Reference Architecture of Application Services for Personal Wellbeing Information Management a
Mika TUOMAINENa,1, and Juha MYKKÄNENa University of Eastern Finland, School of Computing, HIS R&D Unit, Kuopio, Finland
Abstract. Personal information management has been proposed as an important enabler for individual empowerment concerning citizens' wellbeing and health information. In the MyWellbeing project in Finland, a strictly citizen-driven concept of "Coper" and related architectural and functional guidelines have been specified. We present a reference architecture and a set of identified application services to support personal wellbeing information management. In addition, the related standards and developments are discussed. Keywords. Citizen empowerment, service-oriented architecture, standards, personal health records, interoperability
1. Introduction According to many political agendas, individual's, citizen's or consumer's personal needs must be at the centre of the development of high quality health and wellnessrelated information services [1,2]. In healthcare, the transition of health care system from provider-centric to patient-centric or consumer view has been seen both necessary and inevitable [3]. This requires empowering individuals to better manage their own wellbeing and health care. Personal Information Management (PIM) solutions have been suggested to promote citizen or patient empowerment [4,5]. The MyWellbeing (OmaHyvinvointi) project was a national-level R&D initiative in Finland which focused on citizen as the center of services ecosystem and developed conceptual and concrete tools and solutions for personal empowerment. The project focused on a holistic concept of a "Coper" to explore and define features of an aid for personal wellbeing. The Coper is designed to help citizens cope with the services they use and to manage them. It also promotes the coordination with and between service providers. In addition, virtual communities and social networks provide information and support, and aid in the decision-making for citizens [e.g. 6]. Platform and service provider interchangeability and use through multiple channels such as internet portals or mobile phones are required characteristics of the Coper. The Coper is not an implemented product as such, but many of its features are supported by existing applications such as personal health records (PHR applications), electronic government services and personal time and content management tools. 1
University of Eastern Finland, HIS R&D Unit, POB 1627, Fi-70211 Kuopio, Finland,
[email protected]
The basic idea of the Coper in healthcare closely resembles that of Personal Health Record (PHR) Systems [e.g. 7,8]. There are, however, many different content, use and implementation models related to PHRs, mainly due to different business models [9]. PHRs or other self-managed digital information collections are also mostly absent in collaborative health information system typologies [e.g. 10]. Furthermore, to be able to support information management in different wellbeing-related services, a reference architecture which could be populated by specific services and components was needed.
2. Materials and Methods The objective of this work was to specify a reference architecture for the Coper and to identify components for personal wellbeing management solutions. A service-oriented architecture (SOA) approach which facilitates reuse and integration of application services [11,12] was used. In addition, a classification of services was pursued. The work is based on literature and standards survey, experience from citizen eService development projects, existing products, and results from nine workshops of the project participants. The workshop participants included two EPR vendor companies, vendor companies for community, citizen and knowledge services, message delivery operator, five research institutes, and four health service provider organizations. The literature survey covered articles on personal information management, studies and comparisons of PHRs, and standards such as [8]. The survey confirmed that many PHR solutions share main features of the Coper. Experience from efforts such as guidelines for eBooking [11] stressed the need to identify benefits for both service providers and consumers. Four out of nine workshops in the project focused on service implementation and specification. The services were further prioritized, identifying combinations which could be realized using the existing offerings. The work was also harmonized with the information architecture for the Coper, and the prototypes for the case groups: persons retiring from work life and families having a baby.
3. Results Instead of an enterprise standpoint, the project used the analysis of citizen needs and activities as a starting point for the solutions and the architecture. The architecture is based on the dual model of services. The citizen has the right to receive a copy of documents from wellbeing services. Information is traditionally stored in the providers’ professional systems, but the customer's copy is under the control of the individual and can be used to combine information from various services. Such combination, if performed by service providers, is often difficult due to legal and privacy constraints. In our design, the wellbeing services offered to the citizen are reflected the identified software services. The SOA services are classified according to functional, platform, information or interactivity requirements (See Figure 1). The classification is generic, and all identified Coper services and functionalities can be located in one of the classes. In addition to the core functionalities of the Coper, personal information repository and user interfaces are basic building blocks of Coper realizations. Based on the results of the workshops and surveys, a total of 62 identified services were classified (See Figure 2). Core functionalities of the Coper include basic entry, management and organization of data and documents. Many basic functionalities
follow those of PHR systems [8]. Personal information repository holds the documents received from different sources and personal data, including both structured and unstructured formats. Viewing, sorting and searching functions are supported by webbased, mobile or desktop user interfaces. Added value presentation services for different user devices and presentation personalization can also be provided. Core of ”Coper”
Platform services
User interfaces
Presentation services
Core functionalities
Added value services
Provider collaboration
Communication Information management
Community Knowledge Personal
User management
Service provider Personal information repository
Information source services
Personal health device Scanning
Figure 1. Classification of services supporting personal information management.
