Presentation of my PhD dissertation. Contains three main subjects: -Archetype representation of non-dual model architectures -Archetype-based mapping between clinical information models -Automatic generation of implementation guides from clinical information models

1. 26 Enero 2016
DETAILED CLINICAL MODELS AND THEIR RELATION
WITH ELECTRONIC HEALTH RECORDS
Diego Boscá Tomás
PRESENTED BY: DIEGO BOSCÁ TOMÁS
SUPERVISED BY: PhD. MONTSERRAT ROBLES VIEJO
and PhD. ALBERTO MALDONADO SEGURA
DETAILED CLINICAL MODELS AND THEIR RELATION
WITH ELECTRONIC HEALTH RECORDS

2. 26 Enero 2016
DETAILED CLINICAL MODELS AND THEIR RELATION
WITH ELECTRONIC HEALTH RECORDS
Diego Boscá Tomás
CONTENTS
• Introduction and Objectives
• Outline
• Research work
I. Archetype representation of non-dual model
architectures
II. Archetype-based mapping between clinical
information models
III. Automatic generation of implementation guides
from clinical information models
• Conclusions, Contributions, and Future Work
• Projects, Publications, and Research Stays
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3
INTRODUCTION AND GOALS

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DETAILED CLINICAL MODELS AND THEIR RELATION
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Diego Boscá Tomás
INTRODUCTION
• Accessing the full Electronic Health Record
(EHR) of a patient is still difficult as this
information tends to be distributed into
different systems with different semantics,
and needs semantic interoperability for their
meaningful communication
• Semantic interoperability is still far from being
achieved in the clinical domain, mostly due to
the complexity, variability, and evolving
knowledge
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WITH ELECTRONIC HEALTH RECORDS
Diego Boscá Tomás
INTRODUCTION
• One of the prerequisites to achieve semantic
interoperability is the standardization of both
the data and clinical information models
present in the information system
(SemanticHealth)
• Standards need to be brought to live. There is
a lack of adequate methodologies and tools
for they widespread use
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DETAILED CLINICAL MODELS AND THEIR RELATION
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Diego Boscá Tomás
INTRODUCTION
HYPOTHESIS
Archetypes can be applied to describe the
structure, content, and meaning of existing EHRs
as well as to facilitate the development and
deployment of new EHR systems that require
semantic interoperability
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Diego Boscá Tomás
OBJECTIVE
GENERAL OBJECTIVE
Provide methodologies and advanced tools
based on archetypes to ease the achievement
of higher levels of EHR semantic interoperability
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DETAILED CLINICAL MODELS AND THEIR RELATION
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Diego Boscá Tomás
OBJECTIVE
SPECIFIC OBJECTIVES
To provide means of applying dual model
methodology to non-dual information models
To provide tools and methodologies for the
transformation of existing data into archetype data
instances
To generate reference materials automatically from
archetypes to achieve suitable views for each type of
user
8
O1.
O2.
O3.

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OUTLINE
R III
R II
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Diego Boscá Tomás
ARCHETYPE REPRESENTATION OF NON-DUAL MODEL
ARCHITECTURES
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Diego Boscá Tomás
MOTIVATION
• Current EHR systems (typically based on a single
model EHR architecture) tend to have clinical
knowledge mixed into the information model
• Dual model methodology allows the formal
description of clinical models of a given EHR
information model
• Even single model EHR architectures may be
suitable to be used as a reference model for
archetype definition
• Dual model methodology provides a set of
advantages, such as formalization, reuse,
terminology bindings, or multilinguality
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DETAILED CLINICAL MODELS AND THEIR RELATION
WITH ELECTRONIC HEALTH RECORDS
Diego Boscá Tomás
OBJECTIVE
Create a set of methodologies and tools to
define archetypes for non-dual
information models, ease their definition,
and support their advanced use
12
O1.

