Interoperability framework for integrated e-health services

Bulletin of Electrical Engineering and Informatics
Vol. 9, No. 1, February 2020,pp. 354~361
ISSN: 2302-9285,DOI: 10.11591/eei.v9i1.1825  354
Journal homepage: http://beei.org
Interoperability framework for integrated e-health services
M. Miftakul Amin1, Adi Sutrisman2, Deris Stiawan3, Ermatita4, Mohammed Y. Alzahrani5,
Rahmat Budiarto6
1,2
Department of Computer Engineering, Politeknik Negeri Sriwijaya, Indonesia
3,4
Department of Computer Science, Universitas Sriwijaya, Indonesia
5,6
College of Computer Science and IT, Albaha University, Saudi Arabia
Article Info ABSTRACT
Article history:
Received Aug 26, 2019
Revised Oct 31, 2019
Accepted Nov 24, 2019
As one of the country with largest population in the world, Indonesia
is facing major challenge to serve people in various sectors, one of them
is health sector. Utilization of Information and Communication Technology
(ICT) has a strategic role in improving efficiency and expanding services
access. The main challenge related to data interoperability is the ability
to integrate and synchronize data sourced from health information (e-health)
systems with different (heterogeneous) platforms. This research aims to build
a framework to materialize data interoperability and information exchange
among e-health systems. The interoperability is materialized by utilizing
service oriented architecture (SOA) paradigm and is implemented using Web
Service technology. Service oriented analysis and design (SOAD) is used
as method in the system development at the analysis phase and designing
phase to generate service portfolio which consisting of three
levels: conceptual view, logical view, and physical view. This research
intruduces Interoperability Matrix (IM) to describe the modules and entities
that involved in the framework design. The framework resulted from this
research can be used as reference in e-health systems development in variety
of health care applications.
Keywords:
E-health system
Interoperability
SOA
SOAD
Web service
This is an open access article under the CC BY-SA license.
Corresponding Author:
Deris Stiawan,
Department of ComputerEngineering,
Universitas Sriwijaya,
Jalan Srijaya Negara Bukit Besar, Palembang30139,Indonesia.
Email: deris@unsri.ac.id
1. INTRODUCTION
At this moment, Indonesia is in the fourth rank, as one of the largest population country
in the world. The role of development sector of Information and Communication Technology (ICT)
in Indonesia hasbeen widely perceived by society. In the health sector, application of ICT is known as health
information systems (e-health). The decree of the Minister of Health of the Republic of Indonesia,
number: 192/MENKES/SK/VI/2012 mentions that e-health system is the use of ICT in health sector,
especially to improve health service. Implementation and application of e-health in Indonesia has started
since 1985 [1], and over time also adapt to the development of ICT which is most of directed to the aspect
of health care service. On the other hand, we come to the era of high-speed technology, characterized
by cellular technology, high-speed Internet, and wireless communication [2]. This technology encourages
the development of e-health in adopting the development of the technology. Ministry of Health
of the Republic of Indonesia in 2004 defines the National Health System (SKN) as a setting that compils
the efforts of Indonesian integrated and mutually supportive, to ensure the supermacy of health as

