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Detailed description (section by section)

1. Context and the central question

The chapter starts from pressures arising from costs, demographic change and expectations concerning quality of care. It asks whether methods for reorganizing and modelling enterprises can be transferred to healthcare systems without adaptation. The answer is nuanced: paradigms can move between domains, but acquire new meanings when applied to healthcare.

2. The meaning of “paradigm” and its role in modelling

A paradigm is defined as a reference model grounded in a way of thinking and a set of values that shape how we describe and transform reality. The author treats it both as an intellectual tool for interpreting existing systems and as a guide to their design. This definition supports the use of common metamodels to compare different domains.

3. Organizational paradigms and their relation to HL7

Fig. 1 presents a metamodel of organizational activity: agents perform activities, use instruments and transform objects. The chapter discusses this schema as an abstraction of organizational processes that may support the modelling of healthcare activities. Comparison with Fig. 2 — the HL7 v3 RIM metamodel — is central: Act, Entity, Role, Participation and their relationships provide another way of describing the domain. The author also notes the potential for transfer in the opposite direction, from healthcare modelling to systems engineering.

4. Paradigm shifts in healthcare services

The chapter surveys transformations that are not confined to software: patient-centred care, a shift from episodic encounters to continuity of care, decentralization and personalized services. These organizational trends should not be confused with the technical validation of an information-system architecture.

5. Electronic record paradigms: EHR, PHR and VHR

The eHealth discussion distinguishes electronic records held within an organization, a longitudinal Electronic Health Record, and a Personal Health Record under the patient’s control. Fig. 3 depicts the EHR, while Fig. 4 shows the VHR. As defined in the chapter, the VHR is more than a document repository: it collects and integrates contextual data, reports events, supports the tracking of care processes and offers services to authorized applications. LuMiR is mentioned as an illustration of this approach; implementation details found only in other LuMiR publications should not be imported here.

6. The multi-agent systems paradigm

The first of two future directions is to represent healthcare actors and applications through autonomous, cooperating software agents. The chapter lists properties such as autonomy, social ability, proactivity, mobility and reactivity, and argues that agents could aid coordination, access to distributed information, semantic interoperability and reduced dependence on a single central point. Possible roles for agents acting on behalf of patients, care providers, devices and organizations are described. This is an architectural and forward-looking argument, not an experimental validation report.

7. The digital healthcare ecosystem paradigm

The second direction portrays healthcare as an ecosystem comprising providers, patients, organizations, institutions and the socioeconomic environment. Its associated digital ecosystem (DHE) is an information infrastructure capable of organizing distributed information and knowledge resources. Fig. 5 shows the relationship between the two ecosystems. The chapter envisages local digital ecosystems that retain their identities while collaborating on a broader scale, together with mechanisms for self-organization and adaptation. These elements should be understood as research directions proposed in 2012.

8. Conclusions and the chapter’s role in the research programme

The chapter’s conclusion is methodological: the chosen paradigm shapes the questions we ask, the architectures we envisage and the solutions we consider possible. In the development of the author’s research, this text has a synthesizing role: it links conceptual modelling and software engineering to healthcare information systems and explicitly sets out the two approaches, multi-agent systems and digital ecosystems. It does not attribute clinical achievements to those paradigms that are not reported in the chapter.

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