Interoperability and Integration Considerations for a Process-Oriented Clinical Decision Support System

Electronic medical record systems (EMRs) can be made more attractive to the clinicians if Clinical Decision Support Systems (CDSS) are integrated with them. However, CDSS have to be developed with integration in mind, such that they may be integrated not just with the local EMR but EMRs developed by others as well. Web Services Technology ameliorates the challenge of integration if the CDSS is well-designed but several other issues still need to be considered. The integration has to allow two-way data exchange between the CDSS and the EMR, which requires the EMR also to expose a set of interfaces. Further, the CDSS itself needs integration with services on which it depends for its functionality. In the semantic data capture initiative (SDCI) project, we integrated, Proteus (http://proteme.org), an open source, process-oriented clinical decision support system with Henry Ford Health System's EMR, Care Plus. The effort involved addressing some of these challenges and some that are unique to a system like Proteus.