Platform to Support the Development of Information Services

for Informal and Formal Care

Carlos Cardoso

, Yosvany Llerena Rodriguez

, Miguel Grade

, Filipe Augusto

, Alexandra Queirós

João Quintas

and Nelson Pacheco Rocha

Maisis, Rua D. Manuel B. Vasconcelos, Aveiro, Portugal

Instituto de Engenharia Electrónica e Telemática de Aveiro, University of Aveiro,

Campo Universitário de Santiago, Aveiro, Portugal

Health Sciences School, Instituto de Engenharia Electrónica e Telemática de Aveiro, University of Aveiro,

Campo Universitário de Santiago, Aveiro, Portugal

Instituto Pedro Nunes, Rua Pedro Nunes, Coimbra, Portugal

Health Sciences Department, Instituto de Engenharia Electrónica e Telemática de Aveiro, University of Aveiro,

Campo Universitário de Santiago, Aveiro, Portugal

Keywords: Integrated Care, eHealth, Electronic Health Record, Personal Health Record, Social Health Record, Services

Oriented Architecture.

Abstract: This paper presents a platform to support the development of services and applications for informal and

formal care, which is based on the principles of the Services Oriented Architecture. In particular, the paper

presents the mechanisms that allow the developers a significant freedom to implement and use new types of

information objects.

1 INTRODUCTION

Due to the ageing population and the inherent shift

in the burden of illness from acute to chronic

conditions, there is a generation of people living

with long term illness and disability and,

consequently, a substantial increase of the health

costs. Therefore, significant organizational changes

of the care away from medical institutions are

required, which means the urgency for the

consolidation of new practices that can contribute to

increase efficiency and, consequently, to decrease

costs.

As a consequence of major structural changes of

the contemporary society, particularly in terms of

structure and size of the families, there are a

considerable number of elderly people living alone.

Thus, the interventions should not be exclusively

focused on medical needs, but also in maintaining

the autonomy and independence of the individuals

(Santana et al., 2007) by supporting a set of

activities that are normal for every citizen, such as

home activities, mobility, recreation or safety, and

also social participation.

Significantly, the ageing population coincides

with the technological revolution of the last decades,

which is redefining how people work, communicate

and relate to each other and that should contribute

both to effectiveness and efficiency of the healthcare

and social care systems. In this respect, the ehealth

(Eysenbach, 2001) paradigm is essential.

One of the objectives of the TICE.Healthy

project, which integrates diverse Portuguese

academic and industrial partners, is to answer to

some of the identified needs by providing a

platform, the We.Can platform, supporting

applications in the health and quality of life

domains.

In this paper, we present some features of the

We.Can platform, based on the principles of the

Services Oriented Architecture (SOA). This

platform intends to complement the existing clinical

communication networks. Its main requirement is

the support of informal and formal care providers,

outside the hospitals wards, that, nowadays, do not

have access to services providing structured

information related with their clients.

417

Cardoso C., Llerena Rodriguez Y., Grade M., Augusto F., Queirós A., Quintas J. and Pacheco Rocha N..

Platform to Support the Development of Information Services for Informal and Formal Care.

DOI: 10.5220/0004903304170421

In Proceedings of the International Conference on Health Informatics (HEALTHINF-2014), pages 417-421

ISBN: 978-989-758-010-9

 2014 SCITEPRESS (Science and Technology Publications, Lda.)

The paper is composed by this section

(Introduction) and three more sections: Related

Work, Architecture, Services and Conclusion.

2 RELATED WORK

Health Care Networks (HCN) (Katehakis et al.,

2006) are used for the integration and sharing of

distributed clinical information. Most HCN in

Europe are typically regional, although some

national solutions also exist. The implementation of

these networks requires the solution of a broad range

of technical and non-technical issues, such as user’s

identification, security, privacy, governance and

financial support for common operations.

The sharing of clinical information requires, in

addition to the communication infrastructure, the

existence of interoperable Electronic Health Records

(EHR). This interoperability can contribute to a

more effective and efficient care, facilitating the

transfer of information and knowledge between

different entities.

For that several standards (e.g. Reference

Information Model - RIM - or Clinical Document

Architecture - CDA) are being developed by the

Health Level Seven (HL7) organization, part of the

American National Standard Institution and founded

in 1987, while the European Committee for

Standardization - Technical Committee 251

(CEN/TC 251) is being defining the EHRcom whose

overall goal is to provide a rigorous and stable

information architecture for communicating part or

all of the EHR information of a patient.

However, despite all the advances in systems

interconnection and interoperability protocols,

semantic heterogeneity of information remains a

difficult problem to solve. This interoperability is

still more difficult knowing that health conditions

are influenced by the individual's medical history

and other factors, including behavioural, social and

environmental factors (Glass &. McAtee, 2006).

