Joint ITU-WHO Workshop on
e-Health Standards and Interoperability
(Geneva, Switzerland, 26-27 April 2012)
Combining Medical-Managerial Information
and Communications Technology Standards
to promote Interoperability in Health-Care:
A Status Report
Prof. Basile P. Spyropoulos
Biomedical Technology Laboratory
Medical Instrumentation Technol.
Department, Technol. Education
Institute (TEI) of Athens, Greece
Geneva, Switzerland, 26-27 April 2012
Background
Contemporary Health-Care in most countries
is characterized by isolated and small-scale
applications that cannot promote effectively
enough, communication and informationsharing
among
Health-Care
Providers,
Medical Institutions and Health Insurance
Organizations.
Therefore, interoperability of Health-Care
Information Systems has become one of the
most crucial and challenging aspects in
National Health Systems and other Healthcare Providers.
Geneva, Switzerland, 26-27 April 2012
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Objectives
The aim of the presentation is to
report on Research and Development
activities during the last 15 years:
First, attempting the Harmonization of
Medical-Managerial and InformationCommunications
Technology
(ICT)
Standards.
Second, promoting Interoperability in
contemporary Health-Care.
Geneva, Switzerland, 26-27 April 2012
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Results
We
have
developed
various
systems
promoting
Interoperability, mostly based on semantically annotated
Web-Services, covering important Medical issues such as:
On-line
Medical
Education
Means based on Patient
Records.
Means
supporting
the
Acquaintance of Health-Care
Personnel to Operational-Cost
Monitoring.
Medical Decision-making and
Treatment
within
the
emerging Hi-Tec Home-care
environment.
Medical House-Call as an
emerging IT-supported Option
in contemporary Health-care.
Digital Blood - Banking and
modern Transfusion Medicine.
Geneva, Switzerland, 26-27 April 2012
Patient treatment at home
and medical data exchange in
the
emerging
networked
society.
Supporting technically the
post-discharge Continuity of
Medical Care.
A Web-based “Quality System
Advisor” supporting:
The Certification of Hospital
Departments
(Out-patient,
Emergency, Surgery etc.)
The Accreditation of in vitro
Diagnostics and Transfusion
Medicine Services.
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An example: Schematic representation of a
Transfusion Medicine related Web-service
B. Spyropoulos et al, Towards Digital Blood-Banking, ITU-T
Kaleidoscope, Mar del Plata, Argentina, 31 Aug-1 Sep 2009
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Some Standards, Clinical Terminologies etc.
employed in the above mentioned projects
Standard Organizations
Common Standards Clinical Terminologies
& Vocabularies
WHO
ICD-9/10 (other: SNOMED, LOINC, ABC, CCC
etc.)
ISBT (International Society
of Blood Transfusion)
ISBT 128 Standard Technical Specification
4.1.0
ANSI
ASTM E2369-05 Continuity of Care Record
ISO
ISO 13606-1:2008 (EHR communication)
ISO-22870 (Point-of-Care Testing)
CEN
prEN-13940 European Standard for Continuity
of Care
HL7 (Health-Level 7)
CDA (Clinical Document Architecture)
ACR/NEMA300 (1985)
DICOM (NEMA Standard PS3 & ISO
12052:2006)
IEEE
Numerous mainly hardware-related Standards
ITU
Numerous Telecommunication-related
Standards
Geneva, Switzerland, 26-27 April 2012
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Discussion
Clinical terminologies and vocabularies, such
as SNOMED, ICD-9, ICD-10, and LOINC are
already in use for several years and they
provide a well established description of the
Medical-domain knowledge.
Furthermore, the HL7-CDA (Health Level 7 Clinical Document Architecture) is already in
use by several countries, providing for a
common representation of clinical documents,
enabling the clinical document exchange and
facilitating document management.
Geneva, Switzerland, 26-27 April 2012
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A schematic representation of an
interim interoperability solution
Semantically annotated Web-services conforming
with Medical and ICT Standards
Isolated and small-scale Health-Care applications
with no interconnectivity in most countries
Graphics: S. M. Wasson, Virtual Information Exchange: Healthcare’s
Present and Future HIE Solution www.relayhealth.com
Geneva, Switzerland, 26-27 April 2012
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Barriers and opportunities concerning
Standards adoption and compliance
Barriers
Different priorities due to the
Countries’ development levels.
Understanding the Standards’
necessity and perspectives.
Cost of the adoption process.
Personnel level and training.
Integration of existing Biomedical Equipment and ICT.
Lack of necessary resources.
No National Health System or
Strategic Policies Framework.
Professional Unions resistance.
Limited International contacts.
No Treaties and commitments.
Geneva, Switzerland, 26-27 April 2012
Opportunities
The Health-Care Internationalization procedure acceleration.
Very positive outcomes of pilotprograms for serious needs.
The miniaturization trend of ICT
& Biomedical Technology (BMT).
Their strongly falling prices.
The merging of Equipment, ICT
and Medical Decision Making.
