Medexter’s ArdenSuite and Fuzzy Arden Syntax have been chosen as exemplary case studies in Mark L. Braunstein’s book. This book discusses health informatics broadly; from traditional applications of informatics in health care to population and public health, mHealth, big data, and analytics. It provides an historical overview and draws a likely future state. It addresses the historically unmet need to share medical data between diverse systems and institutions and the resulting limitations. Past approaches for standardization are presented culminating in HL7’s Fast Healthcare Interoperability Resources (FHIR). Over the past years, FHIR has grown globally into a broad standard, widely accepted as the best, yet available approach to enable interoperability.

As one of the use cases, as well as a pre-FHIR and decision support standard, the Arden Syntax is presented.  Arden Syntax is a standard for encoding, representing, and sharing medical knowledge. The basic building blocks of Arden Syntax are medical logic modules (MLMs). Each MLM contains knowledge for at least a single clinical decision. Transferring MLMs from one site to another currently requires site specific changes to be made. Due to the curly braces used to enclose these site-specific references, this is also known as the curly braces problem. By introducing FHIR as a standard data model to the Arden Syntax, references to clinical data are regularized, connecting to FHIR Resources is made possible. Thereby the need to for the curly braces construct is reduced, resulting in simplified interoperability.

As case study Mark L. Braunstein presents Medexter’s ArdenSuite and Fuzzy Arden Syntax. Medexter’s ArdenSuite is listed among the four Arden Syntax use cases on the HL7 page. ArdenSuite, a clinical decision support (CDS) platform, consists of ArdenSuite IDE for content development and testing and the ArdenSuite server for content management and processing. It has been developed for clinical contexts and allows the creation of a customized CDS solution, making it applicable in every medical discipline. The content is written in HL7’s Arden Syntax standard. With the integration of Medexter’s fuzzy concepts in the Arden Syntax version 2.9, the ambiguity in medical statements that are neither clearly true, nor clearly false are taken into account. In Medexter’s Fuzzy Arden Syntax a truth value is defined over a continuous spectrum in a range: 0 = is false, 1 is true; an intermediate value like 0.8 indicates a degree of compatibility. Moreover, thanks to its component-based design, Medexter’s ArdenSuite can serve as local stand-alone application, be integrated into a hospital information system as their CDS component, or serve even as cloud-based service using our SaaS option. Medexter also offers an ArdenSuite FHIR Connector to enable connecting to FHIR Resources.