Interoperability of clinical decision-support systems and electronic health records using archetypes: A case study in clinical trial eligibility

Journal of Biomedical Informatics

Volumn 46, Issue 4, 2013, Pages 676-689

  Marcos, Mar ^a   Maldonado, Jose A ^b   Martínez Salvador, Begoña ^a   Boscá, Diego ^b   Robles, Montserrat ^b  

^a UNIVERSITAT JAUME I   (Spain)

^b UNIVERSITAT POLITÈCNICA DE VALÈNCIA   (Spain)

Author keywords

Clinical decision support systems; Clinical trials; Electronic health records; SNOMED CT; Systems integration; Terminology

Indexed keywords

CLINICAL DECISION SUPPORT SYSTEMS; CLINICAL TRIAL; ELECTRONIC HEALTH RECORD; SNOMED-CT; SYSTEMS INTEGRATION;

ARTIFICIAL INTELLIGENCE; COMPUTERIZED TOMOGRAPHY; EXPERIMENTS; INFORMATION MANAGEMENT; INTEROPERABILITY; MEDICAL APPLICATIONS; MEDICAL INFORMATION SYSTEMS; MODELS; QUERY LANGUAGES; RECORDS MANAGEMENT; SEMANTICS; TERMINOLOGY; TOOLS;

DECISION SUPPORT SYSTEMS;

ARTICLE; BLOOD PRESSURE MEASUREMENT; CHARLSON COMORBIDITY INDEX; CLINICAL TRIAL (TOPIC); COLORECTAL CANCER; DECISION SUPPORT SYSTEM; ELECTRONIC MEDICAL RECORD; HOSPITAL PLANNING; HUMAN; MEDICAL DOCUMENTATION; MEDICAL INFORMATION SYSTEM; OCCULT BLOOD TEST; PRACTICE GUIDELINE; PRIORITY JOURNAL; SYSTEMATIZED NOMENCLATURE OF MEDICINE;

CLINICAL DECISION SUPPORT SYSTEMS; CLINICAL TRIALS; ELECTRONIC HEALTH RECORDS; SNOMED CT; SYSTEMS INTEGRATION; TERMINOLOGY;

CLINICAL TRIALS AS TOPIC; COLORECTAL NEOPLASMS; DECISION SUPPORT SYSTEMS, CLINICAL; ELECTRONIC HEALTH RECORDS; HUMANS; MEDICAL RECORD LINKAGE;

EID: 84880324881     PISSN: 15320464     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.jbi.2013.05.004     Document Type: Article

References (50)

