Smart Medical Information Technology for Healthcare (SMITH)

Alfred Winter; Sebastian Stäubert; Danny Ammon; Stephan Aiche; Oya Beyan; Verena Bischoff; Philipp Daumke; Stefan Decker; Gert Funkat; Jan E. Gewehr; Armin de Greiff; Silke Haferkamp; Udo Hahn; Andreas Henkel; Toralf Kirsten; Thomas Klöss; Jörg Lippert; Matthias Löbe; Volker Lowitsch; Oliver Maassen; Jens Maschmann; Sven Meister; Rafael Mikolajczyk; Matthias Nüchter; Mathias W. Pletz; Erhard Rahm; Morris Riedel; Kutaiba Saleh; Andreas Schuppert; Stefan Smers; André Stollenwerk; Stefan Uhlig; Thomas Wendt; Sven Zenker; Wolfgang Fleig; Gernot Marx; André Scherag; Markus Löffler

doi:10.3414/ME18-02-0004

Methods of Information in Medicine, Table of Contents

CC BY-NC-ND 4.0 · Methods Inf Med 2018; 57(S 01): e92-e105
DOI: 10.3414/ME18-02-0004

Focus Theme – Original Articles

Schattauer GmbH

Smart Medical Information Technology for Healthcare (SMITH)^[*]

Data Integration based on Interoperability Standards

Alfred Winter

¹Leipzig University, Institute of Medical Informatics, Statistics and Epidemiology, Leipzig, Germany

,

Sebastian Stäubert

¹Leipzig University, Institute of Medical Informatics, Statistics and Epidemiology, Leipzig, Germany

,

Danny Ammon

²University Medical Center Jena, Central Service Provider For Information Technology, Jena, Germany

,

Stephan Aiche

³SAP SE, Potsdam, Germany

,

Oya Beyan

⁴RWTH Aachen University, Chair of Computer Science 5, Aachen, Germany

,

Verena Bischoff

⁵University of Leipzig Medical Center, Division Staff and Justice, Leipzig, Germany

,

Philipp Daumke

⁶Averbis GmbH, Freiburg, Germany

,

Stefan Decker

⁴RWTH Aachen University, Chair of Computer Science 5, Aachen, Germany

,

Gert Funkat

⁷University of Leipzig Medical Center, Division Information Management, Leipzig, Germany

,

Jan E. Gewehr

⁸University Medical Center Hamburg-Eppendorf, Business Division for Information Technology, Hamburg, Germany

,

Armin de Greiff

⁹Essen University Hospital, Central Information Technology, Essen, Germany

,

Silke Haferkamp

¹⁰RWTH Aachen University Hospital, Division Information Technology, Aachen, Germany

,

Udo Hahn

¹¹Friedrich-Schiller-Universität Jena, Language & Information Engineering Lab (JULIE Lab), Jena, Germany

,

Andreas Henkel

²University Medical Center Jena, Central Service Provider For Information Technology, Jena, Germany

,

Toralf Kirsten

¹²Leipzig University, LIFE Research Centre for Civilization Diseases, Leipzig, Germany

,

Thomas Klöss

¹³Martin-Luther-Universität Halle-Wittenberg Medical Center, Medical Director, Halle, Germany

,

Jörg Lippert

¹⁴Bayer AG, Wuppertal, Germany

,

Matthias Löbe

¹Leipzig University, Institute of Medical Informatics, Statistics and Epidemiology, Leipzig, Germany

,

Volker Lowitsch

¹⁰RWTH Aachen University Hospital, Division Information Technology, Aachen, Germany

,

Oliver Maassen

¹⁵RWTH Aachen University Hospital, Department of Intensive Care and Intermediate Care, Aachen, Germany

