Evaluation of international standards for ECG-recording and storage for use in tele-medical services

This report is written to clarify which of the international standards for ECG recordings that can be used in tele-medical services, where the recordings should be transmitted by wireless telecommunication facilities and finally stored as information integrated into the patients Electronic Health Record (EHR). Some principals for recording, transmission and storage of digital vital signs parameters are highlighted and important aspects of wireless communication of recorded signals from biomedical sensors are described, in order to understand the significance and differences in the storing formats to be used. Even if most of the relevant standards are not yet ratified (the last meeting in ISO TC 251 WH6 was held in October 2005), the actual international standards SCP-ECG, MFER, FDAXML and DICIOM are defined and already widely adopted. In this report, these standards are briefly described and evaluated with respect to possible use in tele-medical services, and recommendations are given in order to obtain a reliable and secure communication solution. Requirements for integration of the ECG file formats into the EHR are briefly described, and it is given some recommendations for actual standards to be used in future solutions

Evaluation of ISO EN 13606 as a result of its implementation in XML.

The five parts of the ISO EN 13606 standard define a means by which health-care records can be exchanged between computer systems. Starting within the European standardisation process, it has now become internationally ratified in ISO. However, ISO standards do not require that a reference implementation be provided, and in order for ISO EN 13606 to deliver the expected benefits, it must be provided not as a document, but as an operational system that is not vendor specific. This article describes the evolution of an Extensible Markup Language (XML) Schema through three iterations, each of which emphasised one particular approach to delivering an executable equivalent to the printed standard. Developing these operational versions and incorporating feedback from users of these demonstrated where implementation compromises were needed and exposed defects in the standard. These are discussed herein. They may require a future technical revision to ISO EN 13606 to resolve the issues identified

Medical informatics : the generic interchange of comprehensive health data

The objective of this project was to study the area of generic transfer of comprehensive medical data.The work presented in this thesis had as its main premise the belief that generic transfer of comprehensive medical data will help towards the goal of better healthcare particularly in an environment of shared care. It studied the main methods of data transfer available at present, and as a result carried out an in depth review of one such method adopted by the National Health Service (NHS). Criticism of this method was made. These criticisms lead on to the development of an alternative method of generic data transfer based on an emerging European standard for the storage of medical data. This in turn led on to the consideration of data in legacy systems. Finally, an evaluation of the developed method was undertaken

Medical informatics : the generic interchange of comprehensive health data

The objective of this project was to study the area of generic transfer of comprehensive medical data.The work presented in this thesis had as its main premise the belief that generic transfer of comprehensive medical data will help towards the goal of better healthcare particularly in an environment of shared care. It studied the main methods of data transfer available at present, and as a result carried out an in depth review of one such method adopted by the National Health Service (NHS). Criticism of this method was made. These criticisms lead on to the development of an alternative method of generic data transfer based on an emerging European standard for the storage of medical data. This in turn led on to the consideration of data in legacy systems. Finally, an evaluation of the developed method was undertaken

UML profile for MIF static models. Version 1.0

HL7 provides standards for interoperability that improve care delivery, optimize workflow, reduce ambiguity and enhance knowledge transfer among all of our stakeholders, including healthcare providers, government agencies, the vendor community, fellow SDOs and patients. In all of our processes we exhibit timeliness, scientific rigor and technical expertise without compromising transparency, accountability, practicality, or our willingness to put the needs of our stakeholders first. HL7 is holding a contest to encourage the development of HL7 tools. This document describes the specification of a UML Profile for MIF Static Models as a particular submission to the HL7 2012-2013 Tooling ChallengePreprin

Large-scale database modeling: Developing XML schema

This thesis is concerned with the team efforts to develop a large database to track medical information. A large XML schema is developed from the Extended ER diagram to capture key and foreign key constraints. The strong types of XML schema were also used to assert patterns and domain constraints. These constraints will be used to aid the recognition of medical forms

Clinical foundations and information architecture for the implementation of a federated health record service

Clinical care increasingly requires healthcare professionals to access patient record information that may be distributed across multiple sites, held in a variety of paper and electronic formats, and represented as mixtures of narrative, structured, coded and multi-media entries. A longitudinal person-centred electronic health record (EHR) is a much-anticipated solution to this problem, but its realisation is proving to be a long and complex journey. This Thesis explores the history and evolution of clinical information systems, and establishes a set of clinical and ethico-legal requirements for a generic EHR server. A federation approach (FHR) to harmonising distributed heterogeneous electronic clinical databases is advocated as the basis for meeting these requirements. A set of information models and middleware services, needed to implement a Federated Health Record server, are then described, thereby supporting access by clinical applications to a distributed set of feeder systems holding patient record information. The overall information architecture thus defined provides a generic means of combining such feeder system data to create a virtual electronic health record. Active collaboration in a wide range of clinical contexts, across the whole of Europe, has been central to the evolution of the approach taken. A federated health record server based on this architecture has been implemented by the author and colleagues and deployed in a live clinical environment in the Department of Cardiovascular Medicine at the Whittington Hospital in North London. This implementation experience has fed back into the conceptual development of the approach and has provided "proof-of-concept" verification of its completeness and practical utility. This research has benefited from collaboration with a wide range of healthcare sites, informatics organisations and industry across Europe though several EU Health Telematics projects: GEHR, Synapses, EHCR-SupA, SynEx, Medicate and 6WINIT. The information models published here have been placed in the public domain and have substantially contributed to two generations of CEN health informatics standards, including CEN TC/251 ENV 13606