Bulletin of Electr Eng & Inf ISSN: 2302-9285 
Interoperability framework for integrated e-health services (M. Miftakul Amin)
355
manifestation of general welfare as intended in the opening of Indonesia constitution (UUD 1945). In order
to keep this health system on target, the management of population database is also one of the aspect that
need to be considered. The Ministry of Interior of the Republic of Indonesia has implemented E-KTP,
with Citizen Identification Number (NIK) as single reference in population administration [3]. This E-KTP
Data asthe referral for various services for the society, including in the health sector [4].
In e-health sytem development, wide range of healthcare applications are built by various vendors
and run on different platforms. One of the challenge in the context of app development is interoperability,
which playsan important role in data and information exchange [5]. As time goes by, healthcare applications
begin to shift from paper-based to paper-less with the use of computer. Healthcare organization such as
hospital requires relevant data and necessary information in its e-health such as population data, health
insurance data, and electronic medical records. Many countries have been actively engaged in development
of interoperability for data exchange and electronic transaction amonggovernment agencies to provide better
public service to its citizen [6]. In e-health system, data associated with the patient is stored in distributed
data source [7], which is in organization of health providers such as doctor, hospital, laboratory, and other.
These health providers are autonomous, so that data is independently managed by the organization.
Therefore, when data will be exchanged between organizations, each organization has agreed to share data
with considering objectives,schemes, and agreed data [8].
Interoperability generally is defined as ability of two or more systems or components to exchange
information and used the exchange information [9]. Data exchange and information format play an important
role in facilitating interoperability. Standardization of data exchange and information format is very
important to do [10]. Interoperability allows different information systems and organizations to work
together. Interoperability have four levels as shown in Figure 1. The development of data interoperability
requires an interface, which is published following specific standard. A system, which does not require
the ability of exchange data and information, does not require such interface [12]. Referring to Figure 1,
the organizational interoperability level allows performing both internal and external interoperability.
Internal interoperability can occur in some data/information sources from an organization, while external
interoperability allows the exchange of data perfom by different organizations.
Organizational
Interoperability
Business process integration beyond the
boundaries of a single organization
Semantic
Interoperability
Ensuring the same meaning of exchanged
data through predefined and shared
meaning of terms and expressions
Syntactic
Interoperability
Exchange of information through
predefined data format and structure
Technical
Interoperability
Technical end-to-end exchange of data
among systems
Figure 1. Levels of Interoperability (adapted from [11])
In e-health systems, interoperability is required in process of exchanging data related to patient [13].
In its implementation, minimal interoperability involves two different systems or applications.
One application or system serves as data provider, while other applications/systems act as data consumer.
Referring to Figure 1, the syntactic interoperability level allows multiple applications that built using
different type of programming languages and running on variety of platform can exchange data
and information. While the syntactic interoperability level focuses on data exchange mechanism, and at
semantic interoperability level, it allows a document to be translated and read on receiver
data/information side.
Interoperability can be implemented using Service Oriented Architecture (SOA) approach. SOA
is one of the approach to meet the standards of need and quality of software development. SOA cover
functionality of a system into services [14]. Then, various applications with different platforms can connect
each other and exchange data without having direct connection each other (loosely coupled). SOA is a form
of architectural technology, which follows the principles of service orientation [15] by performing app roach
through dividing large functionality into smaller services with specific objective. Many of that technology
can be used to implement SOA architecture, including CORBA (Common Object Request Broker
Architecture), DCOM (Distributed Component Object Model), RMI (Remote Method Invocation),
and Web Services. Some of these technologies in another side have weakness, for example CORBA, DCOM,
RMI is closed (proprietary) so that the development is only on certain platform. While the Web service
is open (non-proprietary) and web-based.

 ISSN: 2302-9285
Bulletin of Electr Eng & Inf, Vol. 9, No. 1, February 2020 : 354 – 361
356
The Web service is a communication method between two electronic devices running on computer
network [16]. The service, which is owned, by web service is software module provided by service
provider [17]. Web Service is based on the concept of SOA, as an alternative solution in development of
distributed system. At the beginning of web service development, people use SOAP protocol, until REST
protocol was introduced [18, 19]. Figure 2 provides information on the differences between SOAP and REST
protocol. Figure 2(a) shows that the SOAP Protocol defines web services as three entities, which are service
provider, service registry, and service consumer. Service provider serves the requests of service consumer.
While the service consumer in general is an application that consumes web services. Service registry acts as
directory, provides number of services, in which there is description of the service provided.
Based on the description and documentation provided by this service registry, service consumer can find
a service and interact with the service provider. Communication between each entity uses XML notation.
Fielding [20] introduced representational State Transfer (REST) protocol as shown in Figure 2(b)
Fielding defines REST as a client/server communication where the client requests to the server,
and the server sends response to the client. Communication between this client/server is based on
the resource which identified as a URI. RESTful Web Services use HTTP methods such as GET, PUT,
POST, and DELETE which can be integrated with CRUD operation (Create, Read, Update, and DELETE) in
a database operation [21]. In every software engineering methodology, there are steps, which must be
followed for system analysis and design. In the development of Service Oriented Architecture (SOA),
developers use an approach called Service Oriented Analysis and Design (SOAD), which provides guidance
on design implementation of SOA concept through three stages, including Conceptual View (CV), Logical
View (LV), and Physical View (PV) [22]. The results of these three steps will be packaged into
a service portfolio [23].
Registry
Service
Provider
Service
Consumer
find
register
Bind and execute
contract
Web Service
Internet
JSON Request
JSON Response
Mobile App
Desktop App
Web App
GET
POST
PUT
DELETE
Multi OS/
Language
HTTP
METHOD
Custome
Params
(a) (b)
Figure 2. SOAP and REST protocol, (a) SOAP protocol (adapted from [19]), (b) REST protocol
(adapted from [3])
Currently, organization in public service in global business environment are challenged by very
competitive and rapid changes that demands cooperation between organizations. This challenge leads
to software implementation needs, which have high level of interoperability and require cross-organization
business process modeling [24]. Business processes is a series of task and activity executed to produce
specific output. Intra-organizational business process is a series of activities carried out by a scope
of organization, while the carried out cross-organizational business process activity is not only within one
organization, but engage with other organizations to achieve common objectives. Business processes need to
be documented, optimized, and possible to do business process automation (BPA).
Most of the cross-organizational business processes are implemented using an infrastructure such
asWeb Services [25].
2. RESEARCH METHOD
This work follows SOAD Framework as logical approach for classification and organize
information related to the analysis and SOA concept design. This system development step will result
portfolio service as information stored for service consolidation. Figure 3 depicts the proposed
Service Portfolio.
Steps in CV consist of functional domains, business processes, business services, software services
and software components.The CV also illustrates business process activity diagram (BPAD) and subbusiness
process activity diagram (SBPAD), which illustrates series of activities in each business process. In LV,
the Steps are based on Enterprise Architecture (EA) which is useful for mapping the structure and objectives

