UNIVERSIDAD NACIONAL DE COLOMBIA
DOCTORADO EN INGENIERÍA DE SISTEMAS Y COMPUTACIÓN
Progress of Research Project
TITLE:
MULTI-AGENT ARCHITECTURE BASED ON THE HL7 RIM MODEL TO SUPPORT
DECISION MAKING IN FIXED AND MOBILE ENVIRONMENTS IN THE HEALTH
SECTOR IN COLOMBIA
SHORT TITLE:
MULTI-AGENT ARCHITECTURE BASED ON THE HL7 RIM MODEL TO SUPPORT
DECISION MAKING IN FIXED AND MOBILE ENVIRONMENTS
Presented to:
Eng. Fabio A. González O., Ph.D.
Presented by:
Miguel A. Zurita A.
Marzo 16 2009
1
TABLA DE CONTENIDO
TABLA DE CONTENIDO
1 SUMMARY OF THE PROJECT...................................................................................... 2
2 CLASIFICACIÒN DE LA BIBLIOGRAFIA Y LISTADO EN FORMATO IEEE ...... 3
2.1 Conference Procedings .............................................................................................................. 4
2.2 Journal Articles.......................................................................................................................... 4
2.3 Electronic Articles ..................................................................................................................... 5
2.4 Thesis .......................................................................................................................................... 6
2.5 Audiovisual Material ................................................................................................................. 7
2.6 Books ........................................................................................................................................... 8
2.7 Electronic Books ........................................................................................................................ 8
2.8 Legislation over Telemedicine in Colombia ............................................................................ 8
2.10 Not Published Works............................................................................................................... 9
2.11 Standarization in Colombia .................................................................................................... 9
3 ANNOTATED BIBLIOGRAPHY ................................................................................... 10
4 PRESENTATION OF THE PROJECT ......................................................................... 23
4.1 STATE OF THE ART ............................................................................................................. 24
4.3 OBJETIVES ............................................................................................................................. 31
4.3.1 General Objetive .....................................................................................................................................31
4.3.2 Specífic objetives....................................................................................................................................31
2
1 SUMMARY OF THE PROJECT
The development and use of standards such as HL7 in the health sector, allow
providing a common protocol to data exchange interfaces between different
organizations from the area. It is worth to point out that to provide a
communication between two systems making use of the HL7 standard, every sub-
system uses a personalized code to produce or read structured messages through
this format (even other versions of HL7 used by other sub-systems).
Something that should be taken into account is that during the management of this
kind of projects, the process of generation of interfaces Hl7 consumes too much
time, can produce errors, is expensive, and lacks flexibility and scalability.
In the suggested project an information system based on a multi-agent
architecture, that can be used as well in a fixed context as in a mobile one (cell
phones, PDA´s, intelligent phones) is going to be modeled, in a way that the
previously mentioned deficiencies can be partly resolved. The application to be
developed is expected to supports the decision-making in a terminal and to do this
will gets information from the remaining terminals through the use of the HL7
standard in its different versions.
2 CLASIFICACIÒN DE LA BIBLIOGRAFIA Y LISTADO EN FORMATO IEEE
This section include 49 bibliographical references analyzed in the IEEE format
(while section 3 includes the Annotated Bibliography.)
The literature reviewed till the moment is categorized into the following
classification:
Conference Procedings
Journal Articles
Electronic Articles
Thesis
Audiovisual Material
Books
Electronics Books
Legislation over telemedicine in Colombia
Not publisheds work
Standarization in Colombia
2.1 Conference Procedings
[1] C. Gallego, "HISTORIA CLÍNICA ELECTRONICA CON CDA," in Foro
Normalizaciòn España 2006 España: HL7Spain, 2006, p. 3.
[2] A. H. A. d. Barbará, "SISTEMA DE TELEMEDICINA DE LAS FUERZAS
ARMADAS ESPAÑOLAS," in Tecnimap Sevilla, Sevilla, 2006, p. 12.
[3] J. Bryson, and Brendan McGonigle,, "Agent Architecture as Object Oriented
Design," in Intelligent Agents IV: Agent Theories, Architectures, and Languages.
Proceedings of ATAL'97, Berlin, 1998.
[4] J. J. Q. b. Marcia C. Pulido a, María L Barreto c, Lilia E. Aparicio d, U. d. C.
a Facultad de Ingeniería, U. d. C. b Facultad de Ingeniería, U. d. C. c Facultad de
Ingeniería, and U. D. F. J. d. C. d Facultad de Ingeniería, " Análisis bajo el
Estándar HL7 del proceso de Referencia y Contrarreferencia en el Hospital San
Rafael de Fusagasugá " in INFOLAC2008 - AAIM, 2008, p. 6.
[5] G. Schadow., "Motivations and Effects of Different Guideline
Representations on the Example of the HL7 RIM. ," in Computerized Guidelines
and Protocols, EuroMISE., Praha 2004, p. 52.
[6] T. H. Yang1, P. H. Cheng1, C. H. Yang3, F. Lai1,4,5, C. L. Chen4, H. H.
Lee4, K. P. Hsu4,, C. T. T. C. H. Chen5, Y. S. Sun2., C. o. M. 1 National Taiwan
University Hospital, National Taiwan University, Taipei,, Taiwan, N. T. U. 2
Department of Information Management, Taipei, Taiwan, S. U. 3 Department of
Computer Science, California, USA, N. T. U. 4 Department of Computer Science
and Information Engineering, T. Taipei, and N. T. U. 5 Department of Electrical
Engineering, Taiwan, "A Scalable Multi-tier Architecture for the National Taiwan
University Hospital Information System based on HL7 Standard," in Proceedings of
the 19th IEEE Symposium on Computer-Based Medical Systems (CBMS'06),
2006, p. 6.
2.2 Journal Articles
[1] A Schloegl , F Chiarugi , E Cervesato , E Apostolopoulos, CE Chronaki , B.
Fraunhofer, Institute for HCI, Graz, Austria, Institute of Computer Science,
Heraklion, Crete, Greece,ARC-Cardiology, Italy, and Computer Science
Department, Heraklion, Crete, Greece, "Two-Way Converter between the HL7
aECG and SCP-ECG Data Formats Using BioSig," Computers in Cardiology 2007,
vol. 34, p. 3, 2007.
[2] P. R. Bill Vargas , Westmead Children’s Hospital, and A University of New
South Wales, "Interoperability of Hospital Information Systems: A Case Study,"
IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE,, p.
7, 2003.
[3] F. a. Burstein, Zaslavsky, A.b, Arora, N. b , a. S. o. I. M. Systems, and A. b
School of Computer Science and Software Engineering Monash University, "
Context-aware mobile agents for decision-making support in healthcare emergency
applications " Monash University grants, p. 16, 2005.
[4] A. C. Gómez, Fernandoa; Kaminker, Diegob ; Martínez, Marcelaa; Luna,
Daniela; De Cristófano, Miguel Angelb; González Bernaldo de Quirós, Fernána , H.
Departamento de Información Hospitalaria, Argentina , and B. A. b Laboratorio
Central del Hospital Italiano de Buenos Aires, Argentina " Implementación de
mensajería HL7 en un sistema de consulta de resultados de laboratorio " HL/
Argentina, p. 5, 2005.
[5] H. V. D. P. James Odell, Bernhard Bauer, "Extending UML for Agents," p.
15, 2007.
[6] M. Jinwook Choi, IEEE, Sooyoung Yoo, Heekyong Park, and Jonghoon
Chun, "MobileMed: A PDA-Based Mobile Clinical Information System," IEEE
TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE,, vol. 10,
p. 9, 2006.
