Updated: Feb 1, 97
NUCLEUS

Project Code:   A2025 Project value:   2231 KECU EC contribution:   2141 KECU No of partners:   12 No of countries:   5 Duration:   36 months

Contact: Prof. Dr. Albert van der Werff Groupe RICHE S.C. c/o VanderWerff Consult B.V. Vrouwgeestweg 20 NL-2481 KN Woubrugge, The Netherlands Tel.: +31-17-29.89.10 Fax: +31-17-29.92.04

Overview

Purpose and objectives

The most essential innovation of the previous RICHE project was the development of the (intelligent) Act Management concept. Aspects of this concept, as applied in the NUCLEUS project, are described in several parts of the NUCLEUS Public Final Report. Act Management is a major tool to structure the primary processes of producing and delivering healthcare to patients (including work flow management), and to facilitate inter professional communication and co-operative working between healthcare providers.

Key element of the NUCLEUS solution has been the association of one or more components of the electronic patient dossier with each change of status (`event') in the life cycle of actual acts. Each of such components (derived from templates, duly configured, customised and applied) can contain administrative and/or professional patient data, together with methods, tools and/or associations to manipulate these data, and with (semantic) links from these data to other relevant dossier components. In order to turn a large, heterogeneous and distributed set of EPR components into a seemingly integrated and homogeneous dossier, NUCLEUS has introduced the concept of the Patient Reference Dossier.

On one hand, this PRD concept integrates the dossier components. On the other hand, it provides aggregation and navigation facilities (which, in turn, can be fully configured and customised) in order to assist in the appropriately personalised utilisation of the dossier by the respective healthcare providers. In this context, special attention has been given to the identification of the patients, and of the associated (normally precisely one) electronic patient dossier.

Through the application of advanced technology, NUCLEUS has replaced the hitherto prohibitive level of standardisation by radical configuration and customisation facilities. Hence, only few basic concepts (universal by nature) need to be standardised. This is particularly important when turning the integrated dossier into a `personalised' dossier, which the individual healthcare provider perceives as exactly matching his or her preferred modus operandi. NUCLEUS has developed and implemented advanced View Management features to achieve this. One of the previously prohibitive types of standardisation is that of specifying the professional activities when delivering patient care, and the associated patient dossier components.

NUCLEUS has developed and implemented, through Performer Act Customisation, advanced facilities, which allow the respective (individual and/or categories of) healthcare providers to register the characteristics and protocols of their primary processes, and the templates, according to which they want their professional activities be documented in the EPR. (In addition to paper patient dossiers, these templates can perfectly describe the incorporation of multimedia data in the dossier, like sound samples, bio-signals, images, etc.) Performer Act Customisation subsequently ensures, that any other healthcare provider, co-operating with the `owner' of a certain class of acts and templates, will have access to and utilise the act and template specifications, provided by that `owner'. Finally, NUCLEUS has identified and implemented the special requirements on security, integrity and robustness, associated with an advanced integrated EPR. Through Professional Information Administration, these facilities have been developed, and in particular the resulting Security Manager has taken a flexible and practical approach, which has found recognition well beyond the NUCLEUS project alone.

Results

• Three working systems, implementing an integrated patient dossier solution in the respective practical environments of three major European hospitals.
• Integrated patient dossier services, integrated and delivered on a variety of platforms, including all operational and configuration / customisation facilities.

The respective component modules to build such integrated patient dossier services, i.e. PAC (Performer Act Customisation), AC/VM (Access Customisation / View Manager), KMT (Knowledge Management Tools, incl. navigation facilities), PRD (Patient Reference Dossier), PID (Patient and dossier Identification), Securer (security control service), Messenger (message communication service), as well as several enhanced supporting component modules, i.e. ALCM (Act Life Cycle Management), AIRS/IW (dossier and document repository), etc. Hence, the NUCLEUS results have been implemented (and need to be operated) on top of an enhanced RICHE platform. These results, strictly in line with the axiomatic of the RICHE framework, have all been developed and implemented on the basis of open, modular, client-server inter working of components. Complete portability has been achieved by means of advanced configuration facilities. Optimum end-user significance has been achieved by means of extensive customisation capabilities.

