Health Information Exchange for Continuity of Maternal and Neonatal Care Supporting: A Proof-of-Concept Based on ISO Standard

Abstract

Background Around the world, people receive care at various institutions; therefore, clinical information is recorded either on paper or distributed on different information systems with reduced capabilities for sharing data. One approach to handling the complex nature of the health information systems and making it interoperable is the two-level modeling, and the ISO 13606 standard is an option to support this model. A regionally governed EHR program in Brazil proposed to use the ISO 13606 standard and archetypes. This program includes an EHR repository for consolidating the longitudinal electronic record of patients' health.

Objective This article aims to present the results and lessons learned from a proof-of-concept (POC) for integrating the Maternal and Neonatal Healthcare Information System (SISMater) developed by the Federal University of Minas Gerais (UFMG) with the EHR system developed by the Department of Healthcare for the State of Minas Gerais (SES/MG).

Methods The design of the architecture and software development were driven by the content to be exchanged between the SISMater system and the EHR system and the usage of XML transformation to translate an ISO 13606 EHR extract and vice versa. This POC did not include tests related to revision objects according to ISO 13606 reference model.

Results The software architecture and software components required for this POC were proposed and tested. The EHR system validated the syntax and semantic and persisted the extract in the EHR repository. Complete results can be accessed at https://github.com/pocppsus/repository.

Conclusion The approach for using XML transformations could make easier the process for ISO 13606 noncompliant EMR systems to exchange EHR data with the SES/MG EHR system.

Keywords

maternal and neonatal healthcare information system - health information exchange - electronic health records and systems - two-level modeling - ISO 13606 standard - openEHR

Protection of Human and Animal Subjects

The authors declare that human and animal subjects were not included in this research.

Funding

This study was supported by Fundação de Amparo à Pesquisa de Minas Gerais (FAPEMIG)-PPSUS APQ 03486–13.