[7] Liliana María Puerta Escobar, Jenny Marín Carvajal, " LA TELEMEDICINA
" VentanaInformatica, vol. 10, p. 13, Mayo 15 2002
[8] K. P. Robert H. Dolin, Alschuler.Spinosa, Sandy Boyer, Fred M. Behlen,
Amnon Shabo (Shvo), "HL7 Clinical Document Architecture, Release 2," American
Medical Informatics Association., p. 39, October 12 2005.
2.3 Electronic Articles
[1] Z. S. A. Alexander García D, "Agentes en Computación Móvil," in GITUAO
Cali-Valle: Universidad Autonoma de Occidente, 2006, p. 28.
[2] D. H. F. M. Brieux, "HL7 V2.X -Introducción," in Historia Clinica -HL7
Argentina Buenos Aires: Fundaciòn HL7 Argentina, 2009, p. 87.
[3] H. A. Diego Kaminker, , "CDA R2 Alcances, Aplicaciones, Situación actual y
Futura," in 2do Meeting Group Fundación HL7 Colombia MARZO 2008 Bogotà:
Fundación HL7 Colombia, 2008, p. 10.
[4] A. S. S. Joaquìn Seoane Pascual, Valent´ın Villaroel Ortega, Andres
Martınez Fernandez, Alberto S´aez Torres, "EHAS: programas libres para apoyar
el sistema de salud en zonas aisladas de Am´erica Latina.," in Proyecto ehas, 18
de Febrero ed Madrid: Proyecto EHAS, 2004, p. 6.
[5] Departamento de Telematica Programa EHAS. Universidad del Cauca,
"Infraestructura y servicios de telemedicina rural en el Departamento del Cauca,
Colombia," in Publicaciones Departamento Telematica Popayan: Universidad del
Cauca, 2008, p. 6.
[6] Tthe Real College of Radiologists, "DICOM and HL7 standards," in Guides
of Implementation Portland Place London: Board of the Faculty of Clinical
Radiology, 2008, p. 5.
[7] P. D. Richard E. Swaja, "NIH Research Opportunities in Bioengineering and
Bioinformatics," in National Institute of Biomedical Imaging and Bioengineering:
National Institutes of Health, 2003, p. 32.
[8] Enlace Hispnao Americano de Salud, "Tecnologías de la Información
aplicadas a salud en zonas rurales de América Latina," in Proyecto ehas, 2008, p.
16.
2.4 Thesis
[1] M. A. R. BARAHONA, "CONSTRUCCIÓN DE HBPS: HEALTHBOOK
PATIENT SERVICES, UNA SOLUCION DE ALMACENAMIENTO DE HISTORIAS
CLINICAS EN LA RED SOCIAL HEALTHBOOK ENFOCADA A LA SALUD," in
DEPARTAMENTO DE INGENIERIA DE SISTEMAS Y COMPUTACIÓN. vol.
Ingeniero de Sistemas y Computación Bogota: Universidad de los Andes, 2008, p.
56.
[2] G. G. Bernardo Gonçalves 1, 2, José Gonçalves Pereira Filho 1, F. U. o. E.
S. U. 1 Computer Science Department, B. Vitória, and L. f. A. O. (ISTC-CNR), "An
Electrocardiogram (ECG) Domain Ontology," Trento, Italy, 2006.
[3] V. Bharadwaj, "Web Based Workflow in Secure Collaborative
Telemedicine," in Department of Computer Science and Electrical Engineering. vol.
Master of Science in Computer Science Morgantown, West Virginia: West Virginia
University, 2000, p. 130.
[4] M. A. C. Blumenthal, "Servicio de Datos SOA para Arquitecturas
Extensibles: Diseño e implementaciòn de HealthBook Data Services," in
Departamento de Ingenieria de Sistemas. vol. Ingenieria de Sistemas Bogota:
Universidad de los Andes, 2008, p. 51.
[5] FREDY MAURICIO SANABRIA HIGUERA and R. A. R. VARGAS, "DISEÑO
E IMPLEMENTACIÓN DE UN SISTEMA PARA EL ALMACENAMIENTO DE
HISTORIAL CLÍNICO," in DEPARTAMENTO DE INGENIERIA ELECTRONICA.
vol. Ingenieria Electronica Bogota: UNIVERSIDAD DE LOS ANDES, 2005, p. 93.
[6] P. d. T. Heras, "PROPUESTA DE UN MODELO DE SISTEMA DE
TELEMEDICINA PARA LA ATENCIÓN SANITARIA DOMICILIARIA," in
Departamento de Tecnología Fotónica,Grupo de Bioingeniería y
Telemedicina,E.T.S.I. de Telecomunicación. Doctorado Ingeniera de
Telecomunicación Madrid: UNIVERSIDAD POLITÉCNICA DE MADRID, 2003, p.
299.
[7] L. D. G. B. LEZCANO, "Tecnología GRID computing aplicada al sector
hospitalario para compartir información de la historia clínica de los pacientes," in
Departamento ingeniería de sistemas y computación vol. MAGÍSTER EN
INGENIERÍA DE SISTEMAS Y COMPUTACIÓN Bogota: UNIVERSIDAD DE LOS
ANDES, 2006, p. 123.
[8] M. R. A. Nicolás Fonnegra Martínez, "Plataforma de servicios distribuidos
basada en agentes móviles," in FACULTAD DE INGENIERIA. vol.
DEPARTAMENTO DE INGENIERIA DE SISTEMAS Bogotà: PONTIFICIA
UNIVERSIDAD JAVERIANA, 2005, p. 146.
[9] B. Orgun, "Interoperability in heterogeneous Medical Information Systems
using Smart Mobile Agents and HL7 (EMAGS)" in Department of Computing,
Division of Information and Communication Sciences, Division of Information and
Communication Sciences. Masterof Science, Sydney: University of Macquarie-
Sydney. 2003, p. 275.
[10] T. A. P. Páez, "Diseño e implementacion de un sistema de gestion de
operaciones y calidad en una institucion de salud: sistema de gestion de historias
clinicas," in DEPARTAMENTO DE INGENIERIA INDUSTRIAL. vol. Ingenieria
Industrial Bogota: Junio 16 de 2006, 2006, p. 131.
[11] A. Ryan, "Towards Semantic Interoperability in Healthcare: Ontology
Mapping from SNOMED-CT to HL7 version 3," in School of Economics and
Information Systems, Northfields Avenue, Email: ajr883@uow.edu.au Wollongong,
Australia: The University of Wollongong,, 2007.
[12] J. E. Stone, "AN INTELLIGENT DIGITAL LIBRARY SYSTEM FOR
BIOLOGICAL DATA," in Department of Computer Science. vol. Master of Science,
Specializing in Computer Science Vermont: University of Vermont, 2005, p. 86.
2.5 Audiovisual Material
[1] M. Eric B. Durbin, "NAACCR HL7 E-PATH TRANSMISSION STANDARDS,"
in NAACCR Toolkit Workshop, Potomac, Maryland: Kentucky Cancer Registry,
2005.
2.6 Books
[1] H. W. Group, Specification of HL7 V 2 ( Health Level Seven) 1999.
[2] A. R. Martínez, Roberto J. Infante, Alberto. Campillo, Carlos. Gattini, César.
Borrás, Cari, Pról., A. c. OMS, and A. c. U. P. d. Madrid, Bases metodológicas
para evaluar la viabilidad y el impacto de proyectos de telemedicina -OPS-.
Washington, D.C. :: OMS, 2001.
[3] R. J. Rodríguez, Ed. Oliveri, Nora C. Monteagudo, José Luis. , A. c. F. d. I.
Médica, and A. c. E. M. d. S. y. C. I. d. S. C. III, E-Salud en Latinoamérica y el
Caribe tendencias y temas emergentes. Washington, D.C. : OMS, 2003. .