1. Musen M.A., Shahar Y., Shortliffe E.H. Biomedical informatics: computer applications in health care and biomedicine. Health informatics 2006, 698-736. Springer, [chapter Clinical Decision-Support Systems]. 3rd ed.
2. Berner E.S., La Lande T.J. Clinical decision support systems 2007, Heath Informatics, Springer, [chapter Overview of Clinical Decision Support Systems]. 2nd ed.
3. Sujansky W. Heterogeneous database integration in biomedicine. J Biomed Inform 2001, 34:285-298.
4. Schadow G, Russler D, Mead C, McDonald C. Integrating medical information and knowledge in the HL7 RIM. In: Proc. of the AMIA 2000 annual symposium; 2000. p. 764-768.
5. Sonnenberg F., Hagerty C. Computer-interpretable clinical practice guidelines. Where are we and where are we going?. IMIA Yearbook Med Infor 2006, 145-158.
6. International Organization for Standardization. Health informatics - electronic health record communication - Part 1: Reference model; 2008. <>http://www.iso.org/iso/catalogue_detail.htm?csnumber=40784.
7. The openEHR Foundation. openEHR: future proof and flexible EHR specifications. <>http://www.openehr.org/.
8. Health Level Seven International. HL7 Clinical Document Architecture Release 2.0 (CDA R2); 2005. <>http://www.hl7.org/implement/standards/cda.cfm.
9. Clinical Data Interchange Standards Consortium. Specification for the Operational Data Model (ODM); 2010. <> [accessed 08.12]. http://www.cdisc.org/odm.
10. Beale T. Archetypes. Constraint-based domain models for future-proof information systems; 2001. <> [date of access 12.11]. http://www.openehr.org/publications/archetypes/archetypes_beale_web_2000.pdf.
11. Marcos M., Martínez-Salvador B. Towards the interoperability of computerised guidelines and electronic health records: an experiment with openEHR archetypes and a chronic heart failure guideline. LNCS 2011, vol. 6512:101-113. Springer. D. Riano, A. ten Teije, S. Miksch, M. Peleg (Eds.).
12. Marcos M., Maldonado J.A., Martínez-Salvador B., Moner D., Boscá D., Robles M. An archetype-based solution for the interoperability of computerised guidelines and electronic health records. LNCS 2011, vol. 6747:276-285. Springer. M. Peleg, N. Lavrač, C. Combi (Eds.).
13. Pryor T., Hripcsak G. The arden syntax for medical logic modules. Int J Clin Monit Comput 1993, 10:215-224.
14. Hripcsak G., Ludemann P., Pryor T.A., Wigertz O.B., Clayton P.D. Rationale for the arden syntax. Comput Biomed Res 1994, 27:291-324.
15. Lenzerini M. Data integration: a theoretical perspective. In: Proc. of the 21st ACM SIGMOD-SIGACT-SIGART symposium on principles of database systems. ACM: 2002. p. 233-46.
16. Wiederhold G. Mediators in the architecture of future information systems. Computer 1992, 25:38-49.
17. Angulo C., Crespo P., Maldonado J., Moner D., Pérez D., Abad I., et al. Non-invasive lightweight integration engine for building EHR from autonomous distributed systems. Int J Med Inform 2007, 76(S3):417-424.
18. Johnson PD, Tu SW, Musen MA, Purves I. A virtual medical record for guideline-based decision support. In: Proc. of the AMIA 2001 annual symposium; 2001. p. 294-98.
19. Sutton D., Fox J. The syntax and semantics of the PROforma guideline modeling language. J Am Med Inform Assn 2003, 10(5):433-443.
20. Peleg M., Miksch S., Seyfang A., Bury J., Ciccarese P., Fox J., et al. Comparing computer-interpretable guideline models: a case-study approach. J Am Med Inform Assoc 2003, 10:52-68.
21. Kalra D., Beale T., Heard S. Regional health economies and ICT services: the PICNIC experience. Studies in Health Technology and Informatics 2005, vol. 115:153-173. IOS Press, [chapter The openEHR Foundation].
22. The openEHR Foundation. Architecture overview. <> [04.07]. http://www.openehr.org/releases/1.0.1/architecture/overview.pdf.
23. The openEHR Foundation. Archetype Definitions and Principles. <> [03.07]. http://www.openehr.org/releases/1.0.2/architecture/am/archetype_principles.pdf.
24. Leslie H, Heard S. Archetypes 101. In: Westbrook J. et al. editors. Bridging the digital divide: clinicians, consumers, computers - Proc. of the 2006 Health Information Conference (HIC 2006); 2006.
25. The openEHR Foundation. Archetype Definition Language ADL 2. <> [03.07]. http://www.openehr.org/releases/1.0.2/architecture/am/adl2.pdf.
26. The openEHR Foundation. openEHR Clinical Knowledge Manager. <>http://www.openehr.org/knowledge/.
27. Biomedical Informatics Group, Universidad Politécnica de Valencia. LinkEHR Normalization Platform. <> [accessed 08.12]. http://www.linkehr.com/.