• References

• 1 Pan American Health Organization. eHealth in Latin America and the Caribbean: interoperability standards review. 2016 . Available at: http://iris.paho.org/xmlui/bitstream/handle/123456789/28189/9789275118818_eng.pdf?sequence=1&isAllowed=y
• 2 Mendes EV. As redes de Atenção à Saúde. Ciência e Saúde Coletiva. Rio de Janeiro 2010; 15 (05) 2297-2305
• 3 dos Santos MR. Sistema de registro eletrônico de saúde baseado na norma ISO 13606: aplicações na Secretaria de Estado de Saúde de Minas Gerais. Perspectivas em Ciência da Informação. Belo Horizonte 2011; 272-272
• 4 Healthcare Information and Management Systems Society (HIMSS). Electronic Health Records. Available at: http://www.himss.org/library/ehr
• 5 International Organization for Standardization. ISO 13606–1:2008:Health informatics, Electronic health record communication, Part 1: Reference model. 2008
• 6 Brasil. Lei n ^o 8.080, de 19 de setembro de 1990: Dispõe sobre as condições para a promoção, proteção e recuperação da saúde, a organização eo funcionamento dos serviços correspondentes e dá outras providências. Diário Oficial da União 1990 . Available at http://www.planalto.gov.br/ccivil_03/leis/L8080.htm
• 7 Brasil. Estratégia e-Saúde para o Brasil. Diário Oficial da União. Brasília: Ministério da Saúde Departamento de Informática do SUS, Secretária de Gestão Estratégica e Participativa; 2014
• 8 Maia TA. Processo de Desenvolvimento de Arquétipos do Registro Eletrônico em Saúde em Minas Gerais: Estudo de Caso. Projetos e Dissertações em Sistemas de Informação e Gestão do Conhecimento. 2015;3 Available at: http://www.fumec.br/revistas/sigc/article/view/2685 . Accessed June 1, 2016
• 9 Benson T. Principles of health interoperability HL7 and SNOMED. London: Springer Science & Business Media; 2012: 316
• 10 Newell A. The knowledge level. Artif Intell 1982; 18: 87-127
• 11 Gruber TR. A translation approach to portable ontology specifications. Knowl Acquis 1993; 5 (02) 199-220
• 12 Guarino N. Formal ontology, conceptual analysis and knowledge representation. Int J Hum Comput Stud 1995; 43: 625-640
• 13 Guarino N, Giaretta P. Ontologies and knowledge bases: Towards a terminological clarification. Towards very large knowledge bases: knowledge building and knowledge sharing. 1995 25. -32
• 14 Johnson SB. Generic data modeling for clinical repositories. J Am Med Inform Assoc 1996; 3 (05) 328-339
• 15 Chandrasekaran B, Josephson JR, Benjamins VR. . The ontology of tasks and methods 1999 :31–43. Available at: http://ksi.cpsc.ucalgary.ca/KAW/KAW98/chandra/ . Accessed February 3, 2016
• 16 Kalra D. Electronic health record standards. Germany: Schattauer GMBH-Verlag; 2006. . Available at: http://www.schattauer.de/en/magazine/subject-areas/journals-a-z/imia-yearbook/imia-yearbook-2006/issue/special/manuscript/6382/show.html . Accessed February 3, 2016
• 17 Kalra D. The SYNAPSES project: Current Perspectives in Healthcare Computing Conference. Harrogate, England: BJHC LTD; 1997. . Available at: http://discovery.ucl.ac.uk/66281/ . Accessed February 3, 2016
• 18 Grimson J, Grimson W, Berry D. , et al. A CORBA-based integration of distributed electronic healthcare records using the synapses approach. IEEE Transactions on Information Technology in Biomedicine 1998; 2 (03) 124-138 . Available at: http://ieeexplore.ieee.org/ielx5/4233/15835/00735777.pdf?tp=&arnumber=735777&isnumber=15835 . Accessed February 3, 2016
• 19 Bird L, Goodchild A, Tun ZZ. Experiences with a two-level modelling approach to electronic health records. J Res Pract Inf Technol 2003; 35: 121-138
• 20 OpenEHR. Design Principles. Available at: http://www.openehr.org/releases/1.0.1/html/architecture/overview/Output/design_principles.html
• 21 Michelsen L, Pedersen SS, Tilma HB, Andersen SK. Comparing different approaches to two-level modelling of electronic health records. Studies in Health Technology and Informatics. Amsterdam; Washington, DC: IOS Press; 1991. 2005: 113-118
• 22 Beale T, Heard S. Archetype Definitions and Principles. Release 1.0. 1. 2007:15. Available at: http://www.openehr.org/releases/1.0.2/architecture/am/archetype_principles.pdf . Accessed February 3, 2016
• 23 Beale T, Heard S. Architecture Overview. The OpenEHR Foundation. Available at: http://www.openehr.org/releases/1.0.1/architecture/overview.pdf
• 24 Buck J, Garde S, Kohl CD, Knaup-Gregori P. Towards a comprehensive electronic patient record to support an innovative individual care concept for premature infants using the openEHR approach. Int J Med Inform 2009; 78 (08) 521-531
• 25 Beale T, Heard S. Archetype Definition Language. The OpenEHR Foundation. 2007: 115 . Available at: http://www.openehr.org/releases/1.0.1/architecture/am/adl.pdf . February 3, 2016
