Improving the efficiency with which clinical research studies are conducted can lead to faster medication innovation and decreased time to market for new drugs. To increase this efficiency, the parties involved in a regulated clinical research study, namely, the sponsor, the clinical investigator and the regulatory body, each with their own software applications, need to exchange data seamlessly. However, currently, the clinical research and the clinical care domains are quite disconnected because each use different standards and terminology systems. In this article, we describe an initial implementation of the Semantic Framework developed within the scope of SALUS project to achieve interoperability between the clinical research and the clinical care domains. In our Semantic Framework, the core ontology developed for semantic mediation is based on the shared conceptual model of both of these domains provided by the BRIDG initiative. The core ontology is then aligned with the extracted semantic models of the existing clinical care and research standards as well as with the ontological representations of the terminology systems to create a model of meaning for enabling semantic mediation. Although SALUS is a research and development effort rather than a product, the current SALUS knowledge base contains around 4.7 million triples representing BRIDG DAM, HL7 CDA model, CDISC standards and several terminology ontologies. In order to keep the reasoning process within acceptable limits without sacrificing the quality of mediation, we took an engineering approach by developing a number of heuristic mechanisms. The results indicate that it is possible to build a robust and scalable semantic framework with a solid theoretical foundation for achieving interoperability between the clinical research and clinical care domains.

Interoperability in eHealth systems is important for delivering quality healthcare and reducing healthcare costs. Some of the important use cases include coordinating the care of chronic patients by enabling the co-operation of many different eHealth systems such as Electronic Health Record Systems (EHRs), Personal Health Record Systems (PHRs) and wireless medical sensor devices; enabling secondary use of EHRs for clinical research; being able to share life long EHRs among different healthcare providers. Although achieving eHealth interoperability is quite a challenge both because there are competing standards and clinical information itself is very complex, there have been a number of successful industry initiatives such as Integrating the Healthcare Enterprise (IHE) Profiles, as well as large scale deployments such as the National Health Information System of Turkey and the epSOS initiative for sharing Electronic Health Records and ePrescriptions in Europe. This article briefly describes the subjects discussed in the VLDB 2012 tutorial to provide an overview of the issues in eHealth interoperability describing the key technologies and standards, identifying important use cases and the associated research challenges and also describing some of the large scale deployments. The aim is to foster further interest in this area.

Medical devices are essential to the practice of modern healthcare services. Their benefits will increase if clinical software applications can seamlessly acquire the medical device data. The need to represent medical device observations in a format that can be consumable by clinical applications has already been recognized by the industry. Yet, the solutions proposed involve bilateral mappings from the ISO/IEEE 11073 Domain Information Model (DIM) to specific message or document standards. Considering that there are many different types of clinical applications such as the electronic health record and the personal health record systems, the clinical workflows, and the clinical decision support systems each conforming to different standard interfaces, detailing a mapping mechanism for every one of them introduces significant work and, thus, limits the potential health benefits of medical devices. In this paper, to facilitate the interoperability of clinical applications and the medical device data, we use the ISO/IEEE 11073 DIM to derive an HL7 v3 Refined Message Information Model (RMIM) of the medical device domain from the HL7 v3 Reference Information Mode (RIM). This makes it possible to trace the medical device data back to a standard common denominator, that is, HL7 v3 RIM from which all the other medical domains under HL7 v3 are derived. Hence, once the medical device data are obtained in the RMIM format, it can easily be transformed into HL7-based standard interfaces through XML transformations because these interfaces all have their building blocks from the same RIM. To demonstrate this, we provide the mappings from the developed RMIM to some of the widely used HL7 v3-based standard interfaces.

