The UNICOM Test Lab enhances patient safety and healthcare efficiency by implementing ISO's IDMP standards across the EU. Funded by the EU's HORIZON Programme, this initiative unites diverse stakeholders to enable the seamless exchange of medicinal product information. This paper details the interoperability challenges and methodologies employed, highlighting the UNICOM Test Lab's role in validating and testing tools for IDMP standards implementation, aiming for semantic interoperability and a safe pharmaceutical supply chain within the EU.

The ISO standards for the Identification of Medicinal Products (IDMP) prove to be difficult to implement. Guidance needs to be provided to those using and further developing IDMP-related standards and terminologies. Providing fitting and structured education would be a step forward. This article describes research of current education and certification on IDMP and the creation of an educational framework for targeted IDMP knowledge transfer. This framework indicates the required level of knowledge for the various identified roles within the organizations working with IDMP. Based on a combination of desk research, a questionnaire, and individual interviews, relevant roles were identified covering the various organizations (Users, Educators, Medicine Authorities, Standard Developing Organizations, and IT-suppliers) and five levels of required knowledge were determined, including applicable roles and educational components. Furthermore, this article lists several recommendations that should be taken into consideration whilst developing content and implementing educational modules for IDMP.

The eStandards methodology stressed the importance of trust and flow for health data as a key characteristic of well-functioning health systems. A digital health compass, leveraging perspectives of health systems, digital health markets, citizens, and workforce, drives a process of co-creation, governance and alignment in eStandards. A repository of best practices and common components further advances interoperability, as new projects add their experience. This paper proposes a governance framework for requirements management, intelligence gathering, specification use, and updates to promote sustainable governance for International Patient Summaries. It is based on interviews of 14 patient summary projects and initiatives in Europe and the United States.

AbstractClinical data interoperability requires shared specifications of meaning. This is the rationale for clinical data standards. Up until now, the adoption of such standards has been varied, although they are increasingly advocated in an area where proprietary specifications prevail, and semantic resources are geared to specific purposes and limited by boundaries of languages and jurisdictions. This chapter highlights the need of data standards in the context of the difficult and heterogeneous field of clinical data and the way how they are addressed by terminologies, ontologies and information models. It provides an overview of existing standards and discusses quality and implementation issues. Emphasis is also put on the eStandards methodology, which investigates needs for health data standards, supports the creation of standardised artefacts and defines actions for the implementation of standards.

Healthcare systems increasingly rely on digital technologies to sustain costs and improve access to quality care. Data drive a wave of automation aspiring to improve productivity by forging connections between health and wellness, medical research, and clinical decision support. Mobile apps and patient-generated data combined with provider recordings pave the way towards personalized care pathways and just-in time access to health services. Navigating the health ecosystem becomes challenging as roles and relationships change. This paper reflects on the digital health compass to navigate the health system using one's own data. Health information technology standards are at the core of the compass, to tap the potential of shared aggregate data and sustain trust. The notion of the patient summary as a window to one's health is used as an example to drive our call for action for health informatics to develop methods to calibrate the digital health compass and feed on ‘my data’, respecting ‘my decision’, to fuel ‘our ePower’.

The objective of this study was to evaluate a decade of Electronic Patient Record development. During the study a second question was added: How to take the next step in the Netherlands? This paper describes the developments but the main results create a framework for the future situation. The USE IT method was used, which is derived from DOI and TAM theory but applies it in a qualitative way. The results show six P’s that have to be covered to introduce a nation-wide EPR. The first three handle the end users of the EPR: Patients, Professionals and the Public. The latter three show the action types of a nation-wide EPR, namely: Purpose, Process and Prerequisites. In conclusion, the combination of these six P’s show that the main purpose for a patient is the quality of health, that the process of the professional has to be smoothed and that the data quality has to be guaranteed as well as privacy.

We present a ten-year-update of the EPR-orientation-model for success of Electronic Patient Records (EPR’s), based on our research. An EPR is seen as a way to make healthcare more efficient and effective. Many initiatives lead to the implementation of EPR’s, but also regional infrastructures for informationand network services are realized. The law to realize a national EPR is rejected by the Dutch Senate, however. The EPR-orientation-model characterizes EPR in three orientations: administration, medical technology and care process. The developments in the last decade in the Netherlands are described in relation to the orientations. This leads to the extension of the model with external relations and the enlargement of the intersection between the administration orientation and care process orientation. The four criteria for a successful EPR from the end-user viewpoint are updated to five criteria. In order to be successful an EPR must: 1. Be micro-relevant to the end-users; 2.Provide complete and integrated patient data; 3. Be available and accessible anywhere and anytime; 4. Contain active elements, like alerts, decision support and workflow management; 5. Register data necessary for quality and finance, without extra effort for the care providers.

