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Service Oriented Architecture for Clinical Decision Support: A Systematic Review and Future Directions

  • Transactional Processing Systems
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Abstract

The use of a service-oriented architecture (SOA) has been identified as a promising approach for improving health care by facilitating reliable clinical decision support (CDS). A review of the literature through October 2013 identified 44 articles on this topic. The review suggests that SOA related technologies such as Business Process Model and Notation (BPMN) and Service Component Architecture (SCA) have not been generally adopted to impact health IT systems’ performance for better care solutions. Additionally, technologies such as Enterprise Service Bus (ESB) and architectural approaches like Service Choreography have not been generally exploited among researchers and developers. Based on the experience of other industries and our observation of the evolution of SOA, we found that the greater use of these approaches have the potential to significantly impact SOA implementations for CDS

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Acknowledgments

VH is supported by the Intramural Research Program of the National Institutes of Health Clinical Center and the National Library of Medicine.

KK’s effort for this review was supported by the University Of Utah Department Of Biomedical Informatics. KK has in the recent past or is currently serving as a consultant on CDS to the following organizations: the U.S. Office of the National Coordinator for Health IT, Partners HealthCare, RAND Corporation, ESAC, Inc., McKesson InterQual, ARUP Laboratories, Inflexxion, Inc., and Intelligent Automation, Inc. KK receives royalties for a Duke University-owned CDS technology for infectious disease management known as CustomID that he helped develop. KK was formerly a consultant for Religent, Inc. and a co-owner and consultant for Clinica Software, Inc., both of which provide commercial CDS services. KK no longer has a financial relationship with either Religent or Clinica Software.

Author information

Authors and Affiliations

  1. School of Engineering and Informatics, University of Sussex, Shawcross building, Falmer, Brighton, East Sussex, BN1 9QT, UK

    Salvador Rodriguez Loya & Chris Chatwin

  2. Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA

    Kensaku Kawamoto

  3. National Institutes of Health, Clinical Center, Bethesda, MD, USA

    Vojtech Huser

Authors
  1. Salvador Rodriguez Loya
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  2. Kensaku Kawamoto
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Corresponding author

Correspondence to Salvador Rodriguez Loya.

Additional information

This article is part of the Topical Collection on Transactional Processing Systems.

Appendices

Appendix 1

ACM digital library

The search in the ACM Digital Library was performed on October 16, 2013 and four studies were obtained. Because of the options available in this database the search string had to be divided into the following two substrings: Table 9

Table 9 Search strings used on the ACM Digital Library database
Full size table

Compedex

The search in the Compendex database was performed on October 16, 2013 and 80 studies were returned. The search was conducted in the subject, title and abstract of all the databases available. The result was filtered by language, considering only studies written in English. The defined search is presented in the following Table. Table 10

Table 10 Search string used on Compendex
Full size table

IEEE explore

Since IEEE Xplore does now allow searching in the abstract and title in the same string, the search string was divided into the following two substrings. The search was performed on October 16, 2013 and 13 studies were returned. Table 11

Table 11 Search string used on IEEE Xplore
Full size table

Science direct

The search in ScienceDirect was performed on October 17, 2013. The title, abstract, and keywords were included and 12 studies were returned. The following table shows the search string and number of publications retrieved. Table 12

Table 12 Search string used on ScienceDirect
Full size table

Scopus

The search in Scopus was performed on October 17, 2013 and 79 studies were retrieved. The following table shows the string used in this database. Table 13

Table 13 Search string used on Scopus
Full size table

Springer

The search in Springer was performed on October 17, 2013. The following table shows the string used in the Springer search engine. Table 14

Table 14 Search string used on Springer
Full size table

We removed the terms "CDS" and "CDSS" from the search string because we obtained several not related studies (393). This is because Springer does not provide a search tool that could limit the search to the abstract and title; it does search in the whole content of the studies.

Web of science

The search in Web of Science was performed on October 17, 2013 and a set of 48 articles was obtained. Since this database does not allow searching by abstract, the search was performed using the title and "topic". The defined search string is presented in the following table. Table 15

Table 15 Search string used on Web of Science
Full size table

Total of search results

The following table shows the total of articles before and after removing the repeated studies. Table 16

Table 16 Combined search results
Full size table

Appendix 2

1. Erl T (2005) Service-Oriented Architecture Concepts, Technology, and Design. Prentice Hall PTR

2. Malinverno P, Plummer DC, Huizen G Van (2013) Magic Quadrant for Application Services Governance.

3. Heffner R, Leganza G (2011) SOA Adoption 2010: Still Important, Still Strong.

4. Tesselaar H What’s SOA got to do with it. In: Bobsguide. http://bian.org/participate/bian-blog/whats-soa-got-to-do-with-it/. Accessed 6 Dec 2013

5. Dobrescu R, Purcarea V (2012) Impact of Information Technology on the Quality of Health Services. In: Borangiu T, Thomas A, Trentesaux D (eds) Serv. Orientat. Holonic Multi-Agent Manuf. Control SE - 23. Springer Berlin Heidelberg, pp 307–319

6. Konstantinos K, Marinos T, Da Cunha PR (2013) SOA Implementation Critical Success Factors in Healthcare. J Enterp Inf Manag 26:343 – 362. doi: 10.1108/JEIM-06-2012-0036

7. Kawamoto K, Honey A, Rubin K (2009) The HL7-OMG Healthcare Services Specification Project: Motivation, Methodology, and Deliverables for Enabling a Semantically Interoperable Service-oriented Architecture for Healthcare. J Am Med Inf Assoc 16:874–881. doi: 10.1197/jamia.M3123

8. HL7 Health Level Seven International. http://www.hl7.org/. Accessed 17 Jan 2014

9. OMG Object Magement Group. http://www.omg.org/. Accessed 17 Jan 2014

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12. Kawamoto K, Houlihan C a, Balas EA, Lobach DF (2005) Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ 330:765. doi: 10.1136/bmj.38398.500764.8F

13. Sharma B (2008) Electronic Healthcare Maturity Model (eHMM): A White paper. Chennai, India

14. Garets D, Davis M (2006) Electronic Medical Records vs . Electronic Health Records : Yes, There Is a Difference. Policy white Pap. Chicago, HIMSS Anal.

15. HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM). http://www.himssanalytics.org/emram/emram.aspx. Accessed 10 Jul 2013

16. Wainwright D, Waring T (2000) The information management and technology strategy of the UK National Health Service – Determining progress in the NHS acute hospital sector. Int J Public Sect Manag 13:241–259. doi: 10.1108/09513550010346152

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Loya, S.R., Kawamoto, K., Chatwin, C. et al. Service Oriented Architecture for Clinical Decision Support: A Systematic Review and Future Directions. J Med Syst 38, 140 (2014). https://doi.org/10.1007/s10916-014-0140-z

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