Pragmatic interoperability for ehealth systems: the fallback workflow patterns
Pages 29 - 36
Abstract
Despite decades of research and development on interoperability standards, semantic interoperability among electronic health (eHealth) systems has largely remained an elusive goal. Interoperability functionality that has been implemented as part of national or provincial initiatives often ends up being considered unreliable in practice. We believe that a stronger focus on workflows and other pragmatic aspects of interoperability functions may be a key to overcoming these difficulties. Specifically, we argue that eHealth system interoperability should be modelled as dynamically evolving socio-technical processes, rather than as technical functions of certified devices. In this paper, we explore the example of patient referrals to highlight common problems with eHealth system interoperability. We define a system-theoretic model of the socio-technical e-referral system to derive two pragmatic interoperability workflow patterns to address these problems. The presented research is carried out in collaboration with industry.
References
[1]
"IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries," IEEE Std 610, pp. 1--217, Jan. 1991.
[2]
C. E. Kuziemsky and L. Peyton, "A framework for understanding process interoperability and health information technology," Health Policy Technol., vol. 5, no. 2, pp. 196--203, Jun. 2016.
[3]
F. W. Neiva, J. M. N. David, R. Braga, and F. Campos, "Towards pragmatic interoperability to support collaboration: A systematic review and mapping of the literature," Inf. Softw. Technol., vol. 72, pp. 137--150, Apr. 2016.
[4]
W. M. P. van der Aalst, A. P. Barros, A. H. M. ter Hofstede, and B. Kiepuszewski, "Advanced Workflow Patterns," in Cooperative Information Systems, 2000, pp. 18--29.
[5]
J. C. Segen, "The Dictionary of Modern Medicine," CRC Press, 2011.
[6]
J. C. MacKinnon, "Wait times in Canada," Healthc. Manage. Forum, vol. 30, no. 4, pp. 190--192, Jul. 2017.
[7]
N. Leveson, Engineering a Safer World: Systems Thinking Applied to Safety. MIT Press, 2011.
[8]
E. Coiera, "Putting the technical back into socio-technical systems research," Int. J. Med. Inf., vol. 76, pp. S98--S103, Jun. 2007.
[9]
F. Mason-Blakley, R. Habibi, J. Weber, and M. Price, "Assessing STAMP EMR with Electronic Medical Record Related Incident Reports: Case Study: Manufacturer and User Facility Device Experience Database," in 2017 IEEE Intl. Conf. on Healthcare Informatics (ICHI), 2017, pp. 114--123.
[10]
G. J. Kuperman, "Health-information exchange: why are we doing it, and what are we doing?," J. Am. Med. Inform. Assoc., vol. 18, no. 5, pp. 678--682, Sep. 2011.
[11]
R. H. Dolin et al., "HL7 Clinical Document Architecture, Release 2," J. Am. Med. Inform. Assoc., vol. 13, no. 1, pp. 30--39, Jan. 2006.
[12]
C. Resnick, J. Meara, M. Peltzman, and M. Gilley, "Meaningful use: A program in transition," Bull. Am. Coll. Surg., Mar. 2016.
[13]
D. Giokas, "Canada Health Infoway - Towards a National Interoperable Electronic Health Record (EHR) Solution," in Studies in Health Technology and Informatics, 2005, pp. 108--140.
[14]
M. Koehn and H. Stevens, "EMR-to-EMR Data Transfer & Conversion (E2E-DTC) Standard - Part I - Business Overview," BC Physician Information Technology Office, 2013.
[15]
C. E. Chronaki et al., "Interoperability standards enabling cross-border patient summary exchange.," in MIE, 2014, pp. 256--260.
[16]
J. D. D'Amore et al., "Are Meaningful Use Stage 2 certified EHRs ready for interoperability? Findings from the SMART C-CDA Collaborative," J. Am. Med. Inform. Assoc., vol. 21, no. 6, pp. 1060--1068, Nov. 2014.
