A model driven approach for the German health telematics architectural framework and security infrastructure

https://doi.org/10.1016/j.ijmedinf.2006.05.044Get rights and content

Abstract

Shared care concepts such as managed care and continuity of care are based on extended communication and cooperation between different health professionals or between them and the patient respectively. Health information systems and their components, which are very different in their structure, behavior, data and their semantics as well as regarding implementation details used in different environments for different purposes, have to provide intelligent interoperability. Therefore, flexibility, portability, and future orientation must be guaranteed using the newest development of model driven architecture. The ongoing work for the German health telematics platform based on an architectural framework and a security infrastructure is described in some detail. This concept of future proof health information networks with virtual electronic health records as core application starts with multifunctional electronic health cards. It fits into developments currently performed by many other developed countries.

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)

  • B. Blobel

    Advanced and secure architectural EHR approaches

    Int. J. Med. Inf.

    (2006)
  • B. Blobel
    (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....
  • TrustHealth: The European TrustHealth Project (1996–2000). Project Description and Deliverables....
  • CEN TC 251 ENV 13729 “Health informatics – Secure user identification – Strong authentication using microprocessor...
  • The German Specification for a Health Professional Card v 2.1. PDF Document (English version)....
  • Cited by (22)

    • Building information modeling services reuse for facility management for semiconductor fabrication plants

      2019, Automation in Construction
      Citation Excerpt :

      Komatsoulis et al. proposed the cancer Common Ontologic Representation Environment (caCORE), based on MDA [48]. Blobel and Pharow investigated the German health telematics architectural framework and security infrastructure and argued that health information systems have to provide intelligent interoperability, because the organizations of the system users, structure, behavior, data, and semantics are very different [53]. In fact, past literature shows that MDA technology has been sporadically applied to the construction industry [54].

    • E-patient Card: An Integrated Electronic Health Recording System for Patient

      2021, ICAC 2021 - 3rd International Conference on Advancements in Computing, Proceedings
    • RESTful mobile architecture for social security services: A case study

      2017, Proceedings of the 2016 42nd Latin American Computing Conference, CLEI 2016
    • Security methodologies for Electronic Health Record: A case study

      2017, Journal of Engineering and Applied Sciences
    View all citing articles on Scopus
    View full text