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BMC Medical Informatics and Decision Making
Published in: BMC Medical Informatics and Decision Making 1/2007

Open Access 01-12-2007 | Research article

Reviewing the integration of patient data: how systems are evolving in practice to meet patient needs

Authors: Ricardo J Cruz-Correia, Pedro M Vieira-Marques, Ana M Ferreira, Filipa C Almeida, Jeremy C Wyatt, Altamiro M Costa-Pereira

Published in: BMC Medical Informatics and Decision Making | Issue 1/2007

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Abstract

Background

The integration of Information Systems (IS) is essential to support shared care and to provide consistent care to individuals – patient-centred care. This paper identifies, appraises and summarises studies examining different approaches to integrate patient data from heterogeneous IS.

Methods

The literature was systematically reviewed between 1995–2005 to identify articles mentioning patient records, computers and data integration or sharing.

Results

Of 3124 articles, 84 were included describing 56 distinct projects. Most of the projects were on a regional scale. Integration was most commonly accomplished by messaging with pre-defined templates and middleware solutions. HL7 was the most widely used messaging standard. Direct database access and web services were the most common communication methods. The user interface for most systems was a Web browser. Regarding the type of medical data shared, 77% of projects integrated diagnosis and problems, 67% medical images and 65% lab results. More recently significantly more IS are extending to primary care and integrating referral letters.