[4] Y. Xiao, Mobile telemedicine a computing and networking perspective 2008.
2.7 Electronic Books
[1] ALBERTO KOPEC POLISZUK, PH.D., "TELEMEDICINA: APLICACIONES
DE TELECOMUNICACIONES EN SALUD EN LA SUBREGION ANDINA," in
APLICACIONES DE TELECOMUNICACIONES EN SALUD EN LA SUBREGION
ANDINA, Documentos Institucionales ed, O.-C.-O. A. D. SALUD- and C. H.
UNANUE, Eds.: ORGANIZACION PANAMERICANA DE LA SALUD OPS/OMS,
2004.
[2] NEOTOOL, " The HL7 Evolution : Comparing HL7 Version 2 to Version 3,
Including a History of Version 2 " in The HL7 Evolution, NEOTOOL, Ed. Plano,
Texas NEOTOOL, 2007, p. 14.
2.8 Legislation over Telemedicine in Colombia
[1] MINISTERIO DE LA SALUD, "RESOLUCION NUMERO 3905 DE 1994,"
Bogotà, 1994, p. 5.
[2] MINISTERIO DE LA SALUD,, "RESOLUCION NUMERO 1995 DE 1999,"
Bogota, 1999, p. 7.
[3] MINISTERIO DE LA. SALUD, "RESOLUCIÓN NÚMERO 03374 DE 2000 "
Bogotà, 2000, p. 61.
[4] MINISTERIO DE LA PROTECCIÒN SOCIAL, "RESOLUCION 001715 DE
2005," Diario Oficial 45940, 2005, p. 3.
2.9 Not Published Works
[1] P. P. G.-S. d. Barros, "Arquitectura Orientada a Servicios para Sistemas que
utilizan HL7 " in Estandares de Interoperabilidad: Instituto de Computación,
Facultad de Ingeniería, Universidad de la República de Uruguay, 2007, p. 14.
[2] C. d. E.-C. Dr. Ing. Álvaro Rendón Gallón, "Tecnología informática para la
salud de
zonas rurales," in Publicaciones Departamento Telematica Popayan: Universidad
del Cauca, 2007, p. 3.
2.10 Standarization in Colombia
[1] F. H. COLOMBIA, "Comite Tecnico CDA," Cali: Universidad ICESI, 2008, p.
2.
[2] F. H. C. Comité Técnico CDA HL7 Colombia, "ACTA #1," C. T. C. H.
Colombia, Ed., 2008, p. 2.
3 ANNOTATED BIBLIOGRAPHY
ALBERTO KOPEC POLISZUK, PH.D. (2004). TELEMEDICINA: APLICACIONES
DE TELECOMUNICACIONES EN SALUD EN LA SUBREGION ANDINA. C. H.
UNANUE, ORGANIZACION PANAMERICANA DE LA SALUD OPS/OMS.
This extense document of the OPS/OMS tries to gather the efforts and
experiences of countries in the andin subregion, that have been promoting the
implementation of Telemedicine.
This document focuses in countries like the ours, where people of rural zones is far
away and have difficult and multiple gaps to access health care centres
Alexander García D, Z. (2006) Agentes en Computación Móvil. GITUAO 28
Introducción al paradigma de computación Móvil, el Paradigma de Agentes,
This document analyzes diferent platforms of mobile agents, it performs an study of
the JADE platform and explains the development of agents with examples
BARAHONA, M. A. R. (2008). CONSTRUCCIÓN DE HBPS: HEALTHBOOK
PATIENT SERVICES, UNA SOLUCION DE ALMACENAMIENTO DE HISTORIAS
CLINICAS EN LA REDSOCIAL HEALTHBOOK ENFOCADA A LA SALUD.
DEPARTAMENTO DE INGENIERIA DE SISTEMAS Y COMPUTACIÓN. Bogota,
Universidad de los Andes. Ingeniero de Sistemas y Computación: 56.
In this thesis is proposed a project called HB, the most important feature of HB
consists in put the patient in a protagonistic position in the HIS, by empowering the
patient in the context of a virtual community. With this scheme, a virtual community
enables the HB patient to participate in the management of information in the
health service.
The success of social networks like Facebook (Facebook, 2008) and MySpace
(MySpace, Inc., 2008)takes in account the desire of people of participate in the
construction and management of their own content and interactive spaces,
especially in relation to the content that is associated with entertainment. However,
the entertainment is not the unique reason for build such networks.
Barbará, A. H. (2006). SISTEMA DE TELEMEDICINA DE LAS FUERZAS
ARMADAS ESPAÑOLAS. Tecnimap Sevilla, Sevilla, Unidad de Telemedicina del
Hospital Central de la Defensa IGESAN, Ministerio de Defensa.
This paper describes the telemedicine system for the Armed Forces of Spain, the
architecture is based on teleconsulting in real time via dedicated terrestrial circuits,
radio and communications via satellite.
It also describes the R+D plans and the relations with other Telemedicine systems
both nationally and internationally.
Barros, P. P. (2007). Arquitectura Orientada a Servicios para Sistemas que
utilizan HL7 Estandares de Interoperabilidad, Instituto de Computación, Facultad
de Ingeniería, Universidad de la República de Uruguay: 14.
Currently, interoperability between health institutions is important not only in
Colombia and Uruguay country where was redacted this documen).
For this reason have been developed different standards ANSI and CEN, that are
oriented to the sector of the health, like HL7, EN13606 and OpenEHR.
Specifically, in Uruguay, HL7 was taken as standard in what he has to do with
interoperability of clinical information systems since the creation of SUEIIDISS.
In this document is evaluated a SOA system using HL7 messages.
Bernardo Gonçalves José Gonçalves Pereira Filho, Computer Science
Department, et al. (2006). An Electrocardiogram (ECG) Domain Ontology. Trento,
Italy.
This paper presents an ontology of the electrocardiogram domain. The ontology
purpose is to bring in a theory of the electrocardiogram (ECG).
The ECG is the most applied test for mapping the heart activity. Notably with the
recent advances in information and communication technologies, new services in
Healthcare have been provided, standing out remote reporting and telemonitoring.
In this context the ECG has a key usefulness. However, the diversity of biomedical
data combined to heterogeneous information systems have been inhibited these
advances in Healthcare environments. This initiative then addresses the need for
semantic interoperability, in general, and data integration, in particular, in Health
Informatics. Besides, it also provides an approach for developing ECG automatic
analysis systems.
A Schloegl , F Chiarugi , E Cervesato , E Apostolopoulos, CE Chronaki, B.
Fraunhofer , Germany, et al. (2007). "Two-Way Converter between the HL7 aECG
and SCP-ECG Data Formats Using BioSig." Computers in Cardiology 2007 34:
Bill Vargas,Westmead Children’s Hospital, et al. (2003). "Interoperability of
Hospital Information Systems: A Case Study." IEEE TRANSACTIONS ON
INFORMATION TECHNOLOGY IN BIOMEDICINE,: 7.
In this paper is presented a case study, many enterprises, hospitals and healthcare
organizations are now adopting networked information systems that incorporate
heterogeneous hardware,software, and other elements (e.g., conceptual models).
In this paper is resalted that it is important to integrate these information systems
developed independently by diverse set of people. Since healthcare involves very
high level of diversity of knowledge, the interoperability of healthcare information
systems poses some difficult problems.
The task is challenging given the semantic differences of messages used by
different types of healthcare professionals (e.g., physicians and nurses). This
paper analyzes the problem of interoperability with reference to different solutions,
and presents our experience in the development of a solution for the
interoperability of clinical information systems based on HL7, CORBA and Java for
a modern hospital in Australia.
