Objectives: We developed an electronic health records (EHR) system for regional healthcare in 2000. This EHR stores the health records of more than 6,300 patients in two regions of Japan; however, clinical updates and improved interoperability with other clinical standards, such as HL7 or others are needed. In 2015, this EHR system was upgraded to create a nationwide-scale healthcare data repository to improve the interoperability of clinical data with openEHR technology. Methods: The clinical data in our EHR system has 16 components constructed with Medical Markup Language (MML) standards and periodic mass screening for employees and students. Therefore, we constructed mindmaps of the clinical MML and surveillance data to analyse the concept models. Based on mindmap analysis, we designed archetypes of the concepts identified using Ocean Archetype Editor. The artefacts were mainly quoted from the openEHR clinical knowledge manager (CKM). As the archetypes on CKM did not include all MML semantics, the archetypes were newly designed to complement the semantics of the MML Results: We developed clinical information models by archetypes that semantically equalled the EHR system. Twenty-one MML components/modules and concept models using 99 archetypes were constructed for periodic mass screening services. Most of the archetypes were quoted from CKM; however, 22 archetypes were specialised, and eight archetypes were newly designed. The reasons for specialisation were to adjust the demographics to Japanese and to extend the archetypes to the dental domain. Conclusion: We constructed concept models with archetypes semantically equivalent to conventional data and developed new archetypes for mass screening by archetype technology. The suggested archetype technology improved the flexibility of the EHR system to cover the existing standards.
In the last decades, there is a shi in the provision of health services from the formal facilities to home care. the delivery of care at home is considered a sustainable approach that not only results in substantial cost savings but is also a key step towards achieving op timal outcomes in the delivery of high-quality health services. Moreover, the adoption of this approach is facilitated by the prompt development of medical and non-medical technologies that can simplify care coordination and enable distant monitoring of the patient. However, home care requires the integration and coordination of health and social stakeholders in a continuity of care perspective. this requires the adop tion of standards to define a common shared conceptual model that improves the interoperability among information systems and organizations. In this paper to accomplish this task we combine the ContSys standard and the HL7 FHIR (Fast Healthcare Interoperability Resources) framework to iden tify concepts to be exchanged between systems, organizations and providers involved in the health and social context. this model has been developed to improve the integration and coordination of social and health care services within the Italian H@H project.
- MeSH
- Health Level Seven standards MeSH
- Delivery of Health Care, Integrated * standards organization & administration MeSH
- Continuity of Patient Care standards MeSH
- Humans MeSH
- Aftercare standards organization & administration MeSH
- Home Care Services standards organization & administration MeSH
- Check Tag
- Humans MeSH
Objectives: Aiming to strengthen EU citizens' fundamental privacy rights in the digital age the new European General Data Protection Regulation shall apply from May 25th 2018. It will require companies processing personal data to implement a set of organizational and technical controls for ensuring proper handling of these data. Obviously this applies for companies providing eHealth services. As HL7 offers a lot of material to support security and privacy for handling personal healthcare data, this paper aims at showing which HL7 standards and components can be used to support the implementation of GDPR related controls. Methods: The paper shows some key facts of the European GDPR as well as analyzes HL7 standards and components in the security and privacy domain to provide a basic mapping. Results: As a result the paper provides a table mapping HL7 artifacts to GDPR requirements. Conclusion: The paper shows, that consequently using HL7 security and privacy standards and components e fficiently helps to implement GDPR requirements.
Background: In a population health partnership, shareable clinical decision support (CDS) can reduce service duplication and promote patient wellness by presenting consistent information to all members of a cross-functional, distributed care team. However, existing health IT standards present challenges in the exchange of CDS outputs from multiple systems. Objectives: To exchange and reconcile CDS outputs across systems in a partnership between an integrated health system (Deaconess Health System) and a population health services organization (Evolent Health). Methods: We developed a bi-directional HL7-based interface for CDS outputs between Deaconess’s Electronic Health Record (EHR) and Evolent’s population health services platorm (PHSP). The mapping of CDS logic between systems enabled this interface to automatically reconcile inconsistent CDS outputs. Fifteen quality measure (QM)- based CDS rules to identify care gaps were selected for this initiative. These care gaps remind Deaconess’s clinicians to provide care or documentation necessary for gap closure, and also guide Evolent’s care management services. Results: Two months after launch, Deaconess reconciled 14,040 care gaps from Evolent using data only available in the EHR. Additionally, 1,047 care gaps were resolved due to patient refusal or clinical inappropriateness, and 246 gaps were closed by services or prescriptions provided during clinical encounters. Conclusions: We implemented an HL7-based interface to exchange and reconcile a large volume of CDS outputs between a health system EHR and a PHSP. Future direction is to standardize the linkage between a CDS rule and its reference QM by universal identifiers and a taxonomy of variations.