Various platform services support communication, information management or user management. Communication platform includes secure communication and messaging services, in addition to support services such as technical service directories. Information management platform consists of services for data management such as synchronizing information repositories or translations between different presentation formats. User management platform services include identification, authorization and access control mechanisms supporting also access logs and digital signatures. Communication platfrom
Community added value services User interfaces
Technical service directory
Presentation services Portal / WebUI
Time stamp Secure communication
Desktop application
SMS/MMS
Messaging User management platfrom Identification Authorization Access rights Digital signature
Mobile application
Single signon
Information management platform
Graphical Presentation Core functionalities presentation personalization Enter Import/Download View Delete Edit Sort Destroy Correct Nullify/ Amend Tagging (associate) Search Classify (associate) Print Comment Export
Translation
Comparison & monitoring Content personalization Profiling
Calculators Calendar Reminder & alert
Community forum
Peer group data sharing
Service rating
Knowledge services
Diary Fitness guide Emergency access
Links to knowledge
Information interpretation
Decision support
Patient instructions
Wellbeing services directory
Anamnesis
Payment
Consent
Question – answer servise
Order
Feedbadk
Follow-up of charge limits
Electronic application forms
Prescription renewal
eAccess to EPR archive
Provider collaboration services
Scheduling Queuing Customership
Data selling for research Reachability
Information source services
Backup Compress Encrypt Achive Synchronize
Comparison of data
Risk analysis
Personal added value services Log
Blog
Structured data elements Metadata
Text documents Import service Hyper- and multimedia
Personal information repository Structured Binary document documents
Service provider system
National EPR archive
Scanning
Personal health device
Pulse Blood pressure Glucose ECG Weight
Figure 2. Specific personal wellbeing information management services in different service categories.
Information source services are primary communication channel to import external data into the Coper, in addition to user-entered data. Connections to the systems of the service providers (also including the national eArchive in Finland), document scanning services, as well as connections to different types of personal measurement instruments are supported by these services through dedicated data import interfaces. In addition, there are various added value services which provide functionality related to personal preferences, communication with the selected service providers or communities, or for combining personal information with knowledge repositories. Personal added value services include and link personal tools such as calendars, reminders, diaries or personal trend indicators. Community added value services offer peer-to-peer and other communication and information sharing channels for selected communities. Knowledge services link personal information to external knowledge, interpretation or risk analysis, individual decision support or patient instructions. Finally, provider collaboration services enable transactions and information sharing with the service providers, including eBooking, service directories, prescription renewal and communication with professionals during the patient journey [13].
4. Discussion and Conclusions In contrast to many provider-driven initiatives, only small part of Coper services focus on traditional eServices of health service providers. Many services were identified in readily-made products or completed projects. Prototype implementations of information management and sharing for maternity, as well as document scanning services for persons retiring were implemented in the project. In addition, detailed interfaces were specified for data import from health service provider systems to the Coper and for citizen-oriented decision support. It is not reasonable to expect any given system to contain and integrate all the services, although individual implementations of all services can already be identified. In addition, personal preferences hardly require all the services to be present. The identification of functionalities as SOA services enables stepwise development and individually-driven combination of various services. In addition, service categories promote uniform architecture which is needed to ensure the interoperability of various components. There are readily available standards for many parts of the architecture for integration of services. Many standards are based on the solutions developed for health professionals, but also generic standards can be utilized. Especially relevant are standards for structure and semantics of health information which are in key position for linking personal information to knowledge or provider collaboration services. In our project, the most relevant of these were the national HL7 CDA implementation guides, HL7 Continuity of Care Document specifications and IHE Exchange of Personal Health Record Content profile. Open standards are also available for device connectivity (including Continua and ISO/IEEE 11073 specifications), provider collaboration such as eBooking, and community and web user interface standards, respectively. The service classification is generic and can be used to group electronic services in general. For example, services and interface standards for personal health systems presented in [14] and [15] can be positioned using the framework. The architecture is used and refined in relation to a eService ecosystems architecture produced in an services ecosystems research in Finland (as part of the Mind and Body programme) and
promoted for a national programme for citizen eServices. Several services have been further specified and refined by the participating organizations. In addition to this architecture for the services, infrastructure decisions such as the use of integration platforms, as well as rules for the information architecture including metadata are among the key decisions to be agreed upon within a given ecosystem of services. From citizen perspective, personal wellbeing information management de-couples the individual from health or wellness service provision and avoids several obstacles related to service providers' view. The concept can be extended to cover personal health records, many different domains (healthcare, insurance, social services etc.), interactive eServices and community and knowledge links. The presented classification of individual-oriented application services serves as a step towards open and extensible ecosystem of electronic wellbeing services. Prioritization of services to be implemented and shared, however, must be based on the needs of consumers and aspects which can be implemented by service producers with an acceptable threshold in a sustainable way.
Acknowledgements The authors would like to thank all the members of the MyWellbeing project, the participants of the workshops and the members of the Mind and Body programme.
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