Information Technology Reference
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expectation is driven by rapid developments in
information technology, alongside their increasing
dominance at the heart of individual healthcare
institutions, through the use of data-intensive
electronic health records systems (EHRs) that
drive the health care process. One of the primary
visions of eHealth has been to achieve a technology
supported, seamlessly integrated health service
that ensures the delivery of the right information
about the right individual to the right person at
the right time (Stead W. et al (2000), Taweel, A.
et al (2006)). This vision, however, present many
challenges, including:
at all times. This requires secure yet con-
figurable independent data sharing policies
that reflect the needs of the participating
organizations within the domain.
However, the most serious challenges to
achieving the eHealth vision are not only techno-
logical but also ethical and structural. The large
number of system providers and their business
models and variations in ethical and regulations
for accessing clinical information across health
organisations (let alone individual health centres)
implies an exponential explosion in the number
and type of stakeholders that need to be involved
in achieving the seamless interoperability required
to achieve the above vision. To achieve the need is
to enable interoperation between data centres not
just at the system or data levels but also at the gov-
ernance level. However, consider the complexity
involved in reaching agreements on or enforcing
conformance to interoperability standards at these
different levels within a single enterprise let alone
multiple countries. Therefore, the approach taken
here is motivated by the practical implications of
not being able to completely rely on the use of
common interoperability standards to address this
issue. Instead, this needs to be addressed at the
granularity of the application, data and/or centre
levels, in which an interoperability framework
should overcome heterogeneity and adapt at
run-time and dynamically interoperate with data
providers. Heterogeneity between eHealth systems
and data, however, takes several dimensions; the
most challenging of which is the semantic one,
which the approach proposed in this paper attempt
to address.
In this chapter, we focus on eHealth data sharing
in the context of clinical research, in the context
of health organisations that use electronic health
records systems (EHRs) through which patient
health data is managed and stored. The stores
that hold patient health data are referred to in this
chapter as data sources. We present an approach
•
The heterogeneity of eHealth systems and
their data representations across health in-
stitutions, not just across the eHealth do-
main as whole but even within individual
clinical domains, e.g. secondary care, pri-
mary care etc.
•
Delivery of complete clinical information
at the point of care, potentially requires
health information exchange across geo-
graphically distributed health centres, thus
creating a massive scalability challenge
that puts demands on networking and dis-
tributed system architectures.
•
Legacy and propriety systems and the lack
of, or at best, slow pace adoption of stan-
dards make exchanging clinical data more
difficult and hampers the chances of inte-
grated healthcare. This puts demands on
knowledge representation methodologies
that must cope with the complexity of (het-
erogeneous) eHealth information, whilst
remaining easy to deploy and use by sys-
tem providers.
•
The requirements of patient privacy and
confidentiality that require strict data
governance policies. These policies vary
across institutions to include a variation of
access constraints that observe strict ethi-
cal rules to maintain patient confidentiality
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