Research

LinkEHR Platform is based in a technology you can trust, based on over 10 years of applied research and development of the Biomedical Informatics Group (IBIME), at the ITACA Institute of the Universitat Politècnica de València.

Since 1999 one of our main research objectives has been to facilitate the access, faithful representation and semantic interoperability of existing health data. This includes problems such as the integration of distributed data, the normalization of that data using known standards, and the semantic description of data structures to facilitate its interoperability.

With this aim the PANGEA system was developed. It was a data integration and normalization system based on the ENV 13606 pre-standard, which allowed accessing to existing data basses, extracting EHR health data from them, and making them compatible with the ENV 13606 specifications that were in development those days.

A practical result of that system was the Pangea Integration Engine (now LinkEHR Integration Engine), that has been used as the EHR integration of the Hospital General Universitario de Valencia since 2003.

LinkEHR is originally a result of a coordinated project sponsored by Spanish Education Ministry project grant titled "Semantic Web Technologies-Based Platform for the Management of Standardized Electronic Health Records" (Grant TSI2004-06475-C02) that ended in December 2007 and continued in the project "Platform for the acquisition and sharing of information and knowledge for networked communities of medical research" (Grant TSI2007-66575-C02-01), that ended in 2010. LinkEHR has also received a Grant from the "Programa de Apoyo a la Investigación y Desarrollo" (PAID-06-07) of the Universitat Politècnica de València.

FEDER

The aim of these research projects was to design, implement and evaluate a platform for the publication, intelligent access and reuse for clinical research of clinical information of patients, based on standards and formal methods for the description of the clinical information models. The ENV 13606 pre-standard evolved to the CEN EN 13606 standard, which introduced the dual model approach and the archetype concept. LinkEHR was designed with this dual model approach in mind. Moreover, since archetypes can be used not only with EN 13606 and the openEHR specifications, but can be used with any other reference model (such as HL7 CDA) LinkEHR was designed to be natively compatible with any standard or specification.

Archetypes are formal definitions of clinical information models. They define the data structures and value constraints that must be applied to generate data instances of the EHR, together with their semantics (their meaning) described through terminology bindings in the archetype.

Health domain experts can define those archetypes with LinkEHR Editor. But then, the archetypes have to be used together with existing data and information systems. Since the health data to be made public resides in the underlying data sources, it is necessary to define some kind of mapping information that links entities described in the archetype (object nodes and attributes) to data elements in data repositories (e.g. elements and attributes in the case of XML documents, tables and attributes in the case of relational data sources). LinkEHR Studio provides a framework for developing normalization archetypes. A normalization archetype is kind of archetype thought for transforming non-normalized data into an archetyped EHR instances. An Information Technology expert can map the archetype structure to the schema of the original or legacy information. With that information, the tool is able to automatically generate a transformation software (in XQuery language) in order to transform existing data into normalized data. Therefore:

Integration Archetype = archetype + mapping specification

In LinkEHR any reference model is considered an archetype itself. Therefore, any clinical archetype derived from it will follow the same specialization rules as those applied to any other specialized archetypes. This approach strengthens all the development methodology and, moreover, allows building a tool able of working with any reference models or different version of the same reference model. The tool will only need to have the definition of that reference model in archetype (ADL) format.

LinkEHR basic architecture

New reference models expressed as a W3C XML Schema or openEHR BMM specification files can be imported at any time. The import process generates archetype representations of the reference model classes that will be immediately available as basis for the creation of archetypes by means of specialization. This feature has been very useful in keeping in pace with evolution of reference models without modifying a single line of code.

Currently, LinkEHR has been used to define archetypes and normalize data based on ISO EN 13606, openEHR, HL7 CDA, CIMI reference model, CDISC ODM, ASTM Continuity of Care Record standard (CCR) and MedXML MML.

