This paper presents a Peer to Peer (P2P) agent coordination framework for the exchange of Electronic Health Records (EHR) between health organisations that comply with the existing interoperability standards as proposed by the Integrating Healthcare Enterprise (IHE).

1. Institute of Applied Sciences of Western
Switzerland
V. Urovi, A. Olivieri, S. Bromuri, N. Fornara and M.
Schumacher
A Peer to Peer Agent Coordination
Framework for IHE
based Cross-Community Health Record
Exchange
vendredi, 5 avril 13

2. Applied Intelligent Systems Lab
AISLab – aislab.hevs.ch
eHealth Topics:
Interoperability
Monitoring of chronic diseases
Multi-parametric data analysis
Diagnosis help for General Practitioners
vendredi, 5 avril 13

3. Research Question
• How to enable the
dynamic exchange of
electronic health records
(EHR) of patients beyond
the health organisation
level?
vendredi, 5 avril 13

4. We answer it by
• Extending the existing IHE profiles with a solution for
dynamically discovering and connecting with other
health institutions;
• Using semantic description of data to facilitate the
interpretation and sharing of data between the different
health institutions;
• Connecting health communities in a scalable solution
that uses a P2P based model;
• Automatizing the collection of EHRs by using a
coordination model between communities that is based
on a multi-agent platform.
vendredi, 5 avril 13

5. IHE – Integrating the Healthcare
Enterprise http://www.ihe.net
• Non profit organization composed of
healthcare industry professionals
• Combines standards into specifications
(named Profiles) targeted at solving specific
medical use-cases
• The Swiss strategy recommends the use
of Integrating the Healthcare Enterprise
(IHE) and its profiles to make medical
information systems interoperable
vendredi, 5 avril 13

6. IHE Exchange Profiles
• XDS - Cross Enterprise Document Sharing
• Enables health organisations to share patient-relevant
documents by storing and retrieving them from a central
registry;
• XCA -Cross-Community Access
• Defines how medical data held by other communities can
be queried and retrieved;
• XCPD - Cross-Community Patient Discovery
• Locates communities that hold patient's relevant health
data and translate patient's identifiers across communities
holding the same patient's data.
vendredi, 5 avril 13

7. Example: the XDS profile
Actor
Document Query Document Document
Transaction Registry Consumer
Register Document Set
Provide&Register Retrieve Document
Document Document Set Document
Source Repository
vendredi, 5 avril 13

8. Limitations of these IHE profiles
• XDS does not resolve document sharing among
different health communities;
• XCA requires communities to have pre-
established agreements and knowledge of one
another;
• XCPD does not automatise the discovery of
communities and it still requires communities to
have pre-established agreements for exchanging
the documents.
vendredi, 5 avril 13

9. To address IHE limitations
• We define an IHE and agent-based coordination
model that supports communities to dynamically
connect to one another.
• We also specify an ontology that may be used to
define the knowledge base of every community.
• To model and implement this semantic
coordination layer, we use the coordination
framework TUCSON.
vendredi, 5 avril 13

10. Semantic Tuple Centers in TuCSoN
• TuCSoN is an agent coordination infrastructure where:
• Agents interact performing in/out/rd operations on semantic tuple centers.
• Tuples are read and retrieved associatively using tuple templates.
• Semantic tuple centers are modeled using OWL Web Ontology Language
• Semantic tuple centers: reaction(action, guard, react).
Where: action= in/out/rd a Semantic Tuple
guard= internal/external action and pre/post react
• Are hosted in distributed nodes react= logics+in/out/rd of Semantic Tuple
• Can perform out/in/rd towards other tuple centres.
• The behavior of tuple centers is programmable in the ReSpecT language:
vendredi, 5 avril 13

11. The Architecture
a) Logic Architecture of a Community
Legend
COMMUNITY/Node Publish/Subscribe/Notify/Search
operations
Community/Node
Policy
Tuple Center Tuple Center
Agent
Log Agent Update Agent
Search Agent b) The P2P structure between Communities
Node
Node Node
Node
Node
P2P
NETWORK
Node Node
vendredi, 5 avril 13

12. Policy Tuple Centre Coordination
• Every community maintains a semantic
knowledge of patients and their EHRs and
• Can share patient related data in the P2P;
• Can search data in the P2P;
• Can directly query and subscribe to
updates happening in the knowledge bases of
other communities;
• Can propagate updates on patient’s EHRs.
vendredi, 5 avril 13

13. Semantic Knowledge Base
Datatype Object ∐
Class Union
Property Property
identifier
identifier name
assumes address
name
Role
Role Actor
Actor profession
activities
complies speciality
contact
identifier
relates name follows
∐ Policy
Policy
category member
description
hasHomeCommunity identifier
name
identifier cares address
name Patient
Patient Community
Community
father
address children
subscribe
home has provides
identifier identifier
date name
Document
Document status Service
Service
link
author description
attachment
vendredi, 5 avril 13

14. Searching EHR data
• Health communities can search patient data
in other communities by:
• querying the P2P network about the community
that holds the data of a patient and
• sending a request query to that community
• Subscriptions and update propagations are
treated similarly
vendredi, 5 avril 13

15. Results
 
       
       





  
  






 
             
     
Patient Search Community Search
vendredi, 5 avril 13

16. Conclusions
• We proposed a distributed coordination framework
to dynamically exchange EHR
• The proposed coordination mechanisms that go
beyond the current IHE solutions
• In future works we will focus on defining:
• Security mechanisms for P2P based health record exchange.
• A sophisticated publish-subscribe model based on complex event patterns
• Complex reasoning and deductions over semantic data
vendredi, 5 avril 13

17. Thank you
Any Questions?
vendredi, 5 avril 13

18. vendredi, 5 avril 13

19. Implementation
Legend
System
Certifying body Certification Authority Agent
Logic
Connection
Reasoner
Query Lang.
DomainAuthority Jena Library
Peer Data Base
Community
Component
User
Agent
P2P
NETWORK
OpenXDS OpenXDS
OWL OWL
Jena Post
Jena Post
PTC SPARQL PTC SPARQL gre
gre
SQL Pellet SQL
TuCSoN
Pellet TuCSoN
Community Community
vendredi, 5 avril 13