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The medical project management (MPM) system

Conference Paper · June 2015

DOI: 10.1109/GSCIT.2015.7353336

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 The Medical Project Management (MPM) System
A semantic middleware for a unified representation of medical records

Ahmed Dridi1, Anis Tissaoui2 and Salma Sassi3

Faculty of Law, Economics and Management of Jendouba
University of Jendouba, Avenue de l’U.M.A, 8189 Jendouba, Tunisia
1
ahmed-dridi@outlook.com, 2tissaouianis@yahoo.fr, 3sassisalma@yahoo.fr

Abstract—The Medical information is one of the types of
information that are characterized by the multiplicity and
diversity of its sources. This diversity contributes to the
emergence of many problems; of which the most important is the
difficulty of communication and interaction between systems.
This is what is called the problem of interoperability. In this
context, we propose in this paper a new mediator semantic that
we call the Medical Project Management System. Based on
ontological components and an XML data exchange format, this
mediator allows the user to have a unified representation of the
information originally distributed on several different and
heterogeneous sites and which are related to a specific project. In
addition, it helps the user to interact with a large number of
medical projects and to research similar projects and comparing
them to take advantage of best practices and shared experiences
to improve the quality of treatment.
Keywords—Interoperability; heterogeneity; healthcare
information system; Project Management; Electronic Health
Record; medical information visualization.
I. INTRODUCTION
In the era of globalization and computerization which its
first features are appearing in the middle of the last century, the
digital information has become a crucial element in al- most all
areas and aspects of modern life. Many areas are impacted by
computerization, which in turn she had a great impact on the
social and cultural consequences of society, and contributes
with the globalization to the emergence of the so- called
information society and the knowledge economy. In the
information society, the creation, distribution, use, integration
and manipulation of information is a major activity and the
primary objective of this society is always to get a competitive
advantage internationally, by the use of information technology
(IT) in a creative and productive way [1].
Information systems as a discipline emerged initially as a
result of computerization and the development of Information
Technology and Communication (ICT) and as a response
to the need for a means simple, efficient and economical to
store, organize, retrieve and restore large volumes of scalable
data and information. The information systems are
experiencing a constant growth since inception. Their use
allows new opportunities to access and process information.
However, the growing number and diversity of information
systems consist of a barrier for they can communicate and
exchange data between them. In fact, the communication and
the interaction between different information systems is
essential for the management of projects whose information
was fragmented and scattered on several different and
heterogeneous sites. As the case of medical field, our scope of
application, the need to exchange data between of different
systems of healthcare institutions (hospitals, clinics private,
laboratories of radiology and medical imaging, biological
analysis laboratories, etc.) is still fundamental because it
conditions effective coordination of care and patient
monitoring. However, from a technical point of view, this
sharing is obstructed by some problems.
According to [2] these problems consist primarily of
three points: the first concerns the diversity of systems that
makes them difficult communication because these systems
may involve the same profession but be built with different
models. The second is being the useful information that is
generally owned by its creator with all the risks that this
may entail of which the immediate consequence of these
risks is the loss of information held by the field professional.
Finally, the last point, which is a large variation in the nature,
syntax and format of data. Consequently, access and retrieval
of relevant information in an environment characterized by
the three main problems is made very difficult because the
channels of communication and coordination between the
different sources of information are almost nonexistent. In fact,
these issues described a famous problem that mainly consists
of the interoperability problem. In the following, we would like
firstly to define the concept of interoperability and these
dimensions, before that,we try to develop a state of the art for
the proposed solutions to deal with this problem by focusing
particularly on mediation approaches.
Finally, and before concluding this paper, we present our
proposition that consisting mainly of a new semantic mediator
designed for viewing, analysis, exchange and processing of
medical data that are typically highly distributed and
heterogeneous.
II. THE PROBLEM OF INTEROPERABILITY
The Institute of Electrical and Electronics Engineers
(IEEE) defines interoperability as the ability of two or more
systems or components to exchange information and to use the
information exchanged [3]. Interoperability is considered very
important indeed critical in many fields, including computer
science, medical field in the broad sense, rail activities, electro-
technology, aerospace, military and general industry [4].
Generally, three types of interoperability can be distinguished
[5]:
 Technical interoperability: which aims data transport
and transport security. This type of interoperability
appealed to the infrastructure, protocols, and services
that enable, among other things, the communication of
data between computers [5]. Include, for example, the
Protocols TCP/IP, HTTP, etc.