,

Jens Maschmann

¹⁶University Medical Center Jena, Medical Director, Jena, Germany

,

Sven Meister

¹⁷Fraunhofer Institute for Software and Systems Engineering, Dortmund, Germany

,

Rafael Mikolajczyk

¹⁸Martin-Luther-Universität Halle-Wittenberg, Institute of Medical Epidemiology, Biometry and Informatics, Halle, Germany

,

Matthias Nüchter

¹²Leipzig University, LIFE Research Centre for Civilization Diseases, Leipzig, Germany

,

Mathias W. Pletz

¹⁹University Medical Center Jena, Institute of Infectious Diseases and Infection Control, Jena, Germany

,

Erhard Rahm

²⁰Leipzig University, Department of Computer Science – Database Group, Leipzig, Germany

,

Morris Riedel

²¹Forschungszentrum Jülich, Jülich Supercomputing Centre, Jülich, Germany

,

Kutaiba Saleh

²University Medical Center Jena, Central Service Provider For Information Technology, Jena, Germany

,

Andreas Schuppert

²²RWTH Aachen University, Institute for Computational Biomedicine II, Aachen, Germany

,

Stefan Smers

⁷University of Leipzig Medical Center, Division Information Management, Leipzig, Germany

,

André Stollenwerk

²³RWTH Aachen University, Informatik 11 – Embedded Software, Aachen, Germany

,

Stefan Uhlig

²⁴RWTH Aachen University, Medical Faculty, Dean, Aachen, Germany

,

Thomas Wendt

²⁵University of Leipzig Medical Center, Data Integration Center, Leipzig, Germany

,

Sven Zenker

²⁶University of Bonn Medical Center, Department of Anesthesiology and Intensive Care Medicine, Bonn, Germany

,

Wolfgang Fleig^**

²⁷University of Leipzig Medical Center, Medical Director, Leipzig, Germany

,

Gernot Marx^**

¹⁵RWTH Aachen University Hospital, Department of Intensive Care and Intermediate Care, Aachen, Germany

,

André Scherag^**

²⁸University Medical Center Jena, Center for Sepsis Control and Care, Jena, Germany

²⁹University Medical Center Jena, Institute of Medical Statistics, Computer and Data Sciences (IMSID), Jena, Germany

,

Markus Löffler^**

¹Leipzig University, Institute of Medical Informatics, Statistics and Epidemiology, Leipzig, Germany

› Author Affiliations

Abstract

Summary

Introduction: This article is part of the Focus Theme of Methods of Information in Medicine on the German Medical Informatics Initiative. “Smart Medical Information Technology for Healthcare (SMITH)” is one of four consortia funded by the German Medical Informatics Initiative (MI-I) to create an alliance of universities, university hospitals, research institutions and IT companies. SMITH’s goals are to establish Data Integration Centers (DICs) at each SMITH partner hospital and to implement use cases which demonstrate the usefulness of the approach.

Objectives: To give insight into architectural design issues underlying SMITH data integration and to introduce the use cases to be implemented.

Governance and Policies: SMITH implements a federated approach as well for its governance structure as for its information system architecture. SMITH has designed a generic concept for its data integration centers. They share identical services and functionalities to take best advantage of the interoperability architectures and of the data use and access process planned. The DICs provide access to the local hospitals’ Electronic Medical Records (EMR). This is based on data trustee and privacy management services. DIC staff will curate and amend EMR data in the Health Data Storage.

Methodology and Architectural Framework: To share medical and research data, SMITH’s information system is based on communication and storage standards. We use the Reference Model of the Open Archival Information System and will consistently implement profiles of Integrating the Health Care Enterprise (IHE) and Health Level Seven (HL7) standards. Standard terminologies will be applied. The SMITH Market Place will be used for devising agreements on data access and distribution. 3LGM² for enterprise architecture modeling supports a consistent development process.

The DIC reference architecture determines the services, applications and the standards-based communication links needed for efficiently supporting the ingesting, data nourishing, trustee, privacy management and data transfer tasks of the SMITH DICs. The reference architecture is adopted at the local sites. Data sharing services and the market place enable interoperability.

