Context management: future-proof technology you won’t want to miss
Context management across various vendors’ applications has been an ongoing issue for decades. The multitude of EHR vendors and lack of standardisation presents challenges in seamless and efficient healthcare interoperability. Many systems are not compliant with each other or with other software, even within a single healthcare organisation. The general challenge of synchronising application context across disparate applications from different vendors will be ever-existing—technology changes over the years and, consequently, the needed solutions.
Context managers offer a solution to healthcare interoperability by providing a shared language that enables smooth data exchange among various sources and prevents glitches. So how can we make sure that the latest context manager will withstand the test of time? A capable context manager will be able to manage the sweeping requirements of medical data communication efficiently. For example, such requirements demand an adaptable, compliant, and highly configurable context management solution that offers additional features, extensive operational properties, and future-proof technology.
What does future-proof technology entail? Keeping stride with the latest developments and establishing newer mappings safeguards a data synchronisation system against technological advancements, securing it as a long-term solution. More recent mappings highly relevant to healthcare interoperability facilitate CCOW applications, which fall under HL7 International Standards. Here’s a brief run-through of the protocol.
HL7 International Standards
Health Level Seven (HL7) International Primary Standards have been developed over the past few decades to provide a set protocol that supports medical data exchange across various types of applications and software. These standards facilitate interoperability by enabling healthcare providers to access and input synchronised data within multiple information systems while maintaining consistency across all patient records. Of the various international standards, the three most prevalent and requested criteria regarding context management are CCOW, FHIR, and one non-HL7 de facto standard, SMART on FHIR.
HL7 Standards offer flexibility and adaptability that facilitate ease of use for healthcare organisations. However, these advantages also result in glitches and oversights in interoperability across the broad variation among healthcare applications. One hospital might be using the most recent HL7 Version 3 Product Suite, while another might be using older CCOW applications. These different versions may even be within the same system in a given department. In this case, a compliant context manager can enable seamless and efficient communication between various applications and software – no matter what version of HL7 standards it may use.
CCOW
The Clinical Object Content Workgroup (CCOW) is an organisation that provides guidelines for communication across visual (GUI-based) applications for healthcare providers. CCOW supports secure, unfailing retrieval of patient data, as the context manager coordinates patients with their respective medical records from disparate applications. Healthcare centres typically have multiple applications to store and handle patient data, and with CCOW, the context management system synchronises all the various sources to act as a single interface. The vendor-independent HL7 CCOW standard uses context management to share data across disparate healthcare applications at the point of care. CCOW synchronises the various applications so that a clinician can access the same clinical information, whether it is the same patient, user, test, or appointment.
Although HL7 adopted CCOW standards in 1998, most applications do not fully support CCOW, and some are entirely non-compliant. As mentioned above, there are also various versions still in use. As a result, it is essential to include these partial and non-CCOW-compliant applications as well as older and more recent versions for comprehensive integration of a desktop healthcare IT suite. A context manager must enable CCOW compliance across all three applications for seamless communication in the context sharing session.
Newer CCOW mappings
CCOW emerged as a technology-neutral system, allowing the possibility to choose the most suitable technology mapping for a specific setup. While this breadth of choice promotes ease of use and adaptability, it also contributes to non-standardisation within medical data exchange. Over time, newer technology mappings met the demands of developing context management systems. In the last years, the technology mappings specified from HL7 have stopped evolving, even though technology has kept advancing rapidly. This situation results in a need for newer mappings to keep up with continuously evolving technologies.
A thoroughgoing context management system will comply with HL7 CCOW standards in addition to newer developments. Here is a list of some recent mappings:
• CCOW Component Object Model (COM)
• CCOW JSON over HTTP(S)
• CCOW URLENCODED over HTTP(S)
• CCOW JSON over WebSockets
• CCOW encrypted PROTOBUF/gRPC
FHIRcast
HL7’s standard of Fast Healthcare Interoperability Resources, Release 4, aids in collaborating medical data between healthcare practitioners, patients, and other involved members. Its two primary sections include a content prototype and stipulations on sharing these resources within real-time RESTful applications and other communication flows. In connection with the FHIR standard is the FHIRcast specification for context synchronisation. FHIRcast enables subscribers to receive notifications either through a webhook or over a WebSocket connection. FHIRcast recommends the HL7 SMART on FHIR launch protocol for both session discovery and API authentication.
SMART on FHIR
The SMART App Launch Framework allows browser-based apps to be launched from an Electronic Health Record system. The framework implements a protocol in which certain data and contextual information can be handed over from the starting application to the new application, thus enabling the newly started application to start in the correct context. SMART is proposed by SMART Health IT as an API (application programming interface) to transform EHRs into platforms. By combining elements from SMART and FHIR, the SMART on FHIR solution presents a possible solution for browser-based apps on standard FHIR interfaces.
SMART on FHIR and FHIRcast: emerging solutions
FHIRcast and SMART on FHIR’s real-time healthcare interoperability enable access to the same clinical data without a separate context management system. Although FHIRcast, SMART on FHIR, and CCOW address many of the same concerns, FHIRcast and SMART on FHIR can’t substitute CCOW as its design is more rudimentary and technologically constrained.
Since HL7 started promoting the FHIR standard, its use has become increasingly widespread. FHIRcast and SMART on FHIR solutions are likely to develop for browser-based applications. SMART on FHIR based applications are already running in a range of settings.
FHIRcast and SMART on FHIR are not substitutions for CCOW but are emerging solutions for a subset of the use cases a CCOW Context Manager handles. It is, however, important that a CCOW Context Manager does not hinder the deployment of FHIRcast and SMART on FHIR applications in the complete IT portfolio.
What if you could ensure a long-term investment with a context manager that keeps pace with newer technologies?
Sirenia’s context manager supports SMART on FHIR standards as well as newer CCOW mappings.
If you have questions about how a context manager can support your healthcare organisation for many years to come, we welcome you to discuss your situation with us. Book a free consultation with us below!