 Syntactic interoperability: concerns the structure of
the exchanged messages and is intended to ensure
coherence in the manner in which the information
exchanged are represented. Specified data formats,
communication protocols and others come into play. In
general, XML or SQL standards provide syntactic
interoperability [6].
 Semantic interoperability: which is ensuring that the
exchanges which occur maintain their meaning, that is
to say, the communicating parties share a common
understanding of the meaning of the data they
exchange [7]. It involves the ability of a user to
understand the information obtained in order to use it
properly [8].
III. S TATE OF THE ART: T HE SEMANTIC MEDIATORS
It is inevitable to find a solution for the interoperability
problem so that the different systems and information sources
can communicate and share information. The end of the 1970s,
much research has been conducted in this area and have given
rise to the federated database. These databases are based on a
pivot model manually created and are used to query different
databases. In the 90s, mediators-based techniques [9] allow the
emergence of new mediation architectures. A mediator is a tool
that allows users to query various heterogeneous databases. It
is based on an ontology or a unified view, allowing the user to
feel that queries a single database.
The mediation approach is to develop an application
responsible to act as an interface between databases and
applications used by users. A mediator helps to resolve
conflicts between the models of data sources; it generates an
execution plan between users and those sources. In addition, it
simplifies and describes the distributed data.
E-XMLMEDIA [10] is a mediator system of federated
databases using XML as a federated model. Its purpose is to
provide access to multiple sources of data on the Internet or
Intranet using XML protocols and tools based on Java
components. It allows to federate heterogeneous data sources,
by presenting a unified view of all of the sources. The query
language is based on XQuery, and the results are in XML
format.
MIX [11] (Mediation of Information using XML) is an
XML-based mediator provides the user an integrated view of
different sources developed in the framework of a project
within the “University of California at San Diego Database
Laboratory”. This view is an interface defined using the
XMAS Language (XML Matching and Structuring Language).
XMAS is a declarative language based on the XML- QL query
language used as a definition language of view, and to query
the interface of the system.
PICSEL [12] is a mediator serving as an interface between
users and data sources to query. The architecture of PICSEL
consists of a domain ontology and knowledge bases (BCcomp)
connected to the mediator, describing the content of the
information sources. An ontology is used to represent the
knowledge of a field in the form of a hierarchy of concepts and
semantic relationships between these concepts [13]. The
ontology in PICSEL provides all the useful vocabulary for
users to formulate their requests. It is described by using the
language of representation CARIN-ALN, a rich language to
describe in a very fine way of a domain ontology and content
of information sources. Other knowledge bases allow the
mediator to determine what sources of information can provide
some answers to a user request. Between each knowledge base
and each source is connected to a wrapper. Its disadvantage is
that once shared ontology defined, each source must use the
common vocabulary, which limits the autonomy of local data
sources.
The project MOMIS (Mediator envirOnment for Multiple
Information Sources) [14] concerns the creation of a mediator
based on structured and semi-structured data integration
systems. It was developed in collaboration between the
University of Modena and Reggio Emilia and the University of
Milan and Brescia. It was designed to allow access to
heterogeneous in- formation stored in traditional databases
(relational and Object- oriented), the systems files and semi-
structured data sources. It uses the OQLi query language to
interrogate the sources. Another system has developed in the
same project to provide access to heterogeneous information
sources in the field of energy (research centers, statistics, etc.)
which is the EDC system (Energy Data Collection) [15]. It
takes as input queries expressed in OLAP (Online Analytical
Processing) which it then sends to the query planner developed
in the architecture of MOMIS. The latter is responsible to send
responses to the client by querying databases may contain the
desired information.
IV. T HE M EDICAL P ROJECT M ANAGEMENT (MPM)
S YSTEM
Always aiming to solve the problem of heterogeneity and
ensure interoperability between different medical systems, we
propose a new mediation approach that we call the Medical
Project Management (MPM) System. The MPM System is a
semantic mediator between the so-called information producers
and users of information. Based on a powerful semantic
expression provided by ontologies, our mediator allows
applying a sort of reconstruction and conceptualized
reformulation, annotated and temporalized information to pro-
vide a unified and shareable representation of information that
are complex, heterogeneous and already exploded on different
and highly distributed sites. In addition to its primary purpose
for which the mediator is developed, which consists mainly to
provide a shared semantics between users heterogeneous
medical information systems. The MPM system is also de-
signed to help clinicians and researchers in the medical field to
explore, visualize, and analyze a set of medical data large and
heterogeneous. Practically, our system allows these users to
view and interact with a large number of Electronic Health
Record, and to search for similar EHR and comparing them to
take advantage of best practices and shared experiences to
improve the quality of treatment.
