Contributions to the continuity of care: integration of telemonitoring data into the patient's electronic health records through the concurrent use of open standards
- Autores: María Pilar Muñoz Gargallo
- Directores de la Tesis: Adolfo Muñoz Carrero (dir. tes.), Ignacio Martínez Ruiz (dir. tes.)
- Lectura: En la Universidad de Zaragoza ( España ) en 2013
- Idioma: español
- Tribunal Calificador de la Tesis: José Luis Monteagudo Peña (presid.), Jesús Daniel Trigo Vilaseca (secret.), Dipak Kalra (voc.), José Alberto Maldonado Segura (voc.), Isabel Román Martínez (voc.)
- Materias:
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- Resumen
The society in which we are living is a changing organism that has been evolving as time goes by. The undergone changes (in the demographic structures, population habits, mobility patterns, etc.) have been consequences of technological improvements or discoverings and have caused changes in the heath care system's user profile. So dramatic changes (i.e. more patients, who live longer and who suffer from different types of diseases) need of a change in the paradigm of the patient's care process. Health care system has to know how to adapt itself to handle these changes.
During its development, this Thesis has been presented as a proposal for the improvement in the patient's care process, through a technological viewpoint, based on the reuse of telemonitoring measurements and their proper integration in the patient's Electronic Health Record (EHR) trying to harmonize two worlds which have traditionally been apart from each other: the medical device world and the clinical environment. To accomplish this, and using the standard-based design as premise, the main standards in the medical device environment have been enumerated and briefly described. A similar effort has been carried out in the EHR environment in which, besides of considering additional helpful mechanisms for the transmitted information's semantic integrity, a similar set of EHR standards has been compiled. In this compendium, EHR communication standards have been specially considered and, particularly, their Information Models. In this analysis it has not been obviated either the influence of different organizations that promote one or the other standards.
Moreover, it has been reasoned about the general system's architecture using as basis both the architecture of different telemonitoring systems, the needed infrastructure in the use of medical device's interoperability standards and the various interactions that might be established among the different care services. All of this was done with the purpose of reusing existing telemonitoring modules, thereby avoiding the developing costs of building a system from the ground. This way, not only new systems would have the needed architectural support but developed systems might be re-used, somehow, for this purpose. After that, based on this infrastructure, various standards were selected in base of reaching the most of the medical device environment and, at the same time, a great flexibility and simplicity in the EHR communication.
The integration proposal has mainly been supported by the use of knowledge models to define, not telemonitoring reports but, each element contained in them. Archetypes suit this premise as they are both domain concept definitions and formal elements suiting the Archetype Model which is able to constrain an Information Model.
The integration process which was firstly outlined to harmonize a specific couple of standards, each of them belonging to different environments, evolved to acquire a more generic approach: based on a ISO/EN 13606 - ISO/IEEE 11073 Personal Health Device (PHD) standards compatibility study, the minimum criteria to allow the telemonitoring information acquisition would not be subordinated to a specific standard were obtained. At the same time, in relation to the EHR communication, the various initiatives to transform clinical content according a specific standard into others also justified considering the design from the selected standard viewpoint.
The proposed architecture allows the problem to be staged in two steps: firstly, the telemonitoring information integration in an EHR server and, after that, the EHR generation process to be communicated to other Health Centre Information System (HCIS). Data integration has been based on an acquisition methodology and the definition of those mechanisms which solve the communication gap among medical devices and the EHR environment. This gap is proposed to be solved through the definition of an Information Model, the definition of coding schemes in each of the acquiring systems and the use of a standard interface. On the other side, the reports' generator system has been mainly based on the recursive hierarchy of the clinical report model and the analysis of the various parameters in the standardized EHR request interface. The whole system was deployed as a proof-of-concept and the various processes were tested both by internal procedures and third parties unconnected to the system deployment process.
Using this system implementation, security in the EHR communication has been considered in base of the jointly application of ISO/EN 13606-4 and ISO/TS 22600 standards. This way, in the system development, all the ISO/EN 13606 standard parts have been taken into account. The requirements' analysis to apply the security normative led to design the EHR provider system blueprint. Moreover, in the parameters' analysis, various inconsistencies were detected which led to propose a series of modifications in this document which would provide greater internal coherence among the standard parts.
These modifications were also implemented and tested.
Finally, various future lines are suggested as conclusion.