Blumenthal, M. A. (2008). Servicio de Datos SOA para Arquitecturas Extensibles:
Diseño e implementaciòn de HealthBook Data Services. Departamento de
Ingenieria de Sistemas. Bogota, Universidad de los Andes. Ingenieria de Sistemas:
51.
This thesis is a module of the macro-project Healthbook (Jimenez, Bravo, &
Castro, 2008), and tries to solve problems of duplication, lack of uniqueness and
difficult of access to clinical information by physicians and patients.
The project has been developed through the integration of 4 components, one
component of management of community virtual (Moreno, 2008), a component of
clinical information management , a persistent component of structured data and
standards set by schemes and finally this paper seeks to extend the kernel and
optimize Healthbook for persistence of data using standards.
The standard data to use is a subset of HL7 (HL7 Organization, 1987) called CDA .
Bharadwaj, V. (2000). Web Based Workflow in Secure Collaborative
Telemedicine. Department of Computer Science and Electrical Engineering.
Morgantown, West Virginia, West Virginia University. Master of Science in
Computer Science: 130.
This paper analyzes the workflow an the colaborative telemedicine. Workflow
involves the automation of a business process in whole or part with movement of
information and tasks between parties according to a set of rules.
This research effort aims to investigate the utility of the internet and specifically the
WWW in providing a substrate for complex workflow and to demonstrate that
workflow with a high degree of automation and ability to interface with disparate
data sources can be conducted in a reliable, secure fashion with synchronous and
asynchronous communication between mobile participants.
Brieux, D. H. (2009) HL7 V2.X -Introducción. Historia Clinica -HL7 Argentina 87
In this document is analyzed the structure of one HL7 message, the construction of
messages in HL7 version 2.x, the management of Messages, Segments, Fields.
The Ways to implement Delimiters, Rules of assembly and disassembly, data
types, processing rules and examples, finally are designed HL7 v2.x messages
Bryson, J., and Brendan McGonigle, (1998). Agent Architecture as Object
Oriented Design. Intelligent Agents IV: Agent Theories, Architectures, and
Languages. Proceedings of ATAL'97, Berlin.
Burstein, F. Zaslavsky, A, Arora, N. et al. (2005). " Context-aware mobile
agents for decision-making support in healthcare emergency applications " Monash
University grants: 16.
This paper applies agents to the highly dynamic and variable context of healthcare
emergency decision-support domain. More specifically is analyzed the use of
mobile agents to support the deployment of an ambulance service in real-time. Is
presented an implementation of the proposed agent based architecture, which was
based on the specific functional and non-functional application requirements set
out based on thorough analysis of literature. It is also created an illustrative
emergency scenario in order to demonstrate the validity and feasibility of the
proposed model.
In this project is remarked that mobile agents are a key technology because they
offer a single, general framework in which large-scale distributed real-time decision
support applications can be implemented more efficiently. Healthcare was chosen
as the target application domain to emphasize both the benefits derived from the
exploitation of mobile agent paradigm in this domain as well as to demonstrate the
benefits of the proposed approach in the highly uncertain context.
This is one of the reference papers to analyze during the realization of my project.
COLOMBIA, Funfacion HL7. (2008). Comite Tecnico CDA. Cali, Universidad
ICESI:
Comité Técnico CDA HL7 Colombia, Fundaciòn HL7 Colombia. (2008). ACTA
#1. Comite tecnicoT. Clinical History Colombia: 2.
Diego Kaminker, H. A, (2008) CDA R2 Alcances, Aplicaciones, Situación actual y
Futura. 2do Meeting Group Fundación HL7 Colombia MARZO 2008 10
This document is a presentation of the protocol CDA, discusses the basic concepts
of CDA, the CDA specification, use cases in CDA, examples of use of the protocol,
are analyzed levels of semantic interoperability and the relationship between
documents and messages
This document is important because the “Universidad Nacional de Colombia” will
become a member of the “Fundaciòn HL7 Colombia” to get involved in the
customization of the HL7 and CDA standards for Colombia, another importantr
reason is that, I will participate in the realization of a virtual course in
thisorganzation.
Dr. Ing. Álvaro Rendón Gallón (2007). Tecnología informática para la salud de
zonas rurales. Publicaciones Departamento Telematica. Popayan, Universidad del
Cauca: 3.
This document performs the Analysis of results of the project EHAS, The EHAS
project tries to contribute to the improvement of public health care in rural areas of
Latin America, through the strengthening of the health care system, reducing the
sense of isolation of staff health and improving their capabilities.
This Project Specifically tries to improve conditions of the staff working in rural
health sector through two areas: rural telecommunications and information
services to health.
This paper is also important because the “Universidad del Cauca” is participating
in the technical committes of ”Fundaciòn HL7 Colombia” -organization founded by
University ICESI from Cali·, to customize the CDA and HL7 standar to the specifics
requirements of Colombia.
Eric B. Durbin, M. (2005). NAACCR HL7 E-PATH TRANSMISSION
STANDARDS. NAACCR Toolkit Workshop,. Potomac, Maryland, Kentucky Cancer
Registry.
FREDY MAURICIO SANABRIA HIGUERA and R. A. R. VARGAS (2005).
DISEÑO E IMPLEMENTACIÓN DE UN SISTEMA PARA EL ALMACENAMIENTO
DE HISTORIAL CLÍNICO. DEPARTAMENTO DE INGENIERIA ELECTRONICA.
Bogota, UNIVERSIDAD DE LOS ANDES. Ingenieria Electronica: 93.
This paper presents the development and implementation of a system that can
store the clinical histories of Individuals with Plastic smart cards, the project
includes a device for reading and writing via the computer, a portable reader for
emergencies and a file backup system based on Internet where information is
stored securely, allowing the Remote acces to the records for use in cases of
emergency and preventive medicine.
This paper is interesting because from his analyzes could emerge possible work to
develop in the electronic area in conjuntion with the software project.
Gallego, C. (2006). HISTORIA CLÍNICA ELECTRONICA CON CDA. Foro
Normalizaciòn España 2006. España, HL7Spain: 3.
This paper is a brief document covering the analysis of the implementation of the
HL7 RIM model and the use of XML for data exchange in CDA
Gómez, A. C., Fernando; Kaminker, Diego ; Martínez, Marcela; Luna, Daniel;
De Cristófano, Miguel Angel; González Bernaldo de Quirós, Fernán , Hospital.
Italiano deBuenos Aires, Departamento de Información Hospitalaria, Argentina , et
al. (2005). " Implementación de mensajería HL7 en un sistema de consulta de
resultados de laboratorio " HL/ Argentina: 5.
This paper analyzes a study case. The information Department of the Hospital
Italiano de Buenos Aires, developed a system of consultation and printing of
results of examinations online via the intranet, using HL7 to achieve
interoperability.
In this context the use of HL7 as the standard of communication allows us to
maintain the independence of each system without being tied to one hardware
platform or software
Group, Healtl Level Seven (1999). Specification of HL7 V 2 ( Health Level Seven)
This document contains the specifications for Version 2.3.1 of the Health Level
Seven (HL7) Standard for electronic data exchange in all healthcare environments,
with special emphasis on inpatient acute care facilities (i.e., hospitals). It
summarizes the work of a committee of healthcare providers (i.e., users), vendors
and consultants established in March 1987 on the occasion of a conference hosted
by Dr. Sam Schultz at the Hospital of the University of Pennsylvania. Its
participants, who represent users as well as vendors, share a common goal of
simplifying the implementation of interfaces between computer applications from
different, and often competing, vendors.
Heras, P. d. (2003). PROPUESTA DE UN MODELO DE SISTEMA DE
TELEMEDICINA PARA LA ATENCIÓN SANITARIA DOMICILIARIA.