There is no doubt that the way to high quality, safe and e cient health services leads to distributed cooperative care (shared care) supported by information and communication technologies [1]. Such approach requires interoperability between all principals (persons, organizations, devices, applications, components) involved [1]. Nevertheless, many papers and organizations (e.g. [2]) dedicated to health care interoperability still refer to the IEEE Dictionary de nition of (semantic) interoperability as ... the ability of two or more systems or components to exchange information and to use the information that has been exchanged [3]. However, the problem of interoperability is not limited to the early days' EDI challenge of harmonized data representation and exchange protocol. Nowadays, it is the challenge of the legally, culturally, socially, educationally and organizationally impacted aspect of commonality regarding business processes and objectives, but also interests, knowledge and skills to cooperate for jointly meeting those business objectives [1]. Those aspects go far beyond ICT ontology and communication protocols as commonly understood today. Depending on the sharing of those common aspects, comprehensive interoperability can be provided at di erent interoperability levels such as structural, syntactic, semantic or services, semantic, or services interoperability depending on the level of shared knowledge and skills [1].

Health Level 7 (HL7) is een familie van internationale standaarden die de betekenisvolle uitwisseling van informatie in de zorg ondersteunt. Om ondersteuning aan de verschillende vormen van informatie-uitwisseling in de zorg zelf te kunnen vormgeven, zijn ook verschillende standaarden binnen de HL7 familie ontstaan. In deze bijdrage zal de auteur ingaan op de keuzes die hierbij gemaakt kunnen worden en welke richtlijnen je daarbij zou kunnen hanteren.

The CareRabbit has been introduced as a technological innovation in the care for children, enabling family and friends to stay in touch while the child is hospitalized. This study addresses influence of this innovation on the wellbeing of the children, and uses the validated KINDL questionnaire, eliciting information from children and parents at the end of hospitalization. A baseline and an experimental measurement are compared. The children in the CareRabbit group scored slightly higher on the KINDL questionnaire than children in the control group. For young children (age 4-7) the difference was large. Initial findings indicate that CareRabbit has a positive influence on wellbeing, although sample size and measured differences limit the support for this conclusion. The measured difference suggests that CareRabbit may be more valuable for younger children.

The CareRabbit (ZorgKonijn) is an e-health device that can be used to play messages (e.g. text, MP3) sent through the Internet. It is used in children's departments in hospitals. Its aim is to make children feel comfortable and make their stay more pleasant. Research approach -- During the study, we will conduct a pilot study in five hospital paediatrics departments. We will administer questionnaires about quality of life to admitted children and their parents with a CareRabbit and a control group without a CareRabbit ( N = 200). Also, we will develop a business case to gain insight in the organization and funding of the CareRabbit. This business case will be based on a practice oriented design research with literature research, interviews, and the STOF-model. Findings/Design -- The research is currently in its first phase and this paper presents preliminary results. Our experiences are that the stakeholders are enthusiastic. Moreover, children with the CareRabbit feel more at ease and connected to home and experience their hospital stay as more pleasant. In turn, this could lead to shorter hospital stays. Research limitations/Implications -- The average stay of children in a hospital in the Netherlands is four to five days. Therefore two different groups are compared, instead of measuring the effect of the CareRabbit per child. Because the pilots will only last two to three months, long-term results cannot be elicited from the research findings. Motivation -- Our goal is to investigate the added value of the CareRabbit for children and other stakeholders (e.g. relatives of the child, hospitals, insurance companies) and give advice on how to further develop and implement the CareRabbit (e.g. functionalities, support, organization and distribution).