Use Cases: The methodological use case “Phenotype Pipeline” (PheP) constructs algorithms for annotations and analyses of patient-related phenotypes according to classification rules or statistical models based on structured data. Unstructured textual data will be subject to natural language processing to permit integration into the phenotyping algorithms. The clinical use case “Algorithmic Surveillance of ICU Patients” (ASIC) focusses on patients in Intensive Care Units (ICU) with the acute respiratory distress syndrome (ARDS). A model-based decision-support system will give advice for mechanical ventilation. The clinical use case HELP develops a “hospital-wide electronic medical record-based computerized decision support system to improve outcomes of patients with blood-stream infections” (HELP). ASIC and HELP use the PheP. The clinical benefit of the use cases ASIC and HELP will be demonstrated in a change of care clinical trial based on a step wedge design.

Discussion: SMITH’s strength is the modular, reusable IT architecture based on interoperability standards, the integration of the hospitals’ information management departments and the public-private partnership. The project aims at sustainability beyond the first 4-year funding period.

Keywords

Health information interoperability - inte grated advanced information management systems - systems integration - phenotyping - intensive care - antimicrobial stewardship

Full Text

References

References
1 Federal Ministry of Education and Research, Germany. Medical Informatics Funding Scheme: Networking data – improving health care. Berlin, Germany: 2015. Available from: https://www.bmbf.de/pub/Medical_Informatics_Funding_Scheme.pdf
2 CCSDS Secretariat. Reference Model for an Open Archival Information System (OAIS). Magenta Book; NASA Headquarters: 2012. Available from: http://public.ccsds.org/publications/archive/650x0m2.pdf
3 Kirsten T, Kiel A, Wagner J, Rühle M, Löffler M. Selecting, Packaging, and Granting Access for Sharing Study Data. In: Eibl M, Gaedke M. editors. Informatik 2017 – Bände I-III: Tagung vom 25.-29. September 2017 in Chemnitz. Bonn: Gesellschaft für Informatik; 2017: 1381-1392 (GI-Edition Proceedings; vol. 275).
4 Kirsten T, Kiel A, Rühle M, Wagner J. Metadata Management for Data Integration in Medical Sciences – Experiences from the LIFE Study. In: Mitschang B, Ritter N, Schwarz H, Klettke M, Thor A, Kopp O, et al. editors. BTW 2017: Daten-banksysteme für Business, Technologie und Web (Workshopband); Tagung vom 6. – 7.März 2017 in Stuttgart. Bonn: Gesellschaft für Informatik; 2017: 175-194 (GI-Edition – lecture notes in informatics (LNI) Proceedings; volume P-266).
5 Loeffler M, Engel C, Ahnert P, Alfermann D, Arelin K, Baber R. et al. The LIFE-Adult-Study: Objectives and design of a population-based cohort study with 10,000 deeply phenotyped adults in Germany. BMC Public Health 2015; 15: 691.
6 Löffler M, Binder H, Kirsten T. Leipzig Health Atlas. 2018 [cited 2018 Jan 30]. Available from: https://www.health-atlas.de/en
7 Winter A, Brigl B, Wendt T. Modeling Hospital Information Systems (Part 1): The Revised Three Layer Graph-Based Meta Model 3LGM2. Methods Inf Med 2003; 42 (05) 544-551.
8 Winter A, Haux R, Ammenwerth E, Brigl B, Hellrung N, Jahn F. Health Information Systems – Architectures and Strategies. London: Springer; 2011
