Exchange of information through open interfaces is a natural part of day-to-day work in many industries and the exchange of information is a basis for improving both services and products. Yet there are still many data silos in which the exchange of data can only take place through proprietary interfaces. However, this is about to change in the health care sector.

Denmark is one of the most digitalised countries in the world. It is possible to buy and sell houses, get divorced, buy products using a payment card, and look at your own health information online. But data-exchange is not as simple in all systems. It is difficult to imagine having to use different payment cards for different shops or having a TV dedicated to each TV channel. Fortunately, standardisation has prevented this. Nonetheless, the situation still applies in sectors where standardisation and interoperability have not been adopted – yet. One of these sectors is the health care sector. However, a lot of progress has been made with the integration of data and standardisation of interfaces between different IT systems, while there is room for improvement, especially regarding manufacturer-specific systems.

If only a few interfaces and integrations are needed, it may be affordable to adjust the systems from time to time, just as there are also cases in which other considerations must be made, for example regarding particularly high security or speed.

For solutions in which there are many data sources, and where data generating or data collection equipment must be regularly replaced, or where the users must have the possibility to buy their own devices, known as bring your own device (BYOD), it is an obvious advantage not to adjust interfaces and systems each time a device must be replaced. The health care sector is a good example of how data generation and data collection have increased significantly in recent years as the volume of sensors for measurement and collection of weight, blood pressure pulse, activity level, etc. has increased dramatically, and it has become common for people to monitor and gather data themselves. This trend is expected to continue with the spread of telemedicine and telehealth.

Telemedicine devices

Telemedicine includes remote monitoring and measurement of different parameters using both fitness equipment and medical devices. The collected data is transferred to electronic health systems and patient medical record systems through different devices to ensure data transport. Typically, data is transported and enriched in a number of stages until it is stored in a database.

With the establishment of the strategy for dissemination of telemedicine, the Danish government at that time started a journey, which in 2012 resulted in publishing the first national reference architecture for collecting health data from citizens. The Danish reference architecture was – as is the case for the subsequent reference architectures in Norway (2014) and Sweden (being prepared) – based on Continua Design Guidelines.

Continua is a trademark of Personal Connected Health Alliance, which also develops Continua Design Guidelines (CDG). CDG is based on international standards, such as IEEE 11073 Personal Health Device (PHD), Integrating the Healthcare Enterprise (IHE) PCD-01 and Health Level 7 (HL7) Personal Health Monitoring Report. CDG describes how the international standards are to be implemented in different interfaces to comply with CDG and thus make Continua certification possible. Therefore, the Continua label on a product indicates that the product is Continua certified.
Figure 1 – Interfaces in Continua Design Guidelines.
Continua Design Guidelines are included in the ITU-T standard H.810.

Continua Design Guidelines (CDG) define the interoperable interfaces that make secure data transfer between sensors and systems possible, and it is the only international means of establishing a secure end-to-end framework for personal health in relation to open standards.

As illustrated in Figure 1, different standards are used for different interfaces, because the need for data and metadata is different, just as the need for data protection is different. In Personal Health Devices (PHD), the interface is based on the IEEE 11073 standards family for data exchange between the sensor and the collecting device. The focal point of the service interface is Integration Healthcare Enterprise (IHE) PCD-01 for the exchange of data between the collecting device and the services that are to receive data. In the last interface, it is Health Information Service (HIS) that is the HL7-based PHMR, which is the focal point for data exchange with health and patient medical record systems. The total security in the system is comprised of a combination of security mechanisms in the individual standards and the security mechanisms that are integrated into the underlying communication technologies (BT, BTLE, ZigBee and NFC).

Market trends

As the latest stage of the journey to real dissemination of telemedicine, a joint Nordic reference architecture has been prepared, which comprises the joint superstructure of the national reference architectures in the Nordic countries. In addition, a national tender for telemedicine devices is on the way, which will, hopefully, be the starting point for establishing a real market for interoperable devices in Denmark, and with infrastructures that are comparable, in time, it will be able to result in a real Nordic market.