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.
- Klíčová slova
- archetype, data modelling,
- MeSH
- data management normy MeSH
- elektronické zdravotní záznamy MeSH
- Health Level Seven normy MeSH
- interoperabilita zdravotnických informací normy MeSH
- výměna zdravotnických informací normy MeSH
- Geografické názvy
- Japonsko MeSH
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.
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.
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.
Background: HL7 version 2.x is the most popular and most propagated data exchange standard in the world. It is mature and adopted by several IHE Technical Frameworks. Nevertheless it has some weaknesses especially in the way it is documented. Several conformance constructs (optionality/usage and repetitions) are still under discussion although the meaning is unambiguous and clear. The deadline for HL7 v2.9 proposals is over and the next ballot is in preparation for May 2016. Objectives: Therefore the question arises what will come next? HL7 v2.10? HL7 International is in favor of distributing new releases every year, so that this is a good opportunity to update the representation and documentation of HL7 v2.x while maintaining backward compatibility for running interfaces. Methods: A semantic analysis of the conformance constructs being used by HL7 v2.x allows for developing transition matrices so that the new representation can be automatically generated in large parts. Of course, a new separation into domains require manual support. Results: This paper demonstrates the new representation form rendered out of the HL7 Comprehensive Database. Conclusions: Harmonizing HL7 v2.x with other standards in the way it is represented simplifies implementation and therefore supports interoperability among applications.