Providing an interoperability infrastructure for Electronic Healthcare Records (EHRs) is on the agenda of many national and regional eHealth initiatives. Two important integration profiles have been specified for this purpose, namely, the "Integrating the Healthcare Enterprise (IHE) Cross-enterprise Document Sharing (XDS)" and the "IHE Cross Community Access (XCA)." IHE XDS describes how to share EHRs in a community of healthcare enterprises and IHE XCA describes how EHRs are shared across communities. However, the current version of the IHE XCA integration profile does not address some of the important challenges of cross-community exchange environments. The first challenge is scalability. If every community that joins the network needs to connect to every other community, i.e., a pure peer-to-peer network, this solution will not scale. Furthermore, each community may use a different coding vocabulary for the same metadata attribute, in which case, the target community cannot interpret the query involving such an attribute. Yet another important challenge is that each community may (and typically will) have a different patient identifier domain. Querying for the patient identifiers in the target community using patient demographic data may create patient privacy concerns. In this paper, we address each of these challenges and show how they can be handled effectively in a superpeer-based peer-to-peer architecture.

Effective use of electronic healthcare records (EHRs) has the potential to positively influence both the quality and the cost of health care. Consequently, sharing patient's EHRs is becoming a global priority in the healthcare information technology domain. This paper addresses the interoperability of EHR structure and content. It describes how two different EHR standards derived from the same reference information model (RIM) can be mapped to each other by using archetypes, refined message information model (R-MIM) derivations, and semantic tools. It is also demonstrated that well-defined R-MIM derivation rules help tracing the class properties back to their origins when the R-MIMs of two EHR standards are derived from the same RIM. Using well-defined rules also enable finding equivalences in the properties of the source and target EHRs. Yet an R-MIM still defines the concepts at the generic level. Archetypes (or templates), on the other hand, constrain an R-MIM to domain-specific concepts, and hence, provide finer granularity semantics. Therefore, while mapping clinical statements between EHRs, we also make use of the archetype semantics. Derivation statements are inferred from the Web Ontology Language definitions of the RIM, the R-MIMs, and the archetypes. Finally, we show how to transform Health Level Seven clinical statement instances to EHRcom clinical statement instances and vice versa by using the generated mapping definitions.

Clinical guidelines are developed to assist healthcare practitioners to make decisions on patient's medical problems, and as such they communicate with external applications to retrieve patient data to initiate medical actions through clinical workflows, and transmit information to alert/reminder systems. The interoperability problems in the healthcare information technology domain prevent wider deployment of clinical guidelines because each deployment requires a tedious custom adaptation phase. In this paper, we provide machine-processable mechanisms that express the semantics of clinical guideline interfaces so that automated processes can be used to access the clinical resources for guideline deployment and execution. To be able to deploy the semantically extended guidelines to healthcare settings semiautomatically, the underlying application's semantics must also be available. We describe how this can be achieved based on two prominent implementation technologies in use in the eHealth domain: integrating healthcare enterprise cross-enterprise document sharing integration profile for discovering and exchanging electronic healthcare records and Web service technology for interacting with the clinical workflows and wireless medical sensor devices. The system described in this paper is realized within the scope of the SAPHIRE Project.

Health Level Seven (HL7) is a prominent messaging standard in the eHealth domain, and with HL7 v2, it addresses only the messaging layer. However, HL7 implementations also deal with the other layers of interoperability, namely the business process layer and the communication layer. This need is addressed in HL7 v3 by providing a number of normative transport specification profiles. Furthermore, there are storyboards describing HL7 v3 message choreographies between specific roles in specific events. Having alternative transport protocols and descriptive message choreographies introduces great flexibility in implementing HL7 standards, yet, this brings in the need for test frameworks that can accommodate different protocols and permit the dynamic definition of test scenarios. In this paper, we describe a complete test execution framework for HL7-based systems that provides high-level constructs allowing dynamic set up of test scenarios involving all the layers in the interoperability stack. The computer-interpretable test description language developed offers a configurable system with pluggable adaptors. The Web-based GUIs make it possible to test systems over the Web anytime, anywhere, and with any party willing to do so.