Our research focus continues in the developement of solutions that facilitate the semantic interoperability of health data, not only for delivery of care, but also to support health research and the reuse of clinical information. Current research lines include:

2016

2005

  • Title: Historia Clínica Electrónica Federada Basada en la Norma Europea CEN/TC251 EN13606
  • Author: Jose Alberto Maldonado Segura
  • Defense: Universitat Politècnica de València, July 2005

The following are journal and conference papers related to the development of LinkEHR and its applications.

2016

  • Analysis of the process of representing clinical statements for decision-support applications: a comparison of openEHR archetypes and HL7 virtual medical record. A González-Ferrer, M Peleg, M Marcos, JA Maldonado. Journal of medical systems 40 (7), 1-10, 2016

2015

  • Archetype-based data warehouse environment to enable the reuse of electronic health record data. Marco-Ruiz, L.; Moner, D.; Maldonado, JA.; Kolstrup, N.; Bellika, JG. International journal of medical informatics 84 (9), 702-714, 2015
  • Automatic generation of computable implementation guides from clinical information models. Boscá, D.; Maldonado, J.A.; Moner, D.; and Robles, M. Journal of Biomedical Informatics 55, 143-152, http://dx.doi.org/10.1016/j.jbi.2015.04.002

2014

  • Detailed clinical models governance system in a regional EHR project. Moner, D.; Maldonado, J.A.; Boscá, D.; Mañas, L.; and Robles, M. 13th Mediterranean Conference on Medical and Biological Engineering and Computing 2013 (MEDICON 2013). IFMBE Proceedings, Volume 41, Pages 1258-1261, 2014
  • Detailed clinical models governance system in a regional EHR project. Boscá, D.; Marco, L.; Moner, D.; Maldonado, J.A.; Insa, L.; and Robles, M. 13th Mediterranean Conference on Medical and Biological Engineering and Computing 2013 (MEDICON 2013). IFMBE Proceedings, Volume 41, Pages 1266-1269, 2014

2013

  • Leveraging electronic healthcare record standards and semantic web technologies for the identification of patient cohorts. Fernandez-Breis, J. T.; Maldonado, J. A.; Marcos, M.; d. C.Legaz-Garcia, M.; Moner, D.; Torres-Sospedra, J.; Esteban-Gil, A.; Martinez-Salvador, B.; and Robles, M. Journal of the American Medical Informatics Association, August 2013.
  • Interoperability of clinical decision-support systems and electronic health records using archetypes: A case study in clinical trial eligibility. Marcos, M.; Maldonado, J. A.; Martínez-Salvador, B.; Boscá, D.; and Robles, M. Journal of Biomedical Informatics, 46(4):676--689. August 2013.

2012

  • Using the ResearchEHR platform to facilitate the practical application of the EHR standards. Maldonado JA, Costa CM, Moner D, Menárguez-Tortosa M, Boscá D, Miñarro Giménez JA, Fernández-Breis JT, Robles M. Journal of Biomedical Informatics 45(4): 746-762 (2012)
  • Using Archetypes for Defining CDA Templates. David Moner, Alberto Moreno, José A. Maldonado, Montserrat Robles, Carlos Parra. XXIV International Conference of the European Federation for Medical Informatics (MIE 2012), Pisa. Quality of life through quality of information, pp. 53-57, IOS Press BV, Amsterdam.

