eMedLab

The publications of the eMedLab group are listed under the main research topics below.

The Data Management section brings together various publications on the topic of electronic health record data management at the individual, healthcare institution, and national health information system levels. Peeter Ross, Tanel Ross, Janek Metsallik, Madis Tiik, and Eduard Maron are the leaders of this topic in the eMadLab group.

• Metsallik, J., Draheim, D., Sabic, Z., Novak, T., & Ross, P. (2024). Assessing Opportunities and Barriers to Improving the Secondary Use of Health Care Data at the National Level: Multicase Study in the Kingdom of Saudi Arabia and Estonia. Journal of Medical Internet Research, 26, e53369.
• Hägglund, Maria, Anna Kharko, Annika Bärkås, Charlotte Blease, Åsa Cajander, Catherine DesRoches, Asbjørn Johansen Fagerlund et al. "A nordic perspective on patient online record access and the european health data space." Journal of Medical Internet Research 26 (2024): e49084.
• Hägglund, Maria, Anna Kharko, Josefin Hagström, Annika Bärkås, Charlotte Blease, Åsa Cajander, Catherine DesRoches et al. "The NORDeHEALTH 2022 patient survey: cross-sectional study of national patient portal users in Norway, Sweden, Finland, and Estonia." Journal of Medical Internet Research 25 (2023): e47573.
• Essén, A., Scandurra, I., Gerrits, R., Humphrey, G., Johansen, M.A., Kierkegaard, P., Koskinen, J., Liaw, S.T., Odeh, S., Ross, P. and Ancker, J.S., 2018. Patient access to electronic health records: differences across ten countries. Health policy and technology, 7(1), pp.44-56.
• Metsallik, J., Ross, P., Draheim, D., & Piho, G. (2018, June). Ten years of the e-health system in Estonia. In CEUR Workshop Proceedings (Vol. 2336, pp. 6-15).
• Tiik, Madis, and Peeter Ross. "Patient opportunities in the Estonian electronic health record system." In Medical and Care Compunetics 6, pp. 171-177. IOS Press, 2010.
• Ross, P., Sepper, R., & Pohjonen, H. (2010). Cross-border teleradiology—experience from two international teleradiology projects. European journal of radiology, 73(1), 20-25.

The topic of Terminology and Interoperability is led by Dr Igor Bossenko. The main output of this research topic is the open-source terminology development, management and sharing platform TermX. Master’s students Rainer Randma and Hanna Kätlin Ardel and undergraduate Elis Saarelaid are also involved in this topic.

• Bossenko, I. (2025). A domain-specific framework for supporting semantic interoperability in primary and secondary use of health data on the example of the Estonian National Health Information System, TalTech Press. 
• Marquis, M., Bossenko, I., & Ross, P. (2024). Standardizing X-Ray and Angiography Procedure Coding in Estonia: Validating TermX Through the Implementation of SNOMED CT. In Digital Health and Informatics Innovations for Sustainable Health Care Systems (pp. 53-54). IOS Press.
• Ivanova, M., Bossenko, I., & Piho, G. (2024, February). TermX—Bridging the Gap: Implementing CTS2 and FHIR Compatible Terminology Server. In International congress on information and communication technology (pp. 277-287). Singapore: Springer Nature Singapore.
• Ivanova, Marina, et al. "Comparative Analysis of Clinical Terminology Servers: A Quest for an Improved Solution." International Conference on Digital Economy. Cham: Springer Nature Switzerland, 2024.
• Bossenko, I., Piho, G., & Ross, P. (2024, May). Modelling a Patient Identifier System in the Estonian National Health Information System. In International Conference on Digital Economy (pp. 132-145). Cham: Springer Nature Switzerland.
• Bossenko, I., Piho, G., Ivanova, M., & Ross, P. (2024). TermX: The semantic interoperability, knowledge management and sharing platform. SoftwareX, 27, 101839.
• Bossenko, I., Randmaa, R., Piho, G., & Ross, P. (2024). Interoperability of health data using FHIR Mapping Language: transforming HL7 CDA to FHIR with reusable visual components. Frontiers in Digital Health, 6, 1480600.
• Bossenko, I., Linna, K., Piho, G., & Ross, P. (2023, March). Migration from HL7 Clinical Document Architecture (CDA) to Fast Health Interoperability Resources (FHIR) in Infectious Disease Information System of Estonia. In Proceedings of the 38th ACM/SIGAPP Symposium on Applied Computing (pp. 882-885).
• Bossenko, I., Piho, G., & Ross, P. (2024). Termx: a game changer in the healthcare interoperability. In Digital Health and Informatics Innovations for Sustainable Health Care Systems (pp. 88-89). IOS Press.
• Bossenko, I., Piho, G., & Ross, P. (2022). Forward and Backward Compatibility Design Techniques Applying the HL7 FHIR Standard. In HEDA@ Petri Nets.
• Bossenko, I., Linna, K., Piho, G., & Ross, P. (2022). Migration from HL7 CDA to FHIR in Infectious Disease System of Estonia. In pHealth 2022 (pp. 275-278). IOS Press.

