Integrating Legacy Medical Applications in a Standardized Electronic Health Record Platform
Published in 2015, this article addresses a very concrete and very important problem for healthcare digitization: the integration of existing, heterogeneous, and non-standardized medical applications into a single Electronic Health Record platform. If many of my previous works insisted on the conceptual role of the Virtual Health Record and on patient-centric architectures, here the focus shifts to a decisive practical difficulty: how the legacy applications already used in the healthcare system can be recovered and integrated, without simply abandoning them.
Bibliographic data
Title:
Integrating Legacy Medical Applications in a Standardized Electronic Health Record Platform
Authors:
David Robert Posircaru, Luca Dan Șerbănați
Published in:
2015 E-Health and Bioengineering Conference (EHB),
2015.
DOI: 10.1109/EHB.2015.7391401
Themes:
legacy applications, interoperability, HL7, Electronic Health Record,
cloud computing, e-prescription, national health platform
Central idea:
The real integration of existing medical systems cannot be achieved merely through the
coexistence of disparate applications and local formats. A standardized EHR platform
and an adaptation mechanism capable of translating messages generated by legacy applications
into an interoperable form are needed.
Context
The work falls within the continuity of my concerns for the longitudinal medical record, interoperability, and the integration of clinical information. But, unlike the more conceptual articles about VHR or Smart EHR, this text is anchored in a very practical problem from the Romanian health system.
The identified problem is the lack of interoperability between the medical applications already used and the health information platform. The situation is typical for many healthcare systems: there is functional software, already adopted locally, but it produces data in its own formats and cannot naturally participate in an integrated system.
The solution proposed in the article does not involve the brutal replacement of these applications, but their integration through an HL7 adapter and a standardized EHR platform, hosted in a cloud-type infrastructure.
Conceptual contribution
- treats the integration of legacy applications as a central, not secondary, architectural problem;
- proposes a standardized HL7 EHR as an integration core;
- introduces an HL7 Adapter for converting proprietary messages into HL7 messages;
- links interoperability to a single platform, capable of supporting all activities in the healthcare system;
- uses cloud computing for scalability and broad integration;
- applies the idea to a concrete case: electronic prescriptions reported to the National Health Insurance House.
In the economy of my research, the article is important because it shows how a vision about VHR/EHR can descend into the hard area of real interoperability between systems.
Description
The problem from which the article starts is a very concrete one: in the Romanian healthcare system, medical applications developed at different times, for different purposes and in their own formats continue to exist, and this diversity prevents the emergence of a truly integrated information system. Even if a health IT platform exists, its mere existence does not guarantee interoperability with local applications already used in practice.
Instead of treating these legacy applications as an obstacle to be eliminated, the article treats them as a reality to be integrated. This is, in fact, the most interesting part of the work. A complete reset of the software ecosystem is not proposed, but an intermediate architecture, capable of recovering the utility of existing applications and connecting them to a standardized EHR platform.
The core of this solution is a standardized HL7 Electronic Health Record, used as a convergence platform. The choice is significant: HL7 is not treated here only as a technical message exchange standard, but as an organizing principle of a common interoperability space. Around this core, an HL7 Adapter is introduced, meaning a mediation mechanism between the old applications and the new platform.
The adapter's function is to take the messages produced by medical applications in their internal format and convert them into HL7 messages. In the case discussed by the article, the concrete example is that of applications that generate electronic prescriptions in their own format, as they are reported to the National Health Insurance House. This example is well chosen, because it shows that the interoperability problem is not an abstract one, but one that directly affects already active administrative and clinical processes.
The proposed architecture also uses cloud computing technologies. This choice suggests an orientation towards scalability and controlled centralization of some common services, without denying the existence of distributed data sources and local applications. In this sense, the article is part of a broader trend of the period: building national or regional platforms capable of taking over local diversity without letting it destroy the coherence of the entire system.
What I find important in this work is its character as a bridge between two worlds. On the one hand, there is the world of old applications, pragmatically developed, often around local needs. On the other hand, there is the world of standards, integrated platforms, and the longitudinal electronic record. The article shows that the transition from the first to the second cannot be done by decree, but through architectural mechanisms of adaptation and translation.
Overall, the text is not very extensive, but it clearly expresses an important truth of healthcare digitization: real interoperability is won at the points of contact between old and new. No matter how elegant the model of a standardized EHR platform is, it remains insuficient if it cannot absorb and discipline the software already existing in the system.
Significance in my journey
For me, this article has a special significance because it brings to the forefront a difficulty that any serious digital health project encounters sooner or later: the integration of the existing software legacy. In my previous works, the emphasis often fell on modeling, VHR, distributed architectures, and regional systems. Here, the focus falls on the pragmatics of the transition.
Precisely for this reason, although more modest in theoretical ambition than other articles, the text is very useful in the general economy of my research. It shows that the vision about the virtual record and interoperability does not remain suspended at a conceptual level, but can go down to precise integration solutions for legacy applications and real administrative workflows.
In this sense, the article complements well the series related to VHR, SmartFSE, and EHR 2.0.