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REFERENCE MODEL ARCHETYPES
• Only a subset of the classes contained in reference
models define logical building blocks of EHRs and
can be used to define archetypes (business class)
• The representation of a business class as an archetype
is what we call a Reference Model Archetype (RMA) †
• Any other archetype must be a specialization of one of
them
– Archetype editing becomes a process of subtyping by
constraints
• This approach opens the door to support multiple
reference models
13
† Maldonado et al, LinkEHR-Ed: a multi-reference model archetype editor based on formal semantics. IJMI 2009

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DETAILED CLINICAL MODELS AND THEIR RELATION
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EXAMPLE: ISO13606 BUSINESS CLASSES
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BUILDING REFERENCE MODEL ARCHETYPES
• In order to define archetypes in a given
reference model, we must build the set of
RMAs first
– We achieve this by analyzing the formal schema
definitions (typically XML Schema)
– This is not always possible, as the schema may not
be public, is defined in an unsupported format, or
is underspecified (e.g. XML Schema any type)
• Two alternatives: Creating them from other metamodel
representations or defining them manually
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Diego Boscá Tomás
CREATING RMA FROM METAMODELS
• For this process, a suitable metamodel that
faithfully represents a given standard is
chosen
• The metamodel, e.g. ecore definitions or Basic
Meta Model (BMM) definitions, is analyzed
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CREATING RMA FROM METAMODELS
Base of
FHIR Ecore model
Transformed into
FHIR archetypes /
extended resources
FHIR Reference
Model Archetype
Defined in
FHIR Resource
Base of
openEHR BMM
Transformed into
openEHR archetypes
Defined in
openEHR RM openEHR RMAs
• This approach was used to support archetype
creation for FHIR DSTU and BMM-based
models such as openEHR and CIMI
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CREATING RMA MANUALLY
• As RMAs are archetypes it is feasible to build them by
defining the object, attribute, and primitive constraints
• An Archetype Object Model (AOM) editor was created
• Japanese standard MedXML MML RMAs were built
using this approach
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ADVANCED ARCHETYPE EDITING
• Target users of archetype editors come from the clinical domain.
Archetype editors must hide the complexity of the underlying
reference model
– The easiest solutions is to hard-code the reference model into the
editors but…
– It is harder to cope with multiple reference models and their
evolution.
• In order to support multiple reference models and at the same time
keeping the editing process simple for clinical users, different
approaches and methodologies have been investigated, namely:
– Use of specific editors
– Semantic patterns
– Archetype creation from data instances
– Syntactic model transformation between standards
– Mapping to other standards
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DETAILED CLINICAL MODELS AND THEIR RELATION
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Diego Boscá Tomás
USE OF SPECIFIC EDITORS
• Specific editors for each reference model can
be defined to hide their complexity when
creating archetypes.
• These editors are based on a documentation
file and can be dynamically included in the
tool.
• Specific editors for ISO13606, openEHR, and
HL7 CDA have been defined.
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DETAILED CLINICAL MODELS AND THEIR RELATION
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Diego Boscá Tomás
USE OF SPECIFIC EDITORS
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SEMANTIC PATTERNS
• Archetype reuse is not limited to archetype slots and internal references
• Semantic patterns are reusable solutions to recurring modeling problems
– They combine structural, terminological, and ontological representations
• We implemented the semantic patterns as archetype fragments with
known semantics
• These semantic patterns are useful for creating equivalences between
standards
– E.g. How an openEHR Observation is represented in ISO13606 or HL7 CDA
reference model
• Examples of semantic patterns are
– General use structures such as table, tree, or panels
– Generic clinical models such as exam of XYZ
– Representation of archetypable classes of different reference models such as
observation, event, or history in ISO13606
• In addition to the support for using semantic patterns in archetype
edition, a semantic pattern manager was implemented to allow their
versioning and management
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Diego Boscá Tomás
ARCHETYPE CREATION
FROM DATA INSTANCES
• One of the biggest challenges when applying
archetypes to a non-dual reference model is that
defining a minimum set of archetypes is required in
order to take advantage of archetype-based
methodologies
• As the systems are already deployed, it is feasible to
obtain sample data instances
• A methodology for the creation of archetypes from
data instances was developed
• This process considers each data instance as a
“constant archetype” (an archetype with every
constraint fixed to a constant) and reduces the problem
to merging two archetypes into a single one
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DETAILED CLINICAL MODELS AND THEIR RELATION
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Diego Boscá Tomás
ARCHETYPE CREATION
FROM DATA INSTANCES
• The automatic merging process traverses each
instance and loosens the resulting archetype
constraints according to the new values
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Instance 1 Instance 2 Resulting archetype
|102..115|
|60..70|