The reliable use of health data requires transparency and integrity in both primary and secondary use. PhD student and junior researcher Marten Kask is researching methods and tools to ensure the quality and reliability of health data throughout the use process. The aim is to map existing solutions, develop new ones, and assess their suitability from the perspective of science, software reliability, and system interoperability.

• Kask, M., Piho, G., & Ross, P. (2024). Distributed Ledger-Based System to Support Health Data Integrity and Transparency. In Digital Health and Informatics Innovations for Sustainable Health Care Systems (pp. 1231-1232). IOS Press.
• Kask, M., Klementi, T., Piho, G., & Ross, P. (2023). Maintaining Data Integrity in Electronic Health Records with Hyperledger Fabric. In HEDA@ STAF.
• Kask, M., Klementi, T., Piho, G., & Ross, P. (2023). Preserving Decentralized EHR-s Integrity. In Telehealth Ecosystems in Practice (pp. 296-297). IOS Press.
• Kask, M., Piho, G., & Ross, P. (2021). Systematic literature review of methods for maintaining data integrity. In Advances in Model and Data Engineering in the Digitalization Era: MEDI 2021 International Workshops: DETECT, SIAS, CSMML, BIOC, HEDA, Tallinn, Estonia, June 21–23, 2021, Proceedings 10 (pp. 259-268). Springer International Publishing.

Secure secondary use of health data and big data analytics requires reliable anonymization and pseudonymization of data. PhD student and junior researcher Olga Vovk is investigating methods and tools that enable the automated and rule-based anonymization and pseudonymization of data while ensuring the analytical value of the data and complying with data protection requirements. The aim is to map existing solutions, develop new ones, and assess their suitability for the secondary use of data.

• Vovk, O., Piho, G., & Ross, P. (2023). Methods and tools for healthcare data anonymization: a literature review. International Journal of General Systems, 52(3), 326-342.
• Bende, P., Vovk, O., Caraveo, D., Pechmann, L., & Leucker, M. (2023). A Case Study on Data Protection for a Cloud-and AI-Based Homecare Medical Device. In Transactions on Petri Nets and Other Models of Concurrency XVII (pp. 138-161). Berlin, Heidelberg: Springer Berlin Heidelberg.
• Bende, P., Vovk, O., Caraveo, D., Pechmann, L., & Leucker, M. (2022). A Case Study on Data Protection for a Cloud-and AI-based Homecare Medical Device. In HEDA@ Petri Nets.
• Vovk, O., Piho, G., & Ross, P. (2021, June). Anonymization methods of structured health care data: A literature review. In International Conference on Model and Data Engineering (pp. 175-189). Cham: Springer International Publishing.
• Vovk, O., Piho, G., & Ross, P. (2021). Evaluation of anonymization tools for health data. In Advances in Model and Data Engineering in the Digitalization Era: MEDI 2021 International Workshops: DETECT, SIAS, CSMML, BIOC, HEDA, Tallinn, Estonia, June 21–23, 2021, Proceedings 10 (pp. 302-313). Springer International Publishing.

Secondary use of health data and big data analytics require a unified semantic framework. PhD student and junior researcher Kristian Kankainen is exploring the possibilities of developing a unified semantic base model formulated from existing data and interoperability standards. Master's student Jane-Ly Buhvestova and Dr Gunnar Piho are also involved in the topic.