A. The MPM System architecture
As we have already said, our system is a semantic mediator
between the so-called information producers and users of
information. It takes as input data streams and information
distributed to provide a unified representation of them. All data
coming from different sources of information entering into the
mediator must be converted to cognitive information
graphically represented, passing through three main modules
that are the basis of the architecture of our middleware:
Fig. 1. The MPM System architecture
Data and Knowledge Module: in which data coming from
multiple information sources can be identified, described,
unified and conceptualized according to two meta-ontologies (a
Domain Meta-Ontology and Task Meta-Ontology), that they
solve the problem of heterogeneity and ensure semantic
interoperability. The information generated is stored in what is
called a 'Unified Virtual Folder'. In fact, a UVF for each patient
must be created.
Analysis and Treatment Module: who receives the user's
query in order to analyze it and perform the treatments required
to respond. This module is as an intermediary between the user
interface and the module that has already presented (Data and
Knowledge Module).
Querying and Visualization Module: This module is
attached to the Human-Computer Interaction in our system. It
includes a set of graphical interfaces that allow the user to
interact and communicate with the system.
1) Data and Knowledge Module:
The MPM system consists in a first step to transform the
information contained in the usual information files to concepts
semantically annotated and contextualized in the so called a
“Unified Virtual Folder” (UVF). We define a UVF as being a
set of concepts linked together by semantic relationships.
Contrary to the information contained in the traditional
information folders that are not described and not referenced,
the concepts of the UVF are semantically described by
annotations and metadata are contextualized. These concepts
are also referenced by icons, which are attributed to
documents. Any Information Folder relating to a patient is
converted into UVF. The concepts of the DUV obey a Domain
Meta-Ontology and Task Meta-Ontology. All created UVF are
stored in a relational database. In this database, each record has
an identifier and a set of metadata. In fact, the metadata
consists of a summary of knowledge extracted from the file
itself. The main objective of this metadata is to facilitate
research especially in large amounts of data as our case.
Fig. 2. Data and Knowledge Module
2) Analysis and Treatment Module
This module serves as an intermediary between the user
interface and the basis of the UVF (the basic concept of the
data module and Knowledge). It runs in the background and
supports the analysis and execution of user requests. These
queries that can be varied between a simple project
management task such as adding / deleting or an update of any
project (EHR of a patient), and a complex task such as a task of
search. In fact, our system allows to search the most relevant
possible projects compared to a search query entered by the
user and calculating the degree of similarity between them.
Practically, when the user of the system makes a request
and launches the search operation, the system explores the
basis of the UVF to find the UVF files relevant to the request.
Great importance is also attributed to the metadata of the UVFs
stored in the database due to their active roles to accelerate the
research process. At this stage, a list of UVF files is selected.
Thereafter, each UVF is transformed into a Semantic
Mediation File (SMF: Semantic Mediation XML) through an
SMF generator and by taking into consideration the user
profile. This le contains the metadata detailing the object
context, the information on the source document associated
Fig. 3. Analysis and Treatment Module
The result of this process is a set of Document Medical
Unified (DocMU) files associated with a patient, which
represents the concepts of medical documents in a structured
way and which are all with a unique model and a uniform
structure. These DocMUs are subsequently passed to a second
process called ’the grouping process’ which in turn make
together those in a new file called the Document Medical
unified Patient (DocMUP) file. Therefore, this file is the
concatenation of different DocMUs of the same patient and
used for comparison with other DocMUPs other patients.
The resulting DocMUP with the corresponding SMF files
are passed to the last process in this module, the process
of calculating similarity that aims to calculate the similarity
between the different projects.
The result of calculation will be in the form of a file called
File of Similarity (FoS). The similarity calculation process
includes two steps of calculation:
 Basic calculation (default): where the role of
comparator is to count the common medical episodes
(diseases which present in the SMF files) between the
two files to compare.
 Advanced calculation: the role of comparator in this
level is not calculate diseases Commons, hands farther
than that, he is interested in the tests, medical
examinations, and their parameters (values) that are in
the file DocMUP.
with the object and its url. Based on these Urls, this module
will be able to retrieve records of medical examinations of each
patient. Each recovered document will be at the entrance of a
unification process that aims to reformulate the model of
document. The result of this process is a set of files Document
Medical Unified (DocMU).
The result of this comparator is depicted in a file called the
file of similarity in the form of a table, whose columns present
medical episodes (diseases) relating to a patient given (in the
case of basic calculation ) and parameters medical tests in case
of advanced calculation. And the lines present a list of patients
(patient identifiers) that must be compared with the patient
target.
