Electronic transfer of healthcare record information between heterogeneous systems raises the need for healthcare information standards. Such standards improve the level of quality that healthcare organizations offer and also control the expenditure on healthcare services provided by these organizations. There are a large number of healthcare related applications that effectively support specific needs but are isolated or incompatible. There is an urgent need to integrate those applications or to interoperate between them, ensuring security concepts. The cost is another crucial aspect that should be considered in the integration of already implemented systems and the design of new systems. This paper aims to give a description of the current developed standards that can be used to provide interoperability in healthcare information systems and to make a short comparison between these standards, including the following: HL7, HL7’s CCOW, CEN/TC251 Healthcare Information System Architecture Standard. This paper also discusses a solution that is being developed in the Citizen Health System (CHS) project to achieve integration of data using a healthcare informatics standard. A test scenario to make some of the project’s modules visually interoperate is also implemented.

A reliability model for a health care domain based on requirement analysis at the early stage of design of regional health network (RHN) is introduced. RHNs are considered as systems supporting the services provided by health units, hospitals, and the regional authority. Reliability assessment in health care domain constitutes a field-of-quality assessment for RHN. A novel approach for predicting system reliability in the early stage of designing RHN systems is presented in this paper. The uppermost scope is to identify the critical processes of an RHN system prior to its implementation. In the methodology, Unified Modeling Language activity diagrams are used to identify megaprocesses at regional level and the customer behavior model graph (CBMG) to describe the states transitions of the processes. CBMG is annotated with: 1) the reliability of each component state and 2) the transition probabilities between states within the scope of the life cycle of the process. A stochastic reliability model (Markov model) is applied to predict the reliability of the business process as well as to identify the critical states and compare them with other processes to reveal the most critical ones. The ultimate benefit of the applied methodology is the design of more reliable components in an RHN system. The innovation of the approach of reliability modeling lies with the analysis of severity classes of failures and the application of stochastic modeling using discrete-time Markov chain in RHNs.

This chapter presents an abstract view of the regional health information networks (RHN). A presentation of the architecture and structures of the RHN is included. It also reveals the need for integration of information in the framework of a RHN and key issues for the applicability of health information standards to achieve interoperable health care organizations which are the stakeholders of the RHN are presented. Furthermore, a list of case studies for the implementation of RHN in health systems in European, as well as non-European countries, such as the U.S., Canada, New Zealand, and Australia are demonstrated. Finally, important areas to focus when evaluating RHN are described. The authors hope that the abstract view of RHN would assist in the understanding of the key areas when building regional health networks.

Legal interoperability constitutes a prerequisite for the provision of high-quality cross border e-health services, like ePrescription and ePatientSummary. A review of EU legislation, policy initiatives and relevant judgments of the European Court of Justice (ECJ) and the European Court of Human Rights (ECHR) was held, concerning personal medical data. Four European social welfare systems, according to Esping – Andersen’s typology, were selected and a study of health policy in relation to the national legal framework regarding the data protection regulation is examined. A model of legal interoperability for cross-border eHealth services is proposed for policy makers at EU level based on the following major domains: protection and security of data, transparency and liability, further analyzed in multiple axes and combined with EU targets, policy priorities and basic European legal principles. This model could be viable because of the EU’s transnational existence, the coexistence of national and Community law, and the need of novel models of political governance under a unified regulatory and normative base.