Detected need and technological challenge
The Endocrinology and Nutrition Unit of the Virgen del Rocío University Hospital (HUVR) wanted to evaluate the benefits of adding mobility to teleconsultation for patients with type 1 diabetes.
The teleconsultation system allowed patients to access their clinical reports, communicate with healthcare professionals and record information from their glucose meters and insulin pumps.
The Technological Innovation Group of the Virgen del Rocío Hospital together with the company Primum Health IT aimed to provide mobility to teleconsultation by configuring a mHealth project for the Virgen del Rocio University Hospital: a project called mTelesalud-Diabetes.
Primum Health IT is a company specializing in mHealth solutions. Its system allows remote monitoring of type I diabetes patients. The Primum solution has its own telemedicine platform.
This project presented the challenge of integrating the Telehealth platform of the Virgen del Rocío University Hospital with the external chronicle monitoring platform of Primum.
The messaging included general measurements such as blood pressure, weight and pulsations as well as glucose measurements and patient comments. In addition to the exchange of clinical information, the publication on a clinical wall that allowed communication between doctors and patients was to be implemented.
Caduceus brought its expertise in clinical systems integration and interoperability to ensure that information from the monitoring platform was available to hospital healthcare staff.
Technical aspects of the project
System integration had to meet certain technical requirements.
The information had to be encapsulated in the format ISO EN13606 based on archetypes. ISO EN13606 aims at semantic interoperability for the communication of Electronic Health Records (EHR). The standard establishes two models:
- Reference model: represents, independently of knowledge, the general components to represent any information of the EHR.
- Models based on archetypes: specify the structures defined by the reference model, modelling and restricting knowledge concepts.
The use of archetypes is utilized to encompass clinical concepts built on a reference model for electronic medical record information. This gives a semantic meaning to the data structure.
The two-way communication had to follow the IHE XDS (Cross-Enterprise Document Sharing) clinical documentation profile. This profile facilitates the registration, distribution and access of electronic health records among health organizations. To do this, a repository and a document register are defined. These documents are provided and consumed by participating organizations.
Implementation of the solution
After analyzing the systems involved, it was decided to implement an interoperability solution based on Mirth Connect as the integration engine.
For the project, Mirth version 3.1.0 was used, on which the necessary channels were implemented to establish the exchange of ISO EN13606 according to IHE XDS profile. PostgreSQL was deployed as the integration database.
The solution developed by Caduceus was designed to integrate the HUVR telemedicine system with the mHealth platform of Primum.
Virgen del Rocío University Hospital
The Virgen del Rocío University Hospital is comprised of seven healthcare centres, three industrial buildings, two administrative centres, a government pavilion and a Mental Health area consisting of thirteen units.
It has more than 1,290 beds installed and about 7,900 workers.
It belongs to the Andalusian Public Health System and is a third level hospital whose area of influence is Western Andalusia: Seville and Huelva. Equipped with a portfolio of highly complex services that stands out for the incorporation of cutting-edge technologies.
Source: huvr. es
The system-to-system communications model:
- Communications with HUVR through SOAP, asynchronous, XDS and ISO13606 format.
- Communications with the Primum platform through a REST API.
- ISO EN13606 messages were encrypted based on a shared seed within the XDS structure for security.
- In addition to the exchange of reports, two other communications were also implemented for a clinical wall, which allowed direct communication between professionals and patients.
The use of the telemedicine platform demonstrated its effectiveness as a tool providing high user satisfaction. This new care model can help to improve the control and quality of life of patients with type I diabetes, as well as lower costs, which is a significant improvement in practice.
This project was presented at the 12th Telemedicine Forum Meeting organized by the Spanish Society of Health Informatics in November 2014 and at the meeting that brought together the II Ibero-American Congress of Telehealth and Telemedicine, the XIII Meeting of the SEIS Telemedicine Forum and the XII Meeting of the Iberian Telemedicine Forum in Seville in November 2015.