3) Querying and Visualization Module
This module rep- resents the HMI part of our mediator. It
provides a set of graphical interfaces that allow the user to
interact and communicate with the system. Through these
interfaces, the user is able to consult a database containing a
massive amount of Electronic Health Records, enter queries
and view the results.
The data from the sources and heterogeneous systems that
are recovered and described in the format of a UVF are
represented graphically in the form of a card that we call it
’Iconic Information Card’. The latter represents a synoptic
history of the project of a patient based on an iconic
representation of events and an axis of time on which these
events are placed. In fact, the IC can be viewed according to
different modes of display:
 The Mono Project Visualization: This mode presents
the simplest case, when the user want to view a
medical record of a single patient. In this mode of
 visualization, the EHR is displayed in the form of an
iconic information card, which is used to represent a
synoptic history of the patient from his birth until his
death.
 The Bi-Project visualization: allows the user to
visualize two health records of two distinct patients,
which thus gives him the opportunity to compare these
two files.
 The Multi-projects visualization: follow-up to an
operation to search for similar projects, the
visualization multi-project sub-module intervenes and
Fig. 4. Querying and Visualization Module
V. EVALUATION OF THE MPM SYSTEM
The evaluation of the efficiency of an information system is
one of the key issues in research on this field. Also, researchers
and practitioners in the field of health informatics recognize the
importance of the evaluation of Healthcare Information
Systems (HIS). Ammenwerth et al [16] defined the evaluation
of SIS as “the act of measuring or exploring properties of a
health information system (in planning, development,
implementation, or operation), the result of which informs a
decision to be made concerning that system in a specific
context”. We present in this section the tests carried out with
different healthcare professionals to assess the MPM prototype.
We are only interested in the usefulness and usability of
visualization capabilities, graphic objects filtering, research
similar cases and comparison between different health records.
Our evaluation approach is qualitative. It involves
collecting a set of qualitative data through a questionnaire and
analyze these data. A questionnaire is the most common
method for evaluating an HMI (Human Machine Interface).
This technique is to provide a questionnaire for users to
evaluate and rate the HMI through a series of questions. Our
choice fell on the questionnaire because it allows to gather
display the result of research in the form of a list. This
mode of visualization presents to the user a synthetic
overview on similar to a health record given folders. In
this mode, the projects are displayed in a table, or each
line consists of a medical record.
 The Metaphorical visualization: this mode allows to
display on a card of a human body the different
diseases of a patient, which allows the user to have an
overview of the patient profile of more quickly way
and more expressive.
opinions or suggestions about the degrees of usefulness and
usability of systems.
To start a test, we described to the user project and the
purpose of the test. We asked him then some information on
his profile. We realize a brief demonstration of the tool, in
order to give the user the discovery of the features. Thereafter,
the user is invited to complete the questionnaire and he could
also record his suggestions and propose improvements.
The results of evaluations obtained are rather encouraging.
Clinicians have found all the features useful and it's very easy
to handle the interface. The main criticisms collected focused
on the lack of the vocal aspect interfaces. Healthcare
professionals would find it very relevant to integrate the notion
of speech in interfaces to make them save time.
Although 70% of clinicians said they have not used this
type of tools, they found the general use of the application
rather very simple to 80%. Only 10% of clinicians said they
had really search features (the others have found more easily)
and only 20% of clinicians have confessed to handling errors.
Manipulation, iconic visualization and comparison of projects
as a whole seems to be rather very easy to understand. What
was most encouraging is that clinicians have all said that this
prototype helps immensely to develop plans for the proper care
and communicate more easily with other professionals of
health through the functionality of MPM system.
 Fig. 5. The GUI of the MPM system
VI. CONCLUSION
In the last years, a considerable number of research efforts
have studied the means and ways to improve the collection and
dissemination of medical information useful to the patient’s
health care. These efforts have resulted to the emergence of
many and multiple healthcare information systems, which are
generally heterogeneous and distributed. Often, these systems
need to exchange information to ensure good coordination of
care and patient monitoring by obtaining a global overview of a
patient’s medical record. However, data exchange and
communication between them is very complex and difficult
due to their heterogeneity. To address this problem, we note
that there are some platforms, which help to communication,
such as cross-database approach, federated approaches and
mediator approaches. In this context, we propose in this paper a
new semantic mediator which allows to unify the
representation of the information related to a patient and which
are initially heterogeneous and distributed in a Virtual Folder
Unified and present it in an iconic format and unified
chronological and that through the Iconic Information Card.
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