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Service-Oriented Architecture as an Integration and Scalability Strategy of Clinical Decision Support Systems
Azita Yazdani, Reza Safdari, Roxana Sharifian, Maryam Zahmatkeshan, Marjan Ghazi Saeedi,
Volume 14, Issue 2 (5-2020)
Abstract
Background and Aim: When clinical decision support systems are developed, implementing solutions that enable these systems to be -used on a large scale can reduce the production costs associated with the creation, maintenance and by sharing these systems, producing multiple clinical decision support systems will be prevented. In recent years, one of the approaches used for this purpose in combination with clinical decision support systems is the service-oriented architecture approach. The purpose of this study was to investigate the role and importance of service-oriented architecture in delivering scalable architectures of clinical decision support systems focusing on different approaches to this architecture.
Materials and Methods: This article is a simple review article. Bibliographic databases of IEEE Explore, Science Direct, Springer, Web of Science, and Scopus were reviewed. The keywords "Service Oriented Architecture" and "clinical decision support systems" were used as keywords along with related terms for searching these databases.
Results: The clinical decision support systems based on service-oriented architecture brings benefits such as Facilitate knowledge maintenance, reducing costs and improving agility. Point-to-point communication, enterprise service bus, service registry, clinical and engine guiding engine, and service choreography and orchestration are general architectural designs that are evident in the use of web-based clinical decision support systems based on a service-oriented architecture approach.
Conclusion: Service-oriented architecture is a potential solution for delivering scalable platforms for clinical decision systems.

Promoting Interoperability Program in Electronic Health Record Roadmap: A Scoping Review Study
Niloofar Mohammadzadeh, Zohreh Javanmard, Fatemeh Bahador,
Volume 19, Issue 2 (7-2025)
Abstract
Background and Aim: Today, with the digitalization of many healthcare processes, healthcare organizations strive to implement electronic health records (EHR) as effectively as possible. In this regard, the Meaningful Use (MU) program of EHRs was introduced in the United States. However, due to the existing challenges in this program and in order to accelerate the adoption of EHRs and reduce barriers, the Promoting Interoperability (PI) program was introduced by the Centers for Medicare and Medicaid Services (CMS). This study was conducted with the aim of reviewing the various dimensions of the PI within the EHR roadmap and examining strategies to overcome the obstacles of the MU program.
Materials and Methods: This scoping review was conducted in 2024. To assess the PI program, relevant articles were searched on PubMed, Scopus, and Web of Science databases, as well as electronic documents from CMS, without any time restrictions until March 2024. The searches employed the primary keywords “EHR,” “Meaningful Use,” “Promoting Interoperability,” and their synonyms. Additionally, a manual search was performed using the Google Scholar search engine to ensure comprehensive retrieval of all pertinent literature. Subsequently, articles and documents meeting inclusion criteria were selected, and their main characteristics were extracted.
Results: The review revealed that the PI program introduces substantial changes in EHR program requirements, objectives, and scoring methods. The core objectives of this program include: 1. electronic prescribing, 2. health information exchange, 3. provider-to-patient information transfer, and 4. public health and clinical data exchange. Furthermore, the program emphasizes additional requirements to enhance the quality of implementation, promote better sharing of EHR data, and improve clinical quality.
Conclusion: The Promoting Interoperability program has the potential to enhance patient health outcomes and reduce healthcare costs. Moreover, it is expected to gain increasing significance for hospitals as they adopt innovative healthcare delivery and payment models.

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