Extensions to the HISA standard--the SynEx computing environment.

OBJECTIVES: This paper reports on the integration work required to support the delivery of healthcare. Specifically, four elements are included being: the DHE (a standards based distributed healthcare environment), Synapses which is a patient record server, XML as a technology to deliver records, and finally two client applications that facilitate structured data entry (SDE) and the remote booking of specialist services. METHODS: A general motivation for the work is presented and augmented on hand of a clinical scenario. Additionally, the adoption of a middleware approach is reviewed. The role of computerised patient records is described followed by an account of a federated record server. The approach favoured by standards bodies in utilising XML is covered and the tailoring to suit the needs of the integration is explained. The main practical challenges in achieving integration are presented, one of these being the mapping between the DHE data model and the Synapses server record architecture. RESULTS: The described environment has been demonstrated to provide the functionality that is required and in addition it has been shown that the engineering challenges can be met in a controlled and orderly manner. CONCLUSIONS: The role of the DHE middleware component acting as an 'anchor' has been shown to be a valid one onto which other specialised components can be added to provide a richer service environment. Additionally, it has been demonstrated that XML is a good candidate technology that facilitates connectivity to client applications over an extranet. The demands inherent in both the clinical scenario and the computerised patient record can be met by the computing environment described in the paper.

Towards specialised middleware for healthcare information systems.

Middleware is now a commonly used expression and anyone building distributed applications is referring to 'middleware services'. Nevertheless this notion lacks of sound theoretical foundation. This paper tries to clarify the relationship between the components of distributed environments, especially in healthcare and to establish some classification aiming at gaining a common understanding of the functionality and interdependency of the existing modules of distributed environments. A case study is presented and the potential benefits of using a middleware approach are discussed.

The holistic architectural approach to integrating the healthcare record in the overall information system.

The integration and evolution of existing systems represents one of the most urgent problems facing those responsible for healthcare information systems so that the needs of the whole organisation are addressed. The management of the healthcare record represents one of the major requirements in the overall process, however it is also necessary to ensure that the healthcare record and other healthcare information is integrated within the context of an overall healthcare information system. The CEN ENV 12967-1 'Healthcare Information Systems Architecture' standard defines a holistic architectural approach where the various, organisational, clinical, administrative and managerial requirements co-exist and cooperate, relying on a common heritage of information and services. This paper reviews the middleware-based approach adopted by CEN ENV 12967-1 and the specialisation necessary for the healthcare record based on CEN ENV 12265 'Electronic Healthcare Record Architecture'.

Middleware for healthcare information systems.

Middleware is now a commonly used expression and anyone building distributed applications is referring to "middleware services". Nevertheless this notion lacks of sound theoretical foundation. This paper tries to clarify the relationship between the components of distributed environments, especially in healthcare, and to establish some classification aiming at gaining a common understanding of the functionalities and interdependency of the existing modules of distributed environments.

Synapses in the context of healthcare information systems.

The Electronic Healthcare Record will increasingly lie at the heart of the Healthcare Information Systems of the future, and the ability to share safely and meaningfully patient records between Hospital Information Systems depends crucially on an agreed architecture for EHCR. This paper describes the approach to providing access to Federated Healthcare Records as proposed by Synapses, a pan-European project funded under the EU Health Telematics Programme, through the use of a record server. The positioning of this server within the Healthcare Information Systems Architecture is discussed together with some suitable candidate technologies for implementation.