Thus, we need to consider new requirements in

terms of distributed management, integration and

use of a whole range of information, such as those

related to Personal Health Records (PHR),

Electronic Social Records (ESR) and Ambient and

Assisted Living (AAL) generated information

(Queirós et al., 2013).

PHR include data and information related with

the individuals’ lifetime and the individuals’ care

maintain by themselves, namely patient-reported

outcomes (Bos, 2012).

ESR are composed by forms (e.g. nationally used

forms or local assessment forms), coded data

(mainly for management and statistical reporting

purposes) or unstructured information such as

letters, emails or notes of meetings (SCDH, 2004).

Finally, recent developments related with AAL

and the consolidation of standards such as the

ISO/IEEE 11073 for the interconnection and

interoperability of medical devices, have brought

new possibilities in terms of new services (Teixeira

et al., 2009; Teixeira et al., 2011) and automatic

collection of information about individuals and

environment. Sensory data are captured by sensors

embedded in the environment and can be used for

systems automation or to monitor chronic diseases

among other applications.

Considering this complex reality, there is the

need to develop innovative solutions to persist all

the required information, such as the We.Can

platform.

3 ARCHITECTURE

Although one of the main requirements of the

We.Can platform is the information persistence, its

architecture should not only provide the necessary

services for information persistence, but also other

services supporting applications such as: i) audit

services responsible for verifying all interactions

conducted among services and end users; ii)

authentication services to provide access to the

information only to authorized services or end users;

iii) encryption services to enable secure

communications of sensitive information (Hafner,

2009); iv) concepts and terminology services to

assist the processes of data codification, data

translation into formats easily understood by humans

or data indexing and inference, and to determine the

structure and meaning of some data; and v) users

identification services, enabling a unique identifier

information distributed across multiple entities and

systems.

To consolidate the We.Can architecture it was

necessary to consider a comprehensive set of

problems, namely the heterogeneity of potential end-

users and, consequently, the challenges in terms of

usability, the difficulty of ensuring a safe and

efficient access to different types of information and

ultimately, the capture and management of new

information types related with knowledge not

properly structured, and for which the platform must

ensure that its meaning is transversal (i.e. their

meanings must be the same, regardless the involved

actors and the future evolutions).

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Ideally, the architecture should allow the

integration of software components from different

sources. The SOA approach is a good solution to

ensure technological neutrality, namely because it

can encapsulate components developed in other

technologies. Furthermore, this paradigm allows

business processes to be responsive with a high

degree of flexibility and adaptability, namely

(Crawford et al., 2005): i) the development of new

services from the aggregation of components that

can be built on different systems, running different

operating systems, and build in different

programming languages; ii) consistency of the

infrastructure development and deployment; iii)

reduction of the design, development, testing, and

deployment time due to the reuse of existing

services and components; iv) reduction of the

development costs and the risk of introducing new

errors, and thus potential points of failure, through

the process of enhancing or creating new business

services; v) continuous business process

improvement, since the developers are allowed to

change process flows while monitoring the resulting

effects; and vi) user-configurable solutions.

The formal consistency of the information is the

responsibility of the persistence mechanisms. Those

mechanisms also ensure that the information

requirements of individual applications are met

through the evocation of standardized primitives.

The customization of the applications to specific

requirements of the application domain requires

substantial code modifications. To obviate this

difficulty there is the modelling at two levels

approach (i.e. knowledge and information models),

which has been considerably developed by the

openEHR promoters (Schloeffel, 2003).

The Archetypes and the respective constraint

rules domain constitute the knowledge model that is

used to adapt the underlying information technical

specifications.

The knowledge model considers that there is

contextual information that should always be

recorded and there is information that will vary

according to clients, events and service providers.

Therefore, it exist different types of Archetypes that

are part of the basic care process. A generalization

of base Archetypes was performed in order to

systematize the overall information that can be

considered essential.

An Archetype is a pre-defined structure which

organizes information facilitates the creation of

appropriate forms for data input and queries. The

basic structure of any Archetype consists of a

header, a body and data. The header contains

information such as the type, name, author and

header details, which, in turn, comprise several

attributes.

The body of the Archetype (Figure 1) is a

dynamically modelled component and contains three

main fields: participations (i.e. contextual

information), description (i.e. the elements that

compose the body) and definition. Definition is used

to specify one or more groups of information. Each

group has a name, an id, the minimum and

maximum number of occurrences, and if it is

mandatory. The data field is structured to support the

information groups specified by the aforementioned

body definition field. It comprises a group which can

be subdivided into collections and elements. In turn,

collections may contain elements or other

collections.

Figure 1: Structure of the Archetype body.

To guarantee the flexibility of the Archetypes and to

ensure the persistence of the information together

with the respective semantics there is the need of

robust information models. Therefore, the data

repository (i.e. the information model) was

implemented accordingly to HL7 RIM (ISO/HL7

21731, 2006).