Departamento de Tecnología Fotónica,Grupo de Bioingeniería y Telemedicina,
E.T.S.I. de Telecomunicación. Madrid, UNIVERSIDAD POLITÉCNICA DE
MADRID. Doctorado Ingeniera de Telecomunicación: 299.
This doctoral thesis analyzes the care of chronically ill patients, this topic is
becoming a matter of first order for health systems of developed countries,
beacuse these systems are designed to dont cope with the demand that these
patients generate.
The main contribution of this thesis is the definition of a Model System of
Telemedicine for home care of chronically ill patients ,it provides a way of focusing
attention on the patient and his home, and facilitates Shared care of patients.
James Odell, H. V., Bernhard Bauer (2007). "Extending UML for Agents." 15.
This paper analyzes a way to model a architecture based on agents using UML
This paper is important because the use the use of agents requires both relating it
to object-oriented software developmen) and the use of artifacts to support the
development environment throughout the full system lifecycle.
In this paper are addressed both of these requirements by the description of some
of the most common requirements for modeling agents and agent-based
systems—using a set of UML idioms and extensions. This paper illustrates the
approach by presenting a three-layer AUML representation for agent interaction
protocols and concludes by including other useful agent-based extensions to UML.
Jinwook Choi, M,Sooyoung Yoo, Heekyong Park, and Jonghoon Chun (2006).
"MobileMed: A PDA-Based Mobile Clinical Information System." IEEE
TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, 10(3): 9.
This paper from the IEEE analyzes the implementation of the CDA standard.
In health care centers the patients clinical data are distributed and often
fragmented in heterogeneous systems, and therefore the need for information
integration is a key to reliable patient care.Once the patient data are orderly
integrated and readily available, the problems in accessing the distributed patient
clinical data, the well-known difficulties of adopting a mobile health information
system, are resolved.
This paper proposes a mobile clinical information system (MobileMed), which
integrates the distributed and fragmented patient data across heterogeneous
sources and makes them accessible through mobile devices. The system consists
of four main components: a smart interface, an HL7 message server (HMS), a
central clinical database (CCDB), and a web server.
Joaquìn Seoane Pascual, Valentìn Villaroel Ortega, Andrès Martìnez
Fernandez, Alberto Sàenz Torres (2004) EHAS: programas libres para apoyar el
sistema de salud en zonas aisladas de America Latina. Proyecto ehas 6
The program Hispano American Health Link (EHAS) aims to contribute to the
improvement of the health care public system in isolated rural areas of countries in
Latin América, by means of telecommunications and informatics.
This project proposes connectivity solutions for health centers that are suitables for
low-cost areas where dont have phone or electricity, as well as services tailored to
them. This project want to facilitate the capacitation at distance, the remote
consulting, the electronic ordering of drugs and epidemiological surveillance,
among others aspects.
This project is very important because covers not only the software components in
a Telemedicine project, it also analyzes the architecture from a hardware point of
view
LEZCANO, L. D. (2006). TECNOLOGÍA GRID COMPUTING APLICADA AL
SECTOR HOSPITALARIO PARA COMPARTIR INFORMACIÓN DE LA HISTORIA
CLÍNICA DE LOS PACIENTES. DEPARTAMENTO INGENIERÍA DE SISTEMAS
Y COMPUTACIÓN Bogota, UNIVERSIDAD DE LOS ANDES. MAGÍSTER EN
INGENIERÍA DE SISTEMAS Y COMPUTACIÓN: 123.
This Masther thesis from the ”Universidad de los Andes” analyzes the use of grid
networks in projects of telemedicine. The field of Grid Computing technology is
very broad, like the areas where it can be implemented. A case of study where we
can apply the Grid technology is the Telemedicine where can be shared
information like the clinical history of patients in hospitals where they are served.
The study focuses on the hospital sector and is called "Grid Computing:
Technology Applied in Andalusia at hospitals to share information from medical
records of patients”
Liliana María Puerta Escobar, Jenny Marín Carvajal (2002 ). " LA
TELEMEDICINA " Ventana Informatica 10(julio - diciembre / 2002 2 ): 13.
Definiciòn de conceptos y estado del arte de laTelemedicina
Marcia C. Pulido, María L Barreto , Lilia E. Aparicio, Universidad de
Cundinamarca, Facultad de Ingeniería, et al. (2008). Análisis bajo el Estándar
HL7 del proceso de Referencia y Contrarreferencia en el Hospital San Rafael de
Fusagasugá INFOLAC2008 - AAIM.
This paper from the “Universidad the Cundinamarca” is very important, because
accord to the technical commitees of the ”Fundacion HL7 Colombia”, this
University is one of the academic institutions that have more worked in the
implementation of CDA standard in Colombia, in this paper the authors takes in
account the legislation over telemedicine regent in the present in Colombia.
As part of the project "Pilot System for Management of Health Services in the
Region of Sumapaz" is presented the analysis of the process of referral between
the ESE Hospital San Rafael de Fusagasugá (Cundinamarca, Colombia) and other
public and private entities that belong to the general health system in Colombia.
For this study it was taked in account the Colombian law, the guidelines of the
Health Secretariat of Cundinamarca and the operating procedures of the Hospital,
which allowed to identify seven different scenarios. Subsequently is studied the
Topic of Care Provision Domain Transfer of the HL7 standard that deals with these
processes, and sought to identify the messages according to the standard that
should be used in each one of the scenarios identified.
The main conclusion of the work is the need to create two new messages not
covered by the standard, one application for approval and one authorization by a
government institution .
One of the principals papers to take in account.
Martínez, A. R, Roberto J. Infante, Alberto. Campillo, Carlos. Gattini, César.
Borrás, Cari, Pról., OMS, et al. (2001). Bases metodológicas para evaluar la
viabilidad y el impacto de proyectos de telemedicina -OPS-. Washington, D.C. :,
OMS.
NEOTOOL (2007). The HL7 Evolution : Comparing HL7 Version 2 to Version 3,
Including a History of Version 2 The HL7 Evolution. NEOTOOL. Plano, Texas
NEOTOOL: 14.
HL7 Version 3 is released and available for use by the clinical application
community. Medical informatists are already using it as a vocabulary to discuss
worldwide healthcare issues. Government entities have begun to look forward to
using it to create interfaces between systems that have previously been completely
separate. Healthcare entities in Europe, Canada, Germany, and several others
have launched initiatives to implement Version 3. Even with these activities, HL7
V3 is in the infant maturity stage while HL7 V2 is still growing in its usage
This article provides a background on HL7 and highlights the key differences
between HL7 V3 and V2.
Nicolás Fonnegra Martínez (2005). PLATAFORMA DE SERVICIOS
DISTRIBUIDOS BASADA EN AGENTES MÓVILES. FACULTAD DE INGENIERIA.
Bogotà, PONTIFICIA UNIVERSIDAD JAVERIANA. DEPARTAMENTO DE
INGENIERIA DE SISTEMAS: 146.
The objective of this project is propose an architecture to provide services via
Internet using mobile agents.
A mobile agent is a entity of software that has autonomy to move from one device
to another and execute a task assigned by the owner. Through the use of this
paradigm is possible to save connection times because the completion of a misión
is not subjected to the requirement that the user remains connected.
Páez, T. A. (2006). DISEÑO E IMPLEMENTACION DE UN SISTEMA DE
GESTION DE OPERACIONES Y CALIDAD EN UNA INSTITUCION DE SALUD:
SISTEMA DE GESTION DE HISTORIAS CLINICAS. DEPARTAMENTO DE
INGENIERIA INDUSTRIAL. Bogota, Junio 16 de 2006. Ingenieria Industrial: 131.
