Health Care IT Project Eyes Semantic Web

Next month, a visionary group of IT and health care professionals hope to demo their approach to better interop and integration of medical data between providers - and even to improve patient access to their own medical data. IDN looks at health care IT's latest champions, who say the semantic web will provide better cross-platform data access that will be good for providers, patients and could even lower health care costs.

Tags: Health, Health Care, Patient, Interoperability, Artemis, Hospitals, Semantically-enriched Web,

Next month, a visionary group of IT and health care professionals hope to demo their approach to better interop and integration of medical data between providers - and even to improve patient access to their own medical data, according to the Information Society Technologies, a service is developed for the European Commission's Directorate-General Information Society & Media.).

"The healthcare interoperability problem can be investigated in two categories: Interoperability of the healthcare messages exchanged and interoperability of electronic healthcare records [EHRs]," said Professor Asuman Dogac, Artemis project coordinator.

Among those groups that need better access are:
  • physicians treating patients using patient records and knowledge (such as cost information and research findings) from distributed sources;
  • primary care physicians consulting with remote specialists in the areas of gerontology and radiology, facilitated with computer support for X-rays, Ultrasound, voice-annotations and other multimedia information; and
  • community care networks consisting of a collection of primary care and specialized care providers collaborating to meet a community's health care needs.

    At the Healthcare Information and Management Systems Society annual conference in San Diego in February, Artemis representations will "run a demonstrator that will realize a scenario where, after an accident, a patient is admitted to the most appropriate hospital from the ambulance," Dogac said.

    "The patient will be admitted before the ambulance arrives at the hospital, via a mobile device. The hospital admissions service will then automatically seek out any relevant healthcare records of the patient in the Artemis P2P network, and presents them to the doctor, although the hospitals discovered may not be using interoperable standards with each other. This is a considerable improvement over current systems."

    Later this year, Dogac will begin a new project, dubbed Saphire, which will "seek to extend the functionality of Artemis. It will expose medical sensor data as semantically-enriched Web services. It will process sensor output, the patient's medical history and clinical guidelines to help physicians with diagnoses and treatment" he said.

    A Diagnosis: What's Wrong with Health Care IT Interop
    Right now messaging interfaces, or interface engines, are used to exchange information among different healthcare information systems. Currently, the Health Level 7 (HL7) Version 2 Messaging Standard is the most widely implemented.

    Artemis' health care and IT professionals say that unfortunately, HL7 V2 compliance does not imply direct interoperability between healthcare systems, because V2 has no explicit information model. Instead it has rather vague definitions for many data fields and contains many optional fields.

    EHRs suffer from similar problems. An EHR is digitally stored healthcare information about an individual that supports continuity of care, education and research, while ensuring confidentiality. A number of standardization efforts are progressing to provide EHRs interoperability. However, an exchange of well-structured and machine-processable EHRs has not been achieved yet in practice.

    Artemis looks to provide required interoperability between medical information systems through semantically-enriched web services that use defined meanings of individual pieces of parameters.

    While Artemis uses existing standards, such as HL7, as a basis for defining both the service action semantics and the message semantics, it goes a bit further.

    Artemis also uses constraint rules for specific clinical concepts, called 'archetypes', rather than distinct entities in the reference information model. It annotates their archetypes with ontologies, an established list of definitions, and then composes templates from archetypes and retrieves corresponding data from the underlying medical information systems.

    Artemis also suggests that a new protocol is needed that allows the identification of patients by means of non-unique patient-related attributes. Artemis developed a 'Patient Identification Process' (PIP) Protocol'. PIP provides a solution for continuity of care by locating and accessing prior clinical records and provides comprehensive security and privacy protection mechanisms.

    Artemis' middleware infrastructure extends the IHE RID protocol for cross-enterprise search and access to patient-related clinical information, even if no Master Patient Index is available, and without modifications to existing information source actors. Applied to the Artemis infrastructure, the RID Information Source and Display actors may be located in different institutions using different Patient ID domains and different sets of demographic data.

    Inside Artemis - Health Care IT's Semantic Web Believers
    Artemis is comprised of computer system developers, practicing rural physicians, community care groups, health care researchers, and tertiary care facilities that is committed to provide a solution.

    The goal: To create a field-validated, open collaboration environment for the health care domain and to demonstrate its effectiveness in reducing the cost of health care.

    Collaboration among health care providers can be leveraged via health care networks, which consist of a group of providers working together with a common vision and goal. Implementing such networks will require active collaboration between innovators, systems developers and integrators who will forge a path that allows a phased migration of technologies and practices.

    Modern health information systems today are proprietary and often only serve one department making it impossible to easily share data across one facility, never mind across different facilities or countries. A big problem, it makes it difficult for doctors to capture a complete clinical history of a patient. But one project hopes to overcome this.

    [Currently, the industry's Integrating the Healthcare Enterprise (IHE) initiative proposes the Retrieve Information for Display (RID) integration profile to allow users retrieve and display patient-related documents on systems other than the document keeping systems. Although it is well suited for use in a single hospital or within a trust of hospitals that belong to a single Patient Identifier Domain, it is not designed for cross-boundary access on information stored in different hospitals.]

    For more information, see the Information Society Technologies