The Digital Europe Program (DEP) is concentrated on bringing digital technology to businesses and citizens in five main areas: High Performance Computing (HPC), Artificial Intelligence (AI), Cybersecurity and Trust, Advanced Digital Skills, and the Deployment and Best Use of Digital Capacity and Interoperability. Thus, defining a rigorous and generic Reference Model that is suitable for every kind of information and data structures within an electronic health record (EHR) is key focus for DEP. Open specifications and clinical models in healthcare applications are often accustomed create and build interoperability solutions, to process safely EHR data that have come from heterogeneous sources. The aim of this paper is to present a model of openEHR standard specification and the use for data representation and exchange about Intraocular Pressure (IOP), which is one of the most vital modifiable risk factor for the event of glaucoma. At this stage the focus is on establishing collaboration between engineers and clinicians, thus the proposed model does not claim to be exhaustive.
Technologies are the fastest growing area within the present time. In practice,
there’s a widespread trend of knowledge and communication technologies
developments and implementation and medicine is not any exception. A wide
combination of applications and relevant things are driving towards the rework of the
health services delivery. Today, healthcare is directly linked with the utilization of
recent information and communication technologies (ICT), and other engineering
developments in medical and diagnostic practice, ensuring optimal activities –
diagnosis, treatment, nfiancing, reporting, and information exchange [
The pandemic crisis caused by COVID19 has influenced the emergence of applications within the health care sector. Both web-based applications and individual mobile applications are available. Based on all the mentioned we can see a clear trend that m-Health will cover an increasing share of e-Health.
The increase in coverage of 5G networks ends up in rapid implementation of mobile technologies in health services and enhances the impact of m-Health.
The fast development of electronics and telecommunication technologies defines new dimensions for the methods and tasks of medication and therefore the role and the tasks of the medical doctor specifically. It is often argued with full force that the introduction of technologies in medicine lags behind their development. This puts the health profession in front of the requirement to acquire, develop, and master new knowledge and skills to fit in the new information and technological environment. In this paper it will be emphasized the growing use of data and communication technologies in medicine, underlining the need of collaboration between engineers and clinicians and a cross-disciplinary approach.
One of the European Union’s (EU) objectives for digitalization is to form
one electronic health framework. The aim of the EU framework for e-Health
interoperability is to define a collection of standards and tools for the presentation
of individual elements associated with health and health systems. There are
variety of large-scale open platforms implementations supporting millions of patients
based on compliance built and supported with the HL7 FHIR, SNOMED CT,
openEHR and IHE-XDS standards, delivering open platforms at scale across the
world. Below are presented in short a number of standards and their
characteristics, which are important when considering the representation of clinical content
within an open platform:
• openEHR is that the only currently available open standard specification
for the representation of fine-grained structured clinical content that’s sufi
ciently mature and proven at scale. Thus, it’s the sole contender because the
standard for the storage of fine-grained computable data in an open platform.
• openEHR encompasses a well-established worldwide community
together with a well-developed set of software tools for creating and maintaining
content. This puts openEHR in a superb position to deal with the challenge of
making and curating of fine-grained computable content at scale.
• openEHR has been adopted as a standard for the representation of clinical
content in the Norwegian hospital sector and as a national standard in India,
Slovenia and Brazil and is employed for standards development in Australia,
Finland, Sweden, Russia, Philippines and Canada [as part of a foundation –
defining of open platform][
IHE-XDS is an open standard that provides a mechanism designed for
sharing documents and pictures together with relevant metadata in health and care
environment. IHE-XDS provides structures in which data may be stored in open
formats and a registry, which stores metadata. Although primarily used for
documents and pictures, they may also be used for managing any form of unstructured
or semi-structured data. IHE-XDS is well supported by the seller community and
has been used at scale in many places both standalone and in combination with
openEHR [
SNOMED CT – Terminologies play a vital role within the definition of clini cal content. Here the recognized standard is SNOMED CT, although such a platform may have to support other classification systems in order to both support legacy systems’ interfaces and use cases, where SNOMED CT isn’t universally used. Ideally a platform should provide terminology services supporting standard terminologies and locally defined terminologies together with mechanisms to support mappings between them where this is often relevant.
SNOMED CT is the first terminology employed in an open platform and
plays a vital role in achieving interoperability [
HL7 FHIR is a crucial standard primarily concerned with the specification
of common open APIs for EHR systems and it should be supported by any open
platform implementation. FHIR was designed to support interoperability between
systems and focuses on a little number of profiles to support common interoper
ability requirements. It had been not intended as a standard for knowledge
repository of big scale clinical content systems [
ISO 13606-2 – EHR communication – Part 2: Archetype interchange speciifcation. Specifies the knowledge architecture required for interoperable commu nications between systems and services that require or provide EHR data. This part of ISO 13606 isn’t intended to specify the interior architecture or database design of such systems.