9 Staemmler M. Towards sustainable e-health networks: does modeling support efficient management and operation?. In: Kuhn KA, Warren JR, Leong T-Y. editors. Proceedings of Medinfo 2007 (Part 1). Amsterdam: IOS Press; 2007: 53-57 (Stud Health Technol Inform; vol. 129).
10 Stäubert S, Winter A, Speer R, Loffler M. Designing a Concept for an IT-Infrastructure for an Integrated Research and Treatment Center. In: Safran C, Marin H, Reti S. editors. MEDINFO 2010 Partnerships for Effective eHealth Solutions. Amsterdam: IOS Press; 2010: 1319-1323 (Stud Health Technol Inform; vol. 160).
11 Winter A, Takabayashi K, Jahn F, Kimura E, Engelbrecht R, Haux R. et al. Quality Requirements for Electronic Health Record Systems: A Japanese-German Information Management Perspective. Methods Inf Med. 2017 56. (Open): e92-e104 Available from: https://www.schattauer.de/index.php?id=5236&mid=27796&L=1
12 IHE International Inc. IHE Profiles. 2017 [cited 2018 Jan 4]. Available from: http://wiki.ihe.net/index.php/Profiles#IHE_IT_Infrastructure_Profiles
13 Stäubert S, Schaaf M, Jahn F, Brandner R, Winter A. Modeling Interoperable Information Systems with 3LGM² and IHE. Methods Inf Med 2015; 54 (05) 398-405.
14 HL7.org. Introducing HL7 FHIR. 2014 Jan 1 [cited 2018 Jan 4]. Available from: https://www.hl7.org/fhir/summary.html
15 Otto B, Jürjens J, Schon J, Auer S, Menz N, Wenzel S. et al. INDUSTRIAL DATA SPACE: Digitale Souveränität über Daten. 2016 Available from: www.industrialdataspace.org
16 Juhr M, Haux R, Suzuki T, Takabayashi K. Overview of recent trans-institutional health network projects in Japan and Germany. J Med Syst 2015; 39 (05) 234.
17 International Organization for Standardization (ISO). ISO 18308: 2011 Requirements for an electronic health record architecture. 2011 [cited 2014 Jan 23].
18 Garets D, Davis M. Electronic Medical Records vs. Electronic Health Records: Yes, There Is a Difference. Chicago, IL: HIMSS Analytics; 2006. Available from: http://s3.amazonaws.com/rdcmshimss/files/production/public/HIMSSorg/Content/files/WP_EMR_EHR.pdf
19 Hellrich J, Matthies F, Faessler E, Hahn U. Sharing models and tools for processing German clinical texts. Stud Health Technol Inform 2015; 210: 734-738.
20 Marincola FM. Translational Medicine: A two-way road. J Transl Med 2003; 01 (01) 1.
21 FHIR Developer Introduction. 2015 [cited 2016 Apr 13]. Available from: http://hl7.org/fhir/overview-dev.html#1.8.1.6
22 Health Level Seven International. CDA® Release 2: Health Level Seven International. 2016 [cited 2016 Feb 12]. Available from: http://www.hl7.org/implement/standards/product_brief.cfm?product_id=7
23 Redaktionsgruppe Kerndatensatz der AG Interoperabilität des Nationalen Steuerungsgremiums der Medizininformatik-Initiative. 2017 Mar 10. Available from: http://www.medizininformatik-initiative.de/sites/default/files/inline-files/MII_04_Kerndatensatz_1–0.pdf
24 Wilkinson MD, Dumontier M, Aalbersberg IJJ, Appleton G, Axton M, Baak A. et al. The FAIR Guiding Principles for scientific data management and stewardship. Sci Data 2016; 03: 160018.
25 Darmoni SJ, Thirion B, Leroy JP, Douyère M. The use of Dublin Core metadata in a structured health resource guide on the internet. Bull Med Libr Assoc 2001; 89 (03) 297-301.
26 Meineke Frank, Stäubert S, Löbe M, Winter A. A Comprehensive Clinical Research Database based on CDISC ODM and i2b2. Stud Health Technol Inform 2014; 205: 1115-1119.