Conclusion

It is clear that Information Systems are evolving to meet people's needs by implementing regional networks, allowing patient access and integration of ever more items of patient data. Many distinct technological solutions coexist to integrate patient data, using differing standards and data architectures which may difficult further interoperability.
Appendix
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Literature
1.
2.
Kalra D: Electronic health record standards. Methods Inf Med. 2006, 45 (1): 136-144.
3.
Lenz R, Kuhn KA: Integration of Heterogeneous and Autonomous Systems in Hospitals. Business Briefing: Data management & Storage Technology. 2002
4.
5.
Berg M: Implementing information systems in health care organizations: myths and challenges. Int J Med Inf. 2001, 64 (2-3): 143-156.CrossRef
6.
7.
Ferranti J, Musser C, Kawamoto K, Hammon E: The Clinical Document Architecture and the Continuity of Care Record: A Critical Analysis. J Am Med Inform Assoc. 2006, 13 (3): 245-252.CrossRefPubMedPubMedCentral
8.
Bernstein K, Bruun-Rasmussen M, Vingtoft S, Andersen SK, Nohr C: Modelling and implementing electronic health records in Denmark. International Journal of Medical Informatics - MIE 2003. 2005, 74 (2-4): 213-220.
9.
Takada A, Guo J, Tanaka K, Sato J, Suzuki M, Suenaga T, Kikuchi K, Araki K, Yoshihara H: Dolphin Project—Cooperative Regional Clinical System Centered on Clinical Information Center. Journal of Medical Systems. 2005, 29 (4): 391-400.CrossRefPubMed
10.
Koch S, Hägglund M, Scandurra I, Moström D: Towards a virtual health record for mobile home care of elderly citizens. Proceedings of Medinfo. 2004, 11 (Pt 2): 960-963.
11.
Strom R: A comparison of the object-oriented and process paradigms. 1986, ACM Press New York, NY, USA, 88-97.
12.
Cruz-Correia R, Vieira-Marques P, Ferreira A, Oliveira-Palhares E, Costa P, Costa-Pereira A: Monitoring the integration of hospital information systems: how it may ensure and improve the quality of data. Stud Health Technol Inform. 2006, The Hague, The Netherlands , 121: 176-182.
13.
Wagner M, Collins B: Using electronic medical record data for clinical workflow and analysis: a single center experience. J Crit Care. 2004, 19 (4): 234-242.CrossRefPubMed
14.
Quade G, Novotny J, Burde B, May F, Beck LE, Goldschmidt A: Worldwide telemedicine services based on distributed multimedia electronic patient records by using the second generation Web server hyperwave. Proc AMIA Symp. 1999, : 916-920.
15.
Li H, Tang S, Yang D, Yu Y: An XML Based Electronic Medical Record Integration System. The Second International Conference on Web-Age Information Management Berlin: Springer-Verlag Berlin Heidelberg. 2001, 160167:
16.
Halamka JD, Osterland C, Safran C: CareWeb, a web-based medical record for an integrated health care delivery system. Int J Med Inform. 1999, 54 (1): 1-8.CrossRefPubMed
17.
Safran C, Goldberg H: Electronic patient records and the impact of the Internet. Int J Med Inf. 2000, 60 (2): 77-83.CrossRef
18.
Munch H, Engelmann U, Schroter A, Meinzer HP: The integration of medical images with the electronic patient record and their web-based distribution. Acad Radiol. 2004, 11 (6): 661-668.CrossRefPubMed
19.
Lin SC, Mba KR, Fadlalla A, Henricks WH: Integrating Data from Legacy Systems Using Object Linking and Embedding Technology. Journal of the American Medical Informatics Association. 2000, 7: 357-360.CrossRefPubMedPubMedCentral
20.
Zuker A: From Computerized Patient Records to National Resource. Stud Health Technol Inform. 2003, 95: 892-897.PubMed
21.
Jost RG, Blaine GJ, Fritz K, Blume H, Sadhra S: Enhanced Interfaces for Web-Based Enterprise-Wide Image Distribution. Journal of Digital Imaging. 2002, 15: 189-193.CrossRefPubMed
22.
Cheunga NT, Lamb A, Chanb W, Kong JHB: Integrating images into the electronic patient record of the hospital authority of Hong Kong. Computerized Medical Imaging and Graphics. 2005, 29 (2-3): 137-142.CrossRef
