Search

Objectives: This research addresses several factors relevant to inequity in healthcare that may be susceptible to being addressed in a new generation of electronic health records (EHRs). Methods: Through a scoping review of the literature, inequities related to ethnicity, gender, and socioeconomic aspects in healthcare in general and, more specifically in EHRs, have been considered. Papers have been identified between 2011 and 2022 in three categories: EHR, gender inequalities, and ethnicity inequalities. Results: Twenty-two recommendations have been identified within the scope of the three categories indicated above. These exposed requirements focus on two spheres: (1) technical sphere, mainly focused on the characteristics and tools that the EHR should develop from taking into account the studied inequalities; and (2) clinical sphere, which mainly affects patients, health professionals, and health providers. Conclusions: Ethnic and gender inequalities are essential factors to take into account when diagnosing, monitoring, preventing, and treating a patient. These factors give us the keys to discovering recommendations for a new generation of EHRs to help mitigate these needs.

UNSTRUCTURED

Background Digital transformation in healthcare and the growth of health data generation and collection include an important challenge for the secondary use of healthcare records in the health research field. Likewise, due to the ethical and legal constraints for using sensitive data, understanding how health data is managed by dedicated infrastructures called data hubs is essential to facilitate data sharing and reuse. Methods In order to capture the different data governance behind health data hubs across Europe, a survey focused on analysing the feasibility of linking individual-level data between data collections and the generation of health data governance patterns was carried out. The target audience of this study was National, European, and Worldwide data hubs. In total, the designed survey was sent to a representative list of 99 health data hubs in January 2022. Results In total, 41 survey responses received till June 2022 were analysed in-depth. Stratification methods were performed to cover the different levels of granularity identified in some data hubs’ characteristics. Firstly, a general pattern of data governance for data hubs was defined. Afterward, specific profiles were defined, generating specific patterns of data governance through the stratifications in terms of the kind of organisation (centralised vs. decentralised), and role (data controller or data processor) of the health data hubs interviewees. Conclusions The in-depth analysis of the responses from health data hubs interviewees across Europe provided a list of the most frequent aspects that concluded a set of specific recommendations on data management and governance, taking into account the constraints of sensitive data. In summary, a data hub should work in a centralised way providing a Data Processing Agreement and a formal procedure to identify data providers, as well as data quality control, data integrity and anonymisation methods.

Medical data science aims to facilitate knowledge discovery assisting in data, algorithms, and results analysis. The FAIR principles aim to guide scientific data management and stewardship, and are relevant to all digital health ecosystem stakeholders. The FAIR4Health project aims to facilitate and encourage the health research community to reuse datasets derived from publicly funded research initiatives using the FAIR principles. The 'FAIRness for FHIR' project aims to provide guidance on how HL7 FHIR could be utilized as a common data model to support the health datasets FAIRification process. This first expected result is an HL7 FHIR Implementation Guide (IG) called FHIR4FAIR, covering how FHIR can be used to cover FAIRification in different scenarios. This IG aims to provide practical underpinnings for the FAIR4Health FAIRification workflow as a domain-specific extension of the GoFAIR process, while simplifying curation, advancing interoperability, and providing insights into a roadmap for health datasets FAIR certification.

Medical data science aims to facilitate knowledge discovery assisting in data, algorithms, and results analysis. The FAIR principles aim to guide scientific data management and stewardship, and are relevant to all digital health ecosystem stakeholders. The FAIR4Health project aims to facilitate and encourage the health research community to reuse datasets derived from publicly funded research initiatives using the FAIR principles. The ‘FAIRness for FHIR’ project aims to provide guidance on how HL7 FHIR could be utilized as a common data model to support the health datasets FAIRification process. This first expected result is an HL7 FHIR Implementation Guide (IG) called FHIR4FAIR, covering how FHIR can be used to cover FAIRification in different scenarios. This IG aims to provide practical underpinnings for the FAIR4Health FAIRification workflow as a domain-specific extension of the GoFAIR process, while simplifying curation, advancing interoperability, and providing insights into a roadmap for health datasets FAIR certification.