Uses of healthcare records for other purposes like administration,
management, research and epidemiology, which require aggregations of individual
people’s records, aren’t the main focus of this a part of ISO 13606. This part of ISO
13606 defines an archetype model and it is used to represent archetypes when
they are communicated between repositories, and between archetype services. It
defines an optional serialized representation, which can be used as an exchange
format for communicating individual archetypes. Such communication might, for
instance, be between archetype libraries or between an archetype service and an
EHR persistence or validation service [
Open platforms liberate both data and applications making them portable and interoperable across diferent platform implementations.
Often the extraction of information from such structures has no connection
and influence on the way the structure was generated. At best, knowledge analy
sis and retrieval systems could choose between arrays of already accumulated
data. The challenge is to construct a mechanism in which data collections are
often adapted in terms of modeled results [
The somewhat extraordinary boom within the exchange of knowledge on
the online, on the order of zetta Byte by 2017, per CISCO [
The mentioned briefly standards HL7 FHIR, SNOMED CT, openEHR and IHE-XDS used in various large-scale open platforms rely on reliable transfer information methods. Such methods strong points vary in many aspects and procedural steps. For the purpose the mechanism of transfer of the information is then realized bidirectional covering the application area needs (see Figure 1).
As pilot field to develop a collaboration schema between engineers and cli
nicians we will use here the case of elevated intraocular pressure (IOP). IOP is
a major risk factor for development and/or progression of glaucoma, and IOP
reduction is a well-known treatment strategy for slowing the progression of the
disease. However, due to the fact that IOP is not a constant value and it is afected
by many internal and environmental factors, many glaucoma researchers have
conducted studies to characterize its circadian rhythm and short/long-term
variations [
In the design and development of archetypes and operational templates, the
aim is to use ADL (Archetype Definition Language) and therefore the develop
ment environment to model accurately and very well all possible parameters of
the clinical condition in order that it corresponds to the important situation. Good
work style also implies the likelihood of information validation at the input stage,
which might reduce the likelihood of errors [
Archetypes are described in ADL, which is an XML-like language, and operational templates are XML documents prepared in accordance with the openEHR reference model, represented by a set of XML schemas /XSD files in XML for mat/. Mind map of an example of such archetype is presented in Figure 2. pressure level archetypes Eye examined Coded Text Optional
An example of a clinical description, expressing the overall interpretation of the clinical observation as a coded text will be described in short. Here are presented only part of the usually used data group of elements, including some of the elements that normally must be part of events, protocol and state sets of elements. Further more, details regarding for example the concrete device used details. For simplicity reasons also the applied in the diferent cases tonometry methods are not included in the presented set of elements.
Taking under consideration the openEHR model [
Property: Pressure Arithmetic Units in mm[Hg] Property: Time Aritmetic Units in ms
Choice of: Coded Text Goldmann [Goldmann tonometry.] Perkins [Perkins tonometry.] Tono-Pen [Tono-Pen tonometry.]
Icare (Rebound) [Icare (ReType of tonometery used to mea- bound) tonometry.] sure intraocular pressure. Dynamic Contour [Dynamic
Contour tonometry.] Ocular Response Analyzer [Ocular Response Analyzer.] TGDc-01 [A TGDc-01 device was used to perform the test.] Non-contact tonometry [Noncontact tonometry was used to perfrom the test.] Details about the tonometry device used to measure intraocular pressure.
COVID-19 During the pandemic lockdown, the virtual medicine trajectory in Europe made substantial progress during a matter of months. Still, the longerterm outlook and lasting impacts remain uncertain. A hybrid model is probably going to be implemented in Europe as certain segments of consumers still value the in-person physician relationships. Also the health care structures don’t seem to be yet ready for full virtual care as a replacement for in-person visits. At the same time, many European countries have updated their regulations and protocol to acknowledge and expand telehealth/telemedicine, opening the doors to more virtual care than ever before.
The healthcare system in Europe is facing unprecedented challenges. 5G is positioned to play a critical role in meeting these demands by unlocking the net of Medical Things and providing better, cheaper services and treatment across the continuum of care. This can improve patient outcomes and therefore the lives of European consumers, and provides the healthcare system the resiliency it must face the challenges of our time.
The realization of operational compatibility, which might allow integration and inclusion of the realized projects to the general strategy for e-government, is extremely important. The further development and acceleration of such projects and services, caused by the pandemic changes, and the level of their development of the priorities of the national strategy depend on the level of collaboration between engineers and clinicians.
The presented work provides a simplified clilnician description pilot model of intraocular pressure as a factor in the development of glaucoma. The proposed pilot model does not claim to be exhaustive, but is an attempt to establish collaboration between engineers and clinicians and to present to clinicians opportunities for digitization of clinical information.
This research is supported by the National Scientific Program “е-Health in Bulgaria”, contract number: D01-200/16.11.2018.