As a response to the challenge of providing high-quality healthcare services with reasonable costs while the elderly population and the associated chronic diseases increase, SAPHIRE architecture provides an intelligent healthcare monitoring architecture. The monitoring of patients is achieved through a clinical decision support system based on clinical guidelines. SAPHIRE provides the necessary interoperability layers to access the patient's vital signs from wireless medical sensors and the electronic healthcare records of the patient in order to exploit them in the decision process seamlessly. This architecture is presented through two pilot applications: one for the bedside monitoring of cardiac patients at hospitals, and the other for homecare monitoring of the cardiac patients rehabilitated after a revascularisation therapy.

Integrating healthcare enterprise (IHE) specifies integration profiles describing selected real world use cases to facilitate the interoperability of healthcare information resources. While realizing a complex real-world scenario, IHE profiles are combined by grouping the related IHE actors. Grouping IHE actors implies that the associated business processes (IHE profiles) that the actors are involved must be combined, that is, the choreography of the resulting collaborative business process must be determined by deciding on the execution sequence of transactions coming from different profiles. There are many IHE profiles and each user or vendor may support a different set of IHE profiles that fits to its business need. However, determining the precedence of all the involved transactions manually for each possible combination of the profiles is a very tedious task. In this paper, we describe how to obtain the overall business process automatically when IHE actors are grouped. For this purpose, we represent the IHE profiles through a standard, machine-processable language, namely, Organization for the Advancement of Structured Information Standards (OASIS) ebusiness eXtensible Markup Language (ebXML) Business Process Specification (ebBP) Language. We define the precedence rules among the transactions of the IHE profiles, again, in a machine-processable way. Then, through a graphical tool, we allow users to select the actors to be grouped and automatically produce the overall business process in a machine-processable format.

One of the key problems in healthcare informatics is the inability to share patient records across enterprises. To address this problem, an important industry initiative called "integrating the healthcare enterprise (IHE)" specified the "cross enterprise document sharing (XDS)" profile. In the IHE XDS, healthcare enterprises that agree to work together form a "clinical affinity domain" and store healthcare documents in an ebXML registry/repository architecture to facilitate their sharing. The affinity domains also agree on a common set of policies such as coding lists to be used to annotate clinical documents in the registry/repository and the common schemes for patient identification. However, since patients expect their records to follow them as they move from one clinical affinity domain to another, there is a need for affinity domains to be federated to enable information exchange. In this paper, we describe how IHE XDS can be enhanced to support federated clinical affinity domains. We demonstrate that federation of affinity domains are facilitated when ontologies, rather than coding term lists, are used to annotate clinical documents. Furthermore, we describe a patient identification protocol that eliminates the need to keep a master patient index file for the federation.

Currently, clinical information is stored in all kinds of proprietary formats through a multitude of medical information systems available on the market. This results in a severe interoperability problem in sharing electronic healthcare records. To address this problem, an industry initiative, called "Integrating Healthcare Enterprise (IHE)" has specified the "Cross Enterprise Document Sharing (XDS)" Profile to store healthcare documents in an ebXML registry/ repository to facilitate their sharing. Through a separate effort, IHE has also defined interdepartmental Workflow Profiles to identify the transactions required to integrate information flow among several information systems. Although the clinical documents stored in XDS registries are obtained as a result of executing these workflows, IHE has not yet specified collaborative healthcare processes for the XDS. Hence, there is no way to track the workflows in XDS and the clinical documents produced through the workflows are manually inserted into the registry/ repository. Given that IHE XDS is using the ebXML architecture, the most natural way to integrate IHE Workflow Profiles to IHE XDS is using ebXML Business Processes (ebBP). In this paper, we describe the implementation of an enhanced IHE architecture demonstrating how ebXML Business Processes, IHE Workflow Profiles and the IHE XDS architecture can all be integrated to provide collaborative business process support in the healthcare domain.