4 SERVICES

The information persistence service, based on the

RIM implementation provides a simplified access to

the platform databases. In order to offer a high

abstraction level, the create, read and update

operations to access the relational databases that

support the implementation of the RIM container

allow the manipulation of objects and, therefore,

provide enough abstraction to the services that use

them. Since the deletion of previously persisted

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information is not allowed, the delete operation was

not implemented. This is one of the fundamental

rules that must not be violated in order to ensure

coherence and consistency of the stored information.

Queries are important features to bear for any

information system. This importance becomes even

more critical when the volume, complexity and

variability of the stored data increase.

Considering the Archetypes modelling approach

and the variability of the Archetypes structure

becomes critical the existence of specific search

syntax sufficiently flexible to answer the needs of

the final information consumers (i.e. applications).

Therefore, we propose a domain specific language

with adequate syntax to formalize flexible queries.

A search is formalized through a Search

operation that contains a Query or a Filter

mechanism.

The Query mechanism is prepared to be used

when searching free text fields, which is extremely

useful for research in fields with long text, or when

the result should be sorted by relevance. On the

other hand, it is recommended to use the Filter

operations in binary searches (i.e. searches that

return yes or no results), exact value searches (i.e.

filtering by a certain value) and recurrent searches

that need to be optimized by caching mechanisms.

The formalization of a Filter or a Query search

can be refined with additional criteria including

different types of operators (e.g. Boolean, exact,

range or fuzzy).

Archetypes are complex structures and,

therefore, the platform provides dedicated services

to create and edit them. Furthermore, the support

services provide search functions for the selection,

within the existing Archetypes, the one that must be

edited, and the required operations to manage the

information introduced by the application domain

experts and to manage the different Archetypes

versions.

The developed support services use the LiU

Archetype Editor of the openEHR framework, which

has been complemented by a parser able to adjust to

RIM.

The Archetypes processed by the parser can be

included in an Archetypes repository. This is an

application that allows all the required Archetypes

operations, namely, searching and publishing,

authentication, versioning and ownership

management.

Once the applications that can be supported by

the platform We.Can necessarily have a broad range

of requirements in terms of user interfaces and that

these interfaces must evolve over time with the help

of domain experts and the end users themselves, it is

important to have a support development services

based on the Archetypes formulations for the

extension of the presentation features.

The presentation service provides a generic

interface to create, access, modify and delete records

based on existing Archetypes without the need to

change the persistence layer. The selected

development environment was the Play Framework,

which is a web framework based in Java and the

configurations of generic entities are stored in

JSON.

The created custom fields are dynamic so that

they can be modified at runtime. Depending on the

predefined configurations there is a code generation

component that is able to create a visual

representation of the Archetype contents and

implement the business rules that govern them.

Among the features provided by the module it

should be pointed the following: i) abstraction of

data access and business rules; ii) customization of

fields and web components (e.g. data type,

maximum size or validation constrains); iii)

automatic update of the template whenever there is a

definition of new components; iv) automatic

generation of custom forms for viewing, entering

and editing data; and v) versioning management.

There are four types of views that can be

configured, namely: i) insertion view; ii) edit view;

iii) presentation view (i.e. a view to present data

from a register); and iv) data list view.

In order to allow having presentation services

truly flexible and extensible independently of the

application environment it is necessary to provide a

mechanism to define and modify business rules of

the final application.

The most common validations are pre-

programmed accordingly to rules based on the

Archetypes definition. Additionally, there is the

possibility to validate one or more fields of a

presentation entity in a different way that the one

initially foreseen. For example, if we had two date

type fields whose validation rules include the

requirement that the content of the field should be

posterior to the first one, and this had not been

planned, it should be possible to add a rule to

validate this condition. Beyond this basic case there

are many others cases that may rely on the rules

engine to allow the application modification without

recompilation and deployment costs

A rules engine helps to reduce the problems and

difficulties inherent to the development and

maintenance of the business logic of an application

(e.g. the recompilation and deployment costs).

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5 CONCLUSIONS

Through the use of different application scenarios it

was possible to verify that the RIM based

information container is able to support a wide range

of information structures. Furthermore, the formal

structure of the Archetype was proven to be useful

for the development of the user interactions

mechanisms. In particular, the validation process

demonstrated that user interfaces can be automatic

generated from the Archetypes structure.

Currently, a full version of the platform is being

prepared to be evaluated in real conditions,

supporting different services and applications related

with health and quality of life domains.

ACKNOWLEDGEMENTS

This work was supported by COMPETE - Sistema

de Incentivos à Investigação e Desenvolvimento

Tecnológico, Projectos de I&DT Empresas em co-

promoção, under QREN TICE.Healthy.

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