[Background] Owing to the nature of health data, their sharing and reuse for research are limited by legal, technical, and ethical implications. In this sense, to address that challenge and facilitate and promote the discovery of scientific knowledge, the Findable, Accessible, Interoperable, and Reusable (FAIR) principles help organizations to share research data in a secure, appropriate, and useful way for other researchers., [Objective] The objective of this study was the FAIRification of existing health research data sets and applying a federated machine learning architecture on top of the FAIRified data sets of different health research performing organizations. The entire FAIR4Health solution was validated through the assessment of a federated model for real-time prediction of 30-day readmission risk in patients with chronic obstructive pulmonary disease (COPD)., [Methods] The application of the FAIR principles on health research data sets in 3 different health care settings enabled a retrospective multicenter study for the development of specific federated machine learning models for the early prediction of 30-day readmission risk in patients with COPD. This predictive model was generated upon the FAIR4Health platform. Finally, an observational prospective study with 30 days follow-up was conducted in 2 health care centers from different countries. The same inclusion and exclusion criteria were used in both retrospective and prospective studies., [Results] Clinical validation was demonstrated through the implementation of federated machine learning models on top of the FAIRified data sets from different health research performing organizations. The federated model for predicting the 30-day hospital readmission risk was trained using retrospective data from 4.944 patients with COPD. The assessment of the predictive model was performed using the data of 100 recruited (22 from Spain and 78 from Serbia) out of 2070 observed (records viewed) patients during the observational prospective study, which was executed from April 2021 to September 2021. Significant accuracy (0.98) and precision (0.25) of the predictive model generated upon the FAIR4Health platform were observed. Therefore, the generated prediction of 30-day readmission risk was confirmed in 87% (87/100) of cases., [Conclusions] Implementing a FAIR data policy in health research performing organizations to facilitate data sharing and reuse is relevant and needed, following the discovery, access, integration, and analysis of health research data. The FAIR4Health project proposes a technological solution in the health domain to facilitate alignment with the FAIR principles., This work was supported by the FAIR4Health project [10], which received funding from the European Union’s Horizon 2020 research and innovation program under grant 824666. This research has also been cosupported by the Carlos III National Institute of Health through the Programa de Ciencia de Datos de la Infraestructura de Medicina de Precisión asociada a la Ciencia y la Tecnología program (IMPaCT-Data, code IMP/00019) and through the Platform for Dynamization and Innovation of the Spanish National Health System industrial capacities and their effective transfer to the productive sector (code PT20/00088), both cofunded by the European Regional Development Fund Fondo Europeo de Desarrollo Regional “A way of making Europe.”

Due to the nature of health data, its sharing and reuse for research are limited by ethical, legal and technical barriers. The FAIR4Health project facilitated and promoted the application of FAIR principles in health research data, derived from the publicly funded health research initiatives to make them Findable, Accessible, Interoperable, and Reusable (FAIR). To confirm the feasibility of the FAIR4Health solution, we performed two pathfinder case studies to carry out federated machine learning algorithms on FAIRified datasets from five health research organizations. The case studies demonstrated the potential impact of the developed FAIR4Health solution on health outcomes and social care research. Finally, we promoted the FAIRified data to share and reuse in the European Union Health Research community, defining an effective EU-wide strategy for the use of FAIR principles in health research and preparing the ground for a roadmap for health research institutions. This scientific report presents a general overview of the FAIR4Health solution: from the FAIRification workflow design to translate raw data/metadata to FAIR data/metadata in the health research domain to the FAIR4Health demonstrators' performance., This research was financially supported by the European Union’s Horizon 2020 research and innovation programme under the grant agreement No 824666 (project FAIR4Health). Also, this research has been co-supported by the Carlos III National Institute of Health, through the IMPaCT Data project (code IMP/00019), and through the Platform for Dynamization and Innovation of the Spanish National Health System industrial capacities and their effective transfer to the productive sector (code PT20/00088), both co-funded by European Regional Development Fund (FEDER) ‘A way of making Europe’.

