title: Formalize clinical processes into electronic health information systems: Modelling a screening service for diabetic retinopathy.
abstract: Most healthcare services use information and communication technologies to reduce and redistribute the workload associated with follow-up of chronic conditions. However, the lack of normalization of the information handled in and exchanged between such services hinders the scalability and extendibility. The use of medical standards for modelling and exchanging information, especially dual-model based approaches, can enhance the features of screening services. Hence, the approach of this paper is twofold. First, this article presents a generic methodology to model patient-centered clinical processes. Second, a proof of concept of the proposed methodology was conducted within the diabetic retinopathy (DR) screening service of the Health Service of Navarre (Spain) in compliance with a specific dual-model norm (openEHR). As a result, a set of elements required for deploying a model-driven DR screening service has been established, namely: clinical concepts, archetypes, termsets, templates, guideline definition rules, and user interface definitions. This model fosters reusability, because those elements are available to be downloaded and integrated in any healthcare service, and interoperability, since from then on such services can share information seamlessly.
authors.affiliation: Department of Electrical and Electronic Engineering, Public University of Navarra, Campus de Arrosadia, 31006 Pamplona, Spain. Electronic address: aitor.eguzkiza@unavarra.es.
authors.forename: Aitor
authors.initials: A
authors.lastname: Eguzkiza
authors.affiliation: Department of Electrical and Electronic Engineering, Public University of Navarra, Campus de Arrosadia, 31006 Pamplona, Spain. Electronic address: jesusdaniel.trigo@unavarra.es.
authors.forename: Jesús Daniel
authors.initials: JD
authors.lastname: Trigo
authors.affiliation: Department of Electrical and Electronic Engineering, Public University of Navarra, Campus de Arrosadia, 31006 Pamplona, Spain. Electronic address: miguel.martinezdeespronceda@unavarra.es.
authors.forename: Miguel
authors.initials: M
authors.lastname: Martínez-Espronceda
authors.affiliation: Department of Electrical and Electronic Engineering, Public University of Navarra, Campus de Arrosadia, 31006 Pamplona, Spain; Institute of Smart Cities - ISC, Public University of Navarra, Campus de Arrosadia, 31006 Pamplona, Spain. Electronic address: lserrano@unavarra.es.
authors.forename: Luis
authors.initials: L
authors.lastname: Serrano
authors.affiliation: Department of Ophthalmology, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain. Electronic address: jose.andonegui.navarro@cfnavarra.es.
authors.forename: José
authors.initials: J
authors.lastname: Andonegui
mesh_terms: D000465:Algorithms; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D003936:Diagnosis, Computer-Assisted / Q000379:methods; D057286:Electronic Health Records / Q000592:standards*; D063005:Health Information Systems / Q000592:standards*; D006801:Humans; D016247:Information Storage and Retrieval; D008403:Mass Screening / Q000379:methods; D008490:Medical Informatics / Q000379:methods* / Q000592:standards*; D018802:Patient-Centered Care; D016730:Program Development; D012160:Retina / Q000473:pathology; D013030:Spain; D018511:Systems Integration; D014584:User-Computer Interface
keywords: Clinical knowledge modelling; Diabetic retinopathy; Dual-model layered architecture; Electronic health record; Ophthalmology; Semantic interoperability