28. Maldonado J.A., Moner D., Boscá D., Fernández J., Angulo C., Robles M. LinkEHR-Ed: a multi-reference model archetype editor based on formal semantics. Int J Med Inform 2009, 78(8):559-570.
29. Maldonado JA, Moner D, Boscá D, Angulo C, Marco L, Reig E, et al. Concept-based exchange of healthcare information: the LinkEHR approach. In: Proc. of the 1st IEEE international conference on Healthcare Informatics, Imaging and Systems Biology (HISB 2011); July 2011. p. 150-57.
30. Maldonado J.A., Costa C.M., Moner D., Menárguez-Tortosa M., Boscá D., Minarro Giménez J.A., et al. Using the ResearchEHR platform to facilitate the practical application of the EHR standards. J Biomed Inform 2012.
31. US National Institutes of Health (NIH). ClinicalTrials.gov. <> [accessed 08.12]. http://clinicaltrials.gov/ct2/home.
32. Hospital Clínic, Barcelona. Colorectal cancer screening in average-risk population: immunochemical fecal occult blood testing versus colonoscopy. <>[accessed 08.12]. http://clinicaltrials.gov/ct2/show/NCT00906997.
33. Chute C.G. Medical concept representation. Integrated series in information systems 2005, vol. 8:163-182. Springer, US, Boston, chapter 6. R. Sharda, S. Voß, H. Chen, S.S. Fuller, C. Friedman, W. Hersh (Eds.).
34. Peleg M., Keren S., Denekamp Y. Mapping computerized clinical guidelines to electronic medical records: knowledge-data ontological mapper (KDOM). J Biomed Inform 2008, 41(1):180-201.
35. US National Library of Medicine. Unified Medical Language System (UMLS). <>[accessed 07.12]. http://www.nlm.nih.gov/research/umls/.
36. International Health Terminology Standards Development Organisation (IHTSDO). SNOMED CT. <>[accessed 07.12]. http://www.ihtsdo.org/snomed-ct/.
37. Charlson M.E., Pompei P., Ales K.L., MacKenzie C.R. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987, 40(5):373-383.
38. World Wide Web Consortium (W3C). OWL 2 Web Ontology Language Document Overview; October 2009. <> [accessed 07.12]. http://www.w3.org/TR/owl2-overview/.
39. Farfán Sedano F.J., Terrón Cuadrado M., Castellanos Clemente Y., Serrano Balazote P., Moner Cano D., Robles Viejo M. Patient Summary and medicines reconciliation: application of the ISO/CEN EN 13606 standard in clinical practice. Stud Health Technol Inform 2011, 166:189-196.
40. Health Level Seven International. HL7 Decision Support Service (DSS), Release 1; August 2011. <> [accessed 04.13]. http://www.hl7.org/implement/standards/product_brief.cfm?product_id=12.
41. German E., Leibowitz A., Shahar Y. An architecture for linking medical decision-support applications to clinical databases and its evaluation. J Biomed Inform 2009, 42(2):203-218.
42. Lonsdale D.W., Tustison C., Parker C.G., Embley D.W. Assessing clinical trial eligibility with logic expression queries. Data Knowl Eng 2008, 66:3-17.
43. Cho I., Kim J., Kim J.H., Kim H.Y., Kim Y. Design and implementation of a standards-based interoperable clinical decision support architecture in the context of the korean EHR. Int J Med Inform 2010, 79:611-622.
44. Kim S., Shim B., Kim J.A., Cho I. SW architecture for access to medical information for knowledge execution. Communications in computer and information science 2010, vol. 78:574-580. Springer, Berlin Heidelberg. T.-H. Kim, A. Stoica, R.-S. Chang (Eds.).
45. Bilykh I., Jahnke J.H., McCallum G., Price M. Using the clinical document architecture as open data exchange format for interfacing EMRs with clinical decision support systems. Proc of the 19th IEEE symposium on Computer-Based Medical Systems (CBMS 2006) 2006, 855-860. IEEE Computer Society, Washington, DC, USA.
46. Health Level Seven International. HL7 Version 3 domain analysis model: virtual medical record for Clinical Decision Support (vMR-CDS), Release 1; April 2012. <> [accessed 04.13]. http://www.hl7.org/implement/standards/product_brief.cfm?product_id=270.
47. Rector A.L. The interface between information, terminology, and inference models. Stud Health Technol Inform 2001, 84:246-250.
48. Parker C., Rocha R., Campbell J., Tu S., Huff S. Detailed clinical models for sharable, executable guidelines. Stud Health Technol Inform 2004, 107:145-148.
49. Tu S.W., Campbell J.R., Glasgow J., Nyman M.A., McClure R., McClay J., et al. The SAGE guideline model: achievements and overview. J Am Med Inform Assoc 2007, 14(5):589-598.
50. Goossen W., Goossen-Baremans A., van der Zel M. Detailed clinical models: a review. Healthc Inform Res 2010, 16(4):201-214.