Today's Internet based businesses need a level of interoperability which will allow trading partners to seamlessly and dynamically come together and do business without ad hoc and proprietary integrations. Such a level of interoperability involves being able to find potential business partners, discovering their services and business processes, and conducting business "on the fly". This process of dynamic interoperation is only possible through standard B2B frameworks. Indeed a number of B2B electronic commerce standard frameworks have emerged recently. Although most of these standards are overlapping and competing, each with its own strenghts and weeknesses, a closer investigation reveals that they can be used in a manner to complement one another.In this paper we describe such an implementation where an ebXML infrastructure is developed by exploiting the Universal Description, Discovery and Integration (UDDI) registries and RosettaNet Partner Interface Processes (PIPs). ebXML is an ambitious effort and produced detailed specifications of an infrastructure both for B2B and B2C e-commerce. However a public ebXML compliant registry/repository mechanism is not available yet. On the other hand, UDDI's approach to developing a registry has been a lot simpler and public registries are available. In ebXML, trading parties collaborate by agreeing on the same business process with complementary roles. Therefore there is a need for standardized business processes. In this respect, exploiting the already developed expertise through RosettaNet PIPs becomes indispensable. We show how to create and use ebXML "Binary Collaborations" based on RosettaNet PIPs and provide a GUI tool to allow users to graphically build their ebXML business processes by combining RosettaNet PIPs. In ebXML, trading parties reveal essential information about themselves through Collaboration Protocol Profiles (CPPs). To conduct business, an agreement between parties is necessary and this is expressed

In this article we address delivering highly personalized context sensitive (i.e., time and location dependent) information to mobile clients. We believe providing highly personalized information to mobile clients from a variety of resources like e-mail servers, Web servers, and content providers will be an important service. Mobile network operators can play a major role in delivering this information to users by being strategically positioned between customers and content/service providers. Currently, many mobile network operators (MNO) and software companies are offering some personalized services. However the level of personalization is limited to choosing from available content links, icons and services. We believe that the mobile clients will benefit from a much higher level of personalization where it is possible to express complex queries involving a variety of data resources. For such a system to gain acceptance by the users, the process of defining personalized information (that is, user profiles) must be very easy for the user. The most important objective of such systems should be to provide scalability, that is, acceptable performance when the number of users increases dramatically. The article also elaborates on the nature of location dependent services.

MARIFlow System [1] provides for automating and monitoring the flow of control and data over the Internet among different organizations, thereby creating a platform necessary to describe higher order processes involving several organizations and companies. The architecture is general enough to be applied to any business practice where data flow among different industries and cooperations and the invocation of activities follow a pattern that can be described through a process definition. The example application provided within the scope of this project is on maritime industry A MARIFlow process is executed through cooperating agents, called MARCAs (MARIFlow Cooperating Agents) that are automatically initialized at each site that the process executes. MARCAs handle the activities at their site, provide for coordination with other MARCAs in the system by routing the documents in electronic form according to the process description, keeping track of process information, and providing for the security and authentication of documents as well as comprehensive monitoring facilities. More specifically, the functionality provided by the system is as follows: ¯ A declarative means to specify the control of document flow over the Internet where it is possible to define the source of data, its control flow and the activities that make use of this data. ¯ A fully distributed execution architecture achieved through cooperating agents over the Internet. The agents know about other agents that they need to communicate with and preserve their state during communication. They also manage local information for monitoring purposes and for recovering from failures. ¯ Communicating with inside firewall applications. A MARCA can activate in-house activities automati-

Workflows are activities involving the coordinated execution of multiple tasks performed by different processing entities, mostly in distributed heterogeneous environments, which are very common in enterprises of even moderate complexity. In current commercial workflow systems, the workflow scheduler is a single centralized component. A distributed workflow enactment service, on the other hand, should contain several schedulers on different nodes of a network, each executing a part of the process instances. Such an architecture would fit naturally into the distributed heterogeneous environments. Further advantages of a distributed enactment service are failure resiliency and increased performance, since a centralized scheduler is a potential bottleneck. In this paper, we present the design and implementation of a distributed workflow enactment service based on the work of M. Singh (1996). By starting with a block-structured workflow specification language, we avoid a very general set of dependencies and their related problems. In this way, it is possible to present a simple algorithm for the distributed scheduling of process instances. Further benefits of the approach are the ease of testing and debugging the system, and the execution efficiency through having a reduced number of messages.