The compliance with international quality standards allow to institutions of the
Health sector deploy their abilities to provide services accord to the customer
requirements. For these and other reasons is neccesary a administrative tool to
implement a management system with processes identified and controlled, and
improved continuously in the health care sector. A standard neccesary to reach
these objetives is HL7 and his sub-standard CDA
Programa EHAS. Universidad del Cauca, Departamento de Telematica (2008)
Infraestructura y servicios de telemedicina rural en elDepartamento del Cauca,
Colombia. Publicaciones Departamento Telematica 6
This is another paper from the EHAS project in the “Universidad del Cauca”. The
use of telemedicine applications in public health network of the Department of
Cauca in Colombia will make possible cover identified needs; as health care
coordination, training, monitoring Epidemiological,process of reference and
counter-referral of patients, and avoid the isolation of professionals working in rural
areas .However, the restrictions geographical, social, economic and the lack of
telecommunications infrastructure are a challenge of such magnitude that the
majority of telemedicine projects in Colombia have focused on urban areas with
less difficulty. La Universidad del Cauca has deployed in the Municipality of Silvia a
prototype network using technologies of the EHAS project, which uses systems
like VHF radio and WiFi for the deployment of voice and data networks of low cost
on this network.
The Real College of Radiologysts (2008) DICOM and HL7 standards. Guides of
Implementation 5
These guidelines explain, in basic outline, the meaning and significance of the
Digital Imaging and Communications in Medicine (DICOM) and Health Language
level 7 (HL7) standards, and their relationship to the Integrating the Healthcare
Initiative (IHE): all terms with which the radiologist needs to be familiar in today's
digital imaging environment.
Richard E. Swaja,(2003) NIH Research Opportunities in Bioengineering and
Bioinformatics. National Institute of Biomedical Imaging and Bioengineering 32
Robert H. Dolin, Alschuler.spinosa, et al. (2005). "HL7 Clinical Document
Architecture, Release 2." American Medical Informatics Association.: 39.
This paper analyzes the CDA standard, Release One (CDA R1) became an
American National Standards Institute (ANSI)- approved HL7 Standard in
November, 2000, representing the first specification derived from the HL7
Reference Information Model (RIM).
A CDA document is a defined like a object with complete information that can
include text, images, sounds, and other multimedia content. It can be transferred
within a message, and can exist independently, outside the transferring message.
CDA documents are encoded in XML, and they derive their machine processable
meaning from the RIM, coupled with terminology.
Rodríguez, R. J., Ed. Oliveri, Nora C. Monteagudo, José Luis, et al. (2003. ). E-
Salud en Latinoamérica y el Caribe tendencias y temas emergentes. Washington,
D.C. , OMS.
Ryan, A. (2007). Towards Semantic Interoperability in Healthcare: Ontology
Mapping from SNOMED-CT to HL7 version 3. School of Economics and
Information Systems, Wollongong, Australia, University of Wollongong,.
One of the most successful Healthcare Information Models is version 2 of the
Health Level 7 (HL7) standard. However, this standard has various problems,
mainly its lack of semantic interoperability.
Total semantic interoperability cannot be achieved without defined terminology,
and to this end the use of the Systemised Nomenclature of Medicine - Clinical
Terms (SNOMED-CT) is proposed in this document. The difficulty arrives when
deciding how to integrate the information model and the terminology. The line
between where one ends and the other begins is often indistinct. This paper
describes a proposal for normalising the two using ontology mapping and basing
HL7 message models on SNOMED-CT concepts and their relationships, in an
effort to further total semantic interoperability and seamless
Salud, Enlace Hispanoamericano de. (2008) Tecnologías de la Información
aplicadas a salud en zonas rurales de América Latina. Proyecto ehas 16
The main objective of the project "Hispanic-American Health Link" is provide
opportunities of communication at low-cost and allow the access to information of
health care sector in rural areas of Latin America where dont have the service of
conventional telephony. Some of the services offered by the project allow the
exchange of information between colleagues, consultation with specialists,
distance learning over health topics and access to literature through what the
Project call "facilitators of access to information." The technology inspired in the
experiences of community of users of radio-telephone allow the access to Internet
via radio systems, and are based on the exclusive use of e-mail.
SALUD, Ministerio de la (1994). RESOLUCION NUMERO 3905 DE 1994.
Bogotà: 5.
In this resolution it is adopted a format for gathering information in Institutions that
are Health care providers.
SALUD, Ministerio de la (1999). RESOLUCION NUMERO 1995 DE 1999.
Bogota: 7.
This resolution sets standards for the management of the clinical history
SALUD, Ministerio de la (2000). RESOLUCIÓN NÚMERO 03374 DE 2000
Bogotà: 61.
In this Resolution are regulated the basic data that must be reported by health care
providers and entities administering benefit plans on health services
Schadow., G. (2004). Motivations and Effects of Different Guideline
Representations on the Example of the HL7 RIM. . Computerized Guidelines and
Protocols, EuroMISE., Praha Indiana University School of Medicine,Indianapolis.
This document performs an Analysis of the HL7 RIM Model.
SOCIAL, Ministerio de la Protecciòn (2005). RESOLUCION 001715 DE 2005,
Diario Oficial 45940: 3.
In this resolution is regulated the the quality in the conservation of clinical history.
Stone, J. E. (2005). AN INTELLIGENT DIGITAL LIBRARY SYSTEM FOR
BIOLOGICAL DATA. Department of Computer Science. Vermont, University of
Vermont. Master of Science, Specializing in Computer Science: 86.
To aid researchers in obtaining, organizing and managing biological data, it has
been developed a sophisticated digital library system that utilizes advanced data
mining techniques . This digital library system is implemented as a centralized
J2EE web application with links to publicly accessible data repositories on the
Internet.
The digital library is based on a framework used for conventional libraries and an
objectoriented paradigm, and provides personalized user-centered services based
on the user’s areas of interests and preferences. To make personalized service
possible, a “user profile” that represents the preferences of an individual user is
constructed based upon a user’s past activities, goals indicated by the user, and
options.
T. H. Yang, P. H. Cheng, C. H. Yang, F. Lai, C. L. Chen, H. H. Lee, K. P. Hsu,
H. Chen, Y. S. Sun., et al. (2006). A Scalable Multi-tier Architecture for the
National Taiwan University Hospital Information System based on HL7 Standard.
Proceedings of the 19th IEEE Symposium on Computer-Based Medical Systems
(CBMS'06), IEEE.
This article describes the successful experiences of National Taiwan University
Hospital (NTUH) in moving from IBM Mainframe to connected networking computer
systems. In the projectit was used a multi-tier architecture and HL7 standard to
implement the new outpatient Hospital Information System (HIS). The NTUH HIS is
a complex environment with several operating systems, databases, and
information systems. In the project was adopted a Service- Oriented Architecture
(SOA) to reduce the complex relations between systems and solve data
consistency problems among databases. The main contribution of this paper is
proving that the distributed environment with HL7 standard and SOA can sustain in
a highly demanding environment.
Xiao, Y. (2008). Mobile telemedicine a computing and networking perspective
In this book are analyzed the principals techniques in the telemedicine area.
4 PRESENTATION OF THE PROJECT
When we speak about a system to support decision making in health sector, we
are talking about a platform to obtain, analyze and decode information from
multiple heterogeneous environments in this area. The system will allow collect
and analyze data such as the number of beds available in different health care
centers, availability or not of specialists in a specific area in this centers
(cardiology, neurology, orthopedics, etc.) , availability or not of medical
equipments required for patient care, centers closest to a specified geographic
location, clinical history of a patient, the EPS to the what is affiliated the patient,
hours of attention in a specific health care center, between others requirements.,
This project proposes a multi-agent architecture to provide a flexible and
scalable solution accord to HL7 RIM1 Model and will use the paradigm of mobile
agents to allow the data exchange between the different health care
information systems, some of them were listed above.
