Adding Instructiveness to IHE-XDS Based Electronic Health Records.

eHealth system users need adequate, timely access to health-related information; including the functionality of alerting and notifications on events. This was addressed through requirements engineering techniques. The analysis resulted in a requirements' list and architecture based on IHE standards. Patients, professionals and administrators were identified as main actors, core notification attributes were type and transport channel, and notifications always event-triggered. One challenge is system-based data access events, potentially leading to an invalid triggering of events.

End-to-End Notifications and Interactivity in Standard Based EHR Networks.

One of the main challenges of EHR system is providing information in an adequate and timely manner to its user which can be as well professionals as patients. In both usage scenarios the acceptance and usage of such system benefits from alerting and notification functionality on events. Since this aspect is hardly covered in interoperability and EHR standards the goal of this paper is to identify workflows and extensions to standard based EHR system to provide this functionality. Using requirements engineering technics and a three-tire analysis phase a list of requirements and an architecture based on IHE standards could be identified. In this concept patients, professional and administrators have been identified as main user groups of such systems. Notification events for the user groups could be categorized to the core attribute families Type and Transport Channel. The notifications itself are triggered by events that could be defined. Outlining the workflows that trigger events in the IHE based infrastructure we identified the challenge of differentiating system generated or based events which are also caused by the notification system's operation. This might lead to invalid event triggers and therefore must be discussed in future work.

Blockchains in IHE-Based Networks.

INTRODUCTION: Interoperability of health information systems is one of the key challenges of modern healthcare systems. A weak spot in this technology stack of interoperability protocols as defined by HL7 and IHE is cross affinity domain exchange of access control information and policies. In several industries the Blockchain technology had a major breakthrough. The goal of this paper is to elaborate how to exchange cross affinity domain access information enhancing well established IHE networks with block chain technology. METHODS: Using literature analysis and research on current interoperability standards the state of the art of securely exchanging medical information was elaborated. We enhanced this system with the capabilities of the peer2peer based Blockchain network elaborating the workflows of exchanging the access control specific information. RESULTS: We extended an IHE based affinity domain by adding a block chain ledger to the deployment. This ledger is fed with XACML based policies which are propagated through the peer2peer based system. Using the Blockchain protocol other affinity domains are informed of the change and can retrieve the information. Acting as an additional source of policies and consents the policy decision point is capable of querying this network and building a decision based on the retrieved information.

Patient Summaries in Context of Large Scale EHR Networks with Fine Granular Access Control Restrictions.

BACKGROUND: Large Scale Electronic Health Record (EHR) systems tend to contain a significant higher amount of patient data compared to traditional local Electronic Medical Record (EMR) silos. This demands the requirement of providing a user context and role specific summary of the patient record. Security and Access Control systems are a crucial part of modern EHR systems controlling legal policies and patient consents. Goal of this paper is to elaborate a concept enhancing an already existing, commonly based on IHE XDS and XACML based, EHR systems with summarization functionalities. METHODS: Using literature review and analysis of technical background of standards and currently running eHealth projects the state of the art is compiled. Based on this knowledge a workflow concept is derived and verified using a prototype based on an EHR product. RESULTS: Using the IHE Profiles XDR and On-Demand a standard based connection to the EHR product is established. The data is extracted and stored with a link to the document reference it was contained in. With a standard based IHE ITI-18 transaction the query is filtered by the ACS of the domain. Using the resulting information a patient summary document can be compiled including only data which was gathered from documents the user has access to.

Dynamic Creation of Patient Summaries: A CDA and IHE XDS Based Approach for Regional EHRs.

Cooperative healthcare is regarded as one of the major goals for providing adequate health related information to physicians. To achieve this goal, national authorities and large hospital organizations are introducing large scale, standard based transactional EHR systems. Those systems record and distribute a significant amount of medical related data. This raises the concern of information overload for the intended users. The objective is to elaborate on an architecture and consequently a workflow that allows the generation of an automatic patient summary in a standard based IHE XDS environment. A literature review evaluating the current state of research is conducted. Current eHealth projects, laws and technical background are analyzed. An architecture is suggested, prototyped and compared using SAAM (Software Architecture Analysis Method) against alternative approaches. A technical workflow built on IHE XDR and HL7 FHIR observations is suggested introducing two new services within an IHE XDS product for extracting observations from CDA documents and storing the data on domain level scope. The information is published as an OnDemand Document in the IHE XDS infrastructure.

Developing an Approach for Aggregating Information From a EHR into a Fully Structured Patient Summary.

BACKGROUND: Providing healthcare professionals with adequate access to well-filled electronic patient records and health-related information contributes to an improvement of the treatment process. Compared to conventional Electronic Medical Records these EHR systems commonly contain more medical artifacts due to their cross institutional, multipurpose use cases. Physicians and health professionals are therefore concerned about information overflow. OBJECTIVES: Goal of this paper is to elaborate new concepts for the automated aggregation of a fully-structured patient summary document based on information extracted from documents which are published in large-scale EHRs. METHODS: The first step was the conduction of semi-structured group interviews with experts and customers. This was followed by a qualitative literature analysis. Consequently technical and medical standards in the field of interoperability were screened. RESULTS: The result of this paper is the elaboration of an architectural approach to integrate an automatic patient summary creation into well established workflows of large ehealth projects based on standard IHE XDS infrastructures, taking the Austrian ELGA as an example.

An approach for software-driven and standard-based support of cross-enterprise tumor boards.

INTRODUCTION: For tumor boards, the networking of different medical disciplines' expertise continues to gain importance. However, interdisciplinary tumor boards spread across several institutions are rarely supported by information technology tools today. The aim of this paper is to point out an approach for a tumor board management system prototype. METHODS: For analyzing the requirements, an incremental process was used. The requirements were surveyed using Informal Conversational Interview and documented with Use Case Diagrams defined by the Unified Modeling Language (UML). Analyses of current EHR standards were conducted to evaluate technical requirements. RESULT: Functional and technical requirements of clinical conference applications were evaluated and documented. In several steps, workflows were derived and application mockups were created. CONCLUSION: Although there is a vast amount of common understanding concerning how clinical conferences should be conducted and how their workflows should be structured, these are hardly standardized, neither on a functional nor on a technical level. This results in drawbacks for participants and patients. Using modern EHR technologies based on profiles such as IHE Cross Enterprise document sharing (XDS), these deficits could be overcome.