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SYNTATIC MODEL TRANSFORMATION BETWEEN
STANDARDS
• Transformation of clinical models between different standards is a
difficult problem
– Ontology-based model and data transformations is one of the most
promising approaches
• However, most of the time equivalences are defined in the
standards themselves or are clear enough so complex ontology
reasoning is not needed
• These equivalences can be declared as rules to be executed
• Three different kinds of rules were detected depending on the
trigger:
– Structure-based rules: triggered by the structure and values
– Terminology-based rules: triggered by the terminological binding
– Generic rules: transformation to generic classes
• Defined rules transform the archetypes and create the mapping
equivalences for the automatic data transformation
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DETAILED CLINICAL MODELS AND THEIR RELATION
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Diego Boscá Tomás
SYNTATIC MODEL TRANSFORMATION BETWEEN
STANDARDS
• This methodology is demonstrated by a proposed transformation between
openEHR and ISO13606 (and vice versa). Rules were implemented in drools
– All archetypes from openEHR CKM (415) were translated to ISO13606 and the
Spanish Ministry of Health archetypes (23) were translated to openEHR and
tested as valid for their respective reference model
Target class in openEHR Source term binding contained in SNOMED CT subset
Observation << 363787002 | Observable entity (observable entity) |
OR << 284365007 | Examination of body site (procedure) |
OR << 122869004 | Measurement procedure (procedure) |
Evaluation << 243814003 | Interpretation of findings (observable entity) |
Instruction << 243120004 | Regimes and therapies (regime/therapy) |
OR << 400999005 | Procedure requested (situation) |
Action << 129264002 | Action (qualifier value) |
OR << 416118004 | Administration (procedure) |
OR << 443938003 | Procedure carried out on subject (situation) |
OR << 71388002 | Procedure (procedure) |
Admin_entry << 14734007 | Administrative procedure (procedure) |
OR << 304784009 | Administrative form (record artifact) |
Event << 272379006 | Event (event) |
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ARCHETYPE-BASED MAPPING BETWEEN CLINICAL
INFORMATION MODELS
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Diego Boscá Tomás
MOTIVATION
• Patient health data is distributed among different
healthcare facilities, which makes crucial their
integration and communication
• Health data communication must be done in a
meaningful way, avoiding all possibility of
misunderstanding or misinterpretation
• This crucially depends on the standardization of
the EHR architecture used to represent the data
• Standardizing existing data is one of the main
problems in adopting EHR standards
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OBJECTIVE
To define and implement a set of
methodologies and tools for the
normalization of legacy data and the
transformation between EHR standards
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O2.