This article belongs to the Special Issue Addressing the Growing Burden of Chronic Diseases and Multimorbidity: Characterization and Interventions, The current availability of electronic health records represents an excellent research opportunity on multimorbidity, one of the most relevant public health problems nowadays. However, it also poses a methodological challenge due to the current lack of tools to access, harmonize and reuse research datasets. In FAIR4Health, a European Horizon 2020 project, a workflow to implement the FAIR (findability, accessibility, interoperability and reusability) principles on health datasets was developed, as well as two tools aimed at facilitating the transformation of raw datasets into FAIR ones and the preservation of data privacy. As part of this project, we conducted a multicentric retrospective observational study to apply the aforementioned FAIR implementation workflow and tools to five European health datasets for research on multimorbidity. We applied a federated frequent pattern growth association algorithm to identify the most frequent combinations of chronic diseases and their association with mortality risk. We identified several multimorbidity patterns clinically plausible and consistent with the bibliography, some of which were strongly associated with mortality. Our results show the usefulness of the solution developed in FAIR4Health to overcome the difficulties in data management and highlight the importance of implementing a FAIR data policy to accelerate responsible health research., This study was performed in the framework of FAIR4Health, a project that has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement number 824666. Also, this research has been co-supported by the Carlos III National Institute of Health, through the IMPaCT Data project (code IMP/00019), and through the Platform for Dynamization and Innovation of the Spanish National Health System industrial capacities and their effective transfer to the productive sector (code PT20/00088), both co-funded by European Regional Development Fund (FEDER) ‘A way of making Europe’, and by REDISSEC (RD16/0001/0005) and RICAPPS (RD21/0016/0019) from Carlos III National Institute of Health. This work was also supported by Instituto de Investigación Sanitaria Aragón and Carlos III National Institute of Health [Río Hortega Program, grant number CM19/00164].

BACKGROUND Chronic diseases are responsible for most health problems in older people. We know that chronic conditions tend to cluster in the form of patterns, also known as multimorbidity patterns. However, health systems and professionals are generally organized and trained to respond to specific diseases independently, negatively impacting patients and health systems. Different initiatives are trying to respond to these problems. In this context, the current availability of electronic health records and other types of health research data represents an excellent research opportunity. However, there are also some relevant limitations and challenges related to a current lack of tools that allow us to access, harmonize, integrate and reuse datasets technically, legally, ethically, and respectfully to patients and society. In this sense, the FAIR (Findability, Accessibility, Interoperability, and Reusability) principles can help us to guide scientific data management and stewardship and drive scientific discovery to a new paradigm. FAIR4Health is a European Commission supported project that applies FAIR principles on publicly-funded research datasets. OBJECTIVE To present the FAIR4Health pathfinder case study designed to validate and evaluate the FAIR4Health solution with the aim of identifying multimorbidity patterns and their association with mortality in older adults from different health organizations databases of four European countries. METHODS To apply the FAIR principles in five European cohorts from different healthcare settings (i.e., primary care, hospitals, and nursing homes) and institutions (i.e., University of Geneva from Switzerland, Università Cattolica del Sacro Cuore from Italy, University of Porto from Portugal, Instituto Aragonés de Ciencias de la Salud from Spain, and Andalusian Health Service also from Spain), a multicentric retrospective observational study (N = 11,034) was performed. In FAIR4Health, a workflow was designed to implement the FAIR principles on health datasets, and two tools were developed, a Data Curation Tool to transform the raw datasets into FAIR datasets and a Data Privacy Tool to preserve data privacy. On top of these, the FAIR4Health Platform was implemented to provide an interface for researchers, and enable the usage of federated machine learning algorithms on FAIR datasets. In this study, we applied a federated frequent pattern growth association algorithm to identify the most frequent disease patterns among a set of variables. RESULTS We applied the FAIR principles in the health research datasets from different organizations, and we were able to reuse and integrate heterogeneous datasets, increasing the variability of data compared to the studies not applying those principles. We identified and described high-frequent multimorbidity patterns consistent with the literature and observed a strong association with polypharmacy and mortality. CONCLUSIONS Our results highlight the importance of implementing the FAIR data policy to overcome the difficulties in data management and accelerate responsible health research with patients and society.

