Summary Introduction: This article is part of the Focus Theme of Methods of Information in Medicine on the German Medical Informatics Initiative. “Smart Medical Information Technology for Healthcare (SMITH)” is one of four consortia funded by the German Medical Informatics Initiative (MI-I) to create an alliance of universities, university hospitals, research institutions and IT companies. SMITH’s goals are to establish Data Integration Centers (DICs) at each SMITH partner hospital and to implement use cases which demonstrate the usefulness of the approach. Objectives: To give insight into architectural design issues underlying SMITH data integration and to introduce the use cases to be implemented. Governance and Policies: SMITH implements a federated approach as well for its governance structure as for its information system architecture. SMITH has designed a generic concept for its data integration centers. They share identical services and functionalities to take best advantage of the interoperability architectures and of the data use and access process planned. The DICs provide access to the local hospitals’ Electronic Medical Records (EMR). This is based on data trustee and privacy management services. DIC staff will curate and amend EMR data in the Health Data Storage. Methodology and Architectural Framework: To share medical and research data, SMITH’s information system is based on communication and storage standards. We use the Reference Model of the Open Archival Information System and will consistently implement profiles of Integrating the Health Care Enterprise (IHE) and Health Level Seven (HL7) standards. Standard terminologies will be applied. The SMITH Market Place will be used for devising agreements on data access and distribution. 3LGM 2 for enterprise architecture modeling supports a consistent development process. The DIC reference architecture determines the services, applications and the standards-based communication links needed for efficiently supporting the ingesting, data nourishing, trustee, privacy management and data transfer tasks of the SMITH DICs. The reference architecture is adopted at the local sites. Data sharing services and the market place enable interoperability. Use Cases: The methodological use case “Phenotype Pipeline” (PheP) constructs algorithms for annotations and analyses of patient-related phenotypes according to classification rules or statistical models based on structured data. Unstructured textual data will be subject to natural language processing to permit integration into the phenotyping algorithms. The clinical use case “Algorithmic Surveillance of ICU Patients” (ASIC) focusses on patients in Intensive Care Units (ICU) with the acute respiratory distress syndrome (ARDS). A model-based decision-support system will give advice for mechanical ventilation. The clinical use case HELP develops a “hospital-wide electronic medical record-based computerized decision support system to improve outcomes of patients with blood-stream infections” (HELP). ASIC and HELP use the PheP. The clinical benefit of the use cases ASIC and HELP will be demonstrated in a change of care clinical trial based on a step wedge design. Discussion: SMITH’s strength is the modular, reusable IT architecture based on interoperability standards, the integration of the hospitals’ information management departments and the public-private partnership. The project aims at sustainability beyond the first 4-year funding period.

中文翻译：

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用于医疗保健的智能医疗信息技术（SMITH）

简介：本文是德国医学信息学倡议的医学信息方法重点主题的一部分。“医疗智能医疗信息技术（SMITH）”是由德国医学信息倡议（MI-I）资助的四个联盟之一，该联盟建立了大学，大学医院，研究机构和IT公司的联盟。SMITH的目标是在每个SMITH合作医院建立数据集成中心（DIC），并实施用例来证明该方法的有效性。目标：深入了解SMITH数据集成基础上的体系结构设计问题，并介绍要实施的用例。治理和策略：SMITH对其治理结构及其信息系统体系结构也实施了联合方法。SMITH已为其数据集成中心设计了通用概念。它们共享相同的服务和功能，以充分利用互操作性体系结构以及计划的数据使用和访问过程。通过DIC，可以访问当地医院的电子病历（EMR）。这基于数据受托者和隐私管理服务。DIC工作人员将整理和修改Health Data Storage中的EMR数据。方法和体系结构框架：为了共享医学和研究数据，SMITH的信息系统基于通信和存储标准。我们使用开放式档案信息系统的参考模型，并将一贯实施整合医疗保健企业（IHE）和七级健康（HL7）标准的配置文件。将使用标准术语。SMITH市场将用于制定有关数据访问和分发的协议。用于企业体系结构建模的3LGM 2支持一致的开发过程。DIC参考体系结构确定有效支持SMITH DIC的摄取，数据滋养，受托人，隐私管理和数据传输任务所需的服务，应用程序和基于标准的通信链接。在本地站点采用参考体系结构。数据共享服务和市场实现了互操作性。用例：方法学用例“表型管道”（PheP）根据分类规则或基于结构化数据的统计模型，构造用于注释和分析患者相关表型的算法。非结构化文本数据将接受自然语言处理，以允许集成到表型算法中。临床用例“ ICU患者的算法监测”（ASIC）重点关注重症监护病房（ICU）患有急性呼吸窘迫综合征（ARDS）的患者。基于模型的决策支持系统将为机械通风提供建议。临床用例HELP开发了“基于医院的电子病历的计算机决策支持系统，以改善患有血流感染的患者的预后”（HELP）。ASIC和HELP使用PheP。用例ASIC和HELP的临床益处将在基于阶梯楔形设计的护理变更临床试验中得到证明。讨论：SMITH的优势在于基于互操作性标准的模块化，可重用的IT体系结构，医院信息管理部门的整合和公私伙伴关系。该项目的目标是在第一个四年资助期之后的可持续性。