Background: Current Electronic Health Record (EHR) systems are built using different data representation and information models, which makes difficult achieving information exchange.
Objective: Our aim was to propose a scalable architecture that allows the integration of information from different EHR systems.
Methods: A cloud-based EHR interoperable architecture is proposed through the standardization and integration of patient electronic health records. The data is stored in a cloud repository with high availability features. Stakeholders can retrieve the patient EHR by requesting only to the integrated data repository. The OpenEHR two-level approach is applied according to the HL7-FHIR standards. We validated our architecture by comparing it with 5 different works (CHISTAR, ARIEN, DIRAYA, LLPHR and INEHRIS) using a set of selected axes and a scoring method.
Results: The problem was reduced to a single point of communication between each EHR system and the integrated data repository. By combining cloud computing paradigm with selected health informatics standards, we obtained a generic and scalable architecture that complies 100% with interoperability requisites according to the evaluation framework applied.
Conclusions: The architecture allowed the integration of several EHR systems, adapting them with the use of standards and ensuring the availability thanks to cloud computing features.
Keywords: Cloud EHR; Electronic health records; HL7 FHIR; OpenEHR; health informatics standards; interoperability.