23.
Kim IK, Yun JH: Agent-Based Intelligent Clinical Information System for Persistent Lifelong Electronic Medical Record. Intelligent Agents and Multi-Agent Systems. 2003, Springer Berlin / Heidelberg, 2891/2003: 194-204.CrossRef
24.
Bandon D, Lovis C, GeissbüHler A, Vallée JP: Enterprise-wide PACS: beyond radiology, an architecture to manage all medical images. Academic Radiology. 2005, 12 (8): 1000-1009.CrossRefPubMed
25.
Borst F, Appel R, Baud R, Ligier Y, Scherrer JR: Happy birthday DIOGENE: a hospital information system born 20 years ago. Int J Med Inf. 1999, 54 (3): 157-167.CrossRef
26.
Breant C, Borst F, Campi D, Griesser V, Son Le H JJM: Expanding DIOGENE with a clinical information system based on a new hospital-wide clinical findings dictionary. Int J Med Inf. 2000, 58 (59): 167-177.CrossRef
27.
Scherrer JR, Lovis C, Baud R, Borst F, Spahni S: Integrated computerized patient records: the DIOGENE 2 distributed architecture paradigm with special emphasis on its middleware design. Stud Health Technol Inform. 1998, 56: 15-31.PubMed
28.
Thurler G, Borst F, Bréant C, Campi D, Jenc J, Lehner-Godinho B, Maricot P, Scherrer JR: ARCHIMED: A network of integrated information systems. Methods of Information in Medicine (2000). 39 (1): 36-43.
29.
Goulas NA, Nanou DG, Fotiadis DI: Epirus-net: a wireless health telematics network in Greece. Engineering in Medicine and Biology Society, 2001 Proceedings of the 23rd Annual International Conference of the IEEE. 2001, 4: 3488-3491.CrossRef
30.
Kaae T: A regional health network supported by organisational change. Cross sectorial electronic referral and confirmation of booking. Stud Health Technol Inform. 2000, 77: 988-991.PubMed
31.
Poulymenopoulou M, Vassilacopoulos G: An electronic patient record implementation using clinical document architecture. Stud Health Technol Inform. 2004, 103: 50-57.PubMed
32.
Malamateniou F, Vassilacopoulos G: An implementation of a virtual patient record using Web services. Stud Health Technol Inform. 2003, 95: 158-163.PubMed
33.
Malamateniou F, Vassilacopoulos G: Developing a virtual patient record using XML and web-based workflow technologies. International Journal of Medical Informatics - MIE 2002 Special Issue. 2003, 70 (2-3): 131-139.
34.
Malamateniou F, Vassilacopoulos G: Developing a virtual patient record as a web-based workflow system. Stud Health Technol Inform. 2002, 90: 298-304.PubMed
35.
Bird L, Goodchild A, Tun Z: Experiences with a Two-Level Modelling Approach to Electronic Health Records. Journal of Research and Practice in Information Technology. 2003, 35 (2): 121-
36.
Altmann U, Tafazzoli AG, Katz FR, Dudeck J: XML-Based Application Interface Services–A Method to Enhance Integrability of Disease Specific Systems: Medinfo. London, UK.2001, , 10 (Pt 1): 589-593.
37.
Schabetsberger T, Gross E, Haux R, Lechleitner G, Pellizzari T, Schindelwig K, Stark C, Vogl R, Wilhelmy I: Approaches Towards a Regional, Shared Electronic Patient Record for Health Care Facilities of Different Health Care Organizations—–IT-Strategy and First Results. MEDINFO. 2004, 11 (Pt 2): 979-982.
38.
Schabetsberger T, Ammenwerth E, Andreatta S, Gratl G, Haux R, Lechleitner G, Schindelwig K, Stark C, Vogl R, Wilhelmy I: From a paper-based transmission of discharge summaries to electronic communication in health care regions. Int J Med Inform. 2005, 75 (3-4): 209-215.CrossRefPubMed
39.
Wolff AC, Mludek V, van der Haak M, Bork W, Bülzebruck H, Drings P, Schmücker P, Wannenmacher M, Haux R: Using the eXtensible Markup Language (XML) in a Regional Electronic Patient Record for Patients with Malignant Diseases. Stud Health Technol Inform. 2001, IOS Press, 10 (Pt 1): 698-702.
40.
