Multimedia Appendix

Linkcare® _{technical requirements and list of currently available forms.}

12. Multimedia Appendix 2

Linkcare® web services technical specification.

13. Multimedia Appendix 3

Lessons Learnt in the Validation Trials and Supporting Investigations.

References

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Tables

Table 1. Ten principal features of the Integrated Care Shared Knowledge platform (Linkcare®). 1

1. Supports the clinical process logics of Integrated Care Services 2

2. Highly customizable to both patient and site characteristics 3

3. Technical interoperability with Electronic Health Records across healthcare tiers, directly or via in-place Health Information Exchange

4

4. The implementation does not require replacement of pre-existing proprietary Electronic Health Records

5

5. Key technical elements for organizational Interoperability at a health system level 6 6. Open source 7 7. Three-tier architecture 8

8. Integration with Clinical Decision Support Systems 9

9. Compliant with knowledge management tools 1

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Figures

Figure 1. Three-tier architecture of the Linkcare® platform. This multitier architecture allows separating the presentation or graphical user interface, business or application and data management logics, which permits the option of modifying or adding a specific layer, without reworking the entire application, in response to changes in requirements or technology.

Predictive Medicine for Chronic Patients in an Integrated Care Scenario 129 Figure 2. Based on patient-centered ICSs, the Linkcare® platform provides key technical elements for organizational interoperability between healthcare professionals from various tiers of care and enhances accessibility and proactivity of both patients and caregivers. This is thanks to specific functionalities attached to the Linkcare® platform via interoperability middlewares. These functionalities facilitate access via the support center and portals. The traditional call center functionalities are enriched with novel patient gateways and portals for healthcare professionals. Other interesting features are patient empowerment for self-management of his/her condition with remote monitoring, integration with site-level Electronic Health Records (EHR) and automated clinical decision support.

Predictive Medicine for Chronic Patients in an Integrated Care Scenario 130 Figure 3. The upper panel shows the Linkcare® web-based user interface for healthcare professionals, which provides an overview of the patient information, a calendar view of the patient’s work plan status and a set of tools for work plan follow-up and personalization. The lower panel shows the home page of the Linkcare® patient gateway used to support the wellness and rehabilitation ICS evaluated in the NEXES project. From this home page, patients can access to their optional (“ACTIVA’T”) and scheduled (“AGENDA”) interventions, patients can easily review their follow-up (“SEGUIMENT”), check educational information (“INFORMACIÓ D’INTERÈS”) and finally send patient’s documents of their choice to professionals (“COMPARTIR DOCUMENTS”).

Predictive Medicine for Chronic Patients in an Integrated Care Scenario 131 Figure 4. Linkcare® relational entities that support the creation and edition of ICSs. The Library of ICSs contains the set of available ICS templates and the system users potentially having a role in ICS management and execution. ICS templates are composed of admission and discharge form templates and a customizable work plan, which is used as the reference guide for the scheduling of tasks and the generation of follow-up reports. Finally, event handling is provided during the execution of the patient-specific work plan.

Predictive Medicine for Chronic Patients in an Integrated Care Scenario 132 Figure 5. Linkcare® workflow for ICS management and execution. The corresponding ICS template is used as a library of resources for the correct customization and execution of the ICS workflow. Integration with corporate EHR allows instant access to required patient information for case identification and evaluation, avoid data duplicity and preserve the current corporate clinical data chain of custody. Follow-up and discharge reports can also be sent to the corporate EHR to keep trace of the ICS execution as part of the patient clinical episodes.

Predictive Medicine for Chronic Patients in an Integrated Care Scenario 133 Figure 6. Interoperability framework for the regional deployment of the current HI-Sharing platform (Linkcare® - orange box) in a Catalan Health district and/or sector level. The Catalan Region has seven different healthcare sectors depicted in the figure. The sectorial HIE framework (i.e. the Catalan WiFIS standard) integrate basic highly standardized processes, namely: medical appointments, clinical data exchange, medical referral, etc., among healthcare providers with heterogeneous proprietary systems. In this scenario, the deployment of novel ICSs will be supported by the HI-Sharing platform (Linkcare®) described in the current study. At regional level, the Catalan Shared Electronic Health Record (HC3) currently acts as the common repository for health data exchange. However, it could also perform sectorial message routing and message delivery control. Finally, citizens can access their health related data via a Personal Health Folder (PHF) connected to the HC3. The PHF can also act as the citizen entry point for some of the supported processes (e.g. Medical appointments, participation in ICSs, etc.) and informal health data sources (e.g. mobile health applications, community medical devices, etc.). The NEXES project has shown a high potential of the PHF to support patient’s empowerment for self-management and healthier life styles [27].

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