Medical-Pharmaceutical advance
and BMT Innovation transform
radically Healthcare delivery.
International Cooperation and
increased funds’ availability.
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Conclusions
It is not realistic enough to expect that all careproviders will soon agree on adopting a single
standard, allowing for the interoperability of
different health care information systems.
However, what appears currently to be the most
appealing interim approach, towards optimization
of systems’ interoperability, includes Semantically
annotated Web-Services, delivering Health-Care
relevant information:
Conforming to the most important medical,
managerial and ICT Standards.
Ensuring the well-defined machine-interpretable
meaning of the exchanged data.
Geneva, Switzerland, 26-27 April 2012
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Additional Slides
An overview of indicative already developed
applications demanding Interoperability
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An overview of already developed indicative
applications demanding Interoperability
On-line Medical Education Means based on Patient Records.
Means supporting the Acquaintance of Health-Care
Personnel to Operational-Cost Monitoring.
Medical Decision-making and Treatment within the
emerging Hi-Tec Home-care environment.
Medical House-Call as an emerging IT-supported Option in
contemporary Health-care.
Digital Blood-Banking and contemporary Transfusion
Medicine.
Patient treatment at Home and Medical Data Exchange in
the emerging Networked Society.
Supporting technically the post-discharge Continuity of
Medical Care.
Web-based Systems supporting the Certification of Hospital
Departments and the Accreditation of in vitro Diagnostic
Laboratories.
Geneva, Switzerland, 26-27 April 2012
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On-line Medical Education Means
based on Patient Records
An important role is assigned to the employment of Medical
Records for the Continuous Medical Education (CME) procedures.
Medical records are used in a variety of ways and they serve a
multiplicity of purposes.
Beyond the explicit involvement of records in the therapeutic
process, there are several other discernible uses, such as in
research, in teaching, in the allocation of resources, and in the
reconstruction of the patient’s personal history.
The technological substratum of records, on the one hand,
constitutes itself knowledge and, on the other, it plays a decisive
role in forming the character and the extent of the knowledge,
which the records themselves represent at each particular stage
of their mutual interaction.
A further important issue related to CME is the elaboration,
adoption and dissemination of appropriate Medical Guidelines, as
well as, the development of computerized procedures, associated
to their employment.
B. Spyropoulos, The "Networked Society" Hospital as an important interdisciplinary Distance
Learning Facility, EDEN 10th Anniversary Conference "Learning without limits: Developing the
next Generation of Education", Stockholm, June 10-13, 2001.
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Means supporting the Acquaintance of
Health-Care Personnel to Operational-Cost
Monitoring
The developed system consists of
databases, and allows for every user:
various
related
First, to select one or more out of 37 discrete medical
specialties.
Second, to set up a custom-made menu of available diagnostic
and treatment activities out of the ones contained in the
system.
Third, to attach them either a nominal value, proposed by the
system, which is based upon realistic, empirically collected
data, or to individually price them.
The developed tool allows for every user to set up an
individually designed menu of available diagnostic and
treatment actions, and to attach them a nominal value.
Thus, the employment of this method enables the
formation of a medical record, which is intrinsically,
however latent, related to the costs caused and the
expected reimbursement.
B. Spyropoulos, Supporting the Acquaintance of Health-Care Personnel to Operational-Cost
Monitoring (Invited Lecture), CD-ROM Proceedings of TEHRE 2002, 8-11 December, The
New Connaught Rooms, Covent Garden, London, United Kingdom.
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Medical Decision-making and Treatment
within the emerging Hi-Tec Home-care
environment
We argue that a qualitatively new mobile
home-care is presently emerging out of the
combined employment of:
The modern wireless mobile telephony networks and
equipment.
The contemporary digital entertainment electronics.
The commercially available computer hardware and
software.
This new mobile home-care allows us for to
be optimistic about the reduction of patients’
unnecessary hospitalization, as well as, a
much more attractive way for the patient to
lend himself to be treated, in the near future.
B. Spyropoulos, M. Botsivaly, Reducing Hospital length of stay through the formation of a Hi-Tec
Home-care Environment, Proceedings IEEE/Create Net Broad Nets 2005 Conference: BROADMED
1st IEEE/Create Net International Workshop on "Telemedicine over broadband and wireless
networks", October 3, 2005, Boston, MA, USA.
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Medical House-Call as an emerging ITsupported Option in contemporary
Health-care
The revival of house - call in Medical Practice is
due, beyond the health-insurance adaptation to
the altering social conditions, to the highly
developed equipment made available to the
General Physician of the emerging networked
society.
Patient care, comparable to that of an emergency
room, at home is made possible thanks to:
The Personal Digital Assistant, with embedded Cellphone safekeeping detailed patient-records, and
permitting Electronic Order Entry.
The sophisticated point-of-care diagnostic equipment
and reagents.
Various other technical means, embedded in the so
Called "smart home" residential environment.