BACKGROUND Owing to the nature of health data, their sharing and reuse for research are limited by legal, technical, and ethical implications. In this sense, to address that challenge and facilitate and promote the discovery of scientific knowledge, the Findable, Accessible, Interoperable, and Reusable (FAIR) principles help organizations to share research data in a secure, appropriate, and useful way for other researchers. OBJECTIVE The objective of this study was the FAIRification of existing health research data sets and applying a federated machine learning architecture on top of the FAIRified data sets of different health research performing organizations. The entire FAIR4Health solution was validated through the assessment of a federated model for real-time prediction of 30-day readmission risk in patients with chronic obstructive pulmonary disease (COPD). METHODS The application of the FAIR principles on health research data sets in 3 different health care settings enabled a retrospective multicenter study for the development of specific federated machine learning models for the early prediction of 30-day readmission risk in patients with COPD. This predictive model was generated upon the FAIR4Health platform. Finally, an observational prospective study with 30 days follow-up was conducted in 2 health care centers from different countries. The same inclusion and exclusion criteria were used in both retrospective and prospective studies. RESULTS Clinical validation was demonstrated through the implementation of federated machine learning models on top of the FAIRified data sets from different health research performing organizations. The federated model for predicting the 30-day hospital readmission risk was trained using retrospective data from 4.944 patients with COPD. The assessment of the predictive model was performed using the data of 100 recruited (22 from Spain and 78 from Serbia) out of 2070 observed (records viewed) patients during the observational prospective study, which was executed from April 2021 to September 2021. Significant accuracy (0.98) and precision (0.25) of the predictive model generated upon the FAIR4Health platform were observed. Therefore, the generated prediction of 30-day readmission risk was confirmed in 87% (87/100) of cases. CONCLUSIONS Implementing a FAIR data policy in health research performing organizations to facilitate data sharing and reuse is relevant and needed, following the discovery, access, integration, and analysis of health research data. The FAIR4Health project proposes a technological solution in the health domain to facilitate alignment with the FAIR principles.

In motor rehabilitation therapies, especially with pediatric patients, there is often a loss of interest and motivation due to the lack of variety in exercises and therapeutic activities. NAOTherapist (NT) is a socially assistive robotics (SAR) platform designed to support hands-off rehabilitation sessions through two interactive games: mirror and Simon. It integrates a cognitive architecture with an NAO humanoid robot that acts as a coach, as well as a red-green-blue-depth (RGB-D) sensor that eases body capture. This work aims to deploy and evaluate the developed technology for a long-term experience.

The aim of this study is to build an evaluation framework for the user-centric testing of the Data Curation Tool. The tool was developed in the scope of the FAIR4Health project to make health data FAIR by transforming them from legacy formats into a Common Data Model based on HL7 FHIR. The end user evaluation framework was built by following a methodology inspired from the Delphi method. We applied a series of questionnaires to a group of experts not only in different roles and skills, but also from various parts of Europe. Overall, 26 questions were formulated for 16 participants. The results showed that the users are satisfied with the capabilities and performance of the tool. The feedbacks were considered as recommendations for technical improvement and fed back into the software development cycle of the Data Curation Tool.

[Background] The evidence-based medicine (EBM) paradigm requires the development of health care professionals’ skills in the efficient search of evidence in the literature, and in the application of formal rules to evaluate this evidence. Incorporating this methodology into the decision-making routine of clinical practice will improve the patients’ health care, increase patient safety, and optimize resources use., [Objective] The aim of this study is to develop and evaluate a new tool (KNOWBED system) as a clinical decision support system to support scientific knowledge, enabling health care professionals to quickly carry out decision-making processes based on EBM during their routine clinical practice., [Methods] Two components integrate the KNOWBED system: a web-based knowledge station and a mobile app. A use case (bronchiolitis pathology) was selected to validate the KNOWBED system in the context of the Paediatrics Unit of the Virgen Macarena University Hospital (Seville, Spain). The validation was covered in a 3-month pilot using 2 indicators: usability and efficacy., [Results] The KNOWBED system has been designed, developed, and validated to support clinical decision making in mobility based on standards that have been incorporated into the routine clinical practice of health care professionals. Using this tool, health care professionals can consult existing scientific knowledge at the bedside, and access recommendations of clinical protocols established based on EBM. During the pilot project, 15 health care professionals participated and accessed the system for a total of 59 times., [Conclusions] The KNOWBED system is a useful and innovative tool for health care professionals. The usability surveys filled in by the system users highlight that it is easy to access the knowledge base. This paper also sets out some improvements to be made in the future., This project has received funding from the Andalusian Ministry of Health from Spain (reference PIN-0213-2016), and FEDER funds.