Clayton PD, Narus SP, Huff SM, Pryor TA, Haug PJ, Larkin T, Matney S, Evans RS, Rocha BH, Bowes WA: Building a comprehensive clinical information system from components. The approach at Intermountain Health Care. Methods Inf Med. 2003, 42 (1): 1-7.PubMed
41.
Bouam S, Girou E, Brun-Buisson C, Lepage E: Development of a Web-based clinical information system for surveillance of multiresistant organisms and nosocomial infections. Proc AMIA Symp. 1999, 696: 700-
42.
Zviran M, Armoni A, Glezer C: HIS/BUI: A Conceptual Model for Bottom-Up Integration of Hospital Information Systems. Journal of Medical Systems. 1998, 22 (3): 147-159.CrossRefPubMed
43.
Law MYY: A model of DICOM-based electronic patient record in radiation therapy. Computerized Medical Imaging and Graphics. 2005, 29 (2-3): 125-136.CrossRefPubMed
44.
Lowe HJ, Walker WK, Polonkey SE, Jiang F, Vries JK, McCray A: The Image Engine HPCC Project: A Medical Digital Library System using Agent-Based Technology to Create an Integrated View of the Electronic Medical Record. Proceedings of the 3rd International Forum on Research and Technology Advances in Digital Libraries. 1996
45.
Tsiknakis M, Katehakis DG, Orphanoudakis SC: An open, component-based information infrastructure for integrated health information networks. Int J Med Inform. 2002, 68 (1-3): 3-26.CrossRefPubMed
46.
Katehakis DG, Sfakianakis S, Tsiknakis M, Orphanoudakis SC: An infrastructure for Integrated Electronic Health Record services: the role of XML (Extensible Markup Language). J Med Internet Res. 2001 , 3 (1): E7-CrossRefPubMedPubMedCentral
47.
Potamias G, Tsiknakis M, Katehakis D, Karabela E, Moustakis V, Orphanoudakis S: Role-based access to patients clinical data: the InterCare approach in the region of Crete. Stud Health Technol Inform. 2000, 77: 1074-1079.PubMed
48.
Orphanoudakis S: HYGEIAnet: the Integrated Regional Health Information Network of Crete. E-Health: Current Situation and Examples of Implemented and Beneficial E-Health Applications. 2004, 100: 66-78.
49.
Chiarugi F, Lombardi D, Lees PJ, Chronaki CE, Tsiknakis M, Orphanoudakis SC: Support of daily ECG procedures in a cardiology department via the integration of an existing clinical database and a commercial ECG management system. Ann Noninvasive Electrocardiol. 2002, 7 (3): 263-270.CrossRefPubMed
50.
Katehakis D, Tsiknakis M, Armaganidis A, Orphanoudakis SC: Functional and Control Integration of an ICU, LIS and PACS Information System. Proceedings of MIE. 97: 25-29.
51.
McDonald CJ: Hickam 2000: the maturation of, and linkages between, medical informatics and bioinformatics. J Lab Clin Med. 2001, 138 (6): 359-366.CrossRefPubMed
52.
Biondich PG, Grannis SJ: The Indiana Network for Patient Care: An Integrated Clinical Information System Informed by Over Thirty Years of Experience. Journal of Public Health Management and Practice. 2004, 10: 81-86.CrossRef
53.
Kalinski T, Hofmann H, Franke DS, Roessner A: Digital imaging and electronic patient records in pathology using an integrated department information system with PACS. Pathol Res Pract. 2002, 198 (10): 679-684.CrossRefPubMed
54.
Bernarding J, Thiel A, Grzesik A: A JAVA-based DICOM server with integration of clinical findings and DICOM-conform data encryption. J Med Inform. 2001, 64 (2-3): 429-38.CrossRef
55.
Stewart BK, Langer SG: Integration of DICOM Images into an Electronic Medical Record Using Thin Viewing Clients. Proc AMIA Symp. 1998, 902-906.
56.
Hanzlicek P, Spidlen J, Nagy M: Universal electronic health record MUDR. Stud Health Technol Inform. 2004, 105: 190-201.PubMed
57.
Müller ML, Ückert F, Bürkle T, Prokosch HU: Cross-institutional data exchange using the clinical document architecture (CDA). International Journal of Medical Informatics. 2005, 74: 245-256.CrossRefPubMed
58.
Muller ML, Burkle T, Irps S, Roeder N, Prokosch HU: The diagnosis related groups enhanced electronic medical record. Int J Med Inform. 2003 , 70 (2-3): 221-228.CrossRefPubMed
59.