357
of an organization, business processes, data and information structures, applications, and informatio n
technology infrastructure, also Service Oriented Architecture (SOA) to design services in the system. LV
contains of mapping of business services into service in software design, which is described in the form
of Web method/Web services. In the final step of SOAD, it is design in PV, which consists of Presentation
Layer, Application Service Layer, Domain Model Layer, and Data Access Layer. Presentation Layer
describes Graphical User Interface (GUI) in which there is process of accessing the Web service. Data Model
Layer describes class diagram, activity diagram, and sequence diagram related to SBPAD in CV step.
Furthermore, the step of Data Access Layer contains operations, which connected to the database,
namely: Create, Read, Update, and Delete (CRUD). In PV step is also possible to develop Business Process
Execution Language (BPEL).
Integration of Funcional Domains
(BPMN Orchestration among FDs)
Stakeholder Diagram
Functional Domain Workflow Diagram
(BPMN Choreography for FD)
Business Layer
Including Functional
Domain, Business
Process, Business Service
Service Layer
Including Software
Services
Component Layer
Including Software
Component
Matrix of the Business
Service versus the
Software Component
Business Service
Workflow Diagram
(BPMN Choreography for
BS)
Web Service Layer
Including web methods/
operation, service
sequence diagram
Presentation Layer
Application Service
Layer
Including method,
business sequence
diagram
Data Model Layer
Including components,
class diagram, and Data
Transfer Object
Data Access Layer
Including Data Access
Object
CONCEPTUAL VIEW
LOGICAL VIEW
PHYSICAL VIEW
Figure 3. Service portfolio SOAD framework
3. RESULTS AND ANALYSIS
3.1. E-health services module
In this research, the service portfolio is derived from design of interoperability framework for
e-health service which can illustrate Service Oriented Architecture (SOA) paradigm in system development.
The e-health service includes several computer-based information systems as an effort to fulfill service for
patientsand information needsforstakeholders, which include some services as can be observed in Figure 4.
Figure 4. E-health services environment
E-Health
Services
Patient
Registration
OutPatient
System
InPatient
System
Emergency
Department
System
Laboratory
System
Radiology
System
Hemodialysis
System
Physiotherapy
System
Chemotherapy
System
Surgical
installation
System
Medical records
System
Pharmacy
System
Finance
System
Staffing
Information
System
Administrator
System
Medical
Rehabilitation
Speech
Therapy
System
Logistics
System
Nutrition
System

