The Metadata Information Model for the Italian Interoperability Infrastructure of EHR Systems

A key problem in healthcare informatics is the lack of interoperability among the information systems of different healthcare facilities. This problem hampers the possibility of collecting all the clinical documents of a patient in order to establish his/her Electronic Health Record (EHR). In Italy, this is mainly due to the fact that the implementation of EHR systems has been carried out individually by each regional administration. To address this problem, the Italian Ministry for Public Administration and Innovation and the National Research Council of Italy have undertaken an initiative intended to define a federated interoperability infrastructure that aims at favoring the interconnection of the regional EHR systems. The software infrastructure, called InFSE, lies on a metadata information model shared by the different local EHR systems. This model allows i) the indexing, in regional registries, of patient clinical documents stored in repositories distributed at healthcare facilities according to a shared formalism, and ii) the management of federations of EHR systems. This paper presents the metadata information model for InFSE, obtained by specializing the OASIS ebXML Registry Information Model information model with concepts belonging to standards and initiatives for healthcare domains, such as HL7 RIM Version 3 and IHE XDS profile.