The ever-growing demand for acquiring, managing and exploiting patient health related information has led to the development of many e-Health systems and applications. However, despite the number of systems already developed and the apparent need for such systems, end users can only collect online and exploit, only a limited set of information for health purposes in the context of personalized, preventive and participatory medicine. To this direction, this paper initially presents the personal health record (PHR) concept, related work and best practices for the development of PHR systems in a standardized manner. It also outlines the proposal for meaningful use criteria in the United States (US) and the health level seven (HL7) personal health record system functional model (PHR-S FM). Focus is put on trying to link core functionality modules of the Integrated Care Solutions TM PHR system, designed to support the citizen, paying emphasis on wellbeing, home care and the management of chronic diseases with PHR-S FM personal health functions, in a preliminary effort towards the exploration of functional models to support interoperability. Based on accumulated experiences from many European Union (EU) research projects, the paper concludes by providing directions towards achieving wider PHR adoption and meaningful use.
Background: Inter-organizational healthcare businesses are ruled by a huge set of policies: legal policies, organizational policies, medical policies, ethical policies, etc., which are quite static, patients policy and process, social and environmental conditions, which are highly dynamic. In the context of a business case, those diff erent policies must be harmonized to enable privilege management and access control decisions. Objectives: The authors off er a methodology to achieve interoperability through policies harmonization in a privilege management and access control solution for EHR systems, to be later on implemented in a cancer care network using HL7 specifications. Methods: To meet the objective, the authors make use of a system-theoretical, architecture-centric, ontology-based approach to formally representing the aforementioned polices for harmonization. Results: Because of its fl exibility and generality, a policydriven RBAC model is used to formally represent all the other access control models such as MAC, DAC, RBAC, ABAC, HL7 Data Segmentation and Labeling Services. All the policies deployed in the context of an inter-organizational collaboration for cancer care can be formalized and then harmonized. Conclusions: The authors provide an implementation independent methodology to enable policies harmonization in EHR systems. The methodology described in the paper is independent on the maturity of organizations’ privilege management and access control system. Furthermore, it does not hamper organizations progressing to more advanced solutions over the time. Even dynamic policies can be harmonized at run time, allowing advancement towards a patient-centered care.
Introduction: In Germany, there is currently no consistent analytic structure within genomic diagnostics in oncological diseases. Within the framework of the project GENeALYSE, a standardized and interoperable specification for associated uses cases shall be developed. Intended Methods: Through process analysis and interface modeling, problems of the actual processes will be depicted between the involved actors. In the next step, the workflows and relevant findings will be displayed and adapted. In particular, the heterogeneous workflows in genome diagnostics will be represented by semantic annotation in an international terminology. The results of the semantic annotation build the basement for the creation of an implementation guide for standardized genome analytics, referring to HL7 Clinical Document Architecture (HL7 CDA). Discussion: The problems of heterogeneous genomic diagnostics as well as unstructured findings in oncology leave the actors face comparable challenges on a regional and supranational level. Interfaces, ambiguous semantics and manual activities inhibit interoperability, promote errors and lead to risks for patients and their sufficient medical treatment. A major challenge will be consistency between the heterogeneous terms to be found in genome analysis. The problem shall be addressed via using international terminologies as well as appropriate mapping techniques. Conclusions: The aim of the project is to create an implementation guide for standardized digital documentation and communication solutions between diagnostics, medical therapy and research in the field of genome analysis. GENeALYSE is intended to optimize the coordination between the diagnostic genome laboratory and the clinical therapy decision in order to increase the safety and success of medical treatment, as well as to improve the health-related quality of life of the affected patients.
Many test providers and certification programs define test plans in order to test the conformity of CDA documents against implementation guides. Even if the applications and systems tested provide valid CDA documents, it is not easy for test providers to decide if the validated documents are rich enough to have a good reliability on tested tools; providing the coverage of the areas tested is mandatory based on many test framework specifications. Many projects tried to define a way to describe the richness and providing scoring for validated CDA documents. In this paper, we describe a new methodology to identify the richness of CDA documents based on implementation guides specification. We define a way to provide a scoring for the richness of the CDA documents, with some applications on IHE and C-CDA documents.
This paper proposes a semi-automatic approach to extract information stored in a HL7 Clinical Document Architecture (CDA) and transform them to be loaded in a Data Warehouse for secondary purposes. It represents a suitable solution to facilitate the design and implementation of Extract, Transform and Load (ETL) tools that are considered the most time-consuming step of the data warehouse development process. The implementation of this framework is also proposed adopting the XSLT style sheet language that converts an original CDA XML-based document to an output XML document that can be easily loaded in the Data Warehouse. A case study is also provided to demonstrate the feasibility of the approach proposed.
Development of HL7 v2 data exchange interface specifications has long been problematic, plagued with ambiguous and inconsistent requirement specifications. This situation leads to potential misinterpretation by implementers, thus limiting the effectiveness of the specification and creating artificial and unnecessary barriers to interoperability. Likewise, the ability to test implementations effectively for conformance to the specifications is hindered. The current approach of specification development and test plan creation relies on word processing tools, meaning implementers and testers must read and interpret the information in these documents and then translate it into machine-computable requirements and test assertions. This approach is error prone—a better methodology is needed. We present a set of productivity tools in an integrated platform that allow users to define and constrain HL7 v2 specifications and to develop test plans that result in machine-computable artifacts. A testing infrastructure and framework subsequently uses these artifacts to create conformance testing tools automatically. We present and demonstrate the utility of a platform for developing specifications, writing test plans, and creating testing tools. The value proposition of this end-to-end methodology is explained for authors writing HL7 v2 specifications, for developers implementing interfaces, and for testers creating validation tools.