 ISSN: 2302-9285
358
3.2. Architechtural design
This research work aims to come out with a model of interoperability mechanism for exchanging
data and information among several database namely: National Population Database, health insurance
database,e-health operated by a health data providersuch as hospital. The design of interoperability scena rio
is presented in Figure 5. Stakeholders in turn, are able to develop applications with different programming
languages and platforms. National Population Database and health insurance system can be accessed by
providing interfaces in collection of Web services, so that the e-health system can access the data that have
been provided.
Method 1
Method 2
…
Method n
Web service
Database
Web server
Population Database
Method 1
Method 2
…
Method n
Web service
Database
Web server
Health Insurance Data
Method 1
Method 2
…
Method n
Web service
Database
Web server
E-HEALTH JSO
N
INTERNET
JSON
JSON
Mobile Application
Desktop Application
Web Application
STAKEHOLDER/Public Services
JSON
Method 1
Method 2
…
Method n
Web service
Database
Web server
Prescription System
Method 1
Method 2
…
Method n
Web service
Database
Web server
Public Health Office
J
S
O
N
J
S
O
N
Figure 5. Interoperability of e-health system scenario
3.3. Business process modelling of RESTful web service data exchange
Figure 6 shows a series of business process activities that show the parties who involved
in the e-health service interoperability framework. E-health system is the center of health care activities.
The e-health system is an application used by hospital, public health center, and health clinic.
The Framework is built using RESTful Web service which involving multiple entities including national
population data, health insurance data, electronic prescription system, and health service. Furthermore,
the already formed framework can be accessed by stakeholders as open system architecture
for software developers.
The framework that will be built require connections to RESTful Web Service with predefined
mechanism. Once authentication process is received, the dataset which presented by RESTful Web service
can be accessed. The Data provided by RESTful Web Service can be accessed by accessing number
of services. The number is provided in the routing mechanism in the form of resource address list (URI).
To execute URI the HTTP protocol is used and the method is in the form of POST, PUT, GET,
and DELETE.
Dataset that is generated both from and to the RESTful Web Service Framework will perform
parsing JSON data structure and adjusted by the variable name a nd data type owned by the software or
application that used by e-health System. The process of adjusting variable name and data type used by
the e-health system and RESTful Web Service is known as Schema Mapping. This schema can b e
recognized, because the key-value, which pair in JSON will be adjusted at application level and also at
database level.

359
Figure 6. Data exchange of RESTful web service
3.4. Interoperability matrix
In the development of framework interoperability which integrated several entities or modules
which involved in the system can be described in an interoperability matrix (IM) diagram. This Diagram can
provide entity information or module which serves as service provider and which serves as consumer
of the service which hasbeen provided (consumer). Interoperability Matrix (IM) Diagram can be presented in
Figure 7. Reffering to Figure 6, interoperability development of e-health service can be described in the form
of Interoperability Matrix (IM), describing consumer/provider between entities involved in the framework.
Consumer is an entity, which requires data by executing service provided by a provider. Data exchange
interoperability requirements can be seen in Table 1.
Figure 7. Interoperability matrix

 ISSN: 2302-9285
360
Table 1. Data exchange interoperability
From To Services
1. E-health
National population
database
Health informationsystemwhich onhealth institution needs national population
data which useas single identityfor patient profile. E-health role as entity which
ask for service (consumer)while National PopulationDatabase act as provider.
2. E-health Health insurance data
E-health needs insurance service accepted bypatient when comes to health
institution. In this context e-health acts as consumer while health insurancedata
acts as provider
3. E-health Prescription system
Every prescriptionsystem’s service can create a systemwhichgenerates its data
by e-health.Prescription system becomes electronic refference for prescription
by doctor to patient, sothis informationcan beaccessedopenlyforstakeholder
who needs informationof medicine prescription. In this scenario, e- health acts
as provider and prescriptionsystem acts as consumer.
4. E-health Public health office
Healthcare data is reported periodicallyto the head ofhealthoffice.Those data
are result of operational healthserviceexists in every healthinstitution. In this
scenario e-health acts as providerandpublic Health Office acts as consumer
5. National
population
database
Prescription system
Refference of National Population Database is used as single identity in
prescriptionsystem. In this scenario the National PopulationDatabase acts as
provider, while prescriptionsystemacts as consumer.
6. National
population
database
Insurancesystem
Single identity of National PopulationDatabase is usedas patientrefferencewho
has right to get health serviceinsurance. Inthis scenario, National Population
Database roleis as provider,while insurance systemrole is as consumer.
7. Prescription
system
Insurancesystem
Patien medicineprescriptionsystemneeds informationtypeof medicine covered
by health insurance. So,in this scenario insurance systemacts as provider, while
prescriptionsystemacts as consumer
4. CONCLUSION
This work has resulted a design of framework for interoperability of several e-health services.
The SOAD approach is used as system development method which specifies the system in the form
of a portfolio consisting of conceptual view, logical view, and physical view. Furthermore, this work
described relation between system and integrated entities, and data and information exchange in a form
of Interoperability matrix (IM), so the entities/systems, which serve as consumer or provider are clearly
identified and can be used as a reference for system development in e-health application domain.
In interoperability framework, which has been designed, data exchange between applications can be done
using neutral data format such as JSON. The data format can be parsed and adjusted using variable
and the data type implemented by software application connected in the framework. The authors plan to
conduct a further research work through experimenting development of e-health system using
multi-platformsenvironment including console-based,desktop,mobile, and web.
ACKNOWLEDGEMENTS
The author thanked to all the parties who had given support so that this publication was published.
Thanks to the Ministry of Research, Technology, and higher education who have funded this research
on the Intercollegiate Cooperation Research Scheme (PKPT) yearof funding from 2018 to 2019.
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