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PROBLEM
• The problem of data transformation is a difficult
one, as deals with differences and mismatches
between heterogeneous data formats and
models
• This is even harder in healthcare domain, due to
the intrinsic complexity of EHR data
• Standard EHR architectures and archetypes are
defined without any consideration to the internal
database design
• The definition of these transformation programs
is a complex process, usually involving the
creation of custom non-reusable software
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MAPPING APPROACH
• Existing data transformation formalisms have
been studied and adapted to cope with the
special requirements of the archetypes
• We use a “specify-generate” approach
– High-level declarative assertions are used to
specify relationships between the source and
target schemas
– These assertions are compiled automatically into
executable scripts
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FORMAL DEFINITION
• Source schemas can be either XML Schema or an
archetype
• Target schema is an archetype
• We use the Nested Relational (NR) model for the
specification of both source and target schemas,
as archetypes impose hierarchical structures
• NR model generalizes relational model (tuples
and relations) by modeling them as records and
sets of records respectively
• This model allows the representation of
hierarchical structures as the archetype
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FORMAL DEFINITION
• The set of atomic data types of our model are the ones
supported by archetypes:
– string, integer, real, date, time, date and time, duration, and boolean
• Non-atomic types are
– Record types of the form Rcd 𝑎1
𝑒1:𝑓1
: 𝜏1, … , 𝑎 𝑛
𝑒 𝑛:𝑓𝑛
: 𝜏 𝑛
– Set types of the form SetOf 𝜏1
𝑙1:𝑢1
… 𝜏 𝑛
𝑙 𝑛:𝑢 𝑛
𝑙 𝜏:𝑢 𝜏
– Choice types of the form ChoiceOf 𝑎1: 𝜏1 … 𝑎 𝑛: 𝜏 𝑛
• where:
– 𝜏 represents either an atomic, set, or record type
– 𝑛 ≥ 1, 𝑒𝑖 ∈ 0,1 , 𝑒𝑓 ∈ 0,1 and 𝑒𝑖 ≤ 𝑒𝑓
– li is a natural number, ui is a natural number or ∞ and li ≤ ui
– 𝑖=1
𝑛
𝑙𝑖 ≤ 𝑢 𝜏 and 𝑖=1
𝑛
𝑢𝑖 ≤ 𝑙 𝜏
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DETAILED CLINICAL MODELS AND THEIR RELATION
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FORMAL DEFINITION
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Diego Boscá Tomás
MAPPING DEFINITION
• Only constrained entities (classes and
attributes) of the reference model appear in
the archetypes
– The underlying reference model constraints are
implicit
– This is also the case of the parent archetype in
specialized archetypes
• In order to generate correct data instances,
archetypes must be merged with the parents
archetypes and the underlying reference
model
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MAPPING DEFINITION
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MAPPING DEFINITION
• Mapping language is based on tgds † (tuple-generating-dependencies)
• To describe how to compute a value for an atomic attribute of the
target schema (archetype) a list of filter/function pairs can be defined
37
$gender={ If (/patient/gender=’M’ OR /patient/gender=’m’) then 0
Else if (/patient/gender=’W’ OR /patient/gender=’w’) then 1
Else if (/patient/gender=0 OR /patient/gender=1) then /patient/gender
Else 9 }
† Fagin et al, Data exchange: semantics and query answering. TCS 2005

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• Value correspondences lack expressive power to
completely describe grouping semantics
• Default grouping semantics is based on the
Partition Normal Form (PNF)
– In PNF, two distinct records that coincide in all the
atomic (non-multivaluated) attributes cannot exist
• We use Skolem functions † to achieve PNF
GROUPING
38
† Hazewinkel et al, Encyclopædia of Mathematics

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GROUPING
• Grouping semantics can be customized by
modifying the Skolem functions or by defining
Object Builders
• Skolem parameters can be removed from the
Skolem functions
• Object builders control the generation of target
instances taking into account the data in the
source
– Object Builders represent iterators on the source
nodes they are connected to
– In each iteration, a new element is constructed, of the
kind of the target node reached by the builder
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MAPPING DEFINITION EXAMPLE
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Object builder
Attribute mapping
Object builder nesting
$prof/cargo=“cirujano”
$prof
$ingr
$hosp

