ObjectiveFor realizing pervasive and ubiquitous health and social care services in a safe and high quality as well as efficient and effective way, health and social care systems have to meet new organizational, methodological, and technological paradigms. The resulting ecosystems are highly complex, highly distributed, and highly dynamic, following inter-organizational and even international approaches. Even though based on international, but domain-specific models and standards, achieving interoperability between such systems integrating multiple domains managed by multiple disciplines and their individually skilled actors is cumbersome.MethodsUsing the abstract presentation of any system by the universal type theory as well as universal logics and combining the resulting Barendregt Cube with parameters and the engineering approach of cognitive theories, systems theory, and good modeling best practices, this study argues for a generic reference architecture model moderating between the different perspectives and disciplines involved provide on that system. To represent architectural elements consistently, an aligned system of ontologies is used.ResultsThe system-oriented, architecture-centric, and ontology-based generic reference model allows for re-engineering the existing and emerging knowledge representations, models, and standards, also considering the real-world business processes and the related development process of supporting IT systems for the sake of comprehensive systems integration and interoperability. The solution enables the analysis, design, and implementation of dynamic, interoperable multi-domain systems without requesting continuous revision of existing specifications.
Mr. Snelick's work was completed within the capacity of US governmental employment. US copyright protection does not apply. HL7 ® , HL7 CDA ® and FHIR ® and are registered trademarks of Health Level Seven International, Inc. and are used with permission. HL7 ® Version 2.x, HL7 Version 3.0, HL7 ® CTS2 is copyrighted material owned by HL7 ® International and are used with permission. Use of these trademarks and material does not represent endorsement of HL7 ® International of this text. DICOM ® is the registered trademark of the National Electrical Manufacturers Association for its standards publications relating to digital communication of medical information. This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made.
Objectives: Health systems are on the move to increasing complexity, distribution, autonomy, number of domains or disciplines involved, thereby requesting evolution of interoperability to support required communication and cooperation among those systems for meeting intended business objectives. Methods: Information cycle model with its phases and phase transitions as well as systems theory are used to describe structure and processes of healthcare business cases and the interoperability levels for enabling the communication and cooperation between the principals involved. Results: When focusing on interoperability between health information systems acting as principals in an ICT business case, different levels of contribution to the common business case, i.e. phases to the completion of the information cycle, provided by the principals can be distinguished. While the first two levels, sharing data related to the business case, and sharing information derived from those data to define the required business process actions, deal with the communication challenge of interoperability, just the third level of providing the required action according to the business case concerns its operational part. Such service delivery requires appropriate system architecture for meeting the service functional cooperation challenge. When extending the consideration beyond ICT systems towards real world business systems, the architecture of non-ICT systems regarding their structure and behavior must be represented to be shared as required in the business case as well. This system extension requires domain knowledge based interoperability for covering the domain-specific concepts and relations including the constraints to be applied. When not just considering the domain-specific context, but also the context of the individual user, personalized business systems are managed. Conclusions: Advanced healthcare systems require not just communication standards for enabling interoperability, but also multi-domain, ontology-driven interoperability standards based on a generic reference architecture, that is also shortly presented in this paper.
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