Open protocols make Electronic Health Records easier downloadable from remote sites

Uta 22 February 2000During the second half of the nineties, a CRS4 team headed by Dr. Gavin Brelstaff, worked hard on integrating the Electronic Health Record (EHR) into the hospital information system. The W-MED and Medical Object Web (Medow) projects both served as the solid basis for the Desktop Health InfoBus initiative which culminated last year in an EHR system which relies on the latest Next Generation Internet standard technologies. Both hospital and general practitioner are provided with an efficient multimedia Electronic Patient Record system for information sharing, diagnostic and consultation purposes.


CRS4 was established in Cagliari in 1991 as an interdisciplinary research Center for Advanced Studies, Research and Development in the two fields of computational science and information technology. The CRS4 team defines the Electronic Patient Record as a multimedia object consisting of a structured mixture of texts, forms, graphics and images that can be derived from various sites across the network. The Desktop Health InfoBus project is aiming at facilitating the EPR communication between hospitals and general practitioners by designing an architecture which allows to deliver the EPR as XML (Extensible Mark-up Language) text, to be downloaded in an active data tree structure, indicated as the Document Object Model (DOM), over a secure Intranet/Extranet connection.

In this regard, the novel generation of open protocols and standards enable health care providers, such as hospitals, analysis laboratories and medical imaging services, to interconnect their operating units in an integrated but cost-effective, platform-independent way. A very essential part of the CRS4 system consists in its tolerance to network disconnectivity. Once the EPR is downloaded onto the user's desktop, it remains available off-line as an active document object, for consultation or for submitting changes asynchronously. To this purpose, a series of Java applet software components, referred to as JavaBeans, is introduced to, independently from one another, execute niche tasks on data, residing in the client-side DOM.

To guarantee a smoothly running communication on the desktop, the CRS4 team has implemented the platform-neutral Java InfoBus system, allowing the independent JavaBeans to exchange data and notification events. Also, the EPR document object is enhanced with a medical image viewer to serve images from a network Picture Archival Computer System (PACS) and with a medical reporting applet (MedRep), providing a graphical user interface into a branch of the data tree within the DOM. The XML/XSL (Extensible Style-sheet Language) parser transforms the XML content into the DOM, whereas the user can interact with the text by means of the EPR browser. The image annotations are being stored as XML-compatible Scalable Vector Graphics (SVGs) inside the DOM.

In the near future, the CRS4 team plans to make the EPR document objects available on the newly emerging wireless mobile systems, which soon are to replace the desktop PC. A set of personal digital assistants (PDAs) will enable the health professional to access the patient record from any location. The Java virtual machine will allow to transform visual components directly from software to hardware in small portable light-weight devices. As a result, the health care provider will access the existing InfoBus communication system through Personal Area Networks (PANs). More technical details on past and current realisations by the CRS4 team, which closely works together with the Brotzu Hospital in Cagliari, are available on the home pages of the Medow and Desktop Health InfoBus projects.

Leslie Versweyveld

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