PhD thesis online: Scalability and Semantic Sustainability in Electronic Health Record Systems

Jussara macedo jussara.macedo at
Fri Feb 1 06:00:46 EST 2013

Erik, stupend work, very easy of reading. It is good stuff to
introduce openEHR to clinicians, easy to read , fantastic examples.
I´m sure your defense will be brilliant!
Jussara Rötzsch
Director, OpenEHR Foundation
Owner, Giant Global Graph ehealth Solutions

On Thu, Jan 31, 2013 at 11:42 PM,  <richardh at> wrote:
> I have been following OpenEHR for some time
> Have found it difficult to get a grasp
> This Thesis is easy to read and clarifies a lot of points for me
> Interesting ideas
> Well done!
> Richard Hosking
> ----- Original Message -----
> From:
> "For openEHR clinical discussions" <openehr-clinical at>
> To:
> "For openEHR clinical discussions" <openehr-clinical at>
> Cc:
> "For openEHR technical discussions" <openehr-technical at>,
> "For openEHR implementation discussions"
> <openehr-implementers at>
> Sent:
> Wed, 30 Jan 2013 17:24:59 +0000
> Subject:
> Re: PhD thesis online: Scalability and Semantic Sustainability in Electronic
> Health Record Systems
> Erik,
> Congrats, it must feel really nice to be able to reach this point. Best of
> luck for the defense :)
> Best regards
> Seref
> On Sun, Jan 27, 2013 at 3:44 PM, Erik Sundvall <erik.sundvall at> wrote:
>> Hi!
>> My thesis entitled "Scalability and Semantic Sustainability in Electronic
>> Health Record Systems" is now available online. It contains many
>> openEHR-related papers and discussions (see abstract included below).
>> Permanent link to electronic version of the thesis:
>> Public PhD defence will be held the 15:th of February, in Linköping,
>> Sweden. Faculty opponent: prof. Dipak Kalra, UCL.
>> Temporary event-information page:
>> (That page also contains a form where you have the possibility to indicate
>> interest in online participation or in getting a recording.)
>> Best regards,
>> Erik Sundvall
>> erik.sundvall at  Tel: +46-13-286733
>> Abstract
>> This work is a small contribution to the greater goal of making software
>> systems used in healthcare more useful and sustainable. To come closer to
>> that goal, health record data will need to be more computable and easier to
>> exchange between systems.
>> Interoperability refers to getting systems to work together and semantics
>> concerns the study of meanings. If Semantic interoperability is achieved
>> then information entered in one information system is usable in other
>> systems and reusable for many purposes. Scalability refers to the extent to
>> which a system can gracefully grow by adding more resources. Sustainability
>> refers more to how to best use available limited resources. Both aspects are
>> important.
>> The main focus and aim of the thesis is to increase knowledge about how to
>> support scalability and semantic sustainability. It reports explorations of
>> how to apply aspects of the above to Electronic Health Record (EHR) systems,
>> associated infrastructure, data structures, terminology systems, user
>> interfaces and their mutual boundaries.
>> Using terminology systems is one way to improve computability and
>> comparability of data. Modern complex ontologies and terminology systems can
>> contain hundreds of thousands of concepts that can have many kinds of
>> relationships to multiple other concepts. This makes visualization
>> challenging. Many visualization approaches designed to show the local
>> neighbourhood of a single concept node do not scale well to larger sets of
>> nodes. The interactive TermViz approach described in this thesis, is
>> designed to aid users to navigate and comprehend the context of several
>> nodes simultaneously. Two applications are presented where TermViz aids
>> management of the boundary between EHR data structures and the terminology
>> system SNOMED CT.
>> The amount of available time from people skilled in health informatics is
>> limited. Adequate methods and tools are required to develop, maintain and
>> reuse health-IT solutions in a sustainable way. Multiple levels of modelling
>> including a fixed reference model and another layer of flexible reusable
>> ‘archetypes’ for domain specific data structures, is an approach with that
>> aim used in openEHR and the ISO 13606 standard. This approach, including
>> learning, implementing and managing it, is explored from different angles in
>> this thesis. An architecture applying Representational State Transfer (REST)
>> to archetype-based EHR systems, in order to address scalability, is
>> presented. Combined with archetyping this architecture also aims at enabling
>> a sustainable way of continuously evolving multi-vendor EHR solutions. An
>> experimental open source implementation of it, aimed for learning and
>> prototyping, is also presented.
>> Manually changing database structures used for storage every time new
>> versions of archetypes and associated data structures are needed is likely
>> not a sustainable activity. Thus storage systems that can handle change with
>> minimal manual interventions are desirable. Initial explorations of
>> performance and scalability in such systems are also reported.
>> Graphical user interfaces focused on EHR navigation, time-perspectives and
>> highlighting of EHR content are also presented – illustrating what can be
>> done with computable health record data and the presented approaches.
>> Desirable aspects of semantic sustainability have been discussed,
>> including: sustainable use of limited resources (such as available time of
>> skilled people), and reduction of unnecessary risks. A semantic
>> sustainability perspective should be inspired and informed by research in
>> complex systems theory, and should also include striving to be highly aware
>> of when and where technical debt is being built up. Semantic sustainability
>> is a shared responsibility.
>> The combined results presented contribute to increasing knowledge about
>> ways to support scalability and semantic sustainability in the context of
>> electronic health record systems. Supporting tools, architectures and
>> approaches are additional contributions.
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