Knowledge Base /E /End-to-end interoperability
End-to-end interoperability
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End-to-end operability refers to the ability of medical devices, personal health devices to work together (interoperate) with different health care information systems. Perfect interoperability is not a mere physical connection of two systems where one device provides data to a second device, but also a functional bridge where the second device understands what it is receiving from the first and thereby responds the way it is expected to.
From traditional and local healthcare environments such as hospitals or intensive care units, several medical services have migrated to remote and ubiquitous scenarios. These include ambient assisted living, elderly and chronic patient care, home teleassistance, imminent disease management, healthy living, training, monitoring, and wellness and fitness, among others. This evolution of the application environment to the patient/user context implies the creation of home, personal, and body area networks, extending the concept of telemedicine applications (usually called e-health) to new paradigms of mobile environments (m-health), ubiquitous healthcare systems (u-health), and user-centered personal health solutions (p-health). All these systems and applications make use of medical devices (MD) to acquire biomedical signals and measurements that can be sent to healthcare information systems (HCIS).
Subsequently, health information is analyzed by physicians who eventually provide professional supervision and advice. Nowadays, a wide range of solutions is being created in this area with new personal health devices (PHD) for biomedical signal acquisition based on wireless technologies. However, the transparent use by doctors and patients of different network technologies in this context is a necessary condition for a successful implementation of new p-health solutions.
Most previous healthcare solutions and medical systems developed by manufacturers are based on proprietary protocols and specifications. This has resulted in a lack of interoperability, especially in the case of end-users and HCIS managers, which complicates the incorporation of new MDs and PHDs to achieve a global and ubiquitous solution where the patient becomes the center of the healthcare system.
This new paradigm of personal health demands open standards and middleware components that permit transparent integration and end-to-end interoperability from new personal health devices to healthcare information system. Development of heterogenous solutions and the use of standards such as the ISO/IEEE11073 standard for the interoperability of personal health devices in the patient environment and the ISO/EN13606 standard for the interoperable exchange of electronic healthcare records as well their integration seems to be the internationally accepted way to face this challenge.
Several consortia are addressing the issue of medical device interoperability. The Medical Device Plug and Play program (MD PnP), Continua Health Alliance (Continua) and Integrating the Healthcare Enterprise (IHE) are groups focusing on interoperability. MD PnP is a multidisciplinary, multi-institutional program committed to simplifying and standardising medical device connectivity in support of improving patient safety and healthcare efficiency. In the regulatory arena, FDA is reopening discussion regarding the issue of a unique device identifier (UDI), which is one necessary ingredient for medical device interoperability.
Establishing a perfect interoperability amongst medical devices is not that easy a task. The interoperability package should ideally have simple and user-friendly hardwares that are capable of physically integrating devices from different manufacturers. These hardwares should be governed by a versatile algorithm in order to put all the data into a single platform. This being a new approach, companies should collaborate to manufacture it.
Amidst all the difficulties, it is possible to create a «customised one-off solution» to integrate all the monitoring systems. But it is complicated, expensive and could be possible only if manufacturers and the end-users join hands to bring a permanent solution for a perennial problem.