B. Spyropoulos, Medical House-Call: An outdated Ritual or an emerging IT-supported Option
in contemporary Health-care?, 24th TEPR 2008, May 17-21, 2008, Fort Lauderdale, FL, USA
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Digital Blood - Banking and
contemporary Transfusion Medicine
In this paper it was attempted to report the efforts of our
group during the last decade, to contribute to the design
and the implementation of a universal Information System
with integrated Web-Services, covering the most important
Aspects of modern Transfusion Medicine, i.e. MedicalManagerial and Educational issues, Clinical and Laboratory
Quality Assurance, Haemovigilance, Financial-Managerial
topics, and finally, post Transfusion Continuity of Care.
Although the system components described do not yet fulfill
all legal-administrative demands for clinical employment,
they constitute a low-cost suggestion towards semantically
annotated Web Services supporting bidirectional Exchange
of Transfusion relevant medical and managerial Data,
among various Points of care over an integrated Blood and
Blood Product Network.
B. Spyropoulos, M. Botsivaly, A. Tzavaras, P. Spyropoulou, Towards Digital Blood-Banking,
ITU-T Proceedings Kaleidoscope-Conference, Mar del Plata, Argentina, 31 Aug-1 Sep 2009
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Patient treatment at home and medical data
exchange in the emerging networked
society
A significant portion of Care related to Cardio-respiratory Diseases is
provided at Home, usually but not exclusively, after the discharge of a
patient from Hospital.
We have developed an integrated system, supporting the Continuity of
Care of Cardio-respiratory Diseases at Home that includes:
First, a prototype lap-top based portable monitoring system that comprises
of low-cost commercially available components, supporting patient’s wellbeing observation, by enabling periodical or continuous vital-signs
monitoring at Home;
second, software supporting Medical Decision Making related to
Tachycardia and Ventricular Fibrillation, as well as, Fuzzy-rules based
software supporting Home-Ventilation optimization;
third, a typical Continuity of Care Record (CCR) adapted to support also the
creation of a Home-Care Plan;
and finally, a Prototype Ontology, based upon the HL7 Clinical Document
Architecture (CDA), serving as basis for the development of Semantically
Annotated Web-Services that allow for the exchange and retrieval of HomeCare information.
The flexible hardware design and the adaptable data-exchange mechanism
of the system, result in a useful and standard-compliant tool, for Cardiorespiratory Diseases related Home-Care.
B. Spyropoulos et al., Ensuring the Continuity of Care of Cardio-respiratory Diseases at Home:
Monitoring Equipment and Medical Data Exchange over Semantically annotated Web Services,
Methods of Information in Medicine, 2010; volume 49; issue 2, pp.156-160.
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Supporting technically the postdischarge Continuity of Medical Care
Software for the formation of a Continuity of Care Record,
combining the ANSI-E2369 (CCR), the ISO 13606-1 and
the prEN 13940 standards.
An integrated prototype Notebook-based system enabling
the monitoring of Biosignals, Thoracic Impedance,
Respiratory, Carotid and Pulmonary Sounds, in vitro
Diagnostics Point of Care testing, and the post-discharge
supported Respiration or Ventilation.
Medical Decision-making support for Cardiovascular and
Respiratory Diseases, enabling post-discharge monitoring
evaluation for emergency response, and ensuring
Mechanical Ventilation settings Optimization.
Design of Semantically annotated Web-Services ensuring
the Continuity of Care, including post-discharge Care Plan
and Pharmacovigilance.
Software for Virtual Audiovisual Remote monitoring,
supporting the continuity of care.
B. Spyropoulos, M. Botsivaly, A. Tzavaras, Supporting technically the Continuity of Medical Care:
Status report and perspectives, Proceedings of the ITU-T Kaleidoscope Conference, Cape Town,
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South Africa, 12-14 December 2011
A Web-based System supporting the
Certification of Hospital Departments and
the Accreditation of Diagnostic Laboratories
This designed and partially implemented on-line
“Certification
and
Accreditation
Consultant”,
promotes the optimization of the documentation of
the
routine
processes,
in
the
Outpatient,
Emergency and Surgery Departments and other
associated Surgical Units.
After a thorough analysis of patient treatment
processes, support is offered over a controlledaccess website, providing for a “scaffold of
expertise” for each Unit.
The Website comprises of managerial knowledge,
subject-related standards, legislation, and relevant
medical directives and guidelines, issued by the
pertinent scientific Societies.
B. Spyropoulos et al., A web-based System supporting the Certification of the Outpatient and
Emergency Departments and providing for post-discharge Continuity of medical Care Software,
Springer IFMB Proceedings (EMBEC Sep. 14-18, 2011, Budapest, Hungary), 2011.
B. Spyropoulos et al., A web-based System supporting the Certification of a Surgical Department
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in a general Hospital, Springer IFMB Proceedings (EMBEC Sep.14-18 2011, Budapest, Hungary).
Thank you very much for your interest
about Interoperability in Health-Care !
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