. I would like to thank you for your personal support and great patience at all times. Your firm and kind-hearted personality has affected me to be faithful and never bend to difficulty. You always let me know that you are proud of me, which motivates me to work harder and do my best. Being both a mother and father while I was away was not an easy thing for you. You took every responsibility and suffered all the bitterness to take care of our children and my parents. Words would never say how grateful I am to you. I doubt that I will ever be able to convey my appreciation fully, but I owe you my eternal gratitude. It was you who provided the fundamental needs of our family, and I understand it was difficult for you, therefore, I can just say thanks for everything and may God give you all the best in return.

2016 IEEE Symposium on Computers and Communication (ISCC), 2016

The potential of patient-centred care and a connected eHealth ecosystem can be developed through socially responsible innovative architectures. The purpose of this paper is to define key innovation needs. This is achieved through conceptual development of an architecture for common information spaces with emergent end-user applications by supporting intelligent processing of measurements, data and services at the Internet of Things (IoT) integration level. The scope is conceptual definition, and results include descriptions of social, legal and ethical requirements, an architecture, services and connectivity infrastructures for consumer-oriented healthcare systems linking co-existing healthcare systems and consumer devices. We conclude with recommendations based on an analysis of research challenges related to how to process the data securely and anonymously and how to interconnect participants and services with different standards and interaction protocols, and devices with heterogeneous hardware and software configurations.

Yearbook of medical informatics, 2011

To summarize lessons learned from the European Commission (EC) co-funded project SmartPersonalHealth, a project to promote a greater understanding of the value of interoperability among Personal Health Systems (PHS) and between them and other eHealth systems, in the landscape of continuity of care and across multi-cultural environments in Europe. Key concepts in PHS interoperability, challenges, barriers and benefits were discussed with stakeholders (policy makers, regulators, procurers, healthcare providers, health professionals, patient representatives, industry, researchers) in three consultation workshops and a final conference. The results were synthesized in final report to the European Commission. The survey and analysis presented, which are designed to set the scene on the key requirements of device level interoperability within a context of using sensors, signals and imaging informatics in healthcare, set out key interoperability standards for PHS as provided for in the Con...

International Journal of Environmental Research and Public Health, 2014

Interoperability in health information systems is increasingly a requirement rather than an option. Standards and technologies, such as multi-agent systems, have proven to be powerful tools in interoperability issues. In the last few years, the authors have worked on developing the Agency for Integration, Diffusion and Archive of Medical Information (AIDA), which is an intelligent, agent-based platform to ensure interoperability in healthcare units. It is increasingly important to ensure the high availability and reliability of systems. The functions provided by the systems that treat interoperability cannot fail. This paper shows the importance of monitoring and controlling intelligent agents as a tool to anticipate problems in health information systems. The interaction between humans and agents through an interface that allows the user to create new agents easily and to monitor their activities in real time is also an important feature, as health systems evolve by adopting more features and solving new problems. A module was installed in Centro Hospitalar do Porto, increasing the functionality and the overall usability of AIDA.

Health Policy and Technology, 2014

The contribution of this paper is to provide a formalized methodology to define, specify or design a system of application modules that communicate information between the components. First this paper defines several types of interoperability. Second, it provides a framework for specifying and analyzing the interoperability of existing or proposed medical systems. Third, it provides a simple example of a provider ordering a prescription for a patient to illustrate the interoperability of the proposed healthcare application systems. Methodology: Our theory-based methodology includes an extensive literature search on interoperability, practical experience in standardizing the Internet, and graph theory. Results: Our results include a framework to specify, define, plan, and perform analysis on a set of applications that need to exchange information. Within this framework, an Interoperability Matrix and its associated Interoperability Flow Graph represent different types of interoperability between related applications. This formal representation is useful first to define the architecture and also provides the option of using graph algorithms that determine interoperability traits within a group of related applications. Conclusion: In conclusion, this framework presents a formal methodology to define and classify interoperability within a set of related applications.

The Ubiquity 2.0 Trend and Beyond, 2010

Canada lags other nations in the introduction and use of the electronic medical record (EMR) and the electronic health record (EHR). Progress is slow and Canada ranks last in EMR adoption compared to many other countries (Davis, Doty, Shea, & Stremikis, 2009). Two primary reasons for the lack of progress are a slow rate of adoption

Proceedings of the 4th International ICST Conference on Pervasive Computing Technologies for Healthcare, 2010

Pervasive health care is gaining attention outside the research community. But real-life deployment of many solutions faces the realities that come with everyday life, namely the existence of boundaries between applications, networks and devices. These often impair the end user experience through failing along these boundaries or enforcing particular end user experiences at them, e.g., by providing single-device or single-network solutions. We intend to address these shortcomings with an approach that places information at the centre of the platform design, including the low-level communication framework. We believe that this approach alone can address the various governance and provenance conflicts that emerge in real-life deployments. This paper describes early work by outlining our design vision as well as early findings on its realization.

IEEE Access

In the era of smart devices and connected neighborhoods, the ubiquitous monitoring and care of patients are possible with the Internet of Medical Things (IoMT). Smart healthcare devices may serve their purpose well when they are able to share patient's data with each other. However, data formats vary widely across vendors, rendering these devices not interoperable. Recent solutions mostly rely on cloud services where a source device uploads the data, and the sink devices download it conforming to their own native formats. However, the quality of service is expected to deteriorate in a cloud processing regime with inherent network delays and traffic congestion, and the real-time data acquisition and manipulation is, therefore, not possible. This article presents MeDIC, a framework of Medical Data Interoperability through Collaboration of healthcare devices. MeDIC improves over a cloud-based IoMT by utilizing translation resources at the network edge, with its probing and translating agents. The probing agents maintain a capability list of MeDIC devices within a local network and enable one MeDIC device to request data conversion from another device when the former is not capable of this conversion by itself. The translating agent of the later then converts the data into the required format and returns it to the former. These novel agents allow IoMT devices to share their redundant computing resources for data translations in order to minimize cloud accesses. Legacy devices are supported through MeDIC-enabled, fog resource managers. We evaluate MeDIC in four use cases with rigorous simulations, which prove that this collaborative framework not only reduces the uplink traffic but also improves the response time, which is critical in real-time medical applications.

One of the key problems in healthcare informatics is the lack of interoperability among different healthcare information systems. Interoperability can be investigated in different categories in the eHealth domain, such as the interoperability of the messages exchanged between healthcare applications, interoperability of Electronic Healthcare Records (EHRs), interoperability of patient identifiers, coding terms, clinical guidelines and healthcare business processes. Furthermore, all these categories can be investigated in two major layers: syntactic interoperability layer and the semantic interoperability layer. This paper describes the concepts involved in eHealth interoperability; briefly assesses the current state in some of the countries in the world and discusses the technical issues to be addressed for achieving interoperability.