It will be used a common concept model (ontology) based on HL7 RIM (Health
Level Seven - Reference Information Model) as the basis for data exchange
between the different applications, the ontology provides the common
terminology for a domain, allowing to mobile agents communicate between them
(through agent communication language ACL2).
HL7 RIM is the standard for construction of ontologies in the health sector, RIM
provides an explicit representation of semantics connections in the information
carried in HL7 fields.
It is worth noting that HL7 refers to the seven level (application) of the OSI
model, the HL7 standard essentially provides interoperability at seven level of
this layer.
HL7 has a process for define interoperability mechanisms (email, electronic
documents, rules, reference models, etc., ), this has led to several standards for
the processes of exchange of health information.
As a result, today we talk about HL7 standards.
Some of these standards are:
Messaging HL7 Version 3: Messaging Standard for electronic exchange of
health data.
1 F. M. Brieux, "HL7 V2.X -Introducción," in Historia Clinica -HL7 Argentina Buenos Aires: Fundaciòn HL7 Argentina,
2009, p. 87.
2 F. Bergenti, A. Poggi, B. Burg, G. Caire, “Deploying FIPA-Compliant Systems on Handheld Devices”, IEEE Internet
Computing, pag. 20-25, July-August, 2001.
CDA HL7(Clinical Document Architecture): Standard for electronic Clinical
Document Architecture.
SPL HL7 (Structured Product Labeling) Standard for electronic labeling of
drugs.
HL7 Medical Records: Standard for management of Medical Records.
GELLO: Standard for rules applied in support of clinical decisions.
Arden syntax: Standard for the syntax of rules(IF-THEN) to sharing of clinical
knowledge.
CCOW: Standard for sharing context between applications.
4.1 STATE OF THE ART
Among the advantages of use mobile agents to enable interoperability between
telemedicine platforms, we have that this architecture can makes lower the
bandwidth consumption and the load over the network, the reason is that the use
of mobile agents reduces the amount of messages exchanged between client and
server, because a system of this type sets a communication at local level between
the agent and the host, another advantage is that are allowed asynchronous
connections therefore we have agents acting independently without need for
exchanging information with the client3.
In applications of distributed systems frequently are presented disconnections from
the network from one of the nodes, if that happens, rather than trying to handle
exceptions that occur, the software agent migrates to another node in the network
where the connection is available.
The use of mobile agents in telemedicine networks can reduce the latency of
individual steps to execute during the processing of information and it can avoid
the transmission of intermediate data in the communication between the client and
the server. Another important characteristic is that one node can continue his
work even in the presence of disconnection from the network and complete the
work much faster than a traditional solution server / client 4 . This obviously means
a great advantage in some environments, for example, clients could be on devices
such as cellulars, PDA's or Pocket-PC's, these devices are very used in
environments highly mobiles such as hospital (ambulance, paramedics, onsite
3 Z. S. A. Alexander García D, "Agentes en Computación Móvil," in GITUAO Cali-Valle: Universidad Autonoma de
Occidente, 2006, p. 28.
4 R. Gray, D. Kotz, R. Peterson, J. Barton, D. Chacón, P. Germen, M. Hfmann, J. Bradshaw, M. Breedy, R.
Jeffers, and N. Suri.. ”Mobile-Agent versus Client/Server Performance: Scalability in a Information-Retrieval Task”.
Dartmouth College Computer Science, Hanover, Proceedings of Mobile Agents, 2001.
attention, etc.,) these devices have scarce memory resources and limited
computational power while the server can be a big multiprocessor computer.
In the same way that the paradigm of mobile agents has many advantages,
emerge some possible disadvantages in specific cases, issues such as scalability
that must be analyzed. For example; ¿When the number of clients increase, must
also climb the services of mobile agents in the same proportion? ¿Will there be a
balance between savings in network transmission time and the possible extra time
devoted to expect the availability of a server with heavy load of work? 5
It should be noted that the mobile agents will not always have a better performance
than a typical server / client solution. For example, if the mobile agent, has a code
size that exceeds the amount of data exchanged in a traditional solution
client/server, the mobile agent will have a poor performance, comparatively
speaking, because will transfer a larger amount of bytes through the network than
in a traditional solution. Similarly, if the network is sufficiently fast , the agent may
have a poor performance, even if the mobile code is smaller6 .
We must take in account that the mobile agents are typically written in languages
that are interpreted (for issues of portability and security) and if we have a network
enough fast and reliable , interpret the agent on the server may be slower than
send the intermediate data to the client, but if the speed or reliability of the network
falls, or the size of intermediate data exchanged between client and server is
increased, the outlook varies considerably
It should be noted that although it has been made research and implementations
of systems to support decision making in health care sector using HL7 RIM , still
has not been proposed an architecture to exploit the advantages of the paradigm
of mobile agents in this area either in a fixed context(Web application) or one
mobile (we must remark that in the mobile environment, the clients are devices
with great limitations at level of storing and processing of the information). The use
of mobile agents (paradigm of the area of distributed systems) presents greatest
advantages in the area of support the decision making, some of them listed above.
Therefore propose an architecture for the implementation of a system with these
features is the main objective of the project 4 .
One of the topics to treat in the project is the modelling of the components of the
software infrastructure, respect this issue have been realized work over the
5 White T. et al., “Intelligent Network Management using Mobile Agents”. Proc. of the 2nd Canadian Conf. on Broadband
Research (CCBR „98), June 21-24, 1998, Ottawa, Canada.
6 R. Gray, D. Kotz, R. Peterson, J. Barton, D. Chacón, P. Germen, M. Hfmann, J. Bradshaw, M. Breedy, R.
Jeffers, and N. Suri.. ”Mobile-Agent versus Client/Server Performance: Scalability in a Information-Retrieval Task”.
Dartmouth College Computer Science, Hanover, Proceedings of Mobile Agents, 2001.
application of object oriented techniques like UML to define the structure of
software components in architectures multi-agent7
Basically the project proposed is a services oriented architecture (SOA) that uses
the HL7 standar to allow the interoperability between telemedicine platforms. Until
the moment have been modeled many projects of this type and this is not one of
the principal contributions of the project.
At the national level..........................
The project proposes a information system to support the decission making in the
health care sector,we will have two client interfaces, one of them accesible from a
mobile environment and the another accesible from a fixed environment, we must
take in account that the clinical information of the patients always travels with the
patients, and therefore the ubiquitous access to such information becomes a
necessity nowadays. There are many promising examples
of systems utilizing personal digital assistants (PDAs) in order to access patient
clinical information anytime anywhere 8 ,9
One project that implements interoperability through the use of the HL7 standard
and mobile devices is MobileMed, a PDA-based mobile clinical information system
that provides an integrated computing environment in health care. The scenario for
MobileMed is depicted in Fig. 1. Hospitals from different locations send clinical
laboratory test data into a central clinical database (CCDB). The CCDB is assumed
to be administered by an authorized health care organization for patient privacy
security reason. Hospitals and the CCDB communicate with each other in HL7
messages. The role of the CCDB is to provide an integrated view of the patients to
the authorized medical professionals.
7 J. Bryson, and Brendan McGonigle,, "Agent Architecture as Object Oriented Design," in Intelligent Agents
IV: Agent Theories, Architectures, and Languages. Proceedings of ATAL'97, Berlin, 1998.
8 J. Blackman, P. Gorman, R. Lohensohn, D. Kreamer, and S. Svingen, “The usefulness of handheld computers in a surgical
group practice,” in Proc. AMIA Annu. Symp., 1999, pp. 686–690.
9 M. Ancona, G. Dodero, F. Minuto, M. Guida, and V. Gianuzzi, “Mobile computing in a hospital: The WARD-IN-HAND
project,” in Proc. 2000 ACM Symp. Applied Computing, pp. 554–556.