Uckert F, Gorz M, Ataian M, Tessmann S, Prokosch HU: The new navigation in EHRs: enabling teamwork of professionals and patients. Stud Health Technol Inform. 2003, 95: 334-339.PubMed
60.
Muller ML, Butta R, Prokosch HU: Electronic discharge letters using the Clinical Document Architecture (CDA). Stud Health Technol Inform. 2003, 95: 824-828.PubMed
61.
Muller ML, Ganslandt T, Eich HP, Lang K, Ohmann C, Prokosch HU: Towards integration of clinical decision support in commercial hospital information systems using distributed, reusable software and knowledge components. Int J Med Inform. 2001 , 64 (2-3): 369-377.CrossRefPubMed
62.
Berler A, Pavlopoulos S, Karkalis G, Sakka E, Konnis G, Koutsouris D: Implementation of a novel virtual patient record architecture. Engineering in Medicine and Biology, 2002 24th Annual Conference and the Annual Fall Meeting of the Biomedical Engineering Society] EMBS/BMES Conference, 2002 Proceedings of the Second Joint. 2002, 3:
63.
Bui AAT, McNitt-Gray MF, Goldin JG, Cardenas AF, Aberle DR: Problem-oriented Prefetching for an Integrated Clinical Imaging Workstation. Journal of the American Medical Informatics Association. 2001, 8: 242-253.CrossRefPubMedPubMedCentral
64.
Hägglund M, Scandurra I, Moström D, Koch S: Integration Architecture of a Mobile Virtual Health Record for Shared Home Care. Connecting Medical Informatics and Bioinformatics, Studies in Health Technology and Informatics. 2005, 116: 340–345-
65.
Kay JD, Nurse D, Bountis C, Paddon K: The Oxford clinical intranet: providing clinicians with access to patient records and multiple knowledge bases with internet technology. Stud Health Technol Inform. 2004, 100: 130-138.PubMed
66.
Kay JD, Nurse D: Construction of a virtual EPR and automated contextual linkage to multiple sources of support information on the Oxford Clinical Intranet. Proc AMIA Symp. 1999, 829-33.
67.
Mycek S: The IT connection. An integrated health care system gets wired. Trustee. 2004, 57 (2): 18-21.PubMed
68.
Lober WB, Baer A, Karras BT, Duchin JS: Collection and integration of clinical data for surveillance. Medinfo. 2004, 2004: 1211-1215.
69.
Overhage J, McDonald CJ, Suico JG: The regenstrief medical record system 2000: Expanding the breadth and depth of a community wide EMR. Proc AMIA Symp. 2000, 1173-
70.
McDonald CJ, Overhage JM, Tierney WM, Dexter PR, Martin DK, Suico JG, Zafar A, Schadow G, Blevins L, Glazener T: The Regenstrief Medical Record System: a quarter century experience. Int J Med Inf. 1999, 54 (3): 225-253.CrossRef
71.
Overhage JM, Aisen A, Barnes M, Tucker M, McDonald CJ: Integration of radiographic images with an electronic medical record. Proc AMIA Symp. 2001, 513: 7-
72.
Zhang J, Sun J, Yang Y, Chen X, Meng L, Lian P: Web-based electronic patient records for collaborative medical applications. Computerized Medical Imaging and Graphics. 2005, 29: 115-124.CrossRefPubMed
73.
Taddei A, Macerata A, Dalmiani S, Cecchetti G, Carpeggiani C, Chelozzi L, Emdin M, Raciti M, Micalizzi M, Kraft G: Medical record system for cardiology and cardiac surgery. Computers in Cardiology 1999. 1999, 85-88.
74.
Morales MA, Dalmiani S, Carpeggiani C, Macerata A, Ghione S: Electronic medical records in a cardiological outpatient clinic. Computers in Cardiology, 2002. 2002, 381-384.CrossRef
75.
Carpeggiani C, Dalmiani S, Taddei A, Franchi D, Michelassi C, Chelozzi L, Emdin M, Macerata A, Benassi A, L'Abbate A: Use of an electronic medical record in a department of cardiology. Computers in Cardiology 2000. 2000, 291-294.
76.
Taddei A, Carpeggiani C, Emdin M, Balocchi R, Dalmiani S, Cecchetti G, Macerata A, Pierotti D, Marchesi C: Development of an electronic medical record for patient care in cardiology. Computers in Cardiology 1997. 1997, 641-644.CrossRef
77.
Taddei A, Fiaschi A, Kraft G, Fania A, Furfori P, Del Sarto M, Santoli F: Integrated system for anesthesia records in cardiac surgery. Computers in Cardiology 2000. 2000, 789-792.