A DistributedObject Management (DOM) architecture, when used as the infrastructure of a multidatabase system, not only enables easy and flexible interoperation of D13MSS, but also facilitates interoperation of the multidatabase system with other repositories that do not have DIBMS capabilities.Thk is an important advantage, since most of data still resides on repositories that do not have DIBMS capabilities.In thk paper, we describe a dynamic query optimization technique for a multidatabaae system, namely MIND, implement ed on a DOM environment.Dynamic query optimization, which schedules intersite operations at runtime, fits better to such an environment since it benefits from location transparency provided by the DOM framework.In thk way, the dynamic changes in the configuration of system resources such as a relocated DBMS or a new mirror to an existing DBMS, do not affect the optimized query execution in the system.Furthermore, the uncertainty in estimating the appearance times (i.e., the execution time of the global @ 199(j ACM @89791 +73+/9fj/l 1 ..$3 .5~117 experiments indicate that the dynamic query optimization technique presented in thk paper has a better performance.

No abstract available.

A method called optimistic method with dummy locks (ODL) is suggested for concurrency control in distributed databases. It is shown that by using long-term dummy locks, the need for the information about the write sets of validated transactions is eliminated and, during the validation test, only the related sites are checked. The transactions to be aborted are immediately recognized before the validation test, reducing the costs of restarts. Usual read and write locks are used as short-term locks during the validation test. The use of short-term locks in the optimistic approach eliminates the need for the system-wide critical section and results in a distributed and parallel validation test. The performance of ODL is compared with strict two-phase locking (2PL) through simulation, and it is found out that for the low conflict cases they perform almost the same, but for the high conflicting cases, ODL performs better than strict 2PL.>

Generalized Expert System for Database Design (GESDD) is a compound expert system made up of two parts: (1) an expert system for generating methodologies for database design, called ESGM; and (2) an expert system for database design, called ESDD. ESGM provides a tool for the database design expert to specify different design methodologies or to modify existing ones. The database designer uses ESDD in conjunction with one of these methodologies to design a database starting from the requirement specification phase and producing a logical schema in one of the well-known data models, namely, the hierarchical data model, the network data model, or the relational data model. The system is evolutive in the sense that an existing methodology can be modified or a novel methodology can be added to the existing ones. GESDD is a menu-driven system and it is coded in Prolog.>

A method for concurrency control in distributed database management systems that increases the level of concurrent execution of transactions, called ordering by serialization numbers (OSN), is proposed. The OSN method works in the certifier model and uses time-interval techniques in conjunction with short-term locks to provide serializability and prevent deadlocks. The scheduler is distributed, and the standard transaction execution policy is assumed, that is, the read and write operations are issued continuously during transaction execution. However, the write operations are copied into the database only when the transaction commits. The amount of concurrency provided by the OSN method is demonstrated by log classification. It is shown that the OSN method provides more concurrency than basic timestamp ordering and two-phase locking methods and handles successfully some logs which cannot be handled by any of the past methods. The complexity analysis of the algorithm indicates that the method works in a reasonable amount of time.>

The design and implementation of a generalized database management system based on the RAP database machine is described. The GDBMS architecture, while is similar to the ANSI/SPARC view, has differences in the interpretation of its physical levels. The E/R model is chosen as the Meta Data Model (Conceptual Schema) which generates external model interfaces consisting of the relational, network, and hierarchical models. The SEQUEL, LSL, MRI --- like languages are supported at these interfaces. Structural and operational transformations from the external interfaces into the corresponding constructs of the RAP database machine have been implemented. The RAP DBMS assembler is found to be an efficient facility for language translation and in realizing common operational transformations. It performs these transformations in a way that preserves database consistency.