Fig 1. MobileMed: A PDA-Based Mobile Clinical Information System,10
One project related with the previously analyzed topic (use of mobile devices to
manage the patient's clinical information) uses agents in the variable context of
healthcare emergency decision-support domain. More specifically is proposed the
use of mobile agents to support the deployment of an ambulance service in real-
time. In this project is analyzed an emergency scenario in order to demonstrate
the validity and feasibility of the proposed model.11 The model proposed obtains
the information from a propietary database and therefore the main failure of this
architecture is that only can retrieval information from mirror nodes12, all similars in
architecture. The retrieval information is performed through the use of databases
and not through the implementing of the HL7 standard, for this reason this system
is not interoperable with other nodes in a heterogeneous and distributed network 13
Unlike traditional paradigms, agents exhibit the property of being autonomous and
interactive. Coupled with mobility, they are capable of performing dynamic and
intelligent inference tasks during their execution. Utilizing a framework based on
the mobile agent paradigm provided for a higher degree of flexibility by allowing
applications to dynamically adapt to the changing demands of their execution
environments. 14
10 M. Jinwook Choi, IEEE, Sooyoung Yoo, Heekyong Park, and Jonghoon Chun, "MobileMed: A PDA-Based Mobile Clinical Information
System," IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE,, vol. 10, p. 9, 2006.
11 F. Burstein, Zaslavsky, A., Arora, N. School of Computer Science and Software Engineering Monash University, "
Context-aware mobile agents for decision-making support in healthcare emergency applications " Monash
University grants, p. 16, 2005.
12 Arshad U, Mascolo C, Mellor M (2003) Exploiting Mobile Computing in Health-care, In: Proceedings of the 23rd
International Conference on Distributed Computing Systems (ICDCS‟03), May 2003.
13 Milojicic D; Douglis F,Wheeler R (Eds.) (1999) Mobility: Processes, Computers and Agents, ACM press, 1999.
14 Morton S, Bukhres O (1997) Utilizing Mobile Computing in the Wishard Memorial Hospital Ambulatory
Service, In proceedings of the ACM symposium on Applied Computing, San Jose, California , 287-294.
In Colombia there have been developed many projects oriented to the use of CDA
(Clinical Data Architecture)15,16, many of them have implemented a Services
Oriented Architecture17. We must remark that CDA is a HL7 sub-standard to
manage the patients clinical history , the project proposed makes a intensive use of
CDA.
One major aspect to analyze is the HL7 versiòn that will be used in the project,
while the HL7 V2 standard was created mostly by clinical interface specialists, the
V3 standard has been influenced strongly by work from volunteers representing the
government and medical informatist users. This means that the level of formal
modeling, complexity, and internal consistency is radically higher in V3 when
compared to V2 an these two versions are not totally compatible between them18,
In the table 1 we can see a comparation between the benefits and disadvantages
of HL7 standard V2 and V3 ,these are some issues to take in account.
15 M. ABARAHONA, "CONSTRUCCIÓN DE HBPS: HEALTHBOOK PATIENT SERVICES, UNA SOLUCION DE
ALMACENAMIENTO DE HISTORIAS CLINICAS EN LA RED SOCIAL HEALTHBOOK ENFOCADA A LA SALUD,"
in DEPARTAMENTO DE INGENIERIA DE SISTEMAS Y COMPUTACIÓN. vol. Ingeniero de Sistemas y Computación
Bogota: Universidad de los Andes, 2008, p. 56.
16 FREDY MAURICIO SANABRIA HIGUERA and R. A. R. VARGAS, "DISEÑO E IMPLEMENTACIÓN DE UN
SISTEMA PARA EL ALMACENAMIENTO DE HISTORIAL CLÍNICO," in DEPARTAMENTO DE INGENIERIA
ELECTRONICA. vol. Ingenieria Electronica Bogota: UNIVERSIDAD DE LOS ANDES, 2005, p. 93.
17 M. A. C. Blumenthal, "Servicio de Datos SOA para Arquitecturas Extensibles: Diseño e implementaciòn de HealthBook Data
Services," in Departamento de Ingenieria de Sistemas. vol. Ingenieria de Sistemas Bogota: Universidad de los Andes, 2008, p.
51.
18 NEOTOOL, " The HL7 Evolution : Comparing HL7 Version 2 to Version 3, Including a History of Version 2 " in The HL7
Evolution, NEOTOOL, Ed. Plano, Texas NEOTOOL, 2007, p. 14.
Standard Benefits Challenges
HL7 V2 Reflects the complex “everyone is special” Provides a “one size fits none”
world of healthcare standard
Much less expensive to build HL7 interfaces Not inclusive of international
compared to custom interfaces needs
Provides 80 percent of the interface and a
framework to
Negotiate the remaining 20 percent on an
interface-by-interface basis No compatibility with HL7 V3
Historically built in an ad hoc way, allowing the Defining a detailed list of items
most critical areas to be defined first to be discussed and
negotiated before interfacing
Generally provides compatibility between 2.X can occur is required
versions
Application vendors do not
support the latest and best-
defined versions of HL7
HL7 V3 More of a "true standard” and less of a For clinical interface
"framework for negotiation" specialists:
Model-based standard provides consistency No compatibility with HL7 V2
across entire standard
Adoption will be expensive and
Application roles well defined take time
Much less message optionality Long adoption cycle, unless
strong business case or
Less expensive to build and maintain mid-to- regulatory requirement
long term interfaces changes
Many decades of effort over ten year period Retraining and retooling
reflecting “best and brightest” thinking necessary
Applications will have to
support both V2 and V3 in the
foreseeable future
Table 1: summary assessment of the two HL7 versions15.
One aspect to take also in account in the project are the legal requirements, for this
reason, for the realization of this project should be analyzed the legislation over
telemedicine regent in the present ion Colombia, some resolutions over this topic
are the 00171519 of 2005, 1995 of 1999 20, 3905 of 199421 and 03374 of 200022
from the ministery of health and the ministery of social protection
19 Ministerio de la .Protecciòn. Social, "RESOLUCION 001715 DE 2005," Diario Oficial 45940, 2005, p. 3.
20 Ministerio de la salud, "RESOLUCION NUMERO 1995 DE 1999," Bogota, 1999, p. 7.
21 Ministerio de la salud, "RESOLUCION NUMERO 3905 DE 1994," Bogotà, 1994, p. 5.
22 Ministerio de la Salud, "RESOLUCIÓN NÚMERO 03374 DE 2000 " Bogotà, 2000, p. 61.
4.2 OBJETIVES
4.2.1 General Objetive
Design of a multi-agent architecture based on the HL7 RIM model to support
decision making in fixed and mobile environments in the health sector in Colombia
4.2.2 Specífic objetives
Review the state of art of the standards CDA and HL7 in their different
versions, review the state of art of multi-agent architectures and multi-
agent systems in mobile environments
Perform the capture of requirements
Identify current legislation in Colombia related with the implementation of
the project (clinical data minimum that legally must be reported, levels of
access to information for users, etc.)
Determine a scheme of security for store and transmit the private data
(encryption, encryption, validation, etc..,)
Determine the HL7 and CDA specification to use (The working group
"Fundación HL7 Colombia" is working on the adequacy of HL7 standard
for Colombia)
Analyze potential use of others HL7 sub-standars like GELLO(Standard
for rules applied in support of clinical decisions) and CCOW(Standard for
sharing context between applications).
Perform modeling of hardware and software architecture of the project
Determine the best software alternative for the development and
deployment of the project
Perform Tests at prototype level to access to at least two repositories of
information since a client interface
Redact the project documentation
Deploy and implement the project in for the least two locations (taking in
account their specific characteristics)