Hi Erik, great news, congratulations from Uruguay!

All the best for the defense (I'm sure you don't need good luck ;)

-- 
Kind regards,
Ing. Pablo Pazos Guti?rrez
http://cabolabs.com

Date: Sun, 27 Jan 2013 16:44:42 +0100
Subject: PhD thesis online: Scalability and Semantic Sustainability in  
Electronic Health Record Systems
From: erik.sundv...@liu.se
To: openehr-clinical at lists.openehr.org; openehr-technical at 
lists.openehr.org; openehr-implementers at lists.openehr.org

Hi!
My thesis entitled "Scalability and Semantic Sustainability in Electronic 
Health Record Systems" is now available online. It contains many 
openEHR-related papers and discussions (see abstract included below).

Permanent link to electronic version of the thesis: 
http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-87702

Public PhD defence will be held the 15:th of February, in Link?ping, Sweden. 
Faculty opponent: prof. Dipak Kalra, UCL.Temporary event-information page: 
http://www.imt.liu.se/~erisu/2013/phd/
(That page also contains a form where you have the possibility to indicate 
interest in online participation or in getting a recording.)Best regards,
Erik Sundvall
erik.sundvall at liu.se http://www.imt.liu.se/~erisu/  Tel: +46-13-286733

Abstract
This work is a small contribution to the greater goal of making software 
systems used in healthcare more useful and sustainable. To come closer to that 
goal, health record data will need to be more computable and easier to exchange 
between systems. 

Interoperability refers to getting systems to work together and semantics 
concerns the study of meanings. If Semantic interoperability is achieved then 
information entered in one information system is usable in other systems and 
reusable for many purposes. Scalability refers to the extent to which a system 
can gracefully grow by adding more resources. Sustainability refers more to how 
to best use available limited resources. Both aspects are important. 

The main focus and aim of the thesis is to increase knowledge about how to 
support scalability and semantic sustainability. It reports explorations of how 
to apply aspects of the above to Electronic Health Record (EHR) systems, 
associated infrastructure, data structures, terminology systems, user 
interfaces and their mutual boundaries. 

Using terminology systems is one way to improve computability and comparability 
of data. Modern complex ontologies and terminology systems can contain hundreds 
of thousands of concepts that can have many kinds of relationships to multiple 
other concepts. This makes visualization challenging. Many visualization 
approaches designed to show the local neighbourhood of a single concept node do 
not scale well to larger sets of nodes. The interactive TermViz approach 
described in this thesis, is designed to aid users to navigate and comprehend 
the context of several nodes simultaneously. Two applications are presented 
where TermViz aids management of the boundary between EHR data structures and 
the terminology system SNOMED CT.

The amount of available time from people skilled in health informatics is 
limited. Adequate methods and tools are required to develop, maintain and reuse 
health-IT solutions in a sustainable way. Multiple levels of modelling 
including a fixed reference model and another layer of flexible reusable 
?archetypes? for domain specific data structures, is an approach with that aim 
used in openEHR and the ISO 13606 standard. This approach, including learning, 
implementing and managing it, is explored from different angles in this thesis. 
An architecture applying Representational State Transfer (REST) to 
archetype-based EHR systems, in order to address scalability, is presented. 
Combined with archetyping this architecture also aims at enabling a sustainable 
way of continuously evolving multi-vendor EHR solutions. An experimental open 
source implementation of it, aimed for learning and prototyping, is also 
presented. 

Manually changing database structures used for storage every time new versions 
of archetypes and associated data structures are needed is likely not a 
sustainable activity. Thus storage systems that can handle change with minimal 
manual interventions are desirable. Initial explorations of performance and 
scalability in such systems are also reported.

Graphical user interfaces focused on EHR navigation, time-perspectives and 
highlighting of EHR content are also presented ? illustrating what can be done 
with computable health record data and the presented approaches. 

Desirable aspects of semantic sustainability have been discussed, including: 
sustainable use of limited resources (such as available time of skilled 
people), and reduction of unnecessary risks. A semantic sustainability 
perspective should be inspired and informed by research in complex systems 
theory, and should also include striving to be highly aware of when and where 
technical debt is being built up. Semantic sustainability is a shared 
responsibility.

The combined results presented contribute to increasing knowledge about ways to 
support scalability and semantic sustainability in the context of electronic 
health record systems. Supporting tools, architectures and approaches are 
additional contributions.



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