A Prototype Model Using Clinical Document Architecture (CDA) with a Japanese Local Standard : Designing and Implementing a Referral Letter System

Since clinical document architecture (CDA) became an American National Standards Institute (ANSI)-approved health level seven (HL7) Standard, many countries have begun making an eff ort to make local standards conform to CDA. In order to make CDA compatible with the many diff erent local standards existing in diff erent countries, we designed a prototype model using HL7 CDA R2 with medical markup language (MML), a Japanese medical data exchange standard. Furthermore, a referral letter system based on this model was developed. Archetypes were used to express medical concepts in a formal manner and to make 2 diff erent standards work collaboratively. We share herein the experience gathered in designing and implementing a referral letter system based on HL7 CDA, Release 2 (CDA R2). We also outline the challenges encountered in our project and the opportunities to widen the scope of this approach to other clinical documents.</p

Standardizing and migrating patient information to the national electronic archive

Suomessa on lukuisia potilastietojärjestelmiä, joihin säilöttyjä tietoja koskee näihin liittyvät Suomen lait. Lain mukaan potilasasiakirjat tulee säilyttää, ja ne tulee olla saatavilla, minkä vuoksi vanhoja tietojärjestelmiä täytyy ylläpitää. Vanhasta tietojärjestelmästä voidaan kuitenkin luopua sen jälkeen, kun siihen talletetut tiedot on siirretty Kansaneläkelaitoksen hallinnoimaan kansalliseen sähköiseen arkistoon. Siirrettävät tiedot tulee toimittaa CDA R2 -standardin paikallisen laajennoksen vaatimassa muodossa. Atostekin kehittämä eRA-palvelu tarjoaa XML-rajapinnan, joka lähetettyjen pyyntöjen perusteella kykenee tuottamaan standardin mukaisia asiakirjoja. Tässä työssä esitetään geneerinen ohjelmistoratkaisu, jonka avulla eri lähtöjärjestelmissä olevat tiedot voidaan eRA-palvelua hyödyntämällä muuntaa CDA R2 -asiakirjoiksi. Ohjelmistoa voidaan laajentaa tukemaan erityyppisiä lähtöjärjestelmiä liitännäisten avulla. Työssä toteutettiin Finstar-järjestelmälle liitännäinen, missä haastavinta oli lähtöjärjestelmässä olevan tiedon jäsentäminen CDA R2 -standardin rakenteisiin. Käytössä oli ainoastaan yksi tietojärjestelmäinstanssi, mutta liitännäinen pyrittiin toteuttamaan geneeriseksi siten, että se mahdollistaisi siirron kaikista Finstar-järjestelmän instansseista. Haastavaa oli siis myös arvioida, mikä tietokannassa olevasta tiedosta on yhteistä eri instanssien kesken ja mikä puolestaan on käyttäjien muokattavissa. Kokonaisuudessaan siirtotyökalun arkkitehtuuri vastaa sille asetettuihin vaatimuksiin. Laitteistoratkaisujen ja rinnakkaisen käsittelyn avulla on pyritty lisäämään tehokkuutta. Lokikirjausten avulla on puolestaan lisätty ohjelmiston vakautta ja luotettavuutta. Lopuksi tuki liitännäisille mahdollistaa eri lähtöjärjestelmissä olevien tietojen sekä jopa kirjallisten potilasasiakirjojen siirron kansalliseen sähköiseen arkistoon

A SOA-Based Platform to Support Clinical Data Sharing

The eSource Data Interchange Group, part of the Clinical Data Interchange Standards Consortium, proposed five scenarios to guide stakeholders in the development of solutions for the capture of eSource data. The fifth scenario was subdivided into four tiers to adapt the functionality of electronic health records to support clinical research. In order to develop a system belonging to the \u201cInteroperable\u201d Tier, the authors decided to adopt the service-oriented architecture paradigm to support technical interoperability, Health Level Seven Version 3 messages combined with LOINC (Logical Observation Identifiers Names and Codes) vocabulary to ensure semantic interoperability, and Healthcare Services Specification Project standards to provide process interoperability. The developed architecture enhances the integration between patient-care practice and medical research, allowing clinical data sharing between two hospital information systems and four clinical data management systems/clinical registries. The core is formed by a set of standardized cloud services connected through standardized interfaces, involving client applications. The system was approved by a medical staff, since it reduces the workload for the management of clinical trials. Although this architecture can realize the \u201cInteroperable\u201d Tier, the current solution actually covers the \u201cConnected\u201d Tier, due to local hospital policy restrictions