2011

  • Patient Summary and medicines reconciliation: application of the ISO/CEN EN 13606 standard in clinical practice. Farfán Sedano FJ, Terrón Cuadrado M, Castellanos Clemente Y, Serrano Balazote P, Moner Cano D, Robles Viejo M. Stud Health Technol Inform; 166:189-196. (2011)
  • An Archetype-Based Solution for the Interoperability of Computerised Guidelines and Electronic Health Records. Mar Marcos, José Alberto Maldonado, Begoña Martínez-Salvador, David Moner, Diego Boscá, Montserrat Robles. 13th Conference on Artificial Intelligence in Medicine (AIME 2011); Proceedings: pp. 276-285 (2011)
  • Implementation of a CEN/ISO 13606 platform for medicines reconciliation. David Moner, Marta Terrón, Carlos Angulo, Luis Lechuga, Pablo Serrano, José Alberto Maldonado, Francisco J. Farfán, Montserrat Robles. XXIII International Conference of the European Federation for Medical Informatics (MIE 2011), Oslo; Proceedings (2011)
  • Detailed Clinical Models to facilitate inter-standard interoperability of data types. Diego Boscá, José Alberto Maldonado, David Moner, Montserrat Robles. XXIII International Conference of the European Federation for Medical Informatics (MIE 2011), Oslo; Proceedings (2011)
  • Concept-based exchange of healthcare information: The LinkEHR approach. J.A. Maldonado, D. Moner, D. Bosca, C. Angulo, L. Marco, E. Reig, M. Robles. First IEEE conference on Healthcare Informatics, Imaging, and Systems Biology (HISB 2011); Proceedings: pp. 150-157. IEEE Computer Society Order Number E4407 (2011)

2010

  • Sharing the Concepts: Detailed Clinical Models, Review, Current and Future Work. D. Boscá, J.A. Maldonado, D. Moner, M. Robles. OpenHealth Spain 2010, Madrid; Proceedings (2010)
  • GMM: A visual tool to map between data sources and archetypes. Luis Marco Ruiz, Jose Alberto Maldonado Segura, Diego Boscá Tomás, Monserrat Robles Viejo. OpenHealth Spain 2010, Madrid; Proceedings (2010)
  • Real use case of the CEN EN13606 standard: application in a project for medicines reconciliation during patient transitions between primary and specialised care. Terron Cuadrado M, Farfan Sedano FJ, Serrano Balazote P, Lechuga Suárez L, Moner Cano D, Maldonado Segura JA, Robles Viejo M. International Implementation of electronic health records conference, London; Proceedings (2010)
  • Real use case of the CEN EN13606 standard: application in a project for medicines reconciliation during patient transitions between primary and specialised care. Terron Cuadrado M, Farfan Sedano FJ, Serrano Balazote P, Lechuga Suárez L, Moner Cano D, Maldonado Segura JA, Robles Viejo M. International Implementation of electronic health records conference, London; Proceedings (2010)
  • ResearchEHR: use of semantic web Technologies and archetypes for description of EHRs. Montserrat Robles, Jesualdo Tomás Fernández-Breis, José A. Maldonado, David Moner, Catalina Martínez-Costa, Diego Boscá, Marcos Menárguez-Tortosa. EFMI Special Topic Conference 2010, Reykjavik; Seamless care - Safe care: The Challenges of Interoperability and Patient Safety in Health Care. Proceedings of the EFMI Special Topic Conference, pp. 129-135. IOS Press BV, Amsterdam. (2010)
  • CEN EN13606 normalisation framework implementation experiences. David Moner, José A. Maldonado, Diego Boscá, Carlos Angulo, Montserrat Robles, Daniel Pérez, Pablo Serrano. EFMI Special Topic Conference 2010, Reykjavik; Seamless care - Safe care: The Challenges of Interoperability and Patient Safety in Health Care. Proceedings of the EFMI Special Topic Conference, pp. 136-142. IOS Press BV, Amsterdam. (2010)
  • Standardized and flexible health data Management with an archetype driven EHR system (EHRflex). Anton Brass, David Moner, Claudia Hildebrand, Montserrat Robles. EFMI Special Topic Conference 2010, Reykjavik; Seamless care - Safe care: The Challenges of Interoperability and Patient Safety in Health Care. Proceedings of the EFMI Special Topic Conference, pp. 212-218. IOS Press BV, Amsterdam. (2010)