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XQUERY GENERATION
• Archetype constants are assumed to be transformation functions
whose filter has ‘true’ value and the function is fixed to the
constant value
• Constraints on primitive types (valid ranges, lists of values) are
enforced in the transformation script
• When the mapping correspondences have been defined, they
are traversed in order to generate the transformation script
Archetype constraint Value correspondence XQuery extract
number matches {|0..10|} If true
then /data/measurements/value
(specified by user)
For $val in /data/measurements/value
Where $val≥0 and $val≤10
Return
<number> {data($val)}</number>
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Archetype constraint Value correspondence XQuery extract
number matches {1} If true then 1
(automatically generated)
Return
<number> 1 </number>

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XQUERY GENERATION
• More than one mapping can be applied to a
single attribute. In this case, each one of these
mappings produces a different transformation
program
• For each object in the archetype a nested
XQuery FLWOR is produced
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XQUERY GENERATION
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MAPPING SUMMARY
Archetype
Reference
Model
XQuery script
Source
XML
instance
Output
XML
instance
Mapping source
(XML Schema or
archetype)
Mapping
Comprehensive
ArchetypeMerge
Defines
Defines
Autogenerates Instance of
Generates
Instance of
Instance of
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TECHNICAL EVALUATION
• For the technical validation of the mapping
capabilities, the STBenchmark was used
– This benchmark describes 17 mapping scenarios
that should be supported by mapping systems
• Each scenario contains a source and target
schema expressed as an XML Schema, an
instance of the source schema and a visual
and textual description of the scenario
– In our case, target schema is modeled as an
archetype
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TECHNICAL EVALUATION
• From the 17 scenarios, 15 could be
successfully tested as the expected target
instance could be generated
• Two scenarios could not be tested
– One scenario could not be tested due to
archetypes not supporting the definition foreign
keys
– One scenario could not be tested due to
limitations in the expressive power of our
mapping language
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EVALUATION IN REAL SETTINGS:
MEDICINES RECONCILIATION PROJECT
• The objective was to obtain and
evaluate a complete medication
list of patients regardless where
they came from
• Archetypes are based on epSOS
specifications
• Hospital EHR system was
upgraded to include the patient
summary
• The project was awarded with
the Spanish Ministry of Health
quality award
LinkEHR Platform
DATA NORMALIZATION
DATA INTEGRATION
NOMENCLATOR
DIGITALIS
INDEPENDENT
WEB VIEWER
HOSPITAL EHR
(SELENE)
Web Service
Primary care
OMI-AP
Hospital de Fuenlabrada
FARMATOOLS SELENE
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EVALUATION IN REAL SETTINGS:
PATIENT ELIGIBILITY
• Use of archetypes and mappings in different
abstraction levels to determine if a patient is eligible
for a cancer clinical trial
• Patient is not eligible if it has severe comorbidity,
which is derived from a series of cascade mappings
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EVALUATION IN REAL SETTINGS
PATIENT ELIGIBILITY
• Presence/absence of metastatic tumor
(source EHR)
• Presence/absence of metastatic solid tumor
(source archetype)
Condition Mapping
@count(summary/problems/problem, @in(summary/problems/problem/code, @descendents(“128462008”))>0 TRUE
TRUE FALSE
Condition Mapping
(Evaluation_problem_DS_metastatic_tumor_v1/structure/present = TRUE)
AND (Evaluation_problem_DS_solid_tumor_v1/structure/present = TRUE)
TRUE
TRUE FALSE
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ARCHETYPES FOR THE GENERATION, VALIDATION,
AND USE OF EHR SYSTEMS
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MOTIVATION
• Archetypes ease the communication between
clinicians and IT staff
• Those clinicians and IT staff who are not experts in
dual model architectures need to understand the
archetypes
– Clinicians are able to provide valuable inputs for
archetype validation and evolution
– IT staff can use the archetypes as formal specifications
of the system
• Clinicians and IT staff make use of different sets of
artifacts to understand the archetypes and bring
them to life in their systems
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OBJECTIVE
To enable the automatic generation of artifacts
from clinical archetypes for the validation of
current systems and the creation of new ones
from both clinical and technical perspectives
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O3.