The conceptual results include:

• A complete architecture specification of the NUCLEUS patient dossier solution, conformant to ODP standards, and compatible with the emerging group of RICHE, NUCLEUS, SHINE, TRILOGY, ... framework (reference) architectures.
• An extensive set of conceptual models, underlying the NUCLEUS patient dossier solution, compatible with the RICHE framework conceptual models, as well as with the UK NHS Common Basic Specification.
• A sound initial analysis of the usage of patient dossiers by different categories of healthcare professional users, and of the associated user requirements for an integrated electronic patient dossier.
• The concept of the PRD (Patient Reference Dossier), which allows the seeming integration into homogeneity of the distributed and physically heterogeneous components of the patient dossier (even beyond electronic components, following hypermedia capabilities), as well as the full configuration and customisation of the vertical structure and aggregation of the patient dossier. Moreover, state-of-the-art patient and dossier identification functions are provided, often (to be) integrated with already existing PAS (Patient Administration Services) applications.
• The concept of the PAC (Performer Act Customisation), which allows the full configuration and customisation by means of templates of the horizontal contents of the patient dossier, in such a way, that anybody accessing a pre-defined protocol or set of acts, will automatically be made (or suggested) to apply the correct rules and formats.
• The concept of the AC (Access Customisation) (also called: VM - View Management), which allows the navigation through the (semantic network of) the patient dossier, retrieving, transforming and presenting patient data as per the precise individual requirements of the requester. AC allows the creation of structural views onto the integrated electronic patient dossier (for example, the electronic nursing dossier as a structural view of the integrated electronic patient dossier), as well as ad-hoc views onto one or more patient dossiers (including investigative research, epidemiology, etc.).
• The concept of the PIA (Professional Information Administration), which provides a set of services that create and maintain a secure, robust and reliable environment in which the often sensitive data of the electronic patient dossier can be maintained. Apart from numerous specific services, PIA has developed a novel, very flexible and effective security concept (the NUCLEUS Securer service), and a healthcare professional message exchange facility (the NUCLEUS Messenger service). The above concepts have been specified prior to the development of the respective component modules. Their specification aim, based on thorough analysis of the utilisation aspects of electronic patient records, was directed towards the immediate development of a set of components, which could prove the feasibility and demonstrate the viability of the NUCLEUS solution. These concepts are, at the same time, the starting point for incorporation of the integrated electronic patient dossier in the overall RICHE framework. This incorporation, which was always envisaged in NUCLEUS, but not specifically prepared, will take place beyond the NUCLEUS project, by Groupe RICHE, as the custodian of the RICHE framework. The NUCLEUS consortium has demanded from Groupe RICHE a suitable acceptance process, in order to obtain Groupe RICHE's qualification of the NUCLEUS results, and a commitment for adequate resources to achieve full incorporation, upon proven acceptability of the end-of-NUCLEUS results. The Groupe RICHE Technical Committee and Executive Board have accepted these demands.

Exploitation of the NUCLEUS results takes place in three directions:

• the hospitals will base their IT&T strategies on the expertise gained with the experimentation of the NUCLEUS results (see West Middlesex University Hospital as a good example of such a strategy)
• the French group of suppliers (BULL, IIRIAM and SAPHIS) have launched an initiative to industrialise, commercialise and deliver NUCLEUS-based solutions
• IMS in Ireland is integrating the NUCLEUS results into its products and services offered in their market
• Anglo-Dutch-German perspectives for the industrialisation of a NUCLEUS-based offering are expected to materialise in the second half of 1995
• the NUCLEUS results will be incorporated (at global level and at detailed technical level) in the RICHE Framework, and thus be disseminated in the integrated context of this de facto industry standards for open, modular, patient-centred healthcare information systems.

As a result of the NUCLEUS project, West Middlesex University Hospital and others in the UK have or are about to structure their local IT strategies around the act management, client server principles that NUCLEUS proposed. Our intention at West Mid is to cease purchase of departmental systems and develop, in conjunction with European partners, the servers and the applications that will support the patient process and our business with the view that for the first time systems will be working to support the professional both at a clinical and at managerial level.

List of Deliverables

Year 1

• Overall & First year workplan (2/R/I)
• Basic architectural concepts (architecture base document) (3/R/I)
• Business analysis, state of the art, business/end-user requirements (6/S/R)
• End-user architecture, version 1 (9/S/P)
• Quality assurance & integration strategy plan (12/R/I)

Year 2

• Computational models (2/S/I)
• Conceptual models (7/S/I)
• Engineering models (7/S/P)
• Integrated prototype (12/P/I)

Year 3

• Final scientific report. Validation & end-user acceptance (12/R/R)

List of Participants

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