27 Murphy SN, Mendis M, Hackett K, Kuttan R, Pan W, Phillips LC. et al. Architecture of the open-source clinical research chart from Informatics for Integrating Biology and the Bedside. AMIA Annu Symp Proc 2007; 2007: 548-552.
28 Hripcsak G, Duke JD, Shah NH, Reich CG, Huser V, Schuemie MJ. et al. Observational Health Data Sciences and Informatics (OHDSI): Opportunities for Observational Researchers. Stud Health Technol Inform 2015; 216: 574-578.
29 Kho AN, Cashy JP, Jackson KL, Pah AR, Goel S, Boehnke J. et al. Design and implementation of a privacy preserving electronic health record linkage tool in Chicago. J Am Med Inform Assoc 2015; 22 (05) 1072-1080.
30 Vatsalan D, Sehili Z, Christen P, Rahm E. Privacy-Preserving Record Linkage for Big Data: Current Approaches and Research Challenges. In: Zomaya A, Sakr S. editors. Privacy-Preserving Record Linkage for Big Data: Handbook of Big Data Technologies. Springer; 2017
31 Löbe M, Ganslandt T, Lotzmann L, Mate S, Christoph J, Baum B. et al. Simplified Deployment of Health Informatics Applications by Providing Docker Images. Stud Health Technol Inform 2016; 228: 643-647.
32 Richesson RL, Smerek MM, Blake CCameron. A Framework to Support the Sharing and Reuse of Computable Phenotype Definitions Across Health Care Delivery and Clinical Research Applications. EGEMS (Wash DC) 2016; 04 (03) 1232.
33 Hahn U, Matthies F, Lohr C, Löffler M. 3000PA—Backbone for a national clinical reference corpus of German. MIE 2018. In: Ugon A, Karlsson D, Klein GO, Moen A. editors. Building Continents of Knowledge in Oceans of Data: The future of co-created e-health. Amsterdam: IOS Press; 2018: 26-30.
34 Hahn U, Matthies F, Faessler E, Hellrich J. UIMA-based JCoRe 2.0 goes GitHub and Maven Central: State-of-the-art software resource engineering and distribution of NLP pipelines. In: Calzolari N. editor. LREC 2016: [proceedings]. [S. l.: s. n.]; 2016: 2502-2509.
35 Henry KE, Hager DN, Pronovost PJ, Saria S. A targeted real-time early warning score (TREWScore) for septic shock. Sci Transl Med 2015; 07 (299) 299ra122.
36 Wolkenhauer O, Auffray C, Brass O, Clairambault J, Deutsch A, Drasdo D. et al. Enabling multiscale modeling in systems medicine. Genome Med 2014; 06 (03) 21.
37 de With K, Allerberger F, Amann S, Apfalter P, Brodt H-R, Eckmanns T. et al. Strategies to enhance rational use of antibiotics in hospital: A guideline by the German Society for Infectious Diseases. Infection 2016; 44 (03) 395-439.
38 Vogel M, Schmitz RPH, Hagel S, Pletz MW, Gagelmann N, Scherag A. et al. Infectious disease consultation for Staphylococcus aureus bacteremia – A systematic review and meta-analysis. J Infect 2016; 72 (01) 19-28.
39 DeLisle S, South B, Anthony JA, Kalp E, Gundlapallli A, Curriero FC. et al. Combining free text and structured electronic medical record entries to detect acute respiratory infections. PLoS One 2010; 05 (10) e13377.
40 Deutscher Ethikrat. Big Data und Gesundheit – Datensouveränität als informationelle Freiheits-gestaltung: Stellungnahme. Berlin: 2017. Nov 30. Available from: http://www.ethikrat.org/dateien/pdf/stellungnahme-big-data-und-gesundheit.pdf

Supplementary Material

Online Supplementary Material (PDF)

Smart Medical Information Technology for Healthcare (SMITH)[*]

Smart Medical Information Technology for Healthcare (SMITH)^[*]