The Need of Standardization in Service Platform for Health Services and Ambient Assisted Living

During the last few years a number of new approaches have been proposed to facilitate a fast and secure exchange of patient records between healthcare professionals. In “traditional”' Electronic Patient Records (EPR) the data stored and the access rules are regulated by institutions acting in the different domains of the healthcare sector. The concept of the Personal Health Record (PHR) deflects the responsibility for the handling of ones data to the patient him/herself. The patient should hence decide which data he wants to share with his doctor, a hospital or other institution, depending on the patient's own health status and privacy concerns. While multiple EHRs containing data from one patient are typically maintained in several different health service institutions, storing different data in different formats and providing a variety of proprietary interfaces, the PHR is meant to overcome these limitations by providing standardized communication interfaces under control of the patient, thus enabling data exchange in the course of medical treatments among various institutions.

In particular people with chronic diseases, who are required to take several different medications, while frequently visiting multiple doctors, might strongly benefit from a controlled, but more extensive data exchange. Chronic obstructive pulmonary disease (COPD) and coronary artery disease are severe diseases with increasing prevalence. They cause dyspnoea, physical inactivity, skeletal muscle atrophy and are associated with high costs in health systems worldwide. Physical training has many positive effects on the health state and quality of life of these patients. It has been shown that pulmonary rehabilitation training improves physical capacity, reduces breathlessness, reduces the number of hospitalizations and increases the quality of life.

Not only could the PHR be used to share training data, thus connecting experts, it could also be supplemented by data that can only be obtained in the patients home area (e.g. activity monitoring) or by data that can only be provided by the patient himself (e.g. outdoor sports activity, over-the-counter medication). Because the PHR requires interoperability with different systems, it is important to choose appropriate standards for data storage and communication. Two important non-profit initiatives promote interoperability of health IT systems:

The “Integrating the Healthcare Enterprise” (IHE) initiative works on improving the way computer systems in healthcare share information. The Continua Health Alliance, an industry coalition with more than 200 member companies, was founded to establish a system of interoperable personal health solutions. Both organizations do not define new standards but use and combine existing ones in support of specific use cases. Continua mainly focuses on the end user market and has participated in the development of a document template that is based on the Clinical Document Architecture (CDA) called Personal Healthcare Monitoring Report (PHMR). This specification has been published by HL7 as a Draft Standard for Trial Use. IHE is more involved with the professional side, but has defined an integration profile also based on CDA that describes the information exchange between EPRs and PHRs, named Exchange of Personal Health Record Content (XPHR).

Both (XPHR and PHMR) document types can be bound to one of IHE's transport profiles describing how a standards-based communication between EPR and PHR is actually implemented. There are three such IHE profiles for the exchange of documents: Cross-enterprise Document Sharing (XDS) uses a central registry and repository infrastructure, which is not available yet in most countries. Cross-enterprise Document Reliable Interchange (XDR) describes a point-to-point document exchange using secure Web Services and E-Mail. Cross-Enterprise Document Media Interchange (XDM) allows users to exchange data through media such as USB sticks or CD-Rs.

CDA seems to be the best choice for this specific use case because it is the basis for the XPHR and PHMR document templates, which we use for the exchange of medical data and vital signs. It is also supported by most relevant organizations involved with interoperability of IT systems in the medical domain. Furthermore CDA provides important characteristics like stewardship, authentication, context, wholeness, and human readability, which are important for every clinical document and also for every electronic health record. For these reasons the PHR provides mechanisms for the import, creation and management of CDA documents.

The implementation of these standards is highly important because they are stable in time and enable the exchange of data with other actors of the health care domain and further processing. This provides a solid basis for the next generation of distributed health services and the simplification of today’s manually and error-prone user entries. It is also very likely that the usage of these standards is also a prerequisite for the willingness of the user to manage health data in a PHR and for health professionals to use this data.

-> Download presentation