BACKGROUND Due to an increase in life expectancy, the prevalence of chronic diseases is on the rise too. Clinical Practice Guidelines (CPGs) provide recommendations for suitable interventions regarding different chronic diseases. But a deficit in the implementation of these CPGs could be identified. The PITeS-TIiSS tool, a personalized ontology-based Clinical Decision Support System (CDSS), aims to reduce the variability, prevent errors and consider interactions between different CPGs recommendations, among other benefits. OBJECTIVE To design, develop and validate an ontology-based CDSS which provides personalized recommendations related to drug prescription. The target population is elderly patients with chronic diseases and polypharmacy aiming to reduce complications related to these types of conditions and, also, offering integrated care. METHODS A study scenario about atrial fibrillation and treatment with anticoagulants was selected to validate the tool. After this, a series of knowledge sources were identified, such as CPGs, PROFUND index, LESS/CHRON criteria, and STOPP/START criteria, to extract the information. Modeling was carried out using an ontology, and mapping was done with HL7 FHIR and SNOMED CT. Once the CDSS was developed, validation was carried out by using a retrospective case study. RESULTS This project was funded in January 2015 and approved by the Ethics Committee on 24 November 2015. Two different tasks have been carried out to test the functioning of the tool. On the one hand, retrospective data from a real patient who met the inclusion criteria were used. In addition, the analysis of an adoption model has been performed through the study of the requirements and characteristics that a CDSS must meet in order to be well accepted and used by health professionals. The results have been favourable and allow the proposed research to continue to the next phase. CONCLUSIONS An ontology-based CDSS has been successfully designed, developed, and validated. However, as future work, the validation in a real environment should be performed to ensure the tool is usable and reliable. CLINICALTRIAL

The NIH Strategic Plan for Data Science describes NIH’s Overarching Goals, Strategic Objectives, and Implementation Tactics for modernizing the NIH-funded biomedical dataresource ecosystem. Adherence to FAIR principles is key to this strategy. In this respect, this plan has important similarities with the European Union's EOSC Strategy. The NIH Plan develops eight strategic objectives. The idea is to identify the similarities and differences between the different levels of this Plan (Overarching Goals, Strategic Objectives, and Implementation Tactics) and the EOSC Strategic Implementation Plan. Once the similarities and differences have been identified, the details of these will be explained, and a set of actions will be proposed for collaboration and strengthening of the plans. The alignment in time is fundamental since both plans are being developed close in time, but with differences, therefore the proposed actions have to be viable throughout the year 2020 since even in the very short term there will be difficulties for the synchronization of the actions in the temporal logic of each plan., EOSCsecretariat.eu has received funding from the European Union's Horizon Programme call H2020-INFRAEOSC-05-2018-2019, grant Agreement number 831644.

Background: Timely identification of COVID-19 patients at high risk of mortality can significantly improve patient management and resource allocation within hospitals. This study seeks to develop and validate a data-driven personalized mortality risk calculator for hospitalized COVID-19 patients., Methods: De-identified data was obtained for 3,927 COVID-19 positive patients from six independent centers, comprising 33 different hospitals. Demographic, clinical, and laboratory variables were collected at hospital admission. The COVID-19 Mortality Risk (CMR) tool was developed using the XGBoost algorithm to predict mortality. Its discrimination performance was subsequently evaluated on three validation cohorts., Findings: The derivation cohort of 3,062 patients has an observed mortality rate of 26.84%. Increased age, decreased oxygen saturation (≤ 93%), elevated levels of C-reactive protein (≥ 130 mg/L), blood urea nitrogen (≥ 18 mg/dL), and blood creatinine (≥ 1.2 mg/dL) were identified as primary risk factors, validating clinical findings. The model obtains out-ofsample AUCs of 0.90 (95% CI, 0.87-0.94) on the derivation cohort. In the validation cohorts, the model obtains AUCs of 0.92 (95% CI, 0.88-0.95) on Seville patients, 0.87 (95% CI, 0.84- 0.91) on Hellenic COVID-19 Study Group patients, and 0.81 (95% CI, 0.76-0.85) on Hartford Hospital patients. The CMR tool is available as an online application at covidanalytics.io/mortality_calculator and is currently in clinical use., Interpretation: The CMR model leverages machine learning to generate accurate mortality predictions using commonly available clinical features. This is the first risk score trained and validated on a cohort of COVID-19 patients from Europe and the United States., HW is supported by the National Science Foundation Graduate Research Fellowship under Grant No. 174530.

