An open, component-based information infrastructure for integrated health information networks.

A fundamental requirement for achieving continuity of care is the seamless sharing of multimedia clinical information. Different technological approaches can be adopted for enabling the communication and sharing of health record segments. In the context of the emerging global information society, the creation of and access to the integrated electronic health record (I-EHR) of a citizen has been assigned high priority in many countries. This requirement is complementary to an overall requirement for the creation of a health information infrastructure (HII) to support the provision of a variety of health telematics and e-health services. In developing a regional or national HII, the components or building blocks that make up the overall information system ought to be defined and an appropriate component architecture specified. This paper discusses current international priorities and trends in developing the HII. It presents technological challenges and alternative approaches towards the creation of an I-EHR, being the aggregation of health data created during all interactions of an individual with the healthcare system. It also presents results from an ongoing Research and Development (R&D) effort towards the implementation of the HII in HYGEIAnet, the regional health information network of Crete, Greece, using a component-based software engineering approach. Critical design decisions and related trade-offs, involved in the process of component specification and development, are also discussed and the current state of development of an I-EHR service is presented. Finally, Human Computer Interaction (HCI) and security issues, which are important for the deployment and use of any I-EHR service, are considered.

Support of daily ECG procedures in a cardiology department via the integration of an existing clinical database and a commercial ECG management system.

BACKGROUND: In the context of HYGEIAnet, the regional health telematics network of Crete, a clinical cardiology database (CARDIS) has been installed in several hospitals. The large number of resting ECGs recorded daily made it a priority to have computerized support for the entire ECG procedure. METHODS: Starting in late 2000, ICS-FORTH and Mortara Instrument, Inc., collaborated to integrate the Mortara E-Scribe/NT ECG management system with CARDIS in order to support daily ECG procedures. CARDIS was extended to allow automatic ordering of daily ECGs via E-Scribe/NT. The ECG order list is downloaded to the electrocardiographs and executed, the recorded ECGs are transmitted to E-Scribe/NT, where confirmed ECG records are linked back to CARDIS. A thorough testing period was used to identify and correct problems. An ECG viewer/printer was extended to read ECG files in E-Scribe/NT format. RESULTS: The integration of E-Scribe/NT and CARDIS, enabling automatic scheduling of ECG orders and immediate availability of confirmed ECGs records for viewing and printing in the clinical database, took approximately 4 man months. The performance of the system is highly satisfactory and it is now ready for deployment in the hospital. CONCLUSIONS: Integration of a commercially available ECG management system with an existing clinical database can provide a rapid, practical solution that requires no major modifications to either software component. The success of this project makes us optimistic about extending CARDIS to support additional examination procedures such as digital coronary angiography and ultrasound examinations.