78.
Gong P, Feng D, Lim YS: An Intelligent Middleware for Dynamic Integration of Heterogeneous Health Care Applications. Multimedia Modelling Conference, 2005 MMM 2005 Proceedings of the 11th International. 2005, 198-205.
79.
Grimson J, Stephens G, Jung B, Grimson W, Berry D, Pardon S: Sharing health-care records over the Internet. Internet Computing, IEEE. 2001, 5 (3): 49-58.CrossRef
80.
Grimson J, Felton E, Stephens G, Grimson W, Berry D: Interoperability issues in sharing electronic healthcare records-the Synapses approach. Engineering of Complex Computer Systems, 1997 Proceedings, Third IEEE International Conference on. 1997, 180-185.
81.
Grimson W, Sottile PA: Synapses in the context of healthcare information systems. Stud Health Technol Inform. 1997, 45: 30-39.PubMed
82.
Grimson J, Grimson W, Berry D, Stephens G, Felton E, Kalra D, Toussaint P, Weier OW: A CORBA-based integration of distributed electronic healthcarerecords using the Synapses approach. Information Technology in Biomedicine, IEEE Transactions on. 1998, 2 (3): 124-138.CrossRef
83.
Grimson W, Jung B, van Mulligen EM, van Ginneken A, Pardon S, Sottile PA: Extensions to the HISA standard–the SynEx computing environment. Methods of Information in Medicine. 2002, 41 (5): 401-410.PubMed
84.
Xu Y, Sauquet D, Zapletal E, Lemaitre D, Degoulet P: The" mediator service", a component to ease the integration of medical applications in the SynEx framework. Stud Health Technol Inform. 1999, 68: 768-773.PubMed
85.
Aloisio G, Blasi E, Cafaro M, Fiore S, Lezzi D, Mirto M: Web services for a biomedical imaging portal. Information Technology: Coding and Computing [Computers and Communications], 2003 Proceedings ITCC 2003 International Conference on. 2003, 432-436.CrossRef
86.
Spyrou SS, Berler AA, Bamidis PD: Information system interoperability in a regional health care system infrastructure: a pilot study using health care information standards. Stud Health Technol Inform. 2003, 95: 364-369.PubMed
87.
Dayhoff RE, Kuzmak PM, Kirin G, Frank S: Providing a complete online multimedia patient record. Proc AMIA Symp. 1999, 241: 5-
88.
Kuzmak PM, Dayhoff RE: The use of digital imaging and communications in medicine (DICOM) in the integration of imaging into the electronic patient record at the Department of Veterans Affairs. J Digit Imaging. 2000, 13 (2 Suppl 1): 133-137.CrossRefPubMedPubMedCentral
89.
Bergmann J, Bott OJ, Hoffmann I, Pretschner DP: An eConsent-based System Architecture Supporting Cooperation in Integrated Healthcare Networks. Stud Health Technol Inform. 2005, 116: 961-966.PubMed
90.
Reina-Tosina J, Roa LM, Caceres J, Gomez-Cia T: New approaches toward the fully digital integrated management of a burn unit. IEEE Transaction on Biomedical Engineering. 2002, 49 (12): 1470-1476.CrossRef
91.
Duncan RG, Saperia D, Dulbandzhyan R, Shabot MM, Polaschek JX, Jones DT: Integrated web-based viewing and secure remote access to a clinical data repository and diverse clinical systems. Proc AMIA Symp. 2001, 149-153.
92.
Hripcsak G, Cimino JJ, Sengupta S: WebCIS: Large scale deployment of a web-based clinical information system. Proc of the AMIA Symposium. 1999
93.
Tachinardi U, de Sa Rebelo M, de Magalhaes Oliveira Jr PP, Pilon PE: Real time information from bedside monitors as part of a web-based patient record. Proc AMIA Symp. 2001, 691: 5-
Metadata
Title
Reviewing the integration of patient data: how systems are evolving in practice to meet patient needs
Authors
Ricardo J Cruz-Correia
Pedro M Vieira-Marques
Ana M Ferreira
Filipa C Almeida
Jeremy C Wyatt
Altamiro M Costa-Pereira
Publication date
01-12-2007
Publisher
BioMed Central
Published in
BMC Medical Informatics and Decision Making / Issue 1/2007
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/1472-6947-7-14

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