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Methods Inf Med 2002; 41(05): 401-410
DOI: 10.1055/s-0038-1634369
Original Article
Schattauer GmbH

Extensions to the HISA Standard – the SynEx Computing Environment

W. Grimson
1   Dublin Institute of Technology, Faculty of Engineering, Dublin, Ireland
,
B. Jung
2   Dept. of Computer Science, Trinity College, Dublin, Ireland
,
E. M. van Mulligen
3   Dept. of Medical Informatics, Erasmus University of Rotterdam, Rotterdam, The Netherlands
,
A. van Ginneken
3   Dept. of Medical Informatics, Erasmus University of Rotterdam, Rotterdam, The Netherlands
,
S. Pardon
1   Dublin Institute of Technology, Faculty of Engineering, Dublin, Ireland
,
P. A. Sottile
4   GESI, Roma, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
07 February 2018 (online)

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Summary

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.

Keywords

Hospital information system - distributed healthcare environment - electronic patient record - record server - structured data - XML technology
 

  • REFERENCES

  • 1 Grimson J, Grimson W, Hasselbring W. The SI Challenge in Health Care. Commun ACM 2000; 43 June 6.
    CrossrefPubMedGoogle Scholar
  • 2 Ferrara F. Healthcare information systems architecture, new technologies in hospital information systems in Studies in Health Technology and Information systems, vol. 45. Amsterdam,. The Netherlands: IOS; 1995. pp. 1-9.
    Google Scholar
  • 3 Ferrara F, Grimson W, Sottile PA. The holistic architectural approach to integrating the healthcare record in an overall information system. In Proceedings MIE ’99,. IOS Press; pp. 847-52.
    Google Scholar
  • 4 Healthcare Information System Architecture Part 1 (HISA); Healthcare Middleware Layer,. CEN TC251, prENV; 1997: 12967-1.
    Google Scholar
  • 5 McDonald CJ, Tierney WM. Computer-stored medical records: Their future role in Medical practice. JAMA 1988; 259: 3433-40.
    CrossrefPubMedGoogle Scholar
  • 6 Reiser J. The Clinical Record in Medicine. Part 2: Reforming Content and Purpose. Ann Intern Med 1991; 114: 980-5.
    CrossrefPubMedGoogle Scholar
  • 7 Shortliffe EH. The Evolution of Electronic Medical Records. Acad Med 1999; 74: 414-9.
    CrossrefPubMedGoogle Scholar
  • 8 Sujansky WV. The benefits and challenges of an electronic medical record: much more than a ‘word-processed’ patient chart. West J Med 1998; 169: 176-83.
    PubMedGoogle Scholar
  • 9 Dick RS, Steen EB, Detmer DE. eds. The computer-based patient record: an essential technology for health care. Revised Edition. Institute of Medicine. National Academy press. 1997
    PubMedGoogle Scholar
  • 10 Kuhn IM, Wiederhold G, Rodnick JE, Ramsey-Klee DM, Benett S, Beck DD. Automated ambulatory medical record systems in the US. In: Information Systems for Patient Care. Blum BI. ed. Springer-Verlag; 1984: 199-217.
    CrossrefGoogle Scholar
  • 11 Schoenbaum SC, Barnett GO. Automated ambulatory medical records systems. An orphan technology. Int J Technol Assess Health Care 1992; 8 (Suppl. 04) 598-609.
    CrossrefPubMedGoogle Scholar
  • 12 McDonald CJ, Tierney W, Blevins L. The benefits of automated medical record systems for ambulatory care. In: Information Systems for Patient Care. Blum BI. ed. Springer-Verlag; 1984: 63-83.
    Google Scholar
  • 13 Cimino JJ. Data storage and knowledge representation for clinical workstations. Int J Biomed Comput 1994; 34: 185-94.
    CrossrefPubMedGoogle Scholar
  • 14 Baud RH, Rassinoux AM, Scherrer JR. Natural Language Processing and Semantical Representation of Medical Texts. Methods Inf Med 1992; 31: 117-26.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Rasmussen JENG, Bassoe CF. Semantic analysis of medical records. Methods Inf Med 1993; 32 (Suppl. 01) 66-72.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Wyatt JC, Wright P. Medical records: Design should help use of patients’ data. Lancet 1998; 352: 1375-8.
