International Journal of Medical Informatics
A model driven approach for the German health telematics architectural framework and security infrastructure
Introduction
Any communication and cooperation between healthcare providers must be supported by intelligently interoperable health information systems. This challenge needs to be met especially for managed care and continuity of care concepts widely introduced in most of the developed countries to improve quality and efficiency of patient's care.
Interoperability might be provided at different levels. Those interoperability levels are ranging from simple data exchange and meaningful data exchange with agreed vocabulary to a functional interoperability with agreed communicating applications’ behavior, or finally to a service oriented interoperability directly invoking the applications’ services.
Health information systems enabling such advanced co-operation mentioned above in the managed care context are characterized by openness, scalability, portability, distribution at Internet level, service oriented interoperability as well as appropriate security and privacy services. Finally, they have to be based on standards [1].
Section snippets
The German health telematics platform
As many other countries, Germany has launched a national programme for establishing a health telematics platform supporting seamless care [2], [3]. This platform combines card enabled communication mediated by the patient with network based interoperability between all actors involved. In 2003, the German Federal Ministry for Healthcare and Social Security launched the bIT4health (better IT for better health) project defining an architectural framework and a related security infrastructure for
bIT4health architectural framework
Within the bIT4health project, health telematics objectives such as, e.g., interoperability and scalability, aimed visions such as the architectural paradigm, the architectural framework with its strategy, principles, guidelines and patterns as well as a corresponding solution outline defining specifications, interfaces and components have been developed and documented.
For establishing a future proof health telematics platform, a call for proposals has been launched by the German Federal
System integration and migration paths
Keeping in mind that systems consist of hierarchically built subsystems or capsules, at least three different levels of interoperability can be modeled and implemented as a migration path starting at the highest level of service oriented collaboration between directly related components up to simple data retrieval.
The next level comprises aggregated services mediated either by super-component interactions or by the exchange of messages via architecture-independent interfaces (e.g. HL7 V2.x) [25]
Electronic health record
Because all facts directly or indirectly established during patient's care are needed for its optimized management, shared care information systems and networks have to be based on a comprehensive and lifelong virtual EHR system as the HIS core application. Therefore, the German health telematics platform must be completed by a modern EHR architecture, which is also open, component based and model driven, etc.
The EHR architecture deployed in the second phase of the German health telematics
Architecture and security infrastructure implementation
Beside the definition and demonstration of an architectural framework and security infrastructure as German health telematics platform, the rollout of that approach shall first specify in details as well as manage the card enabled environment and second provide basics and migration path for a future proof ICT supporting shared care. In that context, the acceptance of the solution by patients and health professionals including the responsible and influencing bodies within the German healthcare
Comparing health telematics approaches
Both the European action plan and many countries’ national strategies look for EHR as core application prioritized and strived for a health telematics platform. Shaping the EHR varies between the countries, however, starting with a medication file in The Netherlands and with an EHR extract in Finland all of them are finally moving to a more or less comprehensive EHR in undetermined time. For establishing a health telematics platform and especially for design and implementation of the
Conclusion
Modeled as a multi model approach at the meta model level, the future proof secure health information system (HIS) is a virtual and at runtime self-organizing architecture consisting of certified components which exchange digitally signed and attributed XML messages. Reference model, constraint models, terminology, and methodology have to comply with international standards or must be standardized.
Following the challenging example of other countries such as Australia, Denmark, Finland, the USA,
Acknowledgments
The authors are indebted to thank the German Federal Ministry for Health and Social Security for supporting their activities and the bIT4health Consortium as well as the partners from GEHR/openEHR and Object Management Group for collegial collaboration.
References (26)
Advanced and secure architectural EHR approaches
Int. J. Med. Inf.
(2006)- (2002)
- German Federal Republic, Federal Ministry for Health and Social Affairs....
- Aktionsforum Telematik im Gesundheitswesen....
- Federal Ministry for Health and Social Affairs. bIT4health....
- bIT4health, Deutsches Institute für Medizinische Dokumentation und Information, Cologne....
- Council of Europe. Council of Europe 99/93/EC: Directive on Electronic Signatures. Strasbourg,...
- ISO 21549 “Health informatics – Patient health card data”....
- Object Management Group Inc.: CORBA Specifications....
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