[17]
M. Chinosi and A. Trombetta, "BPMN: An introduction to the standard," Comput. Stand. Interfaces, vol. 34, no. 1, pp. 124--134, Jan. 2012.
[18]
R. Johnson and J. Vlissides, "Design patterns," Elem. Reusable Object-Oriented Softw. Addison-Wesley Read., 1995.
[19]
A. Grimstrup et al., "Toward Interoperability of Mobile-Agent Systems," in Proc. of 6<sup>th</sup> Intl. Conf on Mobile Agents, Springer LNCS 2535, pp. 106--120, 2002,
[20]
J. H. Weber and C. Kuziemsky, "Towards Continuous Certification of Clinical Information Systems," in Software Engineering in Health Care, 2017, Springer LNCS 9062, pp. 178--193
[21]
T. Greenhalgh et al., "Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies," J. Med. Internet Res., vol. 19, no. 11, p. e367, 01 2017.
[22]
N. Russell, W. M. P. van van der Aalst, and A. H. M. ter Hofstede, Workflow Patterns: The Definitive Guide. The MIT Press, 2016.
[23]
A. Harris and C. Kuziemsky, "Connectivity Patterns for Supporting BPM in Healthcare," in Advances in Information and Communication Networks, 2019, pp. 697--703.
[24]
G. Bruno et al., "Key challenges for enabling agile BPM with social software," J. Softw. Maint. Evol. Res. Pract., vol. 23, no. 4, 2011.
[25]
C. Friedman et al., "Toward a science of learning systems: a research agenda for the high-functioning Learning Health System," J. Am. Med. Inform. Assoc. JAMIA, vol. 22, no. 1, pp. 43--50, Jan. 2015.
[26]
Jennifer Ruttan, "OSCAR," in The Architecture of Open Source Applications, vol. Volume II: Structure, Scale and a Few More Fearless Hacks, 2012.
[27]
C. Liddy, I. Moroz, A. Afkham, and E. Keely, "Sustainability of a Primary Care-Driven eConsult Service," Ann. Fam. Med., vol. 16, no. 2, pp. 120--126, 2018.
Recommendations
Interoperability in digital electrocardiography: harmonization of ISO/IEEE x73-PHD and SCP-ECG
The ISO/IEEE 11073 (x73) family of standards is a reference frame for medical device interoperability. A draft for an ECG device specialization (ISO/IEEE 11073-10406-d02) has already been presented to the Personal Health Device (PHD) Working Group, and ...
Interoperability in eHealth systems
Interoperability in eHealth systems is important for delivering quality healthcare and reducing healthcare costs. Some of the important use cases include coordinating the care of chronic patients by enabling the co-operation of many different eHealth ...
Process interoperability in healthcare systems with dynamic semantic web services
Healthcare systems are very complex due to extreme heterogeneity in their data and processes. Researchers and practitioner need to make systems interoperable and integrate for the benefit of all the stakeholders including hospitals, clinicians, medical ...
Comments
Please enable JavaScript to view thecomments powered by Disqus.Information & Contributors
Information
Published In
May 2019
90 pages
Sponsors
- SIGSOFT: ACM Special Interest Group on Software Engineering
- IEEE-CS: Computer Society
Publisher
IEEE Press
Publication History
Published: 27 May 2019
Check for updates
Author Tags
Qualifiers
- Research-article
Conference
ICSE '19
Sponsor:
- SIGSOFT
- IEEE-CS
Upcoming Conference
Contributors
Other Metrics
Bibliometrics & Citations
Bibliometrics
Article Metrics
- 0Total Citations
- 60Total Downloads
- Downloads (Last 12 months)1
- Downloads (Last 6 weeks)0
Reflects downloads up to 13 Feb 2025
Other Metrics
Citations
View Options
Login options
Check if you have access through your login credentials or your institution to get full access on this article.
Sign in