The developments in the ICT led companies to strive to make parts of the business transaction electronic and raised again the issue of interoperability. Although interoperability between computer systems has been widely addressed in literature, the concept of interoperability between organizations is still to a large extent unexplored. Standards are claimed to help achieving interoperability. However, experience with the implementation of EDI standards shows that many EDI implementation projects led to technical solutions with unclear business benefits. New standards are currently being developed, however their implementation can also lead again to purely technical solution, if the social context is not taken sufficiently into account. In this paper we address the problem on how to identify interoperability problems on a pragmatic level that can occur between organizations that want to carry out business transactions electronically. We also point out that, in order to identify interoperability problems on a pragmatic level, it is necessary to capture the communication requirements of the business parties and to evaluate to what extent a standard is capable to meet these requirements. To perform that evaluation we develop a meta model for describing communication. The meta model is based on theory of speech-act and communicative actions. The use of the meta model to identify interoperability problems on a pragmatic level is illustrated with an example.

Growing cost of health care, the gradual reorganization of health care on a free-market basis and patients evolving into health care consumers all prompt hospitals to gain competitive advantage by improving efficiency, quality of care, and customer friendliness. An electronic health record system (EHR) is one of the tools to achieve these goals. Hospitals are nevertheless lagging behind industry in implementing IT systems to support their core business processes. Eighteen case studies were conducted among Dutch hospitals to examine the EHR system implementation. Through seventy three interviews with key stakeholders, the relation between perceived value of the EHR, the degree of participation in the implementation process, and the resulting quality of EHR systems was investigated. The value that end users expect is not achieved within Dutch hospitals. It was found that no hospital had so far reached third generation EHR functionality, even though several hospitals are actively pursuing it. Innovation with respect to EHR systems in hospitals is limited because of a lack of capabilities, not because of a lack of participation. Extensive and ill-targeted end user involvement tends to delay decision making and exacerbates the mismatch between implementation goals and results. Quality issues focus on information quality in terms of completeness and system quality in terms of reliability. This study contributes in combining participation models with the technology acceptance model and the IS success models. Electronic Health Records can be evaluated with this combination and a prescriptive analysis has lead to practical advice to the Dutch Ministry of Health.

The workshop is organized by HL7 and its affiliates to present and to discuss HL7's activities for providing international standards and specifications to enable advanced semantically interoperable eHealth and pHealth solutions, adaptable to national health systems through localization. The workshop especially focuses on the multi-disciplinary structure of HL7 and its liaisons with international and national standards developing organizations as well as important health informatics initiatives. Demonstrating existing and emerging solutions and strategies within HL7's broad scope and spectrum, the international scope of HL7 standards is highlighted.

Short consultations and a large and growing amount of available medical information make searching for suitable information difficult for general practitioners. Thus information is often not searched for or not found, diminishing the quality of care. We propose a system that offers decision support by combining medical information sources with data from the electronic patient record. A first evaluation shows that a system like Medintel can be a useful supportive tool and can increase the quality of care provided by general practitioners.

Every year, the Dutch Minister of Health promises that by the following year, all citizens in the Netherlands will have an Electronic Health Record (EHR). Until now this promise has not been met. One of the main requirements for realizing a national EHR is an interoperability framework, agreeable to the government, vendors and users. This paper first studies the demand side using the results of twenty two interviews with physicians, asking them about their core processes and their expected value of an EHR. This provides us with the adoption perspective on the EHR market. Next we look at the current EHR market, investigating the suppliers and their achievements and market share. Finally we take a look at the government side with an overview of the interoperability requirements dictated by the national IT-agenda for healthcare. The contribution of this paper is twofold: o First, our main conclusion is that success in the EHR market in the Netherlands is not yet motivated by interoperability requirements. o Second, from a detailed analysis on micro level the following result stands out: A majority of the end users (demand side) do not get support in their relevant working processes.

The developments in the ICT led companies to strive to make parts of the business transaction electronic and raised again the issue of interoperability. Although interoperability between computer systems has been widely addressed in literature, the concept of interoperability between organizations is still to a large extent unexplored. Standards are claimed to help achieving interoperability. However, experience with the implementation of EDI standards shows that many EDI implementation projects led to technical solutions with unclear business benefits. New standards are currently being developed, however their implementation can also lead again to purely technical solution, if the social context is not taken sufficiently into account. In this paper we address the problem on how to identify interoperability problems on a pragmatic level that can occur between organizations that want to carry out business transactions electronically. We also point out that, in order to identify interoperability problems on a pragmatic level, it is necessary to capture the communication requirements of the business parties and to evaluate to what extent a standard is capable to meet these requirements. To perform that evaluation we develop a meta model for describing communication. The meta model is based on theory of speech-act and communicative actions. The use of the meta model to identify interoperability problems on a pragmatic level is illustrated with an example.