[Background] FAIR (findability, accessibility, interoperability, and reusability) guiding principles seek the reuse of data and other digital research input, output, and objects (algorithms, tools, and workflows that led to that data) making them findable, accessible, interoperable, and reusable. GO FAIR - a bottom-up, stakeholder driven and self-governed initiative - defined a seven-step FAIRification process focusing on data, but also indicating the required work for metadata. This FAIRification process aims at addressing the translation of raw datasets into FAIR datasets in a general way, without considering specific requirements and challenges that may arise when dealing with some particular types of data., [Objectives] This scientific contribution addresses the architecture design of an open technological solution built upon the FAIRification process proposed by “GO FAIR” which addresses the identified gaps that such process has when dealing with health datasets., [Methods] A common FAIRification workflow was developed by applying restrictions on existing steps and introducing new steps for specific requirements of health data. These requirements have been elicited after analyzing the FAIRification workflow from different perspectives: technical barriers, ethical implications, and legal framework. This analysis identified gaps when applying the FAIRification process proposed by GO FAIR to health research data management in terms of data curation, validation, deidentification, versioning, and indexing., [Results] A technological architecture based on the use of Health Level Seven International (HL7) FHIR (fast health care interoperability resources) resources is proposed to support the revised FAIRification workflow., [Discussion] Research funding agencies all over the world increasingly demand the application of the FAIR guiding principles to health research output. Existing tools do not fully address the identified needs for health data management. Therefore, researchers may benefit in the coming years from a common framework that supports the proposed FAIRification workflow applied to health datasets., [Conclusion] Routine health care datasets or data resulting from health research can be FAIRified, shared and reused within the health research community following the proposed FAIRification workflow and implementing technical architecture., This work was performed in the scope of FAIR4Health project31. FAIR4Health has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement number 824666.

UNSTRUCTURED Despite half a century of dedicated studies, medication adherence remains far from perfect, with many patients not taking their medications as prescribed. The magnitude of this problem is rising, jeopardizing the effectiveness of evidence-based therapies. An important reason for this is the unprecedented demographic change at the beginning of the 21st century. Aging leads to multimorbidity and complex therapeutic regimens that create a fertile ground for nonadherence. As this scenario is a global problem, it needs a worldwide answer. Could this answer be provided, given the new opportunities created by the digitization of health care? Daily, health-related information is being collected in electronic health records, pharmacy dispensing databases, health insurance systems, and national health system records. These big data repositories offer a unique chance to study adherence both retrospectively and prospectively at the population level, as well as its related factors. In order to make full use of this opportunity, there is a need to develop standardized measures of adherence, which can be applied globally to big data and will inform scientific research, clinical practice, and public health. These standardized measures may also enable a better understanding of the relationship between adherence and clinical outcomes, and allow for fair benchmarking of the effectiveness and cost-effectiveness of adherence-targeting interventions. Unfortunately, despite this obvious need, such standards are still lacking. Therefore, the aim of this paper is to call for a consensus on global standards for measuring adherence with big data. More specifically, sound standards of formatting and analyzing big data are needed in order to assess, uniformly present, and compare patterns of medication adherence across studies. Wide use of these standards may improve adherence and make health care systems more effective and sustainable.