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GENERATION OF ARTIFACTS
• Archetypes can be used as guidance to
automatically generate a wide range of
artifacts
–Validation rules
–Sample data instances
–Mindmaps and Sample forms
–Implementation guides
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VALIDATION: NATURAL RULE LANGUAGE
• Natural Rule Language (NRL) provides a formal
and executable way of defining English-like rules
• Archetype constraints are interpreted and
translated to NRL
• These rules can be translated to OCL or
Schematron
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VALIDATION: HL7 STYLE RULES
• In the same way, rules from archetypes can be
translated into HL7 conformance statements
• These statements can be generated in the
desired language
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VALIDATION: SCHEMATRON RULES
• Different kinds of Schematron rules are derived
for each kind of archetype constraint
• The definition of two different Schematron
phases allows to validate both the explicit and
the implicit archetype constraints (only archetype
or archetype + reference model)
<!-- Rules for archetype path /items[Blood pressure measurement]/parts[Systolic]/value[at0005] -->
<rule context="ENTRY/items/parts[archetype_id='at0001']/value">
<!-- Existence for attribute 'units' -->
<report test="count(units)=0">Attribute 'units' is required and does not appear in data</report>
<!-- Occurrences for the alternatives of attribute 'units' -->
<assert test="(count(units)=1)">The attribute 'units' has more than one alternative or empty alternatives</assert>
<!-- Existence for attribute 'value' -->
<report test="count(value)=0">Attribute 'value' is required and does not appear in data</report>
<!-- 'value' constraint is not valid-->
<assert test="value&gt;=0.0 and value&lt;1000.0">Constraint for 'value' does not follow the archetype: 'value'
<value-of select="value" /> is not in [0.0,1000.0[</assert>
</rule>
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Diego Boscá Tomás
SAMPLE DATA INSTANCES
• Sample data instances allow to perform stress tests on systems
• Data instances are created by using the mapping mechanism explained
before
– Constant values are assigned to each archetype constraint
– These constant values are used to generate a transformation script to produce
the sample data instance
– Generated instances follow the archetype and the reference model, but do
not describe real clinical cases
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58. 26 Enero 2016
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Diego Boscá Tomás
ADDITIONAL ARTIFACTS
• A mindmap representation from the archetype is created
in order to give an overview of the clinical model
• Archetype constraints can also be interpreted as fields of
an sample html form
• Archetype constraints bound to terminologies can be
displayed in summary value set tables
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Diego Boscá Tomás
IMPLEMENTATION GUIDE GENERATION
• Presented artifacts can be combined according to user’s
needs to provide helpful implementation guides
• Each object in the archetype generates a set of NRL, HL7,
and Schematron rules, as well as a sample data instance for
that object
• A general mindmap, archetype metadata, value set tables,
sample form, reference model documentation, and a table
of contents can also be generated
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CONCLUSIONS, CONTRIBUTIONS, AND
FUTURE WORK