2009

  • LinkEHR-Ed: A multi-reference model archetype editor based on formal semantics. José A. Maldonado, David Moner, Diego Boscá, Jesualdo T. Fernández-Breis, Carlos Angulo and Montserrat Robles. International Journal of Medical Informatics; 78(8):559-570. (2009)

2008

  • Semantic Upgrade and Normalization of Existing EHR Extracts. Maldonado Segura JA., Moner Cano, D., Boscá Tomás, D., Fernández Breis JT., Angulo Fernández, C., Robles Viejo, M. 30th Annual International IEEE EMBS Conference, Vancouver; Proceedings of the 30th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, pp. 1466-1469. (2008)
  • Standardization of Discharge Reports with the ISO 13606 Norm. Moner Cano, D., Maldonado Segura JA., Angulo Fernández, C., Boscá Tomás, D., Pérez, D., Abad Pérez, I., Reig Alvárez, E., Robles Viejo, M. 30th Annual International IEEE EMBS Conference, Vancouver; Proceedings of the 30th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, pp. 1470-1473. (2008)
  • A SemanticWeb-based System for Managing Clinical Archetypes. Fernandez-Breis, J.T., Menarguez-Tortosa, M., Martinez-Costa, C., Fernandez-Breis, E., Herrero-Sempere, J., Moner, D., Sanchez, J., Valencia-Garcia, R., Robles, M. 30th Annual International IEEE EMBS Conference, Vancouver; Proceedings of the 30th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, pp. 1482-1485. (2008)

2007

  • Non-invasive lightweight integration engine for building EHR from autonomous distributed systems. Angulo Fernández, C.; Crespo Molina, P.; Maldonado Segura J.A.; Moner Cano, D.; Pérez Cuesta D.; Abad I.; Mandingorra J.; Robles Viejo, M. International Journal of Medical Informatics; 76(3):417-424. (2007)
  • LinkEHR: a tool for standarization and integration of legacy clinical data. Bosca Tomas, D.; Moner Cano, D.; Maldonado Segura, JA.; Angulo Fernández, C.; Robles Viejo, M. 12th World Congress on Health (Medical) Informatics (MedInfo'07), Brisbane; Proceedings of the 12th World Congress on Health Informatics (MedInfo'07), ISSN: 978-1-58603-774-1. (2007)
  • Framework for clinical data standarization based on archetypes. Maldonado Segura, JA.; Moner Cano, D.; Boscá Tomás, D.; Angulo Fernández, C.; Robles Viejo, M.; Fernández Breis JT. 12th World Congress on Health (Medical) Informatics (MedInfo'07), Brisbane; Proceedings of the 12th World Congress on Health Informatics (MedInfo'07), pp. 454-458; ISSN: 978-1-58603-774-1. (2007)

2006

  • An Ontological Infrastructure for the Semantic Integration of Clinical Archetypes. Fernández-Breis, J.T. Menarguez-Tortosa, M., Moner, D., Valencia-García, R., Maldonado, J.A., Vivancos-Vicente P.J. ,Miranda-Mena, T., Martínez-Béjar, R. Lecture Notes in Computer Science; pp. 156-167; Springer, Hoffmann, A.; Kang, B.-h.; Richards, D.; Tsumoto, S. (Eds.) (2006)
  • Towards the semantic interoperability of EHR information systems. Fernández Breis, J.T.; Vivancos Vicente, P.J.; Menarguez Tortosa, M.; Moner Cano, D.; Maldonado Segura, J.A.; Valencia García R.; Miranda Mena, T.; Martínez Béjar, R. Pacific Rim Knowledge Acquisition Workshop, Guilin (China), (2006)
  • Archetype-Based Semantic Integration and Standardization of Clinical Data. Moner Cano, D.; Maldonado Segura, J.A.; Fernández Breis, J.T.; Angulo Fernández, C.; Crespo Molina, P.; Vivancos Vicente, P.J.; Robles Viejo, M. 28th Anual International Conference IEEE Engineering in Medicine and Biology, New York; Proceedings. (2006)