[Background]: Telemedicine technologies have a valuable potential when it comes to improving the accuracy of triage protocols in selecting severely injured patients who may benefit from transportation. The main objective of this study was to evaluate the correlation of the urgent diagnosis made by telemedicine through an App with traditional face-to-face urgent care and the final diagnosis, made by scheduled consultation., [Methods]: We carried out a descriptive cross-sectional study to evaluate the accuracy of telemedicine in burns evaluation compared to gold standard (in-person consultation). An App was designed. All patients enrolled were evaluated by both teleconsultation and face-to-face approach on burn emergencies. Diagnosis on presentation made by a physician constituted the gold standard., [Results]: A total of 202 patients were included in the study. The use of TM was able to detect that 83.17% of the patients attending the BU could have been managed on as outpatient basis. The intra-observer concordance was k = 0.94 (95% CI: 0.90–0.97). These results highlight a very high sensitivity and specificity (99.40 and 100% respectively)., [Conclusions]: The telemedicine system for planning referrals is a useful tool that may make significant differences in the management of burned patients although further research needs to be taken in that direction.

Despite half a century of dedicated studies, medication adherence remains far from perfect, with many patients not taking their medications as prescribed. The magnitude of this problem is rising, jeopardizing the effectiveness of evidence-based therapies. An important reason for this is the unprecedented demographic change at the beginning of the 21st century. Aging leads to multimorbidity and complex therapeutic regimens that create a fertile ground for nonadherence. As this scenario is a global problem, it needs a worldwide answer. Could this answer be provided, given the new opportunities created by the digitization of health care? Daily, health-related information is being collected in electronic health records, pharmacy dispensing databases, health insurance systems, and national health system records. These big data repositories offer a unique chance to study adherence both retrospectively and prospectively at the population level, as well as its related factors. In order to make full use of this opportunity, there is a need to develop standardized measures of adherence, which can be applied globally to big data and will inform scientific research, clinical practice, and public health. These standardized measures may also enable a better understanding of the relationship between adherence and clinical outcomes, and allow for fair benchmarking of the effectiveness and cost-effectiveness of adherence-targeting interventions. Unfortunately, despite this obvious need, such standards are still lacking. Therefore, the aim of this paper is to call for a consensus on global standards for measuring adherence with big data. More specifically, sound standards of formatting and analyzing big data are needed in order to assess, uniformly present, and compare patterns of medication adherence across studies. Wide use of these standards may improve adherence and make health care systems more effective and sustainable., PK received speaker honoraria from Aflofarm, Fresenius, Polpharma, and Sandoz and received grant funding from European Union’s Horizon 2020 for GATEKEEPER project (grant agreement number 857223) and The European Commission ERASMUS+ Project Skills4Adherence (grant agreement number: 2017-1-PL01-KA202-038672), outside of this work. BV is the CEO and shareholder of AARDEX Group.

[Background and goal] Health information systems are increasingly sophisticated and developing them is a challenge for software developers. Software engineers usually make use of UML as a standard model language that allows defining health information system entities and their relations. However, working with health system requires learning HL7 standards, that defines and manages standards related to health information systems. HL7 standards are varied, however this work focusses on v2 and v3 since these are the most used one on the area that this work is being conducted. This works aims to allow modeling HL7 standard by using UML., [Methods] Several techniques based on the MDE (Model-Driven Engineering) paradigm have been used to cope with it., [Results] A useful reference framework, reducing final users learning curve and allowing modeling maintainable and easy-going health information systems., [Conclusions] By using this approach, a software engineer without any previous knowledge about HL7 would be able to solve the problem of modeling HL7-based health information systems. Reducing the learning curve when working in projects that need HL7 standards., This research has been partially supported by the POLOLAS project (code TIN2016–76956-C3–2-R) of the Spanish Ministry of Science and Innovation, the KNOWBED project (code PIN-0213–2016) founded by the Andalusian Ministry of Health, Carlos III Health Institute within the call Strategic Help in Health (PITeS TIiSS project, code PI15/01213), by the VPPI of the University of Seville, and FEDER funds. The authors are grateful to Carlos III Health Institute for promoting the Network for Innovation in Medical Technologies and Health (“ITEMAS” in Spanish, CODE PT17/0005/0032), and Prevensalud project founded by the Technological Corporation of Andalusia.