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Diego Boscá Tomás
CONCLUSIONS
• The specifications of eHealth interoperability
standards must be brought to life by system
designers and implementers
• The challenge is not the lack of standards, but
its implementation at a reasonable cost
• Presented methodologies and tools ease the
joint use of the three layers of artefacts (Clinical
Models, Reference Models, and Clinical
Terminologies) needed to achieve high levels of
semantic interoperability
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62. 26 Enero 2016
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Diego Boscá Tomás
CONCLUSIONS
• The advantages of a joint use of archetypes with non-
dual model standards outweigh the disadvantages
– Using archetypes for currently used reference models such
as HL7 CDA, HL7 FHIR, or MedXML MML will help to the
rapid adoption of both the original standard and the dual
model approach
• The presented set of integrated innovative tools help
current systems to achieve semantic interoperability by
normalizing data based on clear semantically-rich
clinical models
• Proposed methodology promotes the involvement of
clinical staff in the modeling and validation process
• All presented developments have been included in
LinkEHR platform
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Diego Boscá Tomás
CONTRIBUTIONS
• Design and implementation of a set of methodologies
and tools to support the definition of archetypes from
multiple reference models
• Design and implementation of a new methodology for
the transformation of legacy data into archetype-based
data
• Reuse of this methodology for the data transformation
between archetype-based standards
• Design and implementation of a set of methodologies
for the automatic generation of implementation guides
and reference materials from archetypes
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64. 26 Enero 2016
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Diego Boscá Tomás
FUTURE WORK
• From data perspective, variability in original sources continuously provides
new challenges
– Support to other source schemas such as RDF or OWL
– Automatic schema matching techniques
• Based both in clinical terminologies and tree-matching algorithms
• Use of clinical vocabularies and ontologies provides challenges on their
own. The integration of ontologies in queries and reasoning will benefit
both patient and public health
– Mapping specification must be improved to support this advanced use
• Automatic artifact creation can benefit from terminology bindings
• Having available big quantities of normalized archetype-based data
provides the opportunity to generate semantically rich research and public
health repositories
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PROJECTS, PUBLICATIONS, AND RESEARCH
STAYS

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RESEARCH PROJECTS
• The results of this PhD Thesis have contributed
directly to the results of the following research
projects:
– ResearchEHR: Platform for the acquisition and sharing
of information and knowledge for network-based
clinical research communities (TSI2007-66575-C02-01)
– Trial-Me: Intelligent tools for linking EHR to clinical
trial systems (TIN2010-21388-C02-01)
– Clin-IK-Links: Clinical information and knowledge
models for linking EHR and Clinical Decision Support
Systems (TIN2014-53749-C2-1-R)
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67. 26 Enero 2016
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Diego Boscá Tomás
JOURNAL CONTRIBUTIONS
AND BOOK CHAPTERS
• J. A. Maldonado, D. Moner, D. Boscá, J. T. Fernández-Breis, C. Angulo, and M.
Robles, “LinkEHR-Ed: A multi-reference model archetype editor based on
formal semantics,” International journal of medical informatics, vol. 78, no. 8,
pp. 559–570, 2009
• M. Marcos, J. A. Maldonado, B. Martínez-Salvador, D. Boscá, and M. Robles,
“Interoperability of clinical decision-support systems and electronic health
records using archetypes: a case study in clinical trial eligibility,” Journal of
biomedical informatics, vol. 46, no. 4, pp. 676–689, 2013
• J. A. Maldonado, C. M. Costa, D. Moner, M. Menárguez-Tortosa, D. Boscá, J. A.
M. Giménez, J. T. Fernández-Breis, and M. Robles, “Using the ResearchEHR
platform to facilitate the practical application of the EHR standards,” Journal of
biomedical informatics, vol. 45, no. 4, pp. 746–762, 2012
• D. Boscá, J. A. Maldonado, D. Moner, and M. Robles, “Automatic generation of
computable implementation guides from clinical information models,” Journal
of biomedical informatics, vol. 55, pp. 143–152, Jun. 2015
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Publications in Q1 Journals
RI
RII
RIII

68. 26 Enero 2016
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JOURNAL CONTRIBUTIONS
AND BOOK CHAPTERS
• S. Kobayashi, D. Boscá, N. Kume, and H. Yoshihara, “Reforming
MML (Medical Markup Language) Standard with Archetype
Technology,” Indian Association for Medical Informatics, vol. 91,
p. 57, 2014.
• J. A. Maldonado, D. Boscá, D. Moner, and M. Robles, “LinkEHR: A
Platform for the Normalization of Legacy Clinical Data Based on
Archetypes,” Interoperability in Healthcare Information Systems:
Standards, Management, and Technology: Standards,
Management, and Technology, p. 45, 2013.
• M. Marcos, J. A. Maldonado, B. Martínez-Salvador, D. Moner, D.
Boscá, and M. Robles, “An archetype-based solution for the
interoperability of computerised guidelines and electronic health
records,” in Artificial Intelligence in Medicine, Springer Berlin
Heidelberg, 2011, pp. 276–285.
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RI
RII