    CrossrefPubMedGoogle Scholar
  • 17 Nygren E, Wyatt JC, Wright P. Medical records: Helping clinicians to find data and avoid delays. Lancet 1998; 352: 1462-6.
    CrossrefPubMedGoogle Scholar
  • 18 Powsner SM, Wyatt JC, Wright P. Medical records: Opportunities for and challenges of computerization. Lancet 1998; 352: 1617-22.
    CrossrefPubMedGoogle Scholar
  • 19 Tange HJ, Hasman A, de Vries Robbe PF, Schouten HC. Medical narratives in electronic medical records. Int J Med Inf 1997; 46: 9-27.
    PubMedGoogle Scholar
  • 20 Wyatt JC. Clinical data systems, Part 3:Development and evaluation. Lancet 1994; 344 8938 1682-8.
    CrossrefPubMedGoogle Scholar
  • 21 Howkins TJ, Kay S, Rector AL. et al. An overview of the PEN & PAD project.. In: Lecture Notes in Medical Informatics. Rienhoff O, Lindberg DAB. eds. 1990; 40: 73-78.
    PubMedGoogle Scholar
  • 22 Trace D, Naeymi-Rad F, Haines D. et al. Intelligent Medical Record-entry (IMR-E). J Med Syst 1993; 17 3-4 139-51.
    CrossrefPubMedGoogle Scholar
  • 23 Bell DS, Greenes RA. Evaluation of Ultra-STAR: Performance of a collaborative structured data entry system. In: Proceedings of the 18th SCAMC. Ozbolt JG. ed. Symposium supplement of JAMIA; 1994: 216-22.6.
    Google Scholar
  • 24 Moorman PW, van Ginneken AM, Siersema PD. et al. Evaluation of Reporting Based on Descriptional Knowledge. JAMIA 1995; 2: 365-73.
    PubMedGoogle Scholar
  • 25 Moorman PW, van Ginneken AM, van der Lei JH, van Bemmel JH. A model for structured data entry based on explicit descriptional knowledge. Methods Inf Med 1994; 33 (Suppl. 05) 454-63.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 van Ginneken AM. Structured data entry in ORCA: the strengths of two models combined. In: Cimino JJ. ed. J Am Med Inf Assoc, symposium supplement,; 1996: 797-801.
    Google Scholar
  • 27 van Ginneken AM, Stam H, van Mulligen EM, de Wilde M, van Mastrigt R, van Bemmel JH. ORCA: The Versatile CPR. Methods Inf Med 1999; 38: 332-8.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Grimson J. et al. Synapses – Federated health-care record server, in Procs. MIE’96. Brender J, Christensen JP, Scherrer JR, McNair P. eds. Amsterdam, The Netherlands: IOS Press; 1996. pp. 695-9.
    Google Scholar
  • 29 Grimson W, Berry D, Grimson J, Stephens G, Felton E, Given P, O’Moore R. Federated healthcare record server – the Synapses paradigm. Int J Med Inform 1998; 52: 3-27.
    CrossrefPubMedGoogle Scholar
  • 30 Grimson J, Grimson W, Berry D, Stephens G, Felton E, Kalra D, Toussaint P, Weier W. A CORBA-based integration of distributed electronic healthcare records using the Synapses approach. BioMedicine 1998; 2, 3 (Sept.): 124-38.
    PubMedGoogle Scholar
  • 31 Kalra D. (ed). The Synapses User Requirements and Functional Specifications (Part A). The Synapses Project. Deliverable USER 1.1.1a, EU Telematics Application Programme Office. 1996
    PubMedGoogle Scholar
  • 32 Bosak J. XML, Java, and the future of the Web,. http://sunsite.unc.edu/pub/sun-info/standards/xml/why/xmlapps.961117.html November 1996
    PubMedGoogle Scholar
  • 33 Jung B, Grimson W, Grimson J. The EHCR – if not now, when?. In: Proceedings TEHRE; 1999, November 1999, London/UK.:
    Google Scholar
  • 34 Boyer S, Alschuler L. HL7 Patient Record Architecture update. In: Proceedings XML; Europe: 2000, June 2000, Paris/France.
    Google Scholar
  • 35 Health informatics – Electronic healthcare record communication,. prENV 13606(1-4), CEN TC 251, 1999
    PubMedGoogle Scholar
  • 36 Bray T, Paoli J, Sperberg-Queen CM. Extensible Markup Language (XML) 1.0, W3C Recommendation. 10-February-1998 http://www.w3.org/TR/REC-xml
    PubMedGoogle Scholar
  • 37 Jung B, Andersen P, Grimson J. SynExML as a vehicle for Electronic Patient Records:A status report from the SynEx project. In: Proceedings XML Europe: 2000, June 2000
    Google Scholar