Slovenian Interoperability Backbone Project

Information and data sharing across heterogeneous e-health systems while focusing on the management of patient care have become the backbone of the modern delivery of sustainable medicine services.

An eHealth interoperability backbone represents part of the Slovenian national eHealth project with an important mission to improve the quality of health services with effective electronic solutions. It is a crucial component of the national information infrastructure that enables integration of various information systems. Implementation has brought out many important challenges that are linked to questions as: how to enable an exchange of main clinical documents; how to secure this data exchange; how to identify data about a specific patient in different health institutions; how to control data access; how to answer simple population questions (e.g. what is the percentage of patients with high BMI?).

Project description

The idea of the eHealth project in Slovenia entails the inclusion of stakeholders into a functional network, reconstruction of the healthcare system business model, as well as integration and harmonisation of many specialised health and care providers at different levels. The project’s aim is to integrate all of the country’s existing fragmented Health Information Systems and offer a complete solution benefitting all stakeholders.

Our solution has involved creating an environment (open platform) to support health and care services in Slovenia, enabled document level sharing and mobilisation of documents already produced by legacy systems and ensure the capacity to put data into an open, fine-grained, structured format that is technology and vendor-neutral. We have provided a health data repository to eHealth applications such as eRefferal, ePrescription, eVaccination and national clinical registries. The backbone was developed using widely accepted industry standards such as IHE and openEHR.

The process

Phase I

The interoperability backbone was first developed as IHE based cross-enterprise enabling document level sharing, with the ability to mobilize documents already produced by legacy systems.

• Discharge summary – documenting the key information listed above to be used by other carers when a patient leaves a hospital.
• Clinical notes – documenting key information, listed ambulatory care and other clinical documentation.

Together with document exchange features, it also provides standardised patient and provider identification, or at least mechanisms of negotiating/linking across existing identification systems and patient data privacy mechanisms to ensure acceptable and reliable privacy of health data based on patient consent.

Phase II

In the second phase of the project, the backbone was upgraded with a clinical data repository for storing structured EHR records at the national level based on openEHR. As such, it enhanced the capabilities of the backbone with the ability to share core clinical information sufficient to practice emergency medicine and a reasonable amount of non-emergency treatment:

• Basic data – demographics, blood type,
• Problem list – recognised diagnoses & conditions,
• Referrals – documenting transfers of responsibility and requests for care,
• Prescriptions – documenting prescribed medications,
• Medications list – current medications, including dosage, regimes, etc.,
• Allergies and reactions – list of patient-specific contra-indications to drugs, food, etc.,
• Immunisation records – documenting the record of immunisation or vaccination episode,
• Other related data.

The solution

The solution is a standards-based integrated health information system. It supports health and care services by using document-sharing capabilities (IHE XDS) to mobilise the documents already produced by legacy systems enhanced with the capacity to put data into an open, ne-grained, structured format (openEHR) that is technology and vendor-neutral. As such, the proposed system enables secure access to and exchange of critical information and an accurate patient summary and provides health professionals with access to the critical information they need, while also empowering citizens to have a more active role in the development of quality health services.

• Open service models: all specifications of the APIs are freely accessible to everybody entitled to integrate. Specifications include data security and privacy, electronic health record management, and database queries.
• Open information models: all clinical models are well defined based on established open standards. Data based on these models can be reliably processed and computed in local and distributed environments.
• Open system specifications: all system components and protocols are publicly specified using licenses feasible for commercial and non-commercial use, i.e., each component in the system can be replaced by software from multiple vendors.