Ten Years of Medical Informatics and Standards Support for Clinical Research in an Infectious Diseases Network

Background It is 30 years since evidence-based medicine became a great support for individual clinical expertise in daily practice and scientific research. Electronic systems can be used to achieve the goal of collecting data from heterogeneous datasets and to support multicenter clinical trials. The Ligurian Infectious Diseases Network (LIDN) is a web-based platform for data collection and reuse originating from a regional effort and involving many professionals from different fields. Objectives The objective of this work is to present an integrated system of ad hoc interfaces and tools that we use to perform pseudonymous clinical data collection, both manually and automatically, to support clinical trials. Methods The project comprehends different scenarios of data collection systems, according to the degree of information technology of the involved centers. To be compliant with national regulations, the last developed connection is based on the standard Clinical Document Architecture Release 2 by Health Level 7 guidelines, interoperability is supported by the involvement of a terminology service. Results Since 2011, the LIDN platform has involved more than 8,000 patients from eight different hospitals, treated or under treatment for at least one infectious disease among human immunodeficiency virus (HIV), hepatitis C virus, severe acute respiratory syndrome coronavirus 2, and tuberculosis. Since 2013, systems for the automatic transfer of laboratory data have been updating patients' information for three centers, daily. Direct communication was set up between the LIDN architecture and three of the main national cohorts of HIV-infected patients. Conclusion The LIDN was originally developed to support clinicians involved in the project in the management of data from HIV-infected patients through a web-based tool that could be easily used in primary-care units. Then, the developed system grew modularly to respond to the specific needs that arose over a time span of more than 10 years

A successful model of regional healthcare information exchange in Japan: Case Study in Kagawa Prefecture

In this study, we focused on analysis of healthcare data exchange over the network. For the advance of broadband capability development, many governments expect online medical information exchange between medical institutions. Japanese government also has tried to deploy ICT in the healthcare field. In Japan, many healthcare ICT projects started, but almost of all the projects face many issues and failed to continue. This situation caused us to clarify the success factor of healthcare information exchange network. For inspecting the success factors, we analyzed information access of healthcare systems in Kagawa prefecture of Japan. Kagawa prefecture is one of the most advance areas for healthcare information technology. We analyzed four medical ICT projects in Kagawa prefecture: K-MIX, Critical Pathway for Diabetes, E-prescription, and PHR. In addition, we inspected characteristics of exchanged data in the network, and stakeholder involved in these projects. This analysis lets us find various types of healthcare ICT projects. Characteristic of data processed in the projects caused differences of characteristic of the projects. On the other hand, multiple systems process same data, though the project does not share the data itself. Considering various types of medical information exchanges projects, we propose classification and standard format of exchanged data according to their characteristic are critical for efficient business deployment. --e-Health,regional healthcare information exchange,EHR

Developing a conformance methodology for clinically-defined medical record headings:a preliminary report.

Background: The Professional Records Standards Body for health and social care (PRSB) was formed in 2013 to develop and assure professional standards for the content and structure of patient records across all care disciplines in the UK. Although the PRSB work is aimed at Electronic Health Record (EHR) adoption and interoperability to support continuity of care, the current technical guidance is limited and ambiguous. Objectives: This project was initiated as a proof-ofconcept to demonstrate whether, and if so, how, conformance methods can be developed based on the professional standards. Methods: An expert group was convened, comprising clinical and technical representatives. A constrained data set was defined for an outpatient letter, using the subset of outpatient headings that are also present in the ep-SOS patient summary. A mind map was produced for the main sections and sub-sections. An openEHR archetype model was produced as the basis for creating HL7 and IHE implementation artefacts. Results: Several issues about data definition and representation were identified when attempting to map the outpatient headings to the epSOS patient summary, partly due to the difference between process and static viewpoints. Mind maps have been a simple and helpful way to visualize the logical information model and expose and resolve disagreements about which headings are purely for human navigation and which, if any, have intrinsic meaning. Conclusions: Conformance testing is feasible but nontrivial. In contrast to traditional standards-development timescales, PRSB needs an agile standards development process with EHR vendor and integrator collaboration to ensure implementability and widespread adoption. This will require significant clinical and technical resources