Analysis and Evaluation of EHR Approaches

Objectives: EHR systems are core applications in any eHealth/pHealth environment and represent basic services for health telematics platforms. Standards Developing Organizations as well as national programs define EHR architectures as well as related design, implementation, and deployment processes. Claiming to meet the challenge for semantic interoperability and to offer a sustainable pathway, the resulting documents and specifications are sometimes controversial and even inconsistent. Methods: Based on long-term experiences from national and international EHR projects, inputs from related academic groups, and active involvement at CEN, ISO, HL7, an analysis and evaluation study has been performed. Using the Generic Component Model (GCM) reference architecture, the characteristics for advanced and sustainable EHR architectures have been investigated. The dimensions of such an architectural reference model have been described, including basic principles of the underlying formal logical framework. Results: Strengths and weaknesses of the different standards, specifications, and approaches have been studied and summarized. Migration pathways for re-using and harmonizing the available materials as well as for formally defining standards development roadmaps can be derived. Conclusions: For providing interoperable and sustainable EHR systems, an EHR architecture reflecting all paradigms of the GCM is absolutely necessary. The resulting EHR solution represents a services architecture of distributed components. The development process shall be completely model-driven and tool-based with formalized specifications of all domains' aspects.