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In order to develop smart and innovative solutions which are able to realize the concept of care continuum, the use of a number of different multiple devices, based on heterogeneous technologies, is necessary. In this complex context it is important to study and design systems whose architecture ensure the interoperability between devices and service. A standardized middleware which is able to guarantee this important requirement within the European Project CHIRON, is presented in this article. [ABSTRACT FROM AUTHOR]

The European Project GATEKEEPER aims to develop a platform and marketplace to ensure a healthier independent life for the aging population. In this platform the role of HL7 FHIR is to provide a shared logical data model to collect data in heterogeneous living, which can be used by AI Service and the Gatekeeper HL7 FHIR Implementation Guide was created for this purpose. Independent pilots used this IG and illustrate the impact of the approach, benefit, value, and scalability.

The advancement of healthcare towards P5 medicine requires communication and cooperation between all actors and institutions involved. Interoperability must go beyond integrating data from different sources and include the understanding of the meaning of the data in the context of concepts and contexts they represent for a specific use case. In other words, we have to advance from data sharing through sharing semantics up to sharing clinical and medical knowledge. According to the Good Modeling Best Practices, we have to start with describing the real-world business system by domain experts using Domain Ontologies before transforming it into an information and communication technology (ICT) system, thereafter specifying the informational components and then transforming the system into an implementable solution. Any representation style - in the system development process acc. to ISO 10746 called system view - is defined by a related ontology, to be distinguished from real-world domain ontologies representing the knowledge spaces of involved disciplines. The system enabling such representational transformation shall also support versioning as well as the management of historical evolutions. One of such systems is the Common Terminology Service Release 2 (CTS2), which is a standard that allows the complete management of terminological contents. The main objective of this work is to present the choices we made to transform an ontology, written in the standard Ontology Web Language (OWL), into the CTS2 objects. We tested our transformation approach with the Alzheimer's Disease Ontology. We managed to map all the elements of the considered ontology to CTS2 terminological resources, except for a subset of elements such as the equivalentClass derived from restrictions on other classes.

Integrating evidence from systematic research in daily clinical practice is one of the pillars of evidence-based medicine. Electronic data capture tools simplify data collection from different centers and supports the management of multicenter clinical trials. The Ligurian HIV Network (LHN) is one such tool, originating from a regional effort to integrate clinical trial capabilities for HIV and other chronic infectious diseases. In order to manually collect a complete report of all clinical tests on patients enrolled in a trial, a strenuous human effort and the allocation of great resources would be necessary. Moreover, the risk of error in a manual system is very high. The proposed system automatically extracts clinical data from the EHR of three hospitals of the LHN in a standardized way, and enhance their re-use in clinical trials. Through dedicated questionnaires, physicians reported a strongly positive feedback about the efficacy of the platform in supporting clinical research.

This paper presents the extension of a service-oriented architecture framework for precision oncology to the management of patient generated health data from wearables. The solution follows the indication provided by the Health Level 7 (HL7) and Object Management Group (OMG) initiative Healthcare Service Specification Project (HSSP) and is compliant to Retrieve Locate and Update Service (RLUS) Release 1 standard adopting Clinical Document Architecture Release 2 (CDA R2) as semantic signifier. The system which has been developed supports the management of visits, the setting up of a clinical diary and a comprehensive view of the patients from the wearables data for improve clinical care and for research. The system structure is highly modular and the parameters relating to wearables data are only present in one module. Extension of the systems to other aspects, such as genomics and immune therapy, are planned following the same modular design criteria.

Prevention and control of hospital and community acquired infections caused by multi drug resistant organisms (MDROs) are one major priority nowadays for health care systems worldwide. To improve actions and plans to tackle this problem, the creation of automated regional, national and international MDRO surveillance networks is a mandatory path for international health Institutions and Ministries. In this paper, the authors report on the surveillance system designed for the Abruzzo Region (Central Italy) to monitor the prevalence of MDROs in both infected and colonized patients, to verify appropriateness of antibiotic prescription in hospitalized patients and to interact with other national and sovra-national networks. Service Oriented Architecture (SOA) approach, different Healthcare Service Specification Project (HSSP) standards, local, national and international terminology and Clinical Document Architecture Release 2 (CDA R2) were adopted to design the overall architecture of this regional surveillance system. The Authors discuss the state of implementation of the project, itemizing specific design and implementation choices adopted so far and sketching next steps and reasons of some design and implementation choices, and indicate the next steps.

Vaccination in HIV-infected patients constitutes an essential tool in the prevention of the most common infectious diseases. The Ligurian Vaccination in HIV Program is a proposed vaccination schedule specifically dedicated to this risk group. Selective strategies are proposed within this program, employing ICT (Information and Communication) tools to identify this susceptible target group, to monitor immunization coverage over time and to manage failures and defaulting. The proposal is to connect an immunization registry system to an existing regional platform that allows clinical data re-use among several medical structures, to completely manage the vaccination process. This architecture will adopt a Service Oriented Architecture (SOA) approach and standard HSSP (Health Services Specification Program) interfaces to support interoperability. According to the presented solution, vaccination administration information retrieved from the immunization registry will be structured according to the specifications within the immunization section of the HL7 (Health Level 7) CCD (Continuity of Care Document) document. Immunization coverage will be evaluated through the continuous monitoring of serology and antibody titers gathered from the hospital LIS (Laboratory Information System) structured into a HL7 Version 3 (v3) Clinical Document Architecture Release 2 (CDA R2).

This paper intends to present a Web-based application to collect and manage clinical data and clinical trials together in a unique tool. I-maculaweb is a user-friendly Web-application designed to manage, share, and analyze clinical data from patients affected by degenerative and vascular diseases of the macula. The unique and innovative scientific and technological elements of this project are the integration with individual and population data, relevant for degenerative and vascular diseases of the macula. Clinical records can also be extracted for statistical purposes and used for clinical decision support systems. I-maculaweb is based on an existing multilevel and multiscale data management model, which includes general principles that are suitable for several different clinical domains. The database structure has been specifically built to respect laterality, a key aspect in ophthalmology. Users can add and manage patient records, follow-up visits, treatment, diagnoses, and clinical history. There are two different modalities to extract records: one for the patient's own center, in which personal details are shown and the other for statistical purposes, where all center's anonymized data are visible. The Web-platform allows effective management, sharing, and reuse of information within primary care and clinical research. Clear and precise clinical data will improve understanding of real-life management of degenerative and vascular diseases of the macula as well as increasing precise epidemiologic and statistical data. Furthermore, this Web-based application can be easily employed as an electronic clinical research file in clinical studies.