Vurdering af interoperabilitetsniveauers konsekvenser for data og funktionalitet i FHIR økosystemer

Abstract

Introduktion: Interoperabilitet (IoP) mellem informationssystemer, kan klassificeres vha. taksonomi. Manglen på en gængs metode til at præcisere IoP-graden, gør det svært at sammenligne informatiske studiers resultater. HL7 Fast Health nteroperability Ressources (FHIR) er en IoP-standard, der anvendes som grundlag for økosystemer af applikationer til håndtering af sundhedsdata. Metode: Studiet besvarede problemformuleringen: “Hvad er de indholdsmæssige og funktionelle konsekvenser, for klinisk data, i forbindelse med at opnå forskellige niveauer af interoperabilitet i et FHIR økosystem?” Analysen hertil, grundede i “ISO 12967-1:2011 HISA specifikationsproceduren”. Fokuserede spørgsmål afdækkede ISO-standardens synspunkter: Virksomhed, Information og Datamatisk samt et foresl°aet “Udviklersynspunkt”, til teknologirelaterede konsekvenser. Alle synspunkter analyseredes for de tre niveauer af IoP: “Teknisk og syntaktisk -”(TSI), “Delvis semantisk -”(DSI) og “Komplet semantisk -”(KSI) IoP. Resultat: TSI medførte problematisk patientidentifikation, grundet manglende mulighed for maskinel anvendelse. DSI medførte både frihed og sammenhæng i data, sammen med maskinel anvendelse af fælles data. KSI medførte minimal frihed, men fuldstændig deling af data til anvendelse i avancerede applikationer, p°a tværs af økosystemets domæner. Diskussion og konklusion: Anvendelsen af den foreslåede metode og det matematisk udtryk for den semantiske IoP gjorde det mulig at opgøre de indholdsmæssige og funktionelle konsekvenser for klinisk data. Beregningsmetoden er dog sensitiv, ved anvendelse p°a små datamodeller. Det kan konkluderes at den foreslåede metode kan anvendes til at opgøre de indholdsmæssige og funktionelle konsekvenser for klinisk data.

Introduction The term interoperability can be sub-divided into levels, by the means of taxonomy. An issue regarding taxonomy originates in their often qualitative or narrative nature, the lack of quantitative measures for precise estimation of the level of interoperability. This is exemplified by the taxonomy by Stroetmann et al. [2009] and the taxonomy utilised by Jochem [2010]. These taxonomies can be used for classifying the level of interoperability between two or more interoperating information systems. But in terms of expressing an exact level of interoperability, that can be used in for instance the comparison of the results from studies on informatics, there is a need for a more mathematical approach. Interoperability can be achieved through the application of informatics standards. Some widely applied standards have been developed and published by HL7. The latest interoperability standard from HL7, Fast Health Interoperability Ressources (FHIR), has received great international attention1 from a vast community of FHIR supporters. In a Danish context FHIR has recently been adopted as the basis for establishing a health data ecosystem. The ecosystem is intended for gathering and utilising health data, from a variety of different clinical and social service domains. The heterogeneity of the domains is affecting the need for domain specific data, to support the clinical workflow. This kind of variety is the core competence in FHIR, which is developed to be profiled for specific clinical or administrative purposes. However in an ecosystem including multiple domains and use cases, with their related data models, variety can be expected to have an impact on the level of interoperability. The aim of this study was to examine this issue through an analysis, based on the problem statement: “What are the contents- and functions- related consequences for clinical data, when individual levels of interoperability are meet in a FHIR ecosystem?” Methods and materials As a case for the analysis, a real life FHIR ecosystem was utilised, including models for two clinical domains. The analysis behind the problem statement satisfaction, was based on the “Health Informatics Service Architecture (HISA) specification procedure” of the standard “ISO 12967 ”. The three formal viewpoints of ISO 12967: Enterprise-, Information-, and Computational Viewpoint, was covered by means of formulated research questions. The two viewpoints: Engineering-, and Technolgy Viewpoint, of the HISA specification procedure are not formally described in ISO 12967. Those viewpoints where joined and formalised as “Developer Viewpoint”, and covered by an guided interview with FHIR ecosystem experts. All viewpoints, except Enterprise Viewpoint, were analysed at the three levels of interoperability defined by Stroetmann et al. [2009]: “Technical and syntactical interoperability”, “Partial semantic interoperability”, and “Full semantic interoperability”. For assessing the exact level of interoperability, a mathematical measure for the “effective semantic interoperability” was utilised. Results Enterprise Viewpoint, resulted in a purpose description of the studied FHIR ecosystem along with domain specific data models for the two domains: Home- care and nursery, and physiotherapeutic training. Technical and syntactical interoperability, resulted in the following consequences: Data can be exchanged, but only utilised by human interpretation; problematic patient identification, due to the lack of machine interpretation; simple data viewers, with developer heavy free text search engines. Partial semantic interoperability, resulted in the following consequences: Sharing of common information, that can be machine processed; reuse of FHIR profiles and advanced business transactions across ecosystem applications; application specific profiling is allowed. Full semantic interoperability, resulted in the following consequences: Complete sharing of ecosystem information, allowing for complete machine utilisation; No application specific profiling allowed. Discussion and Conclusion This study demonstrated the application of the suggested model for analysing a FHIR ecosystem, along with the mathematical representation for the level of interoperability. The strictness of the HISA specification procedure, complements the openness of FHIR, by contributing with a standardised modelling framework. The suggested measure for interoperability is applicable as an expression for the exact level of interoperability. The exact level of interoperability in single-layer information architectures, like FHIR, is however criticised for being submitted to degeneration due to domain changes. It can be concluded that the suggested model and the mathematical interoperability measure are applicable as means to analyse interoperability in a FHIR ecosystem.

A master thesis from Aalborg University

Vurdering af interoperabilitetsniveauers konsekvenser for data og funktionalitet i FHIR økosystemer

[Evaluation of interoperability level impact on contents and functionality in FHIR ecosystems]