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CONGRESS PAPERS
• CONGRESS PAPERS RELATED WITH THE THESIS
– D. Boscá, D. Moner, J. A. Maldonado, and M. Robles,
“Combining Archetypes with Fast Health Interoperability
Resources in Future-proof Health Information Systems.,” Studies
in health technology and informatics, vol. 210, pp. 180–184,
2014.
– D. Boscá, L. Marco, D. Moner, J. A. Maldonado, L. Insa, and M.
Robles, “Detailed Clinical Models Governance System in a
Regional EHR Project,” in XIII Mediterranean Conference on
Medical and Biological Engineering and Computing 2013,
Springer, 2014, pp. 1266–1269.
– D. Moner, J. A. Maldonado, D. Boscá, A. Mañas, and M. Robles,
“Development of a Visual Editor for the Definition of HL7 CDA
Archetypes,” in XIII Mediterranean Conference on Medical and
Biological Engineering and Computing 2013, Springer, 2014, pp.
1258–1261.
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CONGRESS PAPERS
• CONGRESS PAPERS RELATED WITH THE THESIS
– D. Boscá, L. Marco, V. Burriel, T. Jaijo, J. M. Millán, A. M. Levin,
O. Pastor, M. Robles, and J. A. Maldonado, “Genetic testing
information standardization in HL7 CDA and ISO13606.,” in
MedInfo, 2013, pp. 338–342.
– C. Martínez-Costa, D. Boscá, M. C. Legaz-García, C. Tao, B. J.
Fernández, S. Schulz, and C. G. Chute, “Isosemantic rendering of
clinical information using formal ontologies and RDF.,” Studies in
health technology and informatics, vol. 192, pp. 1085–1085,
2012.
– D. Boscá, J. A. Maldonado, D. Moner, and M. Robles, “Detailed
clinical models to facilitate interstandard interoperability of data
types,” 23rd International Conference of the European
Federation for Medical Informatics. Oslo, Norway: European
Federation for Medical Informatics, 2011
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71. 26 Enero 2016
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Diego Boscá Tomás
CONGRESS PAPERS
• CONGRESS PAPERS RELATED WITH THE THESIS
– J. Maldonado, D. Moner, D. Boscá, C. Angulo, L. Marco, E. Reig, M.
Robles, and others, “Concept-based exchange of healthcare
information: The LinkEHR approach,” in Healthcare Informatics,
Imaging and Systems Biology (HISB), 2011 First IEEE International
Conference on, 2011, pp. 150–157.
– D. Moner, J. A. Maldonado, D. Boscá, C. Angulo, M. Robles, D. Pérez,
and P. Serrano, “CEN EN13606 normalisation framework
implementation experiences,” Seamless Care, Safe Care: The
Challenges of Interoperability and Patient Safety in Health Care:
Proceedings of the EFMI Special Topic Conference, June 2-4, 2010,
Reykjavik, Iceland, vol. 155, p. 136, 2010.
– M. Robles, J. T. Fernández-Breis, J. A. Maldonado, D. Moner, C.
Martínez-Costa, D. Boscá, and M. Menárguez-Tortosa, “ResearchEHR:
Use of semantic web technologies and archetypes for the description
of EHRs,” Studies in health technology and informatics, vol. 155, p.
129, 2010
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RESEARCH STAY
• RESEARCH STAY
– Main Subject: Detailed clinical model representation of MML Japanese
standard
– Place: Division of Medical Information Technology and Administration
Planning, Kyoto University (Japan)
– Length: 3 Months (2011)
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