• Kankainen, K. J. I., Listenmaa, I., Piho, G., & Ross, P. (2023). Digital Health Data Capture with a Controlled Natural Language. In Caring is Sharing–Exploiting the Value in Data for Health and Innovation (pp. 829-830). IOS Press.
• Sõerd, T., Kankainen, K., Piho, G., Klementi, T., & Ross, P. (2023). Towards Specification of Medical Processes According to International Standards and Semantic Interoperability Needs. In MODELSWARD (pp. 160-167).
• Kankainen, K., Klementi, T., Piho, G., & Ross, P. (2022). Using SNOMED CT as a Semantic Model for Controlled Natural Language Guided Capture of Clinical Data. In HEDA@ Petri Nets.
• Kankainen, K. (2021). Usages of the ContSys standard: A position paper. In Advances in Model and Data Engineering in the Digitalization Era: MEDI 2021 International Workshops: DETECT, SIAS, CSMML, BIOC, HEDA, Tallinn, Estonia, June 21–23, 2021, Proceedings 10 (pp. 314-324). Springer International Publishing.
• Tepandi, J., Grandry, E., Fieten, S., Rotuna, C., Sellitto, G. P., Zeginis, D., ... & Tarabanis, K. (2019). Towards a cross-border reference architecture for the once-only principle in Europe: an enterprise modelling approach. In The Practice of Enterprise Modeling: 12th IFIP Working Conference, PoEM 2019, Luxembourg, Luxembourg, November 27–29, 2019, Proceedings 12 (pp. 103-117). Springer International Publishing.
• Tepandi, J., Lauk, M., Linros, J., Raspel, P., Piho, G., Pappel, I., & Draheim, D. (2017). The data quality framework for the Estonian public sector and its evaluation: establishing a systematic process-oriented viewpoint on cross-organizational data quality. Transactions on Large-Scale Data-and Knowledge-Centered Systems XXXV, 1-26.
• Piho, G., Tepandi, J., Thompson, D., Woerner, A., & Parman, M. (2015). Business archetypes and archetype patterns from the HL7 RIM and openEHR RM perspectives: towards interoperability and evolution of healthcare models and software systems. Procedia Computer Science, 63, 553-560.
• Piho, G., Tepandi, J., Thompson, D., Tammer, T., Parman, M., & Puusep, V. (2014). Archetypes based meta-modeling towards evolutionary, dependable and interoperable healthcare information systems. Procedia Computer Science, 37, 457-464.
• Piho, G., Tepandi, J., & Roost, M. (2010, June). Domain analysis with archetype patterns based Zachman Framework for enterprise architecture. In 2010 International Symposium on Information Technology (Vol. 3, pp. 1351-1356). IEEE.

The ​secondary use of health data involves the application of data in decision support systems and machine learning (ML) and artificial intelligence (AI) solutions. The research focus is on decision support systems for doctors in the field of diagnosis and treatment as well as health continuity and lifestyle support solutions aimed at people. In addition, the possibilities of AI for processing and structuring natural, unstructured language are being investigated to increase the accuracy and usability of health data analyses. The reliable use of health data in the context of AI and ML requires high data quality and semantic interpretability as well as the development of transparent and ethical algorithms. Doctors Ants Torim and Ahti Lohk and master's students Ken Kruuser and Maarja Helena Elisabet Hoop are working in this field.

• Bertl, M., Ross, P., & Draheim, D. (2023). Systematic AI support for decision-making in the healthcare sector: Obstacles and success factors. Health Policy and Technology, 12(3), 100748.
• Bertl, M., Kankainen, K. J. I., Piho, G., Draheim, D., & Ross, P. (2023). Evaluation of Data Quality in the Estonian National Health Information System for Digital Decision Support. In HEDA@ STAF.
• Bertl, M., Klementi, T., Piho, G., Ross, P., & Draheim, D. (2023, November). How domain engineering can help to raise adoption rates of artificial intelligence in healthcare. In International Conference on Information Integration and Web Intelligence (pp. 3-12). Cham: Springer Nature Switzerland.
• Bertl, M., Metsallik, J., & Ross, P. (2022). A systematic literature review of AI-based digital decision support systems for post-traumatic stress disorder. Frontiers in Psychiatry, 13, 923613.

One of the research topics is a possible future scenario where health data is fully owned and under the sovereign control of individuals. To this end, we are testing techniques, architectures, and scenarios for storing health data in decentralised content-addressable storage networks. The topic is led by doctoral student and junior researcher Toomas Klementi. In addition, master's student Lilia Tünts and undergraduates Olga Vald and Maria Timofejeva are working on this topic.

• Klementi, T., Piho, G., & Ross, P. (2024). A reference architecture for personal health data spaces using decentralized content-addressable storage networks. Frontiers in Medicine, 11, 1411013.
• Klementi, T., Kankainen, K. J. I., Piho, G., & Ross, P. (2022). Prospective Research Topics towards Preserving Electronic Health Records in Decentralised Content-Addressable Storage Networks. In HEDA@ Petri Nets.