• 26 Marco-Ruiz L, Moner D, Maldonado JA, Kolstrup N, Bellika JG. Archetype-based data warehouse environment to enable the reuse of electronic health record data. Int J Med Inform 2015; 84 (09) 702-714
• 27 Brasil, CNESNet. Consulta Estabelecimentos de Minas Gerais. Available at: http://cnes.datasus.gov.br/ . Accessed May 18, 2016
• 28 Brasil. Número de municípios nos Censos Demográficos, segundo as Grandes Regiões e as Unidades da Federação-1960/2010. Instituto Brasileiro de Geografia e Estatística. Available at: http://www.censo2010.ibge.gov.br/sinopse/ . Accessed February 15, 2016
• 29 Gaspar J, Chagas J, Cruz-Correa R, Reis SN. Health information system for obstetric and neonatal healthcare monitoring: SISMater. Paper presented at: 8th Iberian Conference; June 19–22, 2013; Lisboa, Portugal. Available at: http://ieeexplore.ieee.org/document/6615808/
• 30 Gaspar Jde S, Reis ZSN, Gusmao RR. , Sá TQV de. Improving health care access using geographic information systems: SISMater-GIS: a study of referencing for childbirth in a university maternity in Belo Horizonte, Brazil. Paper presented at: IEEE 27th International Symposium; May 27–29, 2014; New York, NY. Available at: http://ieeexplore.ieee.org/document/6881939/
• 31 Reis ZSN, dos Santos Junior MR, Gaspar Jde S, Maia TA, de Souza AC. , Santos MR dos. Electronic systems interoperability study: based on the interchange of hospital obstetrical information. Paper presented at: IEEE 28th International Symposium; June 22–25, 2015; Sao Carlos, Brazil. Available at: http://ieeexplore.ieee.org/document/7167486
• 32 Reis ZSN, de Aguiar RALP, Ferreira ÁAT, Viegas AC, Anchieta LM. Análise do conteúdo do sumário de alta obstétrica em maternidade de referência Uma oportunidade para repensar a estratégia da continuidade do cuidado materno e neonatal. Rev méd Minas Gerais. 2015 ;25(4)
• 33 Fundação Nacional de Saúde. Manual de instruções para o preenchimento da declaração de nascido vivo. Fundação Nacional de Saúde Brasília; 2001. Available at: http://bvsms.saude.gov.br/bvs/publicacoes/funasa/declaracao_nasc_vivo.pdf . Accessed February 3, 2016
• 34 OpenEHR. Clinical Knowledge Manager. Available at: http://www.openehr.org/ckm/ . Accessed February 3, 2016
• 35 Santos MR, Bax MP, Kalra D. Dealing with the archetypes development process for a regional EHR system. Appl Clin Inform 2012; 3 (03) 258-275
• 36 Ferreira AAT, Reis ZSN, Frade S, Gaspar JS, Correia RJC, Hadad SC. , et al. Proposição de um sumário de alta obstétrico visando à troca de informações, em padrão OpenEHR, para continuidade do cuidado materno-infantil. Rev Fac Med Ribeirão Preto Hosp Clín FMRP Univ São Paulo 2014; 47 (01) 59-66
• 37 W3C. XQuery 1.0: An XML query language (second edition). Available at: https://www.w3.org/TR/xquery/ . Accessed June 1, 2016
• 38 Fernández-Breis JT, Maldonado JA, Marcos M. , et al. Leveraging electronic healthcare record standards and semantic web technologies for the identification of patient cohorts. J Am Med Inform Assoc 2013; 20 (e2): e288-e296
• 39 World Health Organization. Building foundations for eHealth: progress of member states: report of the Global Observatory for eHealth. Geneva: World Health Organization; 2006. . Available at: http://apps.who.int/iris/handle/10665/43599
• 40 Muñoz A, Somolinos R, Pascual M. , et al. Proof-of-concept design and development of an EN13606-based electronic health care record service. J Am Med Inform Assoc 2007; 14 (01) 118-129
• 41 Rinner C, Janzek-Hawlat S, Sibinovic S, Duftschmid G. Semantic validation of standard-based electronic health record documents with W3C XML Schema. Methods Inf Med 2010; 49 (03) 271-280
• 42 Duftschmid G, Wrba T, Rinner C. Extraction of standardized archetyped data from electronic health record systems based on the entity- attribute-value model. Int J Med Inform Vienna 2010; 79 (08) 585-597
• 43 Sachdeva S, Bhalla S. Semantic interoperability in standardized electronic health record databases. J Data Inf Qual 2012; 3 (01) 1-37
• 44 Maldonado JA, Moner D, Bosca D, Fernández JT, Angulo C, Robles M. Semantic upgrade and normalization of existing EHR extracts. Paper presented at: 30th Annual International Conference of the IEEE Engineering in Medicine and Biology Society 2008: 1466 1469
• 45 Muñoz P, Trigo JD, Martínez I, Muñoz A, Escayola J, García J. The ISO/EN 13606 standard for the interoperable exchange of electronic health records. J Healthc Eng 2011; 2 (01)
• 46 Pahl C, Zare M, Nilashi M. , et al. Role of OpenEHR as an open source solution for the regional modelling of patient